Stuffing Olives & Singing Weezer While Undergoing Awake Brain Surgery

The impressive tasks patients have performed while lying on operating tables with parts of their brains exposed. 

By Jessie Schiewe

Credit: Trav

The ripe smell of cheese permeated the room. No, this was not a fromagerie, nor a restaurant or even a kitchen. It was an operating room at a hospital in Italy, where a 60-year-old woman was undergoing awake brain surgery (also known as a craniotomy). 

Sitting propped up on the operating table, the woman was stuffing cheese into the cavities of green olives with a toothpick, as doctors prodded at a spot on her head that no longer had any scalp or skull. By the time surgeons were ready to sew her head back up, she’d stuffed more than 90 olives. 

It isn’t uncommon for doctors to have patients perform tasks while undergoing awake brain surgery. Commonly performed to remove brain tumors or treat epileptic seizures, the tasks help surgeons know where to make incisions without damaging other neurological functions.

Engaging in conversation, answering questions, counting numbers, reading sentences, and identifying pictures on cards are some of the more standard assignments awake brain surgery patients are tasked with, but sometimes they are asked to flex their memory and motor skills in other ways, namely by doing something they are good at.

For the 60-year-old woman, that task was stuffing olives, but for others, it could be something like playing a Korean folk song on the saxophone, singing the lyrics to Weezer’s “Island in the Sun,” belting German operas, or strumming “Creep” by Radiohead on the guitar. 

Keeping patients awake and performing tasks during surgery helps surgeons monitor their brain activity and ensure that they are treating the correct area and not damaging other parts of the brain that could affect the patient’s vision, movement, or speech. 

“We don’t do awake craniotomies every day, but there are certain circumstances in which they are extremely valuable,” Philip Stieg, a neurosurgeon at Weill Cornell Medicine in New York, told the medical college’s blog.

“When I’m operating near what we call an ‘eloquent’ area of the brain, I need to know immediately what the effects of surgery are. When the patient is awake and talking and answering questions, I know when everything is fine — and if there is even the slightest change in speech or cognition, I can stop before there’s any serious damage. The last thing a surgeon wants is to have a patient wake up compromised in some way — and then it’s too late. I need that feedback right in the OR, and awake craniotomies give me that.”

Robert Alvarez strummed the tune “Creep” by Radiohead during his operation. (Screenshot)

Being awake as part of your brain gets sliced, diced, and zapped with electrodes is enough to make anyone’s stomach churn, but the whole process is actually less frightening than you might think. In fact, the patient isn’t even fully awake during all of the surgery. Especially in the beginning and end, when part of the skull is removed and then reattached, the patient is sedated and on the verge of sleep, thanks to general anesthesia and numbing medications applied to the scalp. Their hair is then clipped or shaved and their head is placed in a fixed position to minimize movement when they’re awake. 

When the surgeon gains access to their brain and is ready to proceed with the surgery, the patient is woken up and taken off the sedatives that were previously administered. The key is to have patients alert so that they can talk, move, and think, helping the surgeon to identify and avoid functional parts of their brain that are not relevant to the operation. 

A 19-year-old musical theater fan who underwent awake brain surgery in 2018 was tasked with humming and repeating clips of songs that were being played for her as she was being operated on. Another patient — a 28-year-old New Yorker named Rachel — regaled her doctor with tales about a trip she and her husband had taken to Cambodia and Thailand during her surgery. She was also given verbal exercises, such as finishing incomplete sentences (“We went to the airport to catch a ____”) and answering questions ( “What does a king wear on his head?”).

“I remember getting onto the operating room table and then nothing else until I woke up during surgery. I remember somebody saying my name. I could tell that I was on some kind of medication, but I could talk and answer questions,” Rachel told the Weill Cornell Brain and Spine Center. “I thought I was falling asleep a couple times but I learned from Dr. Stieg later that they were in an area where I couldn't speak.”

Though the idea of it might make you queasy, awake brain surgeries are not as harrowing as you’d expect. Patients, including Rachel, routinely comment on how little discomfort they experienced during the operation. 

“I wasn't in any pain and I didn't feel uncomfortable on the table,” Rachel said. 

19-year-old Kira sings her way through an awake brain surgery. (Screenshot)

The reason for this is because the brain actually can’t feel pain as there are no receptors in the tissues,” Shreyas Bhavsar, a neuroanesthesiologist at the University of Texas MD Anderson Cancer Center, explained in a YouTube video. 

“It has no sensation, and when you combine that with the fact that we can apply regional anesthesia — numbing medicine — to strategic portions to the brain and you can numb up the skin, the muscle, and the bone, it makes for a remarkably comfortable surgery.” 

Hopefully the prospect of awake brain surgery is not in your future, but if the day ever comes, it begs the question: What’s a task you’re really good at that you could perform while on the operating table? 

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