“More suction please.” Berta, my favorite scrub nurse and at one point lover stuck the tube into the patient’s brain. The large inhalation of the machine slurped up the blood that was obscuring my view. I continued using the cauterizer to start separating the vasculature from the tumor. I felt a bead of sweat trickle down my forehead, and I took a second for my resident to dab my head. This hangover was going to be the death of me.
The patient was a 46-year-old male presenting with right-side weakness and some dysarthria. We immediately took the patient for an MRI and discovered a large mass in the left side of the patient’s brain. None of this was new to me, I had performed more tumor resection in my long career than I would care to count. I had about a 75% success rate, which for the type of operations I did was pretty good. My goal was always to keep my deaths per year below vending machine deaths. Something I had never been able to achieve.
When I came to talk to Scott (The Patient) he was alert if not a little boring. Then again you don’t go to the neurosurgery floor for a scintillating conversation.
“And what is it that you do Scott?” I asked through gritted teeth regretting the last few glugs of bourbon the night before.
“I work at NASA.” He said this quickly and refused to look at me.
“Let me guess,” I smirked behind my clipboard. “Accountant?” Another positive of my job is people with brain tumors often don’t notice when they are being insulted. This man definitely wasn’t exploring the vastness of space his sour face looked like it was instead subscribed to multiple porn sites.
“No” Scott turned his gaze to me, and my smirk disappeared. I left the room quickly to let my resident finish the exam. Something about the way he looked at me was… off.
“More irrigation please,” This sentiment was followed up by more fluid leaving the dropper and more sweat leaving my body. I had almost completely exposed the tumor now and was just trying to make sure it was completely detached from the surrounding blood supply before I began tugging. As surgeons, we emphasize the precision and skill that is a part of this work. This is mostly due to our egos and hubris but also if you understood how indelicate and violent surgery could be, you may be less inclined to let us cut a hole in your skull. “Fluoro please.” The use of fluoroscopic dye helped to cleanly identify the tumor from the surrounding brain tissue. As Berta activated the overhead light, I saw that I had done a great job. I had clean margins and could see no additional tumor clinging to the brain. “All right turn off the fluoro please.” I waited a second but could still see the mass glowing. “Berta turn it off,” I put more urgency into my voice as every second spent with your brain exposed increased your risk of infection and despite the chill he ran up my spine I preferred to avoid the paperwork that came along with a negligent death.
“It is off doctor.” She sounded confused and as I looked up, I could see why. The light had been turned off and there should be no reason for the tumor to continue shining. Yet there it was shining bright green in contrast to the swelling pink that surrounded it. I was about to ask Berta to run a diagnostic on the machine but just then the tumor ceased glowing. It once again looked like the gray lifeless hunk of meat. Me and Berta shared a quick laugh ready to pass off the incident as “One of those things”. That was until I continued my work and the color of the tumor shifted to a bright pink almost matching the brain exactly. I could only make out the difference between it and the surrounding tissue because of my previous work cauterizing the entire area.
“Um more irrigation please,” I said through a shaky voice. As medical science improves our margin of error decreases almost to the point of certainty. The scary thing is though sometimes things just happen in the body that we can’t account for. Tumors don’t show up in scans or show up in the wrong place. Terminal diagnoses can right themselves on their own and people can come in and die from the hiccups. I didn’t know what was happening, but I understood there was a man open on the table who would die if I spent too long speculating. “Berta!” I said this with as much exclamation as I could for someone who was currently holding sharp instruments near grey matter. I finally looked up from the microscope expecting to see her still in shock from the incident. Instead, I saw that she had done exactly what I had asked. She had attempted to irrigate the field, but she and the dropper hung motionless over Scott’s head. I could see the fluid suspended in three tiny droplets refusing to succumb to gravity. I looked over at my resident who was also motionless hovering behind me.
I went to call for help not knowing what was happening but knowing it needed to be fixed. That was when some motion caught my eye. The motion was coming from Scott’s brain, and I carefully looked once more through the microscope.
The “tumor” had given up any thought of camouflage as it turned into a deep purple color. The motion I was witnessing could only be described as wriggling. The creature was pulsating and holding my hand near it I felt enough heat to pull away. If only I had pulled my gaze away as well but at this point, I couldn’t move and was condemned to study this thing that had invaded my OR and Scott’s body. As the purple mass writhed and wriggled it flipped itself over and exposed a red circle that encompassed almost half of the thing itself. It was a sucker and the mass that I had spent time carefully detaching from the brain began to recombine and heal itself. It started to slide out of my field of view and as it did I saw that it was much longer than I thought possible. It passed by like a subway car through viscera for what seemed like hours but couldn’t be more than seconds until it was entirely out of view.
“Here is that irrigation doctor.” Berta’s voice almost gave me a heart attack as I accidentally knocked over the tray of surgical instruments on my right. “Doct… Jim, are you ok?” Her eyes peering at me from above her surgical mask looked at me with concern and then at the patient on the table. “Wait what happened to the tumor?”
I had one of my colleagues close up as I made my way to the bar downtown. The entire time I felt as though I was being followed by scary black cars containing men in black suits. As I was sitting at the barstool cradling a glass of bourbon my phone went off. It was Berta, they had taken Scott back for additional scans and had found that we had made a mistake. The tumor was much bigger than we thought and resided in the opposite side of the brain. Scott was doing well post-op and had been consuming a lot of calories and apparently, he had been asking to see me, quite forcefully.
“Jim I am not sure what happened today, but I am sure that Howowitz can take this case if can’t handle it.” Berta had seen me try and fail rehab multiple times and even drove me to a few of them. I am sure she just expected I needed time to sober up and get my head right. That however was not what I needed to do. I texted her back immediately.
“No,” I typed as I downed the rest of the bourbon. “I will see him tomorrow morning in OR 3.” I don’t know what it is that I saw but I can promise you one thing. Scott Branson will not make it off my table tomorrow.