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You’re prepared, when you have the chance to observe brain surgery, for the gore, the half-horror-flick, half-cartoon images. What you’re not prepared for is the smell. The acrid scent of burning flesh and hair wafts through the sterile operating room as blood vessels are cauterized.
Breathing your own hot breath, trapped behind your surgical mask, mingled with the scent of burned flesh and you can start feeling just a little woozy.
“I dealt with that for several years,” neurosurgeon James Fick says. “I sometimes wondered if I would ever be able to do this.”
The truth is, brain surgery isn’t nearly as gruesome as some might think. The patient, draped head to toe in layers of surgical dressings, looks like a large cocoon. The tools used to cut through bone, though powerful, are precise, because there’s no room for error when you’re working on a brain, digging around in the tissue that controls breath, sight, life.
“What is so different is the brain is so regionally specialized,” says Fick, Centre County’s only neurosurgeon. Fick, 48, specializes in removal of brain and spinal tumors. He also holds four patents in the field of cancer gene therapy.
“The liver works the same whether it’s (injury or disease) in this corner or the other; skin is the same all over,” he says. “In the brain, each area is very discrete and specialized, even a very tiny distance away. That’s how a 3 mm injury can be devastating or it can be nothing at all.”
‘Thousands of small steps’
It’s just past 7 a.m. as Fick strides down the corridors of Mount Nittany Medical Center wearing a crisp, white shirt, faded jeans and bright red running shoes. His relaxed demeanor gives no hint of the seriousness of the surgery he’s about to perform.
The patient, a man in his 50s, has been having trouble with understanding, speaking, balance and coordination due to a tumor behind one eye. Swelling in the brain is complicating this already delicate procedure.
“You like to not touch or manipulate the brain whenever it’s swollen from edema because moving it increases chances of injury,” Fick says. “The general rule is you touch the lesion, not the brain.”
He scrubs and is greeted by the surgical team, including surgical technician Amy Boyer, who’s arranging a wide table laden with everything he’ll need during the procedure.
The huge operating room was custom-built for Fick’s work, with specialized machines such as the hulking surgical microscope with lenses that provide magnification from three to 20 times. The higher the magnification, the less depth of field the surgeon has to work with.
“It’s fine jewelry work, brain surgery,” Fick says. “The approach is very meticulous and very detail oriented, it involves thousands of small steps.”
After checking and re-checking everything from the position of the table to the patient’s X-rays, Fick goes to work. He and Boyer communicate almost wordlessly. They stand shoulder to shoulder, Boyer placing each tool in Fick’s hand almost before he’s reached for it. The concentration in the room is palpable.
“He’s so focused,” Boyer says. “There are times you just don’t say anything, you need to pay attention to what he’s doing. He has to trust that I’m going to hand him something he needs.”
Surgical technicians are trained to set up the surgical table and instruments for surgeons, a task that requires the technician to have nearly as much medical knowledge as the surgeon — and maybe a touch of ESP.
“I feel like he’s a good one to be beside,” Boyer says. “It’s pretty amazing when you first go in and see this brain tumor and then a few hours later, it’s completely out. You feel like maybe they’re leaving with a little more of their life back.”
It’s unusual for a relatively rural area such as Centre County to have a neurosurgeon. There are fewer than 3,500 neurosurgeons in the country, according to the American Association of Neurological Surgeons.“They’re not growing on trees, and they usually stay in big cities or medical centers,” says John McQuery, chief operating officer of Centre Medical Surgical Associates. “We’re extremely lucky to have him here.”
Fick’s arrival in State College came about through a simple twist of fate.
Finding a home
Fick developed a love of medicine as a young boy growing up in rural Iowa, following his veterinarian father on calls.
“I was fascinated by surgery from the time I was a little boy,” he says. What he wasn’t so crazy about was the danger inherent in caring for large, sick animals. He decided veterinary school was not an option.
“When I think about how physically difficult and dangerous that job is, I tell people I know I made the right decision,” he says. But he knew he wanted to be a surgeon.
“I enjoyed the difficult, complex cases,” he says. “Then, during third year rotation one night, I heard an emergency brain operation come in. When I stood in the corner and watched, I was hooked.”
He graduated from Iowa State University, attended the University of Iowa College of Medicine and did his residency and internship at the University of Cincinnati. Then he accepted a fellowship in neuro-oncology at the University of California San Francisco, where he assisted world-renowned neurosurgeon Charles Wilson.
Fick and his wife eventually were recruited to the Medical College of Georgia. For eight years there, Fick taught classes and continued his research into brain cancer gene therapies while Donna Fick, an R.N. with a Ph.D. in nursing, continued her own research.
Then a colleague working at Penn State began trying to recruit Donna Fick. All it took was one visit to the area.
“I came to look because of Penn State’s reputation for research, but I just fell in love here,” Donna Fick says.
The couple and their three children, now age 10, 8 and 6, decided to make the move in 2004.
“It felt like home more than the South. Here, I can drop my kids off at summer camp and be at work in 10 minutes,” Donna Fick says. “That’s after years and years of 45-minute commutes. We’ll never go back to that.”
The boards of Centre Medical and Surgical Associates, Mount Nittany Medical Center and Penn State had been talking for some time about trying to bring a neurosurgeon to the area.“We had the need,” McQueary says. “We thought the community needed one, and here one was available.”
Fick was, and is, impressed by the hospital’s commitment, the willingness to provide him an operating room and the equipment to accommodate his work. “It’s something that really benefits the whole community,” he says.
Commitment is required on Fick’s part too. Being the only neurosurgeon means he’s always on, always available.
“It’s not uncommon for him to leave the house at 6 a.m. and come home at 10 p.m. several days a week,” Donna says. “It’s more than a job to him. He loves helping patients and seeing them get better. Only when he’s physically away is he off.”
There’s no shortage of work for a surgeon whose specialty deals with surgical treatment of the skull, brain, spinal cord and all nervous tissue in arms and legs.
“You change people’s lives,” Fick says. “I tell patients I meet them on the worst day of their lives. Once a week you walk into a room and it’s the kind of deal where someone’s sitting there sobbing. In the next 15 minutes you’ll change their lives by telling them they can have a good outcome and knowing that you can do it.”
‘Making an impact’
Michelle Klein, a former photographer for the Centre Daily Times, was one of Flick’s earliest patients. She had a condition known as a chiari malformation, where the base of the brain becomes elongated and gets pinched. She underwent the first craniectomy performed at Mount Nittany Medical Center, in which a piece of bone was removed from her skull, and the lining patched with membrane from a cow’s heart.
Klein had spent months seeking an answer to her excruciating pain. Getting one was a relief, but a bit frightening.
“It’s a scary thing to hear you need brain surgery, but I felt like he was extremely capable. I never felt nervous,” she says.
Fick averages four to six surgeries a week, although there have been weeks when he’s done eight to 10.
“I miss the teaching, and I miss the research,” he says. “But the ability to care for people with difficult problems makes up for it.
“It’s not uncommon for people to ask me, ‘Are you happy here?’ ” he says. “I will do maybe five very difficult things, cases, a year. At top hospitals, neurosurgeons will do maybe 20, but there are six or seven neurosurgeons and they do them together.”
And there’s satisfaction that comes with doing that work in a place like Centre County, he said.
“You start to see you are making an impact, and when you live in a town this size, you see people you’d seen as patients everywhere — at restaurants, the grocery store, when you’re crossing the street and someone honks and waves,” he says. “The most satisfying part is seeing people return to a normal life.”