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Dr. Bharat Guthikonda: 'The Sounds of Surgery'
The operating room was unbearably cold because, well, that's just the way it always is. For the next hour, Guthikonda and the team, many of whom were wearing layers of clothing beneath their scrubs, thoroughly sterilized the patient's back area and began marking their incision points. Shortly after the first incisions were made, Dr. Joseph Martinez, the junior resident on duty, paused to make a modest request. "Hey, Albert, can you change the CD?" They had been listening to Sarah MacLachlan. By the last notes of her ballad I Will Remember You, Albert, a surgical tool company consultant, strolled over to a black CD boom box labeled "NEURO - OR #5." He selected Dave Matthews from Martinez's eclectic CD collection. The patient, of course, couldn't hum along. Heavily anesthetized, the middle-aged Oklahoman awaited the surgical procedure he hoped would relieve his chronic lower back pain. For Dr. Guthikonda and his team, it was just another day at the "VA." And a long day at that. The procedure took roughly nine hours, longer than most surgeries but nothing out of the ordinary. No lunch breaks. No sitting down. And - given the nature of the surgery - no margin for error. Using precise surgical instruments, Guthikonda steered clear of the spinal sac and surrounding nerve endings to avoid the risk of severe neurological complications. At 11:30 am, the attending physician checked on the residents' progress and offered words of encouragement. Returning 45 minutes later, he officiated over the delicate insertion of four screws into the patient's spine. Otherwise, it was entirely up to the two residents to oversee the procedure, an arrangement that is not uncommon at the MEDVAMC. Not surprisingly, Guthikonda's days are typically full. He and Martinez make their rounds with patients every day, checking on their status in the clinical wing and providing post-operative care. Like every Monday, Tuesday, and Thursday, today was designated for a surgical operation that took up most of the morning and afternoon. Born and raised in upstate New York while attending college and medical school there, BCM and the Texas Medical Center presented both a change of scenery and a remarkable opportunity for his residency. Guthikonda also met his wife here, having been married all of three weeks prior to that day's surgery. Depending on how long the operations last, the residents later tend to their "consults" - inquiries from current patients and new cases needing evaluation - that arise while they are busy in the OR. Guthikonda alternates weekends at the MEDVAMC with Martinez, who is the only other neurosurgery resident in the hospital. They might leave at twilight one day and midnight the next. At any given moment, either of them could be called to the emergency room. Such is life for neurosurgery residents, of which there are 18, grinding it out at various stages in the six-year program. Although the demands are heavy and the stakes are high, Guthikonda hears few complaints from his peers. "It's something I accepted going into neurosurgery, and I think most residents do, too," Guthikonda remarks. "When you first go into it, you think it is not going to be easy. There are going to be sleepless nights from time to time." Although the patients he treats are under the care of the attending physician, he feels they are very much "his" patients. "If things go well, you're the one they're going to thank," he adds. "If things don't go well, you have to look them in the face and tell them why. "My wife has been through some of my most difficult rotations with me, so she knows what to expect in terms of my hours," Guthikonda says. "It was hard for her in the beginning. There are endless examples of times when we made plans, something happens at work, and we end up canceling them. "She's gotten used to that," he adds, "I guess." At the completion of the surgical marathon inspired in part by Counting Crows, Robert Palmer, and Coldplay, the patient appeared to respond well to the procedure. He would feel some pain following the surgery, but in the long run Guthikonda expected him to enjoy a better quality of life. After surgery, Guthikonda relaxed in his office, during his belated lunch break, at a time when most folks were sitting down for dinner. His many "consults" and unreturned pages still beckoned, but the tireless resident was unfazed. It was, after all, just another day at the VA. |
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Volume 1, Issue 2, Summer 2005 |
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| Last modified: October 10, 2008 |
At 9:30 a.m., Dr. Bharat Guthikonda prepared to operate on the lumbar region of a new patient with a severe back problem at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC). His workday had started three hours earlier, when he made the first of his daily patient rounds. It took almost an hour for Guthikonda, a fifth-year senior neurosurgery resident, to position the patient properly belly down and in such a way to mini-mized blood loss during the procedure.