Aug 11, 2008

Another Update (Article Attached)

I thought I’d write a quick update for those of you who asked. So far things are going pretty much as planned. I’m at home right now while I recover and get back to my version of normal. I know everyone keeps telling me to be patient with this whole “healing process” thing but boy does it ever seem like it’s taking forever. Don’t get me wrong; having the summer off is great but after a while it does seem to drag. As of now I am still waiting to see the Endocrinologist at the end of September so he can fix my thyroid, I then have to wait until October to see the Eye Specialist again, after that it’s back into the giant beer can for my MRI in November to see if the remaining pieces of tumors have grown and if so by how much. And finally of course my favorite (and I hope it’s one of yours) radiation treatments every day for a month! That means that I won’t be done until at least December. Oh well a clean bill of health would certainly be a nice Christmas present wouldn’t it?In the mean time there was an article in the Globe & Mail on August 6 written by my Neurosurgeon Dr. Mark Bernstein which I have attached below:A Neurosurgeon's Daily GrindIt's 1:03 p.m. when the resident starts to cut skin with my assistance. It's the second brain tumour operation of the day. The first was a benign tumour. We were able to help a young student and restore his opportunity for a future. The second patient is a nice 38-year-old mother of four, undeserving of what has befallen her. The resident's eyes wander to find the computer monitor showing the patient's MRI. "Yup, sure looks like it's going to be a bloody one, Dr. B.," she says. I nod. We went over the imaging at length before the operation and are well prepared. The patient has four units of blood ready to go and the anaesthetist has them in the room, stored in the same kind of cooler I use when I go fishing. We have talked to the anaesthetist about this possibility and she is ready. The operating room nurse and the scrub nurse are crackerjack.After the bone flap is removed with a high-speed air saw, the brain is exposed and we get a glimpse of the edge of the tumour. It looks like an overripe plum with the skin peeled off. We take a little piece with biting forceps to send to a pathologist, who will freeze it, slice it and look at it under a microscope while we're operating to give us an estimate of whether it is malignant or benign. The final pathology report will take about a week.The place we opened is the size of two grains of rice, and is weeping blood at a pretty good rate. We spend five minutes under the operating microscope with burning forceps to stop the bleeding.The operation continues bit by bit - every time we touch the tumour, we have to methodically stop the bleeding. If you don't keep up with the bleeding, you get too far behind and the patient will go into shock. At one point, we try to coagulate some vessels deep in a bloody hole with the aid of the microscope. All of a sudden, in the clean dryish place created at the end of our two suckers, which suck blood away, we see the burning forceps clamped around a decent-sized artery the size of a small pencil lead. We notice the artery is not going into the tumour but running beside the tumour into the surrounding brain. "I sure hope that isn't supplying anything important," I say nervously. This time the resident nods in agreement. The pathologist has informed us it's a malignant tumour so our job is to take out as much of it as we can, to take the pressure off the brain and make the radiation and chemotherapy work better. So we keep chipping away at the tumour with various tools; it's slow work because it's so bloody. At least once every 10 seconds, or maybe 10 times every second, the worry about what that blood vessel supplied permeates my brain like a dense fog, wrapping me up like a big, cold wet blanket. I look up at the clock; it's 3:27 p.m. Another hour goes by and we get as much tumour out as we can. Then we spend another half hour meticulously stopping any bleeding. Postoperative bleeding, after we've closed the patient's head, can produce a catastrophic stroke and an immediate and unceremonious return to the operating room. I am still worried about that blood vessel. My throat is dry and I have an unpleasant feeling. I wonder what the sour smell is and then realize it's me. This operation is being done with the patient asleep, so I can't tell if she has incurred a stroke from our taking that darned blood vessel. I will just have to wait. We are sewing up the skin and finally applying the head dressing at 5:16 p.m. It takes the anesthetist another 15 minutes to get the patient awake enough to take out the breathing tube."She isn't moving her right hand very well, Dr. B. Too bad, but it couldn't be helped," the resident mumbles. She looks at the floor while she speaks and her voice is low. Maybe if neither of us can hear it, it can't be true."She'll be okay. It was a long operation and a big tumour so there was a lot of brain manipulation. She'll perk up in a few hours." I try to sound encouraging while I say this. Under my breath I'm saying, "Oh shit."The drive home a few hours later is gloomy. The sunny evening seems dull. My dogs' greeting at the door doesn't seem quite as energetic as usual. They sense my fear. Even the 21-year-old single malt doesn't taste very good. Half an hour later I'm lying in the bathtub, completely submerged under the water, trying to disappear. I call the hospital at 11 p.m., before I hit the sack, and learn from the patient's nurse that she is still paralyzed in her right arm.I sleep fitfully and finally get out of bed at 4:30 a.m. to go down to the hospital to see her. She is wide awake and alert, and moving everything well - including her right hand. "Dodged another bullet," I think to myself. I wonder what's on the firing line today.