A Brain (5 page)

“Now, Lisa, turn your head to the left,” said Dr. Newman.

Lisa kept her eyes closed. She felt a finger palpate the ridge of bone that ran back from her right eye toward her right ear. Then she felt the marking pen trace a looping line that began at her right temple and arched upward and backward ending behind her ears. The line defined a horseshoe-shaped area with Lisa's ear at its base. This was to be the flap that Dr. Mannerheim had described.

An unexpected drowsiness coursed through Lisa's body. It felt like the air in the room had become viscous and her extremities leaden. It took great effort
for her to open her eyelids. Dr. Ranade smiled down at her. In one hand was her IV line; in the other hand a syringe.

“Something to relax you,” said Dr. Ranade.

Time became discontinuous. Sounds drifted in and out of her consciousness. She wanted to fall asleep but her body involuntarily fought against it. She felt herself being turned half on her side with her right shoulder elevated and supported by a pillow. With a sense of detachment she felt both wrists bound to a board that stuck out at right angles from the operating table. Her arms felt so heavy she couldn't have moved them anyway. A leather cinch went around her waist securing her body. She felt her head scrubbed and painted. There were several sharp needles accompanied by fleeting pain before her head was clamped in some sort of vise. Despite herself, Lisa fell asleep.

Sudden intense pain awoke her with a start. She had no idea how much time had passed. The pain was located above her right ear. It occurred again. A cry issued from her mouth and she tried to move. Except for a tunnel of cloth directly in front of her face, Lisa was covered with layers of surgical drapes. At the end of the tunnel, she could see Dr. Ranade's face.

“Everything is fine, Lisa,” said Dr. Ranade. “Don't move now. They are injecting the local anesthetic. You'll only feel it for a moment.”

The pain occurred again and again. Lisa felt like her scalp was going to explode. She tried to lift her arms only to feel the cloth restraints. “Please,” she shouted, but her voice was feeble.

“Everything is fine, Lisa. Try to relax.”

The pain stopped. Lisa could hear the doctors breathing. They were directly over her right ear.

“Knife,” said Dr. Newman.

Lisa cringed. She felt pressure, like a finger being pressed against her scalp and rotated around the line drawn by the marking pen. She could feel warm fluid on her neck through the drapes.

“Hemostats,” said Dr. Newman. Lisa could hear sharp metallic snaps.

“Raney clips,” said Dr. Newman. “And call Mannerheim. Tell him we'll be ready for him in thirty minutes.”

Lisa tried not to think about what was happening to her head. Instead she thought about the discomfort in her bladder.

She called to Dr. Ranade and told him she had to urinate.

“You have a catheter in your bladder,” said Dr. Ranade.

“But I have to urinate,” said Lisa.

“Just relax, Lisa,” said Dr. Ranade. “I'll give you a little more sleep medicine.”

The next thing Lisa was conscious of was the high-pitched whine of a gas-powered motor combined with a sense of pressure and vibration on her head. The noise was frightening because she knew what it meant. Her skull was being opened by a saw; she didn't know it was called a craniotome. Thankfully there was no pain, although Lisa braced for it to occur at any moment. The smell of scorched bone penetrated the gauze drapes over her face. She felt Dr. Ranade's hand take hers, and she was thankful for it. She pressed it as if it were her only hope of survival.

The sound of the craniotome died. The rhythmic beeping of the cardiac monitor emerged from sudden
stillness. Then Lisa felt pain again, this time more like the discomfort of a localized headache. Dr. Ranade's face appeared at the end of her tunnel of vision. He watched her as she felt the blood pressure cuff inflate.

“Bone forceps,” said Dr. Newman.

Lisa heard and felt bone crunching. It sounded very close to her right ear.

“Elevators,” said Dr. Newman.

Lisa felt several more twinges, followed by what seemed to her a loud snap. She knew her head was open.

“Damp gauze,” said Dr. Newman, in a matter-of-fact voice.

 

While still scrubbing his hands, Dr. Curt Mannerheim leaned over to look through the door into OR#21 and see the clock on the far wall. It was almost nine o'clock. At that moment, he saw his chief resident, Dr. Newman, step back from the table. The resident crossed his gloved hands on his chest, and walked over to study the X rays arranged on the view box. That could mean only one thing. The craniotomy was done and they were ready for the Chief. Dr. Mannerheim knew he didn't have much time to spare. The investigative committee from the N.I.H. was due to arrive at noon. What was at stake was a twelve-million-dollar research grant that would support his research activities for the next five years. He had to get that grant. If he didn't, he might lose his entire animal lab, and with it, the results of four years of work. Mannerheim was certain he was on the brink of finding the exact spot in the brain responsible for aggression and rage.

Rinsing the suds, Mannerheim caught sight of Lori
McInter, the Assistant Director of the OR. He shouted her name and she stopped in her tracks.

“Lori, dear! I've got two Jap doctors here from Tokyo. Could you send someone into the lounge to make sure they find scrub clothes and all that?”

Lori McInter nodded, although she indicated she wasn't pleased at the request. Mannerheim's shouting in the corridor irritated her.

Mannerheim caught the silent rebuke and cursed the nurse under his breath. “Women,” he muttered. To Mannerheim, nurses were becoming more and more a pain in the ass.

Mannerheim burst into the OR like a bull into the ring. The congenial atmosphere changed instantly. Darlene Cooper handed him a sterile towel. Drying one hand, then the other, and working down his forearms, Mannerheim bent over to look at the opening in Lisa Marino's skull.

“God damn it, Newman,” snarled Mannerheim, “when are you going to learn to do a decent craniotomy? If I've told you once, I've told you a thousand times to bevel the edges more. Christ! This is a mess.”

Under the drapes Lisa felt a new surge of fear. Something had gone wrong with her operation.

“I . . .” began Newman.

“I don't want to hear a single excuse. Either you do it properly or you'll be looking for another job. I got some Japs coming in here and what are they going to think when they see this?”

Nancy Donovan was standing at his side to take the towel, but Mannerheim preferred to throw it on the floor. He liked to create havoc and, like a child, demanded total attention wherever he was. And he got it. He was considered technically one of the best neurosurgeons in the country, if not the fastest. In his
own terms he said, “Once you get into the head, there's no time to pussyfoot around.” And with his encyclopedic knowledge of the intricacies of human neuroanatomy, he was superbly efficient.

Darlene Cooper held open the special brown rubber gloves that Mannerheim demanded. As he thrust in his hands, he looked into her eyes.

“Ahhh,” he cooed, as if he were experiencing orgastic pleasure from inserting his hands. “Baby, you're fabulous.”

Darlene Cooper avoided looking into Mannerheim's gray-blue eyes, as she handed him a damp towel to wipe off the powder on the gloves. She was accustomed to his comments, and from experience she knew that the best defense was to ignore him.

Positioning himself at the head of the table with Newman on his right and Lowry on his left, Mannerheim looked down on the semi-transparent dura covering Lisa's brain. Newman had carefully placed sutures through partial thickness of the dura and had anchored them to the edge of the craniotomy site. These sutures held the dura tightly up to the inner surface of the skull.

“All right, let's get this show on the road,” said Mannerheim. “Dural hook and scalpel.”

The instruments were slapped into Mannerheim's hand.

“Easy, baby,” said Mannerheim. “We're not on TV. I don't want to feel pain each time I ask for an instrument.”

He bent over and deftly tented up the dura with the hook. With the knife he made a small opening. A pinkish gray mound of naked brain could be seen through the hole.

Once under way, Mannerheim became completely
professional. His relatively small hands moved with economical deliberation, his prominent eyes never wavering from his patient. He was a physical person with extraordinary eye-hand control. The fact that he was short, five-foot-seven-inches, was a constant source of irritation to him. He felt he'd been cheated of the extra five inches to match his intellectual height, but he kept in excellent condition and looked much younger than his sixty-one years.

With small scissors and cottonoid strips, which he inserted between the dura and the brain for protection, Mannerheim opened up the covering over Lisa's brain to the extent of the bony window. Using his index finger he gently palpated Lisa's temporal lobe. With his experience the slightest abnormality could be detected. For Mannerheim, this intimate interaction between himself and a live pulsating human brain was the apotheosis of his existence. During many operations, the sheer excitement made him sexually erect.

“Now let's have the stimulator and the EEG leads,” he said.

Dr. Newman and Dr. Lowry wrestled with the profusion of tiny wires. Nancy Donovan, as his circulating nurse, took the appropriate leads when the doctors handed them to her and plugged them into the nearby electrical consoles. Dr. Newman carefully placed the wick electrodes in two parallel rows. One along the middle of the temporal lobe and the other above the Sylvian vein. The flexible electrodes with the silver balls went under the brain. Nancy Donovan threw a switch and an EEG screen next to the cardiac monitor came alive with fluorescent blips tracing erratic lines.

Dr. Harata and Dr. Nagamoto entered the OR.
Mannerheim was pleased not so much because the visitors might learn something, but because he loved an audience.

“Now look,” said Mannerheim, gesturing, “there's a lot of bullshit in the literature about whether you should take the superior part of the temporal lobe out during a temporal lobectomy. Some doctors fear it might affect the patient's speech. The answer is, test it.”

With an electrical stimulator in his hand like an orchestral baton, Mannerheim motioned to Dr. Ranade, who bent down and lifted up the drape. “Lisa,” he called.

Lisa opened her eyes. They reflected the bewilderment from the conversation she'd been overhearing.

“Lisa,” said Dr. Ranade. “I want you to recite as many nursery rhymes as you can.”

Lisa complied, hoping that by helping the whole affair would soon be over. She started to speak, but as she did so Dr. Mannerheim touched the surface of her brain with the stimulator. In mid-word her speech stopped. She knew what she wanted to say, but couldn't. At the same time she had a mental image of a person walking through a door.

Noting the interruption in Lisa's speech, Mannerheim said, “There's your answer! We don't take the superior temporal gyrus on this patient.”

The heads of the Japanese visitors bobbed in understanding.

“Now for the more interesting part of this exercise,” said Mannerheim, taking one of the two depth electrodes he'd gotten from Gibson Memorial Hospital. “By the way, someone call X ray. I want a shot of these electrodes so we'll know later where they were.”

The rigid needle electrodes were both recording
and stimulating instruments. Prior to having them sterilized, Mannerheim had marked off a point on the electrodes four centimeters from the needle tip. With a small metal ruler he measured four centimeters from the front edge of the temporal lobe. Holding the electrode at right angles to the surface of the brain, Mannerheim pushed it in blindly and easily to the four-centimeter mark. The brain tissues afforded minimal resistance. He took the second electrode and inserted it two centimeters posterior to the first. Each electrode stuck out about five centimeters from the surface of the brain.

Fortunately, Kenneth Robbins, the Chief Neuroradiology X-ray technician, arrived at that moment. If he had been late Mannerheim would have thrown one of his celebrated fits. Since the operating room was outfitted to facilitate X ray, the chief technician needed only a few minutes to take the two shots.

“Now,” said Mannerheim, glancing up at the clock and realizing he was going to have to speed things up. “Let's stimulate the depth electrodes and see if we can generate some epileptic brain waves. It's been my experience that if we can, then the chances of the lobectomy helping the seizure disorder are just about one hundred percent.”

The doctors regrouped around the patient. “Dr. Ranade,” said Mannerheim. “I want you to ask the patient to describe what she feels and thinks after the stimulus.”

Dr. Ranade nodded, then disappeared under the edge of the drapes. When he reappeared he indicated to Mannerheim to proceed.

For Lisa the stimulus was like a bomb blast without sound or pain. After a blank period that could have been a fraction of a second or an hour, a
kaleidoscope of images merged into the face of Dr. Ranade at the end of a long tunnel. She didn't recognize Dr. Ranade nor did she know where she was. All she was aware of was the terrible smell that heralded her seizures. It terrified her.