Warmest Greetings!

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     This may be a long post, so pour yourself a cup of tea and grab a biscuit (or not if you're queasy) before settling in.
     I have been repeatedly told that the Stage II DBS surgery is the "unglamourous" side of neurosurgery and employs the mentality of "what needs to be done needs to be done".  You will see what I mean very quickly.
     Stage II DBS surgery consists of the surgeon connecting a wire from the electrodes implanted in the brain to an IPG (implanted pulse generator - basically a battery pack) surgically inserted into the clavicle region.

This is an example of an IPG.

This is roughly where an IPG is implanted.
     The operation seems to be quite straightforward: the surgeon makes an incision and a small pocket in the upper chest/clavicle region for the IPG to sit and a wire is strung underneath the skin connecting said IPG to the electrodes on the skull (previously placed in the Stage I operation).

 .....but how is the wire "strung"?

      A metal tube (diameter of roughly 5mm) called the tunneling rod is manually pushed under the patient's skin.  Yes.  Manually pushed.  I was debating whether or not I was going to get light headed watching two surgeons trying to push the tube across a length of the patient's neck.  The scrub nurse admitted that the first time she was in on the operation, she couldn't watch.

An example of what a tunneling tool looks like.
     It's no surprise that this wire is what patients complain mostly about.  A representative from the Medtronics company said that patients will often feel pain or soreness in the area around where the wire is inserted.  Apparently, not many nerves or blood vessels are damaged.  If there is bleeding (more than normal), once pressure is applied, it will stop.
     Otherwise, watching this operation was a pretty pleasant experience.  Everyone was extremely accommodating and understanding.  There are many steps before and after the procedure that medical shows like Grey's Anatomy or Hopkins Med cut out.  Everyone wears scrubs because they are easy to clean and easy to replace.  I wear paper scrubs because I'm an observer.  No outside clothing can be exposed in the operating room (and the rooms around it) so shoe covers and hair caps are mandatory.  A face mask must be worn at all times in the OR.
Neurosurgeons also wear funny magnifying glasses and a head light.  

Fierce
This is what I look like, except with shoe caps and my shirt tucked in cause I'm professional.

     A scrub nurse will help gown and glove the surgeon and any assisting residents.  Anyone who handles the sterile medical equipment wears two gloves after scrubbing in.  Keeping everything sterile is so important that some medical equipment is doubled packaged.  There is a red square in the center of the room where the patient and surgeons are, and it is dubbed (in my head) the sterility square.



     I watch from outside because I am not of age yet.  Before the operation starts, everyone in the OR states their name and their role.  The surgeon is the top dog in the OR.  Whatever he/she needs, there will be at least three pairs of hands helping him efficiently perform the operation.  The scrub nurse maintains the blades, sutures, irrigation, etc.  There is periodic equipment counting to ensure that all objects are in their rightful places.  The gauze, needles, blades etc are all tallied on the board to double check that nothing is left in the patient.
     Blades are numbered by their size.  The bigger the number the smaller the blade.  The same concept goes for needles.  The two scalpels used in this operation were the 10 blade and 15 blade.



     After the surgery, the surgeon records and dictates the events of the surgery and calls up the family.

So.....what's it like observing an operation?  Really intriguing.  Kinda chilly.  Completely awestruck.  One perk of doing my project in the hospital: everyone is really kind.  People go into the medical field because they want to help others, so the work environment is cheery and jolly (and occasionally sassy).
     When the patient was wheeled out and the room was cleaned, I realized how sore my body was standing in one position for hours (and I wasn't even operating!).  On top of that, doctors walk fast.  Just in general.  They stride efficiently with purpose.  I scamper along after them.
     Needless to say, I now have buckets of respect (even more than before) for the nurses, surgeons, residents, and hospital staff in general for working long shifts and always being on top of their game.  After being thoroughly amazed by how to human body can withstand surgical procedures and re-motivated to hit the books, the main thought as I get into the car to drive home is:




Holly


Image Sources:
http://www.implantable-device.com/2013/12/05/medtronic-implants-activa-pcs-dbs-ipg-in-us/
http://www.tedpella.com/dissect_html/549-3-blades.jpg
http://parkinsonshumor.blogspot.com/2012/11/parkinsons-dbs-surgery-part-4-day.html
http://www.basicspine.com/blog/wp-content/uploads/surgeon-operating.jpg?8212ac