Penthouse Retrospective

by Laurence Gonzales Originally Published: November, 1990

Neurosurgery | 30 Years Ago This Month

I began to regard morning rounds as a test, to see what the world was made of. It was harsh stuff, diamond hard, but it made me clear all day, like taking a jolt of some high-tech ecstasy drug. As we walked down the hall, Dr. Braun told me about one of her patients, a woman who had a fatal form of brain cancer. No one would operate on her. Most doctors would have given her up, told her family to take her home and let her die.

But then, that’s Dr. Braun’s specialty: hopeless cases. You see, the fact is, malignant brain tumors are almost always fatal, so why bother doing surgery? The patient’s going to die anyway. On the other hand, Dr. Braun can sometimes take a comatose patient and, by carefully removing as much of the tumor as possible, give the family someone they can talk to, someone who can say goodbye, maybe even someone with a few good years left.

After the intricate and tedious operation, this particular woman survived for three more years. In fact, there was an unforeseen benefit from the operation. She had gone through a hideous divorce from a very bad husband, and when Anita Braun removed the tumor, she also inadvertently removed the part of the woman’s brain that contained her husband. “She had absolutely no memory of him, nor of the messy divorce. It was kind of a bonus for her. She was happy. She was doing fine. But then she caught on fire and burned up,” Dr. Braun told me. The woman was making coffee when her robe went up in flames. “Her mother came in and watched her burn to death.” I could see the pain in Dr. Braun’s face when she thought of the paradox of losing to fire this woman whose life she’d saved. All Dr. Braun could do was toss it off with a remark. Otherwise, if she became too involved in it, all of her pursuits would seem futile. The whole practice and all her skills would seem a grim joke, and she’d have to quit and go into a cushy private practice.

“I felt as if I were being suffocated as I watched Dr. Braun lift the seal p and peel it back and cut through facial muscles just over the patients eye socket.”

There was a man who made a study of which qualities might predict who would become a good neurosurgeon. He first went to the seminary for advice on how they chose priests, but they were of no help. Then he went to United Airlines to ask how they found good pilots. United told him, “Well, there are pilots who will get you from A to B every time and never do anything interesting, and then there are test pilots. There’s not much in between.”

“Which one are you?” I asked Dr. Braun.

“I’m a test pilot,” she said.

And she was. She took the cases that no one else would touch. Once two little girls were brought from Central America. They both seemed to be terminally ill and no one would operate on them. They did not want the blood on their hands. Besides, they wanted paying customers. Dr. Braun took them for free at the county hospital. She performed both operations. She kept a photograph of herself with one of the girls on her office bulletin board. The picture showed Dr. Braun, smiling, her arm around an eight-year-old girl whose head was all bandaged in white. The little girl was smiling, too, and her parents were smiling. Everybody was smiling.

“How did they do?” I asked.

“She lived,” Dr. Braun said, pointing to the smiling girl with pretty brown eyes. “The other one died.”

And so, as we made rounds, I began to understand what Dr. Braun thought about when she’d say something like, “Oh, this is all lightweight stuff. This is routine.” At other times, she’d hunker down inside herself and whisper something like this: “In one day there is so much drama, there’s such intensity, you have to go home and numb out. Sometimes I get home from a case, and it’s two in the morning, and I’ve been up for days, but I’m not even tired anymore — I’m beyond being tired — and I just sit up watching ‘Ben Casey’ or something moronic. It’s what I call the neverending search for boredom.”

I commuted to work with Dr. Braun, and every morning we’d get into her dusty black Honda Civic and ride downtown, stopping at McDonald’s on the way to get coffee, orange juice, and sometimes a plain biscuit. Dr. Braun liked to try to sum up neurosurgery for me, but we both knew that she never could. She’d say, “Neurosurgery is the most fun you can have with your clothes on.” Then she’d think about it and say, “No, that’s not right. Neurosurgery is… ” But it always came out sounding like something Charlie Brown would say on a greeting card. And then a summary of her world would come down out of nowhere, like the day we were driving home and her beeper went off. Dr. Braun called the hospital on the car phone that she kept on the floor under a knit cap. The sun was going down, and along the lakeshore the waves were crashing in the running sunlight. I heard her talking; then she turned to me and said, “One of my patients is D.O.A. in the hospital. Listen. I’m on hold.” She put the phone to my ear-I could hear elevator music playing. “Isn’t that great music to hear when you’re waiting for someone to tell you your patient is dead?”

Sometimes we just rode in silence. One morning there was a long period of silence, and I knew she was thinking about “Neurosurgery is… ” Finally, she said, “Nobody wants to touch the brain.” She was not being flip. She was making the observation that the brain is a holy place, a dangerous place to be, and that most doctors are afraid of it, just as most pilots are afraid of flying upside down.

Presumably people define "danger" somewhat differently, but Neurosurgery does not seem like such a stretch to include to us. Apparently it did 30 years ago.

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