Irvine -- Dr. Robert Pettis asks for a scalpel. ""OK. Starting.""
Lying before him in an operating room at Hoag Hospital Irvine is a 71-year-old woman with a cancerous thyroid.
Pettis, 46, begins to remove the entire shield-shaped gland from the woman's throat.
Though common, thyroidectomies require surgical precision and patience. Surgeons must carve around a nerve that controls the vocal cords while avoiding puncturing two carotid arteries, which supply blood to the head and neck, and also work around the jugular. If the surgeon fails to avoid the nerve or the arteries or the jugular, consequences for the patient could be dire.
So, with assistance from a surgical technician and a certified nurse assistant, Pettis spends 30 minutes meticulously slicing and cauterizing his way through a few thin layers of muscle and tissue before he even reaches the thyroid, about 2.5 centimeters below the skin.
""You're only as good as your last surgery,"" Pettis says as he works, the strains of Louis Armstrong drowning out the soft humming and beeping of medical equipment.
""It's important not to have an ego.""
Twenty-five years ago, Pettis was a sociology major at UC Berkeley. His ego was plenty healthy back then, and his plan was to become a teacher.
Then, suddenly, everything changed.
He was taking a shower when he noticed the water sounded different to his left ear – ""a static sound,"" he says.
He decided to get it checked out. A routine audiogram revealed no loss of hearing, so Pettis was sent to an ENT – an otolaryngologist, a doctor who specializes in the ear, nose and throat – for more detailed testing. After discovering some problems with Pettis' hearing, that physician ordered an MRI, which at the time was a relatively new diagnostic tool.
The MRI results changed Pettis' life, and shaped his philosophy about what makes a good doctor.
There were other signs that something bad might be happening inside Pettis' head. He recalls periodically having severe headaches around his left eye starting in his early teens. Then, in college, while working part time at an Italian restaurant, his balance wavered. Pettis came home after shifts with bruises on his thighs from bumping into a fountain at the restaurant.
At 22, with only a few semesters to go before graduating, the MRI of Pettis' head revealed a 6.5-centimeter growth on a nerve between the base of his skull and his spinal cord – the nerve that carries information about hearing and balance from the ear to the brain. The diagnosis: Pettis had an acoustic neuroma.
Although acoustic neuromas are rarely cancerous, they can get big. And when they get big – up to 8 centimeters in diameter – they can be so damaging to several vital nerves that they can become lethal.
Within 48 hours, Pettis found himself at the House Research Institute, a nonprofit organization in Los Angeles that specializes in ear disorders. He consulted with pioneering ENT surgeon Dr. William House, who recommended immediate surgery.
Pettis was told his chances for survival were 50/50.
Surgery, however, went well – although the benign tumor permanently altered Pettis' face. The growth, which took 4 1/2 hours to remove, permanently damaged a facial nerve that left part of the left side of his face paralyzed. It also made him unable to entirely close his left eye and made him deaf in his left ear.
Recovery, mainly from a psychological standpoint, was challenging.
""I felt terribly self-conscious,"" Pettis says of returning to college with half his face frozen.
His dating life took a hit.
Friends would ask, ""How long will it take for your face to come back?""
Eventually, Pettis would become comfortable talking about his condition and accepting his appearance.
""If you let it mean so much to you,"" he says, ""it'll destroy you.""
Pettis' medical ordeal solidified his desire to become a doctor. He began volunteering at a hospital in Berkeley.
By 1993, three years after graduating from college with a degree in sociology, Pettis was accepted into medical school at UCLA. He graduated in 1999, and then spent six years in residency at UCLA. While studying for the board exams, he worked for Kaiser Permanente in Harbor City for a year before accepting a position at a private practice in Laguna Beach in 2005.
Pettis, who is married to a neurocritical care nurse at UCLA, now runs South Coast Head and Neck in Laguna Beach and Irvine.
Otolaryngology is one of the most competitive specialties in medicine. There are 32 ENTs on Hoag's medical staff.
Marcy Brown, executive director of operations at Hoag Hospital Irvine, says Pettis, who was born in Dallas and spent much of his childhood in Orange County (he graduated from University High in Irvine), connects easily with his patients, in part because of his background.
Pettis was the first physician Brown met following her appointment in March 2011.
""I think his background enables him to relate to his patients in a meaningful way,"" Brown says. ""He's very compassionate and competent, and he has a way of putting families – especially children – at ease.""
Pettis gets an MRI every five years to make sure his tumor hasn't come back. He had a recurrence in 2001 and had the 3.5-centimeter growth removed.
In addition to his surgical practice, Pettis is a volunteer faculty member at UCLA and teaches residents at Harbor-UCLA Medical Center in Torrance. He also volunteers at Hoag's SOS community clinic and has applied for a reserve surgical position with the U.S. Navy.
Pettis completed the thyroidectomy on the 71-year-old woman in about 2 1/2 hours.
""Surgery is an incredibly beautiful thing, and the human anatomy is beautiful,"" Pettis says. ""Respecting the patient and anatomy is key.
""As a surgeon, you need to be confident about what you do. I really think it's important to consider each patient as a whole and not just someone who is getting surgery.
""It also helps having been on the other side. It keeps you humble.""
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