Week 5 - Hannah

This week has demonstrated the huge span of ups and downs that a neurosurgeon experiences on a daily basis.  During neurosurgery clinic, Dr. Schwartz had a follow up visit with one of his patients whom had had a tumor removed and a shunt implanted in his brain to prevent hydrocephaly from redeveloping.  “Thank you, thank you,” the elderly gentleman stated, “Before, I had the surgery, I could not walk, but now, I do not even need a cane.”  The hydrocephaly had caused an increase in pressure that had impaired the patient’s ability to walk, but once the pressure was relieved, his ability to walk returned.  To think that with one surgery, Dr. Schwartz was able to completely change this man’s life was pretty incredible.  Similarly, later in the day, Dr. Schwartz received an email from a patient thanking him for saving her life.    Unfortunately, the day then took a more somber turn.  Dr. Schwartz was performing a biopsy on a middle-aged woman to determine what type of tumor she had.  The MRI was suggestive of glioblastoma—a deadly type of brain cancer—but a biopsy was needed to know for sure.  Dr. Schwartz drilled into the patient’s head and sucked out a piece of tumor.  There is an art to taking a biopsy sample.  The center of a tumor is often necrotic, providing little information, thus it is best to take a sample from the margin of the tumor.  However, the surgeon has to be careful that the sample is actually coming from the tumor and not the healthy tissue around it, otherwise, the prognosis might be misleadingly positive.  Once several biopsy samples were removed, intraoperative pathology was performed.  The results were quite definitive; the tumor was in fact glioblastoma.  Even with chemotherapy and radiation, the patient probably only had six months left to live.  The biopsy complete, Dr. Schwartz headed to the waiting area to talk to the patient’s family and share the news.  It is hard to imagine the difficulty of having to do something like that; to have sharing horrible news be a fairly regular part of one’s job.  Yes, neurosurgeons are able to save lives, but there are some problems that even they cannot fix. 

On a somewhat lighter note, when the intraoperative pathology was taking place, another specimen was brought into the path lab for analysis.  This sample was quite a bit larger than the sub cubic centimeter pieces that Dr. Schwartz had brought with him…this sample was an entire kidney…and not just any kidney…a massive, watermelon-sized kidney from a patient with polycystic kidney disease (PKD).  Polycystic kidney disease is often due to a genetic mutation and causes hundreds of cysts to be present in the kidney, which then swell and fill with fluid.  Typically, when patients get a kidney transplant, the old kidneys are left in; however, with PKD, the cysts are at high risk of becoming infected, so it is often better to remove them.