For the Designing for Service class this semester, we are exploring design solutions for the University of Pittsburgh Medical Center Neurosurgery Clinic, specifically for Dr. Amin Kassam, who is acclaimed for his minimally invasive endoscopic surgery—a procedure that allows him to remove brain tumors by going in through the patient’s nose.

While our efforts are focused on improving the patience experience at the clinic, last week Dr. Kassam invited us to the OR to watch one of his procedures, “if it will help,” he said. We jumped at the chance.

Yesterday was the day. We arrived around 11:30. They set us up in the observation room, which was adjacent to the OR with windows dividing the two and had LCD screens projecting the view of the camera that was inserted into the patient’s nose that allowed the doctors to see what they were doing.

The surgery we were watching began around 8 am. When we arrived, they were in the process of creating a hole in the skull behind the nose to get to the tumor in a 26-year-old patient. They took a break to wait for Dr. Kassam, who was in another surgery. And the attending physician came out and showed us the MRI of the tumor, which was a few inches in diameter and putting pressure on the optic nerves, causing the patient to go blind.

When Dr. Kassam arrived to the OR to take over for his attending, he invited us into the OR itself. So we suited up and went in.

It took another hour and a half for Dr. Kassam to access the tumor. He used tools that he had created himself and named after his kids. During the surgery he asked if we could do anything to improve his tools, and made adjustments to the tools himself when they weren’t bent at the correct angle.

Six hours from the beginning of the surgery, he reached the tumor, which was rather quickly sucked up by a tiny vacuum. The tumor was the result of the formation of the embryo, all the way back before the patient was born. Some fat and skin cells got caught in the middle of his brain and over time did what they were programmed to do—create fat, skin, and hair. That’s what they sucked out.

Ironically, after drilling through the nasal passage, removing bone, and sucking up blood along the way, it was only after the doctors encountered the hair that they exclaimed, “Disgusting!”