Penthouse Retrospective

by Laurence Gonzales Originally Published: November, 1990

Neurosurgery | 30 Years Ago This Month

“Who was the first person to operate on a meningioma?” Dr. Braun asked as she worked quickly and carefully. Neither of her residents knew the answer. “Durand in 1895,” Dr. Braun told them. As the senior neurosurgeon, it was her job to teach as she worked. “It’s amazing how many neurosurgeons,” she had told me, “don’t even know gross anatomy.” More than once I’d seen her send residents back to their textbooks because they could not identify major landmarks within the brain.

The tank of air was hooked to a pneumatic drill, and a drill bit was inserted — a large one. The helical silver screw skated for a moment on the white surface, then bit and caught and began spewing out curlicues of bone, like holy-candle wax. It took all of Dr. Braun’s strength to keep the drill biting. I couldn’t help wondering what it sounded like inside the secret vault of that woman’s head when they applied the screaming silver drill to her skull. (Could she hear? Once two residents were making jokes during surgery, and Dr. Braun stopped them, saying, “You know, they say that even anesthetized patients can hear what we say. Have a little respect.”)

The chief resident, using something that looked like a basting bulb, splashed salt water on the drill bit to keep it cool. It was a bizarre baptism of holy water and steel. The white bone that was being screwed up out of the growing skull hole mixed with water and blood and ran like semen down the blue surgical drapes into the long, clear plastic bag. One of the residents kicked a bloody sponge down between my feet. As the growling drill gnawed into the patient’s head, I saw the brown eyes of the anesthesiologist peer out at me for a moment, then disappear once again. A Mozart chorus played from a speaker somewhere.

Blood, like fine silver, tarnishes to a black metallic sheen if it’s left in the open air. Blood is the life force; it can also be the kiss of death. One morning Dr. Braun forgot to put on her goggles, and only remembered when she hit an artery. The spray of blood caught us all in its shower, but it hit Dr. Braun directly — in the eye. She leapt from the operating room and ran to wash out her eye. A couple of weeks later, she said to me, walking down the hall, “I still haven’t gotten myself tested for HIV [the AIDS virus].”

Now Dr. Braun withdrew the drill, and the scrimshaw of her art showed clearly: a nickel-sized hole, beneath which we could see the dura mater covering a living human brain. “Do you know what ‘dura mater’ means?” Dr. Braun asked. “It means tough mother.’ And this is one tough mother.”

The bone was not only tough, it was alive. It bled. It was also surprisingly thick. I found it difficult to believe that anything could crack my skull without also killing me. The chief resident was drilling the second hole now, and it took all his strength, too. He got up on his toes and leaned down with elbows out and an expression of fierce concentration on his face.

While the drill was being passed back and forth between the two surgeons, making its siren sound and its dental smell, I caught sight of a man reflected in the glass of a cabinet where surgical supplies are kept: He wore clear plastic goggles (to protect his eyes from flying bone chips and spraying blood), a blue surgical mask, a green hair net, and swamp-green scrubs. His eyes were wide with amazement at what he was seeing; the skin of his face was pale with shock. It took me a moment to realize that I was looking at myself.

Finally, all six holes were drilled, and the air was thick with the smell of burned flesh and bone, as Dr. Braun called for the geelee saw guide. “Do you know what this is used for?” she asked. “It’s a French safecracker’s tool,” she said, waving the thin strip of springy steel at us.

Dr. Braun inserted the saw guide into one of the holes to pass it between the skull and the dura so that it came out the next hole. Blood flowed from each hole as she worked. Meanwhile, the chief resident worked at a steel cart, fitting a cutting bit onto the pneumatic-drill head. The phone rang, and a nurse held it to his ear so that he could prescribe medication for one of his patients without contaminating his hands.

Taking turns, they cut from hole to hole with the pneumatic saw blade. “Like cutting plywood,” Dr. Braun had told me. Only it was nothing like cutting plywood. Bone is alive, and beneath all the blue drapes was a human being, ensconced in the form of a towering sarcophagus. A steel platform on which all the surgical tools were laid out was suspended above the patient, and a scrub nurse stood on a riser above us to reach them and pass them one by one to Dr. Braun. “Surgery is all ritual,” she told me one day.

Now the whistling saw was spuming forth its white froth of spermy bone, giving off a smell of sea wrack, rotten weed, and burning flesh, as Mozart played along. (“We play rock ‘n’ roll when we’re closing,” Dr. Braun said. “It makes it go faster.”) As the buzz saw rounded the corner to the last hole, the bit slowed down and the music stopped as the skull fell open. With four hands, they lifted the teacup saucer of bone and splashed it into a stainless-steel bowl of water, a move that made me think of the sacraments. It was difficult not to, with the vestments, the incense, the ritual nature of surgery, and even the music.

Now through the semi-translucence of the bloody dura, I could see a dark and forbidding blue-gray shade, like building storm clouds, the matter of thought itself, beating and rising with the tide of life, which lay unraveled now in bloody streamers.

Dr. Braun plucked the membrane with a stainless-steel pick as fine as a sewing needle, and then cut it with the tip of a scalpel — the slightest touch of the blade parted the tissue. Then, guiding the instrument carefully, she slit the dura all around and peeled it back to reveal the naked brain.

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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