Dr. Margarett Shnorhavorian takes on the most intimate of surgeries

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by JEAN ENERSEN / KING 5 News

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KING5.com

Posted on June 20, 2010 at 8:10 PM

Updated Monday, Jun 21 at 3:40 PM

It's bright and early and already Dr. Margarett Shnorhavorian's day is off to a rocky start.

"This morning my day started particularly early, at 5 a.m. because my daughter was up sick vomiting.  

Her husband is at home with their 3-year-old daughter.

Knowing she's in good hands, the urologist can now concentrate on caring for other people's kids.

Little Nicholas' operation is an easy one for Dr. Shnorhavorian. It's pretty straightforward. Still, she recognizes this is a big deal for every member of the family.

Dr. Shnorhavorian has six surgeries scheduled today, the majority are operations just like Nicholas'.

"So we are doing an orchiopexy. So this little boy was born with one of the most common male birth defects of the genitalia which is an undescended testis. So his testis didn't make its way all the way down into the scrotum."

It's estimated 3 percent of all newborn boys are born with this defect. With surgery, Dr. Shnorhavorian can fix it.  

It's her most common procedure, certainly not her most unusual. 

Jean: The craziest thing that's ever happened to you as a result of the medical specialty that you are part of?

Dr. Schnorhavorian: I built a vagina out of a girl's inner cheek … go figure that one.

Jean: How did you figure that one?

Dr. Schnorhavorian: I used buccal mucosa, which is the inner cheek, used all the time to reconstruct boys urethras, which is the tube that takes urine through the penis, and so we have it figured out how to rebuild a girl's vagina very well, we've used sigmoid, which is part of the bowel, which is kind of stinky and gross when you think about it, but we can harvest inner cheek.

Dr. Shnorhavorian's surgeries may not be life saving, but they are life changing and life giving.

Today's orchiopexy will help little Nicholas become a father some day.

"We know now that the earlier the testis is brought down into the scrotum the more protective the effect is for his long term fertility potential and his ability to make sperm down the road," said Dr. Schnorhavorian.

The operation may be routine, but not in the mind of Dr. Shnorhavorian.

"It's very ritual and you've done it thousands of times and you don't think about it, but just putting on the mask, gowning and draping the patient, there's a transformation there I just can't explain, and every part of your body knows what to do," she said.

"When I say 'please raise the table to the height of my hands,' that's when I say to myself that I am so thankful. I say it in Greek, I don't know if that matters and it's in my head, nobody else can hear it. So nobody notices, it's my secret, now everybody knows."

"And then you just you know, everything just becomes that small field in front of you, literally that microscopic vision, the world goes away."

_________________

Join urologist Dr. Shnorhavorian in OR 3 and you'll hear the sounds of team work, a heart monitor, and reggae, even rap.

Dr. Shnorhavorian likes music playing while she works.

"You would think it might be distracting and I think some surgeons obviously it's a style, it's a preference thing, for me it's enhancing," she said. "My husband was a D.J. in college and so he's created some playlists for me.  So sometimes it's a surprise what pops up in the O.R.

These surgical soundtracks don't need to be long because it only takes about an hour to fix Nicholas's undescended testis.

"Nicholas did great, he's waking up real comfortable, really healthy testes brought it down. He might have some bruising and swelling like he got kicked down there, but that's normal," Dr. Schnorhavorian tells Nicholas' parents.

A similar surgery is scheduled next.

"The last surgery is scheduled to end at 5:30 and then I'm on call this weekend," said the doctor.

In the life of a surgeon, not every hour is spent in the O.R. They have meetings to attend, patients to visit and, of course, families to love and care for.

"What I've learned is to focus on the moment and what's in front of me," said Dr. Schnorhavorian. "I think that I'm pretty good at protecting my time at home and when, I'm in the operating room I'm in the operating room, when I'm in the lab, I'm in the lab."

Oh, and that's one more passion to add to Dr. Shnorhavorian's list. She spearheads several different research projects.

"All the projects have to do with the development of sexual organs and reproduction," she said.

Working with colleagues at the University of Washington Medical Center and the Fred Hutchinson Cancer Research Center, she hopes to solve many of life's mysteries, including why more and more babies are born with ambiguous genitalia.

"Could part of it be more and more families are willing to disclose these problems and seeking care for sure, could it be changes in the environment, definitely," she said.

Jean: With regard to environmental causes of some the problems, do you have research that is finished to tell us why environmentally this might be happening?

Dr. Schnorhavorian: I think it's a complicated question we are trying to answer. The testis can actually start out, it starts out with the ability to become an ovary or a testis or can go sometimes somewhere in-between and its complicated signals that tell it what to do and where to go and so that's the goal of some of the work I'm doing with the Fred Hutch and the UW and Seattle Children's is to better understand those genes and hopefully understand why these changes happen and preventing them from happening so that families don't have to go through these surgeries.

Dr. Schnorhavorian says she feels honored to be able to do what she does.

"I use to think that the greatest impact I had was assisting in a surgery where we put the bladder inside the body or created a vagina out of a bladder, I use to think those were the really amazing things. And now I'm realizing everything I do every day is pretty amazing. I take a moment before every surgery to be thankful for what an honor it is that this child is my patient," she said.
 

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