Awake and aware: Finding meaning in the OR

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Author: Ali Osman OMS-II

This summer, I find myself at Mayo Clinic in Rochester, immersed in an experience that has stretched me in every direction. I’ve spent long hours in the lab analyzing biomarkers and gene mutations, attended research meetings that push the boundaries of what we know, and stepped into operating rooms where time moves differently. The work has been hard, but it hasn’t felt like work. It has felt like building something—skill, understanding, presence.

What I didn’t expect was how often that building would begin not with data, but with people. One morning, I scrubbed into a procedure I had only read about. A young woman was undergoing an awake craniotomy for a tumor located in her dominant temporal lobe, tucked dangerously close to areas that control language. The room was quiet at first, filled with the sound of soft instructions and steady preparation. Nurses adjusted her head frame, anesthesia monitored sedation closely, and neurophysiologists reviewed the baseline mapping protocol. Everyone moved with focus. No one had to be reminded of the stakes.

She was awake when we began. Her eyes opened slowly as the drapes went up, and the attending leaned in to greet her. The goal was clear: resection of the tumor with maximal preservation of function. What that required was not just surgical precision, but continuous conversation. Language tasks began early and were carefully curated to monitor expressive and receptive speech. The team administered pre-recorded auditory tasks, including sentence repetition, word recall, and responsive naming, such as "What color is the sky?" or "Where do you sleep?" Her voice filled the room with answers, guided by these structured cues.

I watched as the operating room unfolded with precision, measured in each gesture and movement. The neurosurgeon communicated not just with the staff but with the patient herself. Her fluency, her pauses, even her word-finding errors guided the next steps. When she hesitated or repeated herself, the stimulation paused. The direction shifted. At one point, she began to beg for the procedure to stop. A nurse leaned in, reassured her, and gently reset the task. Someone handed her a warm blanket. Someone else asked her about her dog.

What struck me most was not just the skill on display, but the balance between control and compassion. The instruments were steady, the cautery deliberate, but nothing felt cold. Every moment was human. Every move came with intention.

After the final resection, the field was irrigated and inspected. The repeat intraoperative MRI confirmed that the tumor had been resected within appropriate margins. Eloquent cortex remained intact. The staff exhaled quietly. The work had been done, and it had been done well. She had just undergone surgery in one of the most sensitive regions of the brain, where the outcome could dictate her life forever—and yet, her language remained untouched.

I helped transfer her to the MRI and then to recovery. As we rolled her stretcher down the hallway, I looked at her face. She was tired but calm. Awake and speaking. A few hours earlier, she had been lying open in one of the most delicate corners of the human brain. Now she was answering questions again. Her voice had returned.

As a medical student, I often find myself clinging to structure. We live by review books, flashcards, and lecture recordings. We dissect disease pathways and memorize algorithms, hoping that knowledge alone will carry us forward. But this summer has reminded me that the art of medicine does not begin and end with what we know. It lives in how we show up. It lives in how we respond when someone forgets a word. It lives in what we do when silence enters the room.

I came into this summer looking to learn. And I have. I’ve learned from mutations and models, from tumor boards and lab data. But I’ve also learned from a quiet moment in the OR when a patient struggled to speak, and a team of strangers waited without pressure or panic. I’ve learned that being a physician is not just about treatment plans. It’s about presence. And sometimes, that presence means standing still and listening.

To every student unsure of their path, I say this: find the rooms that challenge you. Stay in the moments that move you. Let yourself be surprised by what you feel. You do not need to have it all figured out. You only need to be there, fully.

For me, this summer at Mayo has been more than research. It has been a reminder of why I chose medicine in the first place. Not to master the science alone, but to carry it with care.

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