Penthouse Retrospective

by Laurence Gonzales Originally Published: November, 1990

Neurosurgery | 30 Years Ago This Month

“No one wants to touch the brain,” she had told me more than once. “The general surgeon will do almost anything, but no one wants to touch the brain. It’s too mysterious.” What she meant was that it was too risky. There is no wiring diagram for the human brain. Sometimes they can take enormous pieces of it out, and the person remains completely normal afterward. Other times they can nick a blood vessel and render a patient unable to speak.

Moreover, it takes a lot of blood up there to keep things going. That tidal surge of blood collects at the top of the head-the sagittal sinus-which is not so much a blood vessel as it is a virtual canyon of blood. From there it flows back out of the brain and recirculates. When doing brain surgery — going in with the drills and saws and then puncturing the dura — it is crucial not to start the sinus bleeding, because then it’s like the dam has burst. There’s no way to stop it, and it comes roaring out until there is no more. Once I saw it nicked ever so slightly, and we were awash in blood. One morning a chief resident came out as we were going in. He was shaken and pale: “I’ve begun to think I should do neurosurgery wearing rubber boots,” he told us.

And yet, just when I thought I had heard or seen the strangest thing of all, nature had another surprise in store for me: One day after surgery, Dr. Braun asked me, “Did you see how the brain started looking all red and angry at the end there?” I said I had. She explained that sometimes the brain will take the abuse of trauma, and sometimes it will not. Now and then when they open someone’s head, the irritated brain simply swells up, overflowing the boundaries of the skull, and continues swelling right out of the patient’s head.

“What do you do then?” I asked.

“Lop off as much as we have to and close ‘em up,” she said.

“And then what happens?”

“And then they die.”

I found it difficult to accept that there was nothing more, no secret answer, no maneuver, no last incantation that would save the day. But it was just a measure of how primitive our methods are. And it was a reminder, lest we forget, of how costly mistakes can be, whether they are nature’s mistakes or our own.

As soon as the brain was exposed, Dr. Braun called for the laser. “Is everyone wearing goggles?” She held the laser gun poised over the patient’s beating brain. Dr. Braun took up a wooden tongue depressor, pointed the laser gun at it, and fired. A whisp of smoke curled into the air. A neat black hole appeared in the wooden spatula. “I guess it’s turned on,” she said with a laugh.

As the laser reduced the tumor to ashes, the ‘two surgeons chatted about doctors who had set patients on fire. One surgeon got the nickname “Torch” because he set several patients on fire with a laser. I wanted to say, “Shh! The patient might hear you.”

The tumor began to glow from within. I don’t think I’d ever seen anything as strange as that. The tumor was a fatty, convoluted, angry red blob-like a special effect in a bad horror film, only it was real, and it was inside someone’s brain. There is no limit to the great imagination: One day we went into a lady’s brain and found a fungus ball, a mushroom-shaped growth the size of a bonsai tree right in the center of her head. It’s no wonder people believe in voodoo, hexes, and the presence of the devil. How else to explain such a gleeful, malicious, and devious trick of nature that would cause a mushroom to grow in a brain?

Now the glistening fatty blob, which was the size of a baseball, was being reduced to brown ash from the shimmering caustic laser light inside it-our cancer within the cancer-fighting fire with fire. The chief resident wanted to crank up the laser and blaze away, commando-style, but Dr. Braun took it slowly, inch by smoking inch. The field was flowing with bright hot lava. The anesthesiologist started a unit of blood.

By the time of that particular operation, I had been at it for a while, and I’d become somewhat inured to the vicissitudes of surgery, the blood and smoke, the smells and sounds. I found myself yawning there, exhausted from weeks of work, and somewhat hungry, because it was afternoon, and we’d been there since seven. That was nothing for Dr. Braun — she could go 14 hours.

Early that morning, during prep, she had stopped in the staff room for a cup of coffee, and I watched as she poured the plastic cup full of milk and added a teaspoon of coffee. I had wondered why she did that, until I watched her operate and realized that she didn’t get to go to the bathroom between seven in the morning and seven at night. Sometimes when I would go home to have dinner (or even wimp out and go to bed), Dr. Braun would call me at eleven o’clock or midnight and I’d hear her cackle madly on the other end of the line and say with a kind of goading, prideful levity: “I’m still in the O.R., Laurence. You want to come down and watch some more?”

I began to realize that they took pleasure in the pain of exhaustion, these surgeons. And I began to understand the paradox of what might seem — to the casual observer-their callous attitude, as compared to the actual depth of their passion and compassion. For no matter what they said, no matter what jokes they made or what hard remarks, they always did it while they were saving someone’s life. I’ve seen the same attitude among fighter pilots, who say “It’s not your day,” when they mean “This will kill you.” A surgeon would no more say “I love this patient” than a fighter pilot would say “I’m afraid of dying in a crash,” although both of those statements would certainly be the truth.

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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