I am a man of science. I'm a man of medicine, and I believe in them. I live them. Not only I live them, actually, I love them. I love living in science and living in medicine. But like Andy, I'm not a factual person. So it doesn't quite go with being a scientist and not being factual. Actually, throughout medical school, I always thought I wanted to be a psychiatrist. But I started dealing with those people who are crazy, and they really are crazy. And as you deal with them, I started losing touch with reality and becoming this weird guy. So my mom forbid me from becoming a shrink. Well, I love the brain, and I wanted to do something with the brain, but I need to do something practical to keep ties with this world. So I said, what's practical? What's practical? Well, surgery is practical. So I love the brain surgery. Why don't I do brain surgery? So that's how I decided to become a brain surgeon and traveled over here and I became a neurosurgeon. And they. Well, everybody thinks neurosurgeons have God complex. And guess what? We do have God complex. How can we not? I mean, think about somebody coming almost dead. You take them to surgery and they walk out of the hospital, and that feels great, that feels fabulous. And then you start feeling like God. But that's not the whole story. There is other side of the coin, which is sometimes you feel like the lowest creature on earth because you make a mistake, somebody dies. You know, you mess up. It's just. It's a bad, bad feeling. So there's, you know, these ups and downs, and you have to. You have to deal with them. So you learn how to deal with them. And actually, the way I learned to deal with that was I learned it from. From Al Pacino, from Godfather, I learned the mask face. You can put on the mask face and show people what you feel. And you can sometimes, actually, most of the time, especially if things are not going well, you cannot show people how you feel because they look at you and they trust you, and you have to be strong for them. So I have the mask face. And I used to think I do A good job with it. And I think I do a reasonable job, not a perfect job about it. So you deal with these intensities, these ups and downs, and the practical aspects of neurosurgery, which I call the three Bs of neurosurgery, which is the blood, brain and the bone. That's what we do every day. We see blood, we deal with the brain, we take out the bone, put the bone back in. And that's a practical aspect of neurosurgery. But as I said, it's intense. I mean, it's so hard to deal with it and you have to do day in, day outs. It's just tough. So I at least solve it by creating alternative realities. I tend to travel, I tend to leave out of town. And you feel free. You just need to get out of there, regain your perspective, come back to town and deal with it again. So it's one of those evenings that I'm getting ready to pack, I'm in the office, I'm happy, I'm singing, I'm about to go out of town, I'm feeling good. I get this phone call from the residential, from the emergency room that there's this trauma case. I immediately interrupt him. I go like, I'm not on call. Call the on call attending. And the resident goes, well, actually I did. And like, yeah. And he says the patient is a young patient, has bad trauma, extensive skull fractures and a big bleed. I happen to do vascular neurosurgery, which is the bleeds and the vessel problems, all kinds of intense crazy stuff that nobody else wants to do. So the oncology thought because it was such an extensive trauma, that it was a good case for me. So now I have to make a choice. I was going to go get out of town and be free or it's somebody's life. All right? So as I'm cursing at my fate, I look at the CAT scan and see the skull, which is fractured like eggshells and extensive bleeds in the brain. And I tell the residents, take the patient to the or and I start walking down the hallway and I'm. Now I'm angry, I'm pissed off. I cannot leave town again. I have to deal with this. And I walk in the OR as they're putting the patient to the operating table and the whole world changes. Now all you see is this young kid on the OR table bleeding. And you focus, you focus on the patient, you focus what you have to do. And again, the whole color of the world changes. So we make the incision. And we start seeing what the CAT scan showed, which is his skull is broken like an eggshell. There are extensive fractures all over the place. And we start making our way through that, trying to take out these bone pieces which are stuck to the brain. And you have to pick up all these bones and make way. And as we are doing this, we start seeing quite a bit of bleeding. It's pretty extensive bleeding. And there's a structure on top of the brain called the sagittal sinus, which is a large, large vessel. And that is very hard to reconstruct if there's damage to that. And that's why it's very difficult to separate Siamese twins. And as we are making our way, as we've seen in CAT scan before, there are extensive fractures on the top of his brain affecting structure. So we start taking them out, but there's quite extensive bleeding. And there are 20 people in the room running around. And you yell at the anesthesiologist, keep up with the blood work. They're trying to do everything they can. And they are mainly giving intravenous fluids, which are clear to keep up with the blood loss. But it gets to an extent, of course, we don't know his blood type yet that we have to give him blood because IV fluids are not keeping up with the bleeding. So the only thing you can do is give him O negative blood, which is not matched to his blood type. So there's an extent that you can give, but you do whatever you can. So they start pouring as much as they can, the O negative blood. Now, brain actually is very dumb brain. Whether that is a tumor, a bleed, a stroke, anything responds by swelling. It smells like a sponge. So at this point, we are losing so much blood and it's. We cannot keep up with it because his sagittal sinus, this big vessel, is damaged, all from the front to the back. So as they give fluids more and more, the brain actually starts swelling. And that is a very, very bad feeling. You feel nauseated to your. To your stomach because there's very few things you can do to stop that smelling. And it starts coming almost like a toothpaste. And that is reversible to an extent that the brain sort of sticks out. But after that, it starts basically tearing itself and you have irreparable damage. And as this is happening, his blood pressure starts going down, his heart rate starts going down, and we cannot give him more blood because we don't know his blood type yet. So it gets to a desperate state where you are going frantic, and everybody's doing their best, but the patient is just not responding, and there's not much you can do. And it gets to a point where you realize that there might not be something else that you can do. And you sort of like, feel, as I said, the lowest creature on earth. And something even more terrible happens than this rain coming out, which I've never seen or heard before and I hope I will never see, is that because we were pouring so many, so much, so fast, these IV fluids, which are, again, clear fluids, the color of his blood that was oozing from the wound, start changing color. So it changed from a dark red, which is a normal color, to a bright red, and it start turning pink. And now you're feeling desperate. Now you have no idea. Now you know the patient is not going to make it. I mean, it's just not going to make it. So the whole idea changes. You don't know quite what to do. You're starting to sort of push the limits of your imagination, what you can do. And I remembered from my internship days, when we do general surgery, that when there's a belly trauma, like when the liver is bleeding because you cannot coagulate the liver to stop the bleeding, the only thing you can do is be basically packed the belly with sponges. So I just grabbed this pack of sponges and just put on the kid's brain, and I put two of my hands on top of that, and I could feel the pulsation of the brain, which is actually a great thing, because one of the, again, bad feelings is not to feel that pulsation. And I can see the fluid through my fingers, around my fingers, it's still pink, and his blood pressure is dropping and his heart is dropping. And now you yell that we're just losing him and everybody's doing, but it's just a very tense environment, and there's not much else you can do when you get to that point. It just becomes a situation where you just want to help the family. And all you can think of is basically try to close the skin, get the patient to the intensive care unit, give the family enough time to say goodbye to him when he's living, which helps a lot with the griefing process with the family, because I think it's very tough if you lose somebody in the operating table. So we made the decision that we're going to try to keep him alive for one more hour and have the family see him say goodbye. And then we're going to lose him as we're Doing that as my hands are feeling the pulses that actually blood arrived which was matched. So we start pouring the blood to him. And of course at this time he's not clotting because he lost all his clotting factors through the bleeding. Start pouring all the blood products and slowly he starts coagulating his blood. He slowly on this spine just starts forming a clot and the bleeding starts slowing down, the brain starts calming and the color of the blood blood starts again turning to this red, dark red. So all we have to do now is get him into the icu, find the family, have the family say goodbye, and that's that. We staple the skin as quick as we can. You have a very little short time. We rush him to the intensive care units. And as I'm putting my mask on to go talk to the family and again, you have to be strong for them. I asked the residents what the story was. Turns out that this is a 16 year old college kid who was going in the evening back to college because the final tomorrow, it's the winter night and they skid along the road. He was a passenger unrestrained, so he flew to the windshield and that's why he got the eggshell fractures throughout his skull. So I hear the story you don't want to hear anymore, you don't want to get emotional. I go down to the waiting room, take a deep breath and enter. There's 20 people and they're surrounding this woman who's on the floor and she's on her knees and crying and begging. I sort of didn't quite get what was going on first, but as the people sort of moved around, I see this woman on the floor and she's begging. And as I approached her to tell her, which is obviously a very tough thing, that her kid is not going to make it, but she should go up to the ICU and say goodbye to him. She basically held on to me and she started begging at me, don't let my son die. And I'm trying to find the strength to say it, open my mouth. She doesn't let me talk and anything that I try to say just doesn't happen. So she's begging and begging and I didn't have the strength to tell her at that point that he wasn't going to make it. So I held onto her. We went upstairs and I was trying to explain her that there was extensive bleeding that we tried to control, left the sponges on the brain to control the bleeding, but I don't think she was hearing me and I don't think she wanted to hear me. So I left the family to say goodbye. And we're pouring the blood products and doing everything we can. And I came back a couple hours later to see that he was somewhat stabilized with his vital signs, which it's still his blood oozing from all the incision and everything else. And we basically replace his blood volume a couple times probably that night. Next morning he's more stable. But I need to go talk to the family because I've never seen such an extensive brain injury to recover or have any chance to recover. But the scans show that there's not an extensive stroke. So I guess there's some reason to give some more time to the family again, that you have to go through the grief process and be there with the family. So day one like that and day two like that, and finally on day three, the CAT scans don't again show extensive stroke or anything like that. And mom is just not hearing anything. Mom is just like, wants everything to be done, wants the sponge is out, wants everything. I explained to mom that most likely we're not going to be able to get the sponge is out because we won't be able to reconstruct this big, big vessel here, the sagittal sinus. But she pushed me to do that. So on day three, we took her, took, took the boy to surgery. And under the microscope, hours and hours, millimeter by millimeter, we removed these sponges and basically reconstructed the sinus as best we can. Left big drains in and closed the skin and came up. He did fine. And after six months in the intensive care unit and I think three or four surgeries later, he was able to go to the rehab. He came back a year later, still significantly affected, barely talking. But two years later he went back to his college. And now looking back at it after all this time, I feel like we did what we did and we did what we could, but it was, it was the bond between the mom and the son that saved the boy's life. And I cannot explain that, but I think that the unexplainable, what we deal with is the thing that is the art of medicine. It is the art in medicine and probably art in science. And I think that's what makes it all worthwhile. Thank you.
