Talking over brain surgery

Dr. Sunit Das on brain tumours, “awake craniotomies,” and reinventing the patient experience.Some doctors love talking with their patients. There’s nothing unusual about that. What sets Dr. Sunit Das apart is that he loves talking with his patients while he’s operating on them. Operating, in fact, on their brains. Dr. Das is a renowned neurosurgeon and scientist at St. Michael’s Hospital. Since May is Brain Tumour Awareness Month, we decided to ask him about his work. We particularly wanted to know about a procedure called “awake craniotomies,” where patients remain up and alert, so surgeons can monitor brain activity and preserve brain function.

More than 800 Canadians will be diagnosed with a brain tumour this month alone. Does that weigh on you?

It does weigh on me, because I know that for about half those people, the tumour will be malignant and it will be very bad news. It’s important to note that this is a relatively rare disease. Compared to breast or lung cancer, the number of patients that we see is thankfully relatively small. But no question, these are often devastating tumours.

Why did you become a brain tumour surgeon?

What really got me interested in brain surgery is this one thing – the brain is not like every other organ. It’s what makes us who we are. And for that reason, there’s something deeply personal about being diagnosed with brain cancer, and there is something deeply personal about being responsible for fighting that cancer. It’s challenging, but extremely compelling.

What is the hardest part of the job?

All of us who go into medicine are driven by the fact that we can offer our patients hope at a time when they feel desperation. That’s what it is to be a doctor, right? And the most difficult thing I ever have to do is tell my patients who have malignant brain cancers that we will do everything we can, and I’ll be with them through the whole of it, but I can’t offer them the word “cure.” I pride myself on what I am able to do as a surgeon, but with the malignant tumours, all I can do is buy my patients some time. I don’t get to tell them, “We’ve got this one.”

What is the best part of the job?

You know, it is a simple fact that life is limited and that suffering is part of what it is for us to be human. And being able to find connection with others, and have a place with others, even during the bad moments, is extraordinary. I have the privilege of being part of these people’s lives, and for all of the misery of this diagnosis, I see them and they smile and they hug me and they tell me their stories and we laugh with each other. That is amazing.

The idea of awake brain surgery is something that’s difficult for most people to grapple with. You’re a guy who does it. What is it like to cut into the brain of a person who is awake?

The word I always come back to is “intimate.” And I know it’s weird to use the word intimate when you talk about surgery, but in this case it really is. We talk continuously with the patients and, you might ask, what do you talk about when you’re cutting into someone’s head? I talk about their family, about how they met their spouse, about how they named their kids. Where they grew up, things they remember from childhood. It is intimate.

What are the conversations you have had during these surgeries that you particularly remember?

One time, I was operating on an older gentleman and it came out that he had immigrated to Canada from England just before the war. And he joined the Royal Canadian Air Force. And he was telling me about his time in service in the European theatre, and what it meant for him to be wearing a Canadian uniform when he was with English comrades and Americans. All this while I was operating on his brain. Another patient, just recently, he sang me a Pink Floyd song while I was doing surgery. I will never forget that moment.

How have the last two years been for you?

Tough. A large part of medicine for me is connecting with patients. To be without their loved ones when I talk to them, particularly when I have to give them bad news – that has been a great weight on me.

What gets you through the bad times?

My family. I’m a lucky guy with an amazing family. They know what I do, and they have my back. Just being with my wife and kids, whatever else is going on, it gives me back myself.