Louisville Magazine

AUG 2014

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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LOUISVILLE MAGAZINE 8.14 59 Brain Trust David Sun, 40, is the director of the epilepsy surgery program at Norton Neuroscience Institute. He graduated from the Virginia Commonwealth University School of Medicine in Richmond, Virginia. During his frst weekend as a neurosurgery resident at Vanderbilt University Medical Center, he met his wife, Allison Hatmaker (see opposite page), who was a second-year resident at the time. Sun says, "Te general surgeon who I was working for that day called my (future) wife and said, 'I have a patient coming into the emergency room; it sounds like he has appendicitis and needs to go to the OR. And I've got this neurosurgery intern who doesn't know anything on my service, so can you keep an eye on him?' And she called me and she said, 'Your patient's in the ER.' I said, 'What are you talking about and where is the ER?'" Here, Sun recalls a memorable and "scary" brain-tumor removal. "A young lady in her mid-20s has a seizure and comes to the emergency room. Tey do a CT scan that shows something's not quite right. Tey do an MRI scan, and all of a sudden they say, 'Oh, look at that. Tere's a tumor there.' "So they call our team. I explain brain tumors to all my families the same way. One of the analogies I use is that the brain is a beautiful fower garden. You've got your prize roses over here, and prize roses over here, and prize roses over here. And if we mess up those roses, we have a problem. If we mess up those roses, you may not be able to understand people or get your words out. Te patient had a tumor very close to her language centers, so I said, 'Listen, I'm going to recommend that we do your operation while you're awake.' Te idea is, if we do the surgery awake, we can be talking to you while the operation is going on, and we can map out the diferent parts of your brain that might be those prize roses. "We go into the operating room and everything's going very routine. We've cut of a piece of bone with a special drill; we've cut the wrap around the brain; and now we've started to map her speech. Te big sterile drapes are up — ev- erything's blue and green — but underneath this blue tent there's my partner (a neuropsychologist) with his fashlight and his fashcards and she's reading the words and I'm stimulating the brain. We're getting a sense for where the tumor is in relation to her language centers. When we operate on somebody, we put their head in a special clamp because we don't want anything slipping or sliding. And we give them all kinds of numbing medication on their head so they don't really feel anything. Tey don't feel any pain. "Next thing you know, she has a seizure just after we do this map (of her brain, to identify the speech centers around the tumor). Tis is happening within seconds. She starts to seize, her oxygenation drops, her heart's starting to do funny things. Her brain is swelling out of the bone fap we made. So everything was going right, and now — snap the fngers — everything is going wrong. "Te anesthesia team is emergently getting a breathing tube into her — mind you, she's not positioned properly for an anesthesiologist to do that. You've got team members in the operating room with me who are trying to emergently get her incision closed. You've got scrub techs that are handing me instruments as quickly as they can, not even needing me to say, 'Give me this, give me that,' because they know what to do. You've got nurses running into the operating room and they're starting to do chest compressions. We get her stabilized and all take a deep breath. "I go out and talk to the family. She's a young lady with a young husband who's terrifed. I talk to him and explain everything that's happened. As I'm walking back toward the operating room to go check on everything, one thing that I'll never forget is, we had invited a speech pathologist with her student to come watch the surgery because it was an awake craniotomy. Tey are clearly traumatized. I talk to them, explain what happened, that everything's going to be OK. "Because we'd mapped the information we needed, two days later we took her back to the operating room asleep and did the actual operation she needed. Took out the tumor. And quite honestly, I saw her in the clinic I think two weeks ago and she's doing great. It ended up having the happy ending that we want. Her tumor hasn't grown back, she's doing well, she's living her life. But I can tell you, for 48 hours it was scary." W

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