In February of this year, I had the rare opportunity to assist a world-renowned neurosurgeon as he clipped three intracranial aneurysms in a patient on the same sitting. Dr. Michael T. Lawton led his medical team from Mission BRAIN Foundation on a three-day visit to Philippine General Hospital, to give lectures and workshops for Filipino neurosurgeons and nurses, and to demonstrate surgical techniques on different neurovascular cases.
Dr. Lawton is an expert in every sense of the word. Professor and chief of Vascular Neurosurgery at University of California San Francisco, he wrote Seven Aneurysms, widely considered to be the definitive textbook for aneurysm clipping.
When I was about to do my first aneurysm case in December last year, it was his book that I read, chapter after chapter without skipping a paragraph. Twenty patients and 22 aneurysms later, I continue to re-read his book before every case (and after, if I encounter difficulties during the operation) to reinforce knowledge as I continually strive to refine my surgical techniques. If one day I am diagnosed to have a brain aneurysm, I would daresay that my best chances of surviving without any disability would be in Dr. Lawton’s hands.
Just imagine the thrill when I found out that I would be a given a chance to assist him during surgery, not unlike a novice writer getting the opportunity to write a story with Neil Gaiman, on his MacBook Air.
“Never give up,” Dr. Lawton said in his opening slide during his lecture on the first day. His statement rang true, to me more than anybody else in the audience.
As I listened from the front row, I recalled the harrowing moments of the difficult aneurysm case I had just done two weeks earlier, in which I inadvertently re-ruptured my patient’s aneurysm during the operation. I could not control the bleeding, and when I called my attending in charge of the case, I was despondent and apologetic: I thought I would lose my patient on the operating table. In all likelihood, I would have, had it not been for my attending who drove from Makati to Manila in 15 minutes. For weeks, I would not be able to operate without the slightest tremor, for fear of committing the same mistake.
“It’s really tough when you encounter these problems early on during your training,” Dr. Lawton said to me when I told him about my case during the break. His advice was to just keep practicing, to overcome the fear as I climb my learning curve in aneurysm clipping.
He lamented how fewer and fewer neurosurgery residents in America are choosing to train in open surgery for aneurysms, preferring to specialize in less invasive, endovascular surgery instead. For a Filipino neurosurgeon-in-training, learning to clip an aneurysm is a necessary skill. Our charity patients with ruptured aneurysms usually have no choice but to undergo open surgery (i.e., clipping), given the prohibitive cost of endovascular treatment (i.e., coiling).
Meeting Dr. Lawton, what immediately struck me was his demeanor. Being tall with a cyclist’s body frame and sporting the gray hair of wisdom, he could easily be overbearing if he wanted to, but instead he spoke in a calm voice, devoid of any air of arrogance, articulating every word unhurried. And he was someone who achieved Malcolm Gladwell’s 10,000-hour requirement to reach expert status in only 12 years of practice.
Before their visit, I imagined a stern surgeon, hardened by years of experience, the kind who would throw surgical instruments across the room and listen to the inevitable clang with deranged satisfaction. Dr. Lawton was quite the contrary, and I was even more in awe. The relaxed attitude with which he gave his lectures, he carried with him to the operating room. I witnessed this firsthand when I assisted him. My fingers trembled as I did the craniotomy and incised the patient’s dura, but listening to him teach during surgery, I soon realized that the trepidation was unfounded.
April Sabangan, the Filipina operating room nurse who’s been running his neurosurgery service for the last 10 years, told me how she’s only heard him raise his voice in the operating room twice. She did not even sound sure, and I doubt she could remember the circumstances.
Two times in 10 years? How does an expert do that? Hell, I would easily go beyond two times doing a single case, and my junior residents would agree in a split second.
It was April who brought up the idea of visiting the Philippines to Dr. Lawton, at first, just so her medical team would see the Philippines in a different light, “not simply as an underdeveloped country mostly in the news for either some catastrophe or some story on poverty.” She organized Mission BRAIN’s visit, and I was just grateful she did — more than anything, for the opportunity to share stories with and to ask for advice from someone I could look up to and aspire to be.
“Are there still cases that you would want to do?” I asked Dr. Lawton. “Do you have a list that you tick off one by one?”
It was right after dinner, prepared by my attending in his home to welcome the Mission BRAIN team. I was seated across Dr. Lawton, at a long wooden table set outdoors. He was obviously still jetlagged and tired from a day’s worth of lectures, warding off mosquitoes that would sneak a bite every so often. But over mangoes, and beer and wine, he was listening.
He thought for a while, and said, quite sheepishly, “None. I think I have done everything.”
“So do you still feel excited when you do your cases?”
“Yes,” this time without hesitation, “Every time.”
His smile reflected the sheer fulfillment of someone doing what he was passionate about, and being the best at it. That was an expert speaking to me.
One day, I hope I would be able to say the same, knowing that as doctors, expertise on our part would translate to better outcomes for our patients.
With utmost gratitude to the Mission BRAIN team: Dr. Michael T. Lawton, Dr. Ana Rodriguez-Hernandez, April Sabangan, Lisa Hannigan, Will Arsheim, and Chris Louie.
Photo Credit: Chris Louie