Penthouse Retrospective

by Laurence Gonzales Originally Published: November, 1990

Neurosurgery | 30 Years Ago This Month

I waited, as we cruised along the lakeshore, watching the waves curl and disintegrate in the winter sunlight. Then Dr. Braun said reverently, almost in a whisper, “We’re going to touch the brain today.”

There are very few arts that can make a grown man faint. But when Anita Braun first uncovered the human brain arid showed it to me, I broke out in a cold sweat, and I had to put my head between my knees.

Coming out of surgery, I always felt dangerously contaminated, as if I’d been working with plutonium. In part it was the constant threat of AIDS when we were sprayed with a patient’s blood. In part it was the smoke that seemed to hang continuously in the warm, moist air of the operating room during brain surgery, the toasty smell of flesh from the cautery knives, an odor that seemed to cling to me for days, no matter how many showers I took.

People who have never spent any time in operating rooms may speak of them as the epitome of cleanliness, but when I turn my mind back to surgery, I see the piles of bloody sponges through a curtain of blue smoke; I see the burn-blackened flesh of the scalp that is pinned back to the blue bunting with black threads and silver clamps; and I see a fragment of someone’s skull skittering across the cracked linoleum floor and disappearing underneath the silver-painted radiator in the corner.

My first time, a sense of panic overtook me as we went in. Even before we got through the amazing fortress of the skull to the actual brain, I felt as if I were being suffocated as I watched Dr. Braun lift the scalp and peel it back and cut through facial muscles just over the patient’s eye socket. Dr. Braun is a vegetarian, and I began to understand why. People are made of meat.

But my panic was rooted in a deeper sense of what was going on. To begin with, it takes time to disengage. During my first few operations, the patient’s flesh was my flesh. I could feel each scalpel stroke. I was wide awake, and they were operating on me. The danger was so palpable then — this human form was coming undone before my eyes, as if we’d pulled the keystone out of the great Building of Life.

I knew that we were creating a grave emergency with each new step we took, plunging deeper and deeper into the unknown, and yet on we went. Indeed, what nature had so wonderfully stitched together, molecule by electric molecule — this beautiful, fanciful, dimpled smoothness, this robust living tissue — was being jerked apart, and there was no hope that it would ever go back together again — not the way it was, and maybe not at all, period.

But the problem now before us demanded this sort of desperate action: It had been there for some years, though no one could have known. The woman looked and acted normal enough, until she came in one day complaining of a weakness in her right arm. Then someone took an X ray of her head, and there it was: a tumor as big as a tennis ball in the center of her brain.

Now I saw her hair in a plastic bag on a steel cart. “It’s the law,” Dr. Braun told me when I asked why they had saved it. “In case she dies. To return all the parts to her family.”

As the knife cut, blood vessels burst like grapes — and as they broke, they trickled, and the trickle of red life flickered white in the light, like a molten magic metal that was sometimes red and sometimes silver. The head — the object of this elaborate and daring ritual — was at chest height, clamped in steel points, like a sculpture on display. Beneath the head a large clear plastic bag hung down to the floor and filled with gore as the operation proceeded. The skin is an amazingly tough and resilient fabric, able to take terrible torment, but under the gleaming silver blade of the scalpel it pops submissively, parting along a neat line down to the white surface beneath: the skull. The skin is thick and its edge is white with fat, but immediately blood would ooze forth, and Dr. Braun would touch the vessels with electric forceps to cauterize the bleeding.

Each surgery followed the same pattern: Once the thick scalp had been pulled back from the bone, electric knives were used to denude the skull of the thin membrane that covered it. The first time I saw clouds of smoke rising from a human skull and watched the two blue-shrouded surgeon’s heads (Dr. Braun and her chief resident) bobbing as they worked — the headlights they wore dancing in the smoke and making odd reflections on the silver-red blood pouring down the drape below the patient’s head — I could not help thinking of primitive rituals of human sacrifice, and I understood that we were about to enter into the heart of darkness, armed with little more than our wits and fire and a few metal implements.

We were in an alien world. A foreign language was spoken. “What’s her crit? Give me 20 of Decadron. Cushing retractor.” Sometimes after surgery I’d find going back into the world difficult. Surgery was a strange dream, a kind of madness. Constant noises hurt our ears: high-pitched screeching sounds, the hiss and hum of fans and the roar of machinery, both near and distant, and the intermittent bells, whistles, tones, and sirens, all underlaid with the throbbing heartbeat and breathing of the mechanisms that kept the patient alive as we worked. Usually a beat-up old radio played music somewhere in a far corner.

Now a nurse wheeled a black tank of compressed air into view beside the patient, rolling it out on a black dolly with dirty rubber tires. It looked as if we were preparing to weld. On the far side of the patient, a wall of wires, tubes, and monitors hid the anesthesiologist, who was back there chemically manipulating the patient’s life functions. Now and then I could see the dark eyes, the Indian-brown skin, the red cosmetic dot in the center of her forehead, as she peered over the blue drapes and looked out at the theater of surgery from behind her mask.

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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