Richard in the Nutcracker Suite by Paul Heckbert

Dr. Mark Richardson prepares to perform a right temporal craniotomy and amygdalohippocampectomy (removal of the mesial temporal lobe structures, the amygdala and hippocampus) for Richard Palmer, who had a low grade brain tumor removed from his temporal lobe in 198(6?) and has had medically refractory epilepsy since that time. The goal of the operation is to remove the dysfunctional areas of the brain causing Rick's seizures.

At image center, in the far corner of the room, watching a monitor, is Scott, a neurophysiologist performing neuromonitoring.
In the dark blue scrub cap (brightly lit, looking down on Rick, floating like an apparition) is Mark Richardson, MD.
The scrub nurse, just to the right of Rick's shoulder, is Gwen.

Dr. Richardson has shaved the hair on the right side of Rick's head (in the area where Rick had brain surgery in the 80s) and has marked the curve along which he will cut the scalp (purple line visible near top), and has injected the area with local anesthetic. After this picture was taken, Dr. Richardson cut the scalp, pulled it back, and sawed through the skull. Rick's head is clamped in place so that it will not move during surgery. Rick is under general anesthesia at this point.

The operation was done at UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania.

Rick asked me, Paul, his friend and colleague, to photograph this operation, and we proceeded with Dr. Richardson's approval.