A Stimulating Job

The patient, with a metal frame screwed onto his head like a crown, is being pulled out of the CT machine and transferred to the operating theater upstairs. He is about to undergo a radical surgery that holds the promise to control one part of his Parkinson’s Disease.

I am rotating through neurosurgery for two weeks. Besides the standard ward rounds and outpatient clinics, I get to watch in theater as surgeons tinker with that most delicate part of the body – the brain and spinal cord. This patient being wheeled into theater has been suffering from Parkinson’s Disease for twenty years and his worsening tremor has become refractory to medical treatment. The radical surgery, only the fifth to be performed at this hospital, will put electrodes into the part of the brain affected by the disease. The probe is then connected to a “pacemaker for the brain.” When switched on, the patient’s tremor will be dampened to such a degree that he will regain normal function of his hands and arms.

In theater, the surgeons gain access to the patient’s brain by cutting loose a piece of his skull. In order to find the right part of the brain to implant the electrodes, the surgeons need to talk to the patient. So, after all the instruments are in place, the anesthetist brings the patient up from anesthesia. Under an infusion of sedative and analgesia, the patient answers questions from the surgeon, shows his tremor by reaching for an object. One of the surgeons carries a conversation with the patient while another pulls the probe out ever so slightly. With a few slight adjustments of the probe, the patient’s tremor is noticeably reduced. It’s quite a sight: a team of surgeons and nurses surround the patient, whose head, with part of the skull flipped open, is bolted to a metal frame that is attached to the surgical bed. The patient calmly answers questions from the surgeons and obeys all the commands, seemingly oblivious to all the work going on inside his head.

After about six hours, the surgery comes to an end. Soon, the patient will be able to wave a little device in front of his chest to turn on the stimulator and, just like that, his tremor will be stopped. Isn’t that awesome?