March 22, 2009 -- As doctors Steven Kalkanis and Kost Elisevich performed brain surgery at Henry Ford Hospital in Detroit, a watchful medical team looked on. So did more than 1,900 others, who subscribe to the microblogging social network site Twitter—and had decided to "follow" Henry Ford Hospital.
Holli Charbonneau is one of them. She was watching the surgery not from the operating room but from her kitchen, 15 miles away. Holli, or "Holli81" as she is known on Twitter, is a third-year medical student at Wayne State University. From behind the screen of her computer, she checks the updates or "tweets" streaming in. "They're making good progress." she says.
In Massachusetts, Harvard medical resident Phil Williams is watching, too. He plans to specialize in orthopedics, and has never seen this type of brain surgery, an awake craniotomy, before.
He types in a question for the surgeons. "I asked about the brain. It doesn't feel pain, but does it feel pressure?" he explained. Moments later, one of the doctors in the operating room "tweets" back an answer.
Henry Ford Hospital has launched an unusual marriage of medicine and new media. The hospital began "twittering" some of its more groundbreaking surgical cases.
Doctors will post real-time "tweets" from the operating room, while a technician uploads video of the surgery to YouTube.
A technician installs a computer in a corner of the operating room. As surgeons scrub out of the surgery, they spend time answering questions "tweeted" in from around the country.
Shouldn't You Be Operating?
Dr. Kalkanis reads from the twitter page, "I have a question: shouldn't these surgeons be operating rather than tweeting?"
He then reads his reply, "I said that patient safety comes first. Whoever is not attending to the patient jumps on the feed… but at any given point there is a very senior team with the patient."
This patient is a 47-year-old man with a tumor in the part of his brain that controls his speech. He consented to the twitter feed, and to have video of his surgery uploaded to YouTube.
At home, Holli is watching the first YouTube feed, as surgeons expose the patient's brain.
"I felt like I was right there...in there," she said, " I felt like they were going to ask me to hold the retractor for them, because that's the medical student's job."
Doctors say that immediacy and the real-time nature of the feeds give students a window into the surgeon's decision-making process.
"That is the real power of this technology," explains Dr Kalkanis.
The give and take nature of this technology provides a sort of surgical play-by-play.
Phil Williams kept the questions coming. "I asked what kind of anesthesia is used for this ... basically trying to figure out how they can have the patient go to sleep and then wake them up, and have it be a smooth transition between the two," he explains.
In this surgery, doctors put the patient under to expose his brain, and then wake him up and keep him talking so that surgeons can map his speech center, and navigate around it to remove the tumor.
As doctors send tiny electrical impulses into various parts of the brain, a speech therapist holds up flashcards.
"What is this one" the therapist asks.
"A cow," the patient answers.
At one point, the patient tells the doctors that he has a headache. Not surprising, since they are staring at the right side of his brain.
"Some other people asked is he nervous right now," explained Phil Williams, tracking the twitter exchange, "but he's talking up a storm, apparently."
The patient is put back under, and surgeons successfully removed the entire tumor. The pathology report comes back, and his prognosis is good.
As surgeons close the incision, the questions keep coming.
At her computer, Holli chuckles as she reads this one out loud, "The questions is asking if brain surgery is really as hard as brain surgery." The surgeon's reply:
So, then why have so many people follow along on such a potentially risky operation?
Dr. Kalkanis explained, "It's always better and best if we can err on the side of furthering the field, advancing the frontier, and educating as many people as we can."
"The public comes to know, I think, what our limits are, what our fallibilities are," says Dr. Elisevich, "and can judge essentially where technology can take them at this stage."
Dr. Kalkanis also believes it is important for educators to now communicate in the language this generation of students understands.
"It's a generation skilled in instant, interactive, interpersonal communication and feedback, and I think that if medical education is going to be as relevant and effective as possible, it needs to keep pace with this new standard."