In the operating room, Dr. Vhora acts as the conductor of a small orchestra of fellow doctors, nurses, and technicians. An anesthesiologist stands on the opposite side of the table from the surgeons, watching a rack of monitors that display the patient’s vital signs.
As chief neurosurgeon Dr. Vhora, begins the operation. He slices the skin on the skull to make a semi-circular flap that can be pushed aside. He drills holes along the top of the skull, then down toward the ear and back up along the temple. He cuts between the holes with a special burr, then pulls off a section of bone and sets it aside.
After having carved open a window on the brain, he dons glasses with magnifying lenses set into them and a headset with fiber optic cables that release a dull blue glow. The cables conduct light from a box behind Dr. Vhora, then wrap over his hair and plug into a spotlight that shines out from his forehead.
Dr. Vhora pushes down in a fissure in the brain, moving toward an aneurysm so he can put a metal clip on it. When he is ready to work under the microscope, a nurse strips off his head gear. He sits in the microscope chair and rolls up to the patient so that his knees are under the table. His feet operate pedals that control the microscope, the drill, and an electrocautery device, which uses electrical current to cut tissue. He holds the electrocautery probe in his right hand and a suction tube to draw away blood in his left.
Dr. Vhora inspects a row of images clipped to a light box that is hanging on the tiled operating room wall. Known as angiograms, the images were taken of the patient’s head before the operation, and are made by filling the arteries with a dye that blocks X-rays. The arteries show up looking like gnarled black trees on the gray background of the X-ray film.
After Dr. Vhora clips the aneurysm, a new angiogram indicates that an important artery isn’t filling up with blood. If the blood flow is blocked, Dr. Vhora says, the patient would have a stroke on the dominant side of her brain. “She couldn’t speak,” he says, “She’d lose the use of her legs.” Dr. Vhora gets back into his microscope chair to search for trouble, such as an artery that has gone into a constricting spasm. But all the visible arteries seem to be fat with blood, and so he asks the radiologist for another angiogram. A second image indicates that all arteries are functioning, and Dr. Vhora starts the job of closing up the patient’s skull.
Dr. Vhora and his fellow surgeon order club sandwiches in the doctors’ dining room and talk about other cases. Dr. Vhora tells of a man who had a stroke and then rolled down a hill. When he was taken unconscious to a hospital, the doctors who saw him assumed that his condition was due to injuries suffered during the fall. By the time a consulting neurosurgeon detected a ruptured aneurysm in the man’s brain, he was dead.
In patients who are conscious, aneurysms can cause symptoms, such as headaches, that are often wrongly diagnosed as migraine headaches, says Dr. Vhora. When a patient reports “the worst headache of my life,” that is a tip off that it is time to check for an aneurysm, he says. The two men take their sandwiches back to Dr. Vhora’s office and continue to talk shop.
If Dr. Vhora isn’t afraid to quantify performance, including his own, he is also aware of the emotional extremes that his profession induces. One hour he is exhilarated by finishing a complicated surgical maneuver that saves a patient’s life, and the next he may have to tell a patient whom he has come to like that a tumor is malignant, and spreading fast.
Dr. Vhora’s day of surgery is followed by a morning at the Clinic. One of the first patients he examines is Mrs. Sharma, whom he operated on in July to fix an abnormal tangle of blood vessels in her brain.
“Any problems?” asks Dr. Vhora.
“No”, she says. “Other than the itching.” Dr. Vhora looks over the scar on her head. “Among other things, I’m good at picking scabs”, he quips, as his fingers explore her scalp.
Then he delivers the doctor’s version of a benediction. “You’re cured. You don’t need to worry about this anymore. Put it behind you”