Reflections on an Incredible Experience

I returned from Los Angeles on Saturday night. I am glad to be back in South Carolina, and I am excited to begin my junior year at Wofford. However, I will certainly miss working at Cedars-Sinai Medical Center as well as all of the friends I made in LA. Before I began working at Cedars-Sinai, I viewed the internship which I had been awarded as an opportunity of a lifetime. After working for three months in the department of neurosurgery, the experience definitely lived up to my expectations.

I lived in the second largest city in America. I worked in one of the best neurosurgical departments at one of the best hospitals in the country. I saw multiple brain surgeries. I shadowed some of the most brilliant physicians in the world. I attended lectures, brain tumor boards, neurovascular meetings, and lab meetings all of which were focused on providing the best care possible to the patients of the Maxine Dunitz Neurosurgical Institute. I studied immunology. I gained practical research experience while working very hard in the lab. I participated in an experiment that lasted over 24 straight hours and then directly afterwards went into the OR to shadow a surgery. I saw many, many movies in the movie capital of the world. I dined, danced, and enjoyed life in LA. I visited New York and met one of my favorite movie stars. I witnessed the tremendous amount of dedication and time that is required to be a successful neurosurgeon, and I gained even more excitement and enthusiasm at the prospect of becoming one. In short, I had an absolutely amazing experience!

I feel very blessed to have participated in this program. I come away from the past three months more excited than ever to become a physician. My time at Cedars-Sinai has significantly increased my desire to become a neurosurgeon. I am more determined than ever to study hard so that I can become the best physician that I can possibly be, and I absolutely cannot wait for the day when I too can work to improve the lives of patients. I only hope that one day I will be like the neurosurgeons of Cedars-Sinai: totally committed to the well-being of their patients, doing everything possible to give their patients hope and the chance at a brighter tomorrow, and tirelessly working to cure brain cancer. I know that this summer would not have been possible without God, the members of the selection committee, my professors at Wofford, and my being a Terrier. So I would like to take this opportunity to sincerely thank every single person who had a hand in providing me with this opportunity. I will truly never forget my summer at Cedars-Sinai, and I know that it will have an immeasurable impact on my future career and life.

So how do I end this blog? Perhaps with a challenge:
Dream big.
Develop your passions.
Pour your heart into what interests you.
Spend your time on things that matter.
Go after opportunities, no matter how unattainable they may seem.
Have faith.
If you do these things, then you just might stumble upon something that defines who you are, you just might find something that you love, you just might attain your dreams.

Thanks so much for reading my blog!

-Joseph H. McAbee

Can we crank the bipolar up to 35, please? … microscissors … let’s get some irrigation in here!

These are a couple of phrases that you may hear should you ever find yourself in the operating room. They are commands used by surgeons, regardless of specialty, many, many times each day. The “bipolar” is an instrument that delivers an electric current from one metal tip to another. It allows a surgeon to burn and cut through tissue, fat, etc. It also minimizes blood loss as it cauterizes the blood vessels as they are being cut. Microscissors are just that…micro scissors. The scissors portion of the instrument are smaller than a paper clip, but they are really useful for making precise cuts under a microscope. Finally, irrigation refers to a saline solution that surgeons utilize to wash out the wound should it get full of blood or fluid.

I saw my first brain surgery a few weeks ago! It was AMAZING! It was truly awe inspiring when I stopped and thought about what all the brain controls. I mean the brain controls breathing, memory, speech, walking, personality, and pretty much everything else about us! And neurosurgeons have the responsibility of operating in this complicated control center of our bodies! They have to get in, do what needs to be done, and get out without causing neurological deficits to the patient. That is no small task. It is nerve-racking, but mostly it is really exciting. Spending time in the Cedars-Sinai OR, working with the neurosurgeons and residents, seeing brain tumor resections, watching the brain pulse along with the heartbeat, examining facial nerves, and more, have convinced me that I want to become a neurosurgeon!

Just to give you an idea of a few cases that a neurosurgeon may have to deal with on any given day, I am going to briefly describe trigeminal neuralgia (TN) and ependymomas.

Trigeminal neuralgia is a disorder characterized by intense facial pain. It typically is caused by a blood vessel putting pressure on the left or the right trigeminal nerve. The trigeminal nerve controls a multitude of functions. It transmits signals from the face to the brain, it controls jaw muscle movement, and it involves a person’s ears, eyes, nose, forehead, teeth, tongue, and more. A patient who has TN may experience intense pain in any or all of the above areas, typically on one side of the face, many times throughout the day. Attacks can be triggered by something as simple as brushing one's teeth or a cool breeze. It is a debilitating disease that gets worse over time. A neurosurgeon can correct the problem through microvascular decompression. He/she can make an incision behind the ear, cut open the skull, move the brain to expose the trigeminal nerve, separate the nerve from the blood vessel, and place a Teflon pad between the nerve and vessel to insure that the blood vessel can no longer put pressure on the nerve. The patient should recover well with little to no pain or facial numbness.

An ependymoma is a tumor that develops from ependymal tissue of the central nervous system. Most often it develops in the fourth ventricle, but it is also common in the spinal cord. Symptoms, if they arise, are typically due to an obstruction in the flow of cerebrospinal fluid. A subependymoma is a less common type of ependymoma that is typically benign and more often found in men. Ependymomas may be treated through radiation or surgical resection. The fourth ventricle, as it is situated directly over the top of the brain stem can be a tricky place to operate. Neurosurgeons have to be extremely careful when operating near the brain stem as there are only a few layers of cells that protect it. The surgeon has to tease the tumor away from the healthy brain tissue and remove it piece by piece, while continuously monitoring the brain stem evoked responses and the heart rate. It is a long, but interesting process in which the surgeon looks for visual clues that distinguish tumor from brain, such as vascularity, color, and texture.