Gifted Hands: The Ben Carson Story (19 page)

Maranda's brown eyes stared at her mother's face. “No more seizures.”

Tears shining in her eyes, Terry embraced her daughter. She held her as if she could never let her go. “That's what we want too,” she said.

On the night before surgery I walked into the pediatric playroom. Mr. and Mrs. Francisco were sitting on the edge of the play pit, a special area that the children especially enjoy. A little giraffe on wheels stood across the room. Trucks and cars were scattered around the floor. Someone had lined stuffed animals against one wall. Mrs. Francisco greeted me calmly, cheerfully. I was amazed at her calmness and the brightness in her eyes. Her serenity encouraged me to know that she was at peace and ready to accept whatever happened. Maranda played with some toys nearby.

Although I had warned them of the possible complications of surgery at the time they consented, I wanted to make certain they heard everything again. I sat on the edge of the play pit with the couple and carefully, slowly, described every phase of the surgery.

“You've obviously had some information already about what we need to do,” I said, “because you talked to the pediatric neurologist. We expect the surgery to take about five hours. There's a strong possibility that Maranda could bleed to death and die on the table. There's a chance that she'll be paralyzed and never speak again. A multitude of possibilities exist of bleeding and infection and other neurological complications. On the other hand, she might do very well and never have seizures again. We don't have a crystal ball, and there's no way to know.”

“Thank you for explaining,” Mrs. Francisco said. “I understand.”

“There is one more thing we do know,” I added. “I'd like you to understand that if we don't do anything her condition will continue to worsen until you can't keep her out of an institution. And then she will die.”

She nodded, too emotional to risk speaking, but I realized she had fully grasped what I said. “The risk for Maranda is compounded,” I went on. “The lesion is on the left side—her dominant half of the brain.” (In most right-handed people, the left hemisphere dominates speech, language, and movement on the right side of the body.) “I want to emphasize,” I said, and paused, wanting to make certain they fully understood, “the major long-term risk, even if she survives surgery, is that she'll be unable to talk, or she might be permanently paralyzed on the right side. I want you to be clear about the risk you're facing.”

“Dr. Carson, we know the risk,” Luis said. “Whatever is going to happen is going to happen. This is our only chance, Dr. Carson. Otherwise she might as well be dead now.”

As I stood to leave, I said to the parents, “And now I have a homework assignment for you. I give this to every patient and family member before surgery.”

“Anything,” Terry said.

“Whatever you want us to do,” Luis said.

“Say your prayers. I think that really does help.”

“Oh, yes, yes,” Terry said and smiled.

I always tell parents that because I believe it myself. I've not yet had anybody disagree with me. While I steer away from religious discussions with patients, I like to remind them of God's loving presence. I think what little I say is enough.

I was a little anxious as I went home that night, thinking about the operation and the potential for disaster. I had talked about it with Dr. Long, who told me he had once performed a hemispherectomy. Step by step, I went over the procedure with him. Only later did I realize that I hadn't asked him if his one surgery had been successful.

So many things could go wrong with Maranda, but I had come to the conclusion years earlier that the Lord would never get me into anything He couldn't get me out of, so I wasn't going to spend an excessive amount of time worrying. I've adopted the philosophy that if somebody is going to die if we don't do something, we have nothing to lose by trying. We surely had nothing to lose with Maranda. If we didn't proceed with the hemispherectomy, death was inevitable. We were at least giving this pretty little girl a chance to live.

I finally said, “God, if Maranda dies, she dies, but we'll know that we've done the best we could for her.” With that thought I had peace and went to sleep.

CHAPTER 15

Heartbreak

I
n one sense, I was moving into groundbreaking surgical procedure—if I succeeded. Surgeons had recorded so few cases of full functional recovery that most doctors wouldn't consider a hemispherectomy as viable.

I was going to do my best. And I went into the surgery with two things clear. First, if I didn't operate, Maranda Francisco would worsen and die. Second, I had done everything to prepare myself for this surgery, and now I could leave the results in God's hands.

To assist me I asked Dr. Neville Knuckey, one of our chief residents, whom I had met during my year in Australia. Neville had come to Hopkins to do a fellowship, and I considered him extremely capable.

Right from the beginning of the surgery we had problems, so that instead of the expected five hours we stayed at the operating table exactly twice that long. We had to keep calling for more blood. Maranda's brain was very inflamed, and no matter where an instrument touched, she started to bleed. It was not only a lengthy operation but one of the most difficult I'd ever done.

The dramatic surgery began simply, with an incision drawn down the scalp. The assisting surgeon suctioned away blood with a hand-held tube while I cauterized small vessels. One by one, steel clips were placed on the edge of the incision to keep it open. The small operating room was cool and quiet.

Then I cut deeper through a second layer of scalp. Again small vessels were sealed shut, and a suction tube whisked away blood.

I drilled six holes, each the size of a shirt button, in Maranda's skull. The holes formed a semicircle, beginning in front of her left ear and curving up across her temple, above and down behind the ear. Each hole was filled with purified beeswax to cushion the saw. Then with an air-powered saw I connected the holes into an incision and lifted back the left side of Maranda's skull to expose the outer covering of her brain.

Her brain was swollen and abnormally hard, making the surgery more difficult. The anesthesiologist injected a drug into her IV line to reduce the swelling. Then Neville passed a thin catheter through her brain to the center of her head where it would drain off excess fluid.

Slowly, carefully, for eight tedious hours I inched away the inflamed left hemisphere of Maranda's brain. The small surgical instruments moved carefully, a millimeter at a time, coaxing tissue away from the vital blood vessels, trying not to touch or damage the other fragile parts of her brain. The large veins along the base of her brain bled profusely as I searched for the plane, the delicate line separating brain and vessels. It was not easy to manipulate the brain, to ease it away from the veins that circulated life through her small body.

Maranda lost nearly nine pints of blood during the surgery. We replaced almost twice her normal blood volume. Throughout the long hours, nurses kept Maranda's parents up-to-date on what was happening. I thought of their waiting and wondering. When my thoughts turned to God, I thanked Him for wisdom, for helping to guide my hands.

Finally we were finished. Maranda's skull was carefully sewed back in place with strong sutures. At last Neville and I stood back. The OR technician took the last instrument from my hand. I allowed myself the luxury of flexing my shoulders, rotating my head. Neville and I and the rest of our team knew we had successfully removed the left hemisphere of Maranda's brain. The “impossible” had been accomplished.
But what happens now?
I wondered.

We didn't know if the seizures would stop. We didn't know if Maranda would ever walk or talk again. We could only do one thing—wait and see. Neville and I stepped back as the nurses lifted off the sterile sheet and the anesthesiologist unhooked and unplugged the various instruments that had recorded Maranda's vital signs. She was taken off the ventilator and began breathing on her own.

I watched her closely, searching for any purposeful movement. There was none. She moved a little when she awakened in the OR but did not respond when the nurse called her name. She did not open her eyes.
It's early
, I thought as I glanced toward Neville.
She'll wake up before long
. But would she? We had no way of knowing for certain.

The Franciscos had spent more than 10 hours in the waiting room designed for the families of surgical patients. They had resisted the suggestions to go out for a drink or to take a short walk but had stayed there praying and hoping. The rooms are cozy, decorated in soft colors, as comfortable as a waiting room can be. Magazines, books, even jigsaw puzzles, are scattered about to help pass the time. But, as one of the nurses told me later, when the morning hours stretched into afternoon, the Franciscos grew very quiet. The worry lines in their faces said it all.

I followed Maranda's gurney out of surgery. She looked small and vulnerable under the pale green sheet as the orderly wheeled her down the hall toward the pediatric intensive care unit. An IV bottle hung from a pole on the gurney. Her eyes were swollen from being under anesthesia for 10 hours. Major fluid shifts in her body had altered the working of her lymph system, causing swelling. Having the respirator tube down her throat for 10 hours had puffed her lips badly, and her face looked grotesque.

The Franciscos, alert to every sound, heard the gurney creaking down the hallway and ran to meet us. “Wait!” Terry called softly. Her eyes were red-rimmed, her face pale. She went to the gurney, bent down, and kissed her daughter.

Maranda's eyes fluttered open for a second. “I love you, Mommy and Daddy,” she said.

Terry burst into joyful tears, and Luis brushed his hand across his eyes.

“She talked!” a nurse squealed. “She talked!”

I just stood there, amazed and excited, as I silently shared in that incredible moment.

We had hoped for recovery. But none of us had considered that she could be so alert so quickly. Silently I thanked God for restoring life to this beautiful little girl. Suddenly I caught my breath in amazement, as the significance of their conversation reached
my
brain.

Maranda had opened her eyes. She recognized her parents. She was talking, hearing, thinking, responding.

We had removed the left half of her brain, the dominant part that controls the speech area. Yet Maranda was talking! She was a little restless, uncomfortable on the narrow gurney, and stretched her right leg, moved her right arm—the side controlled by the half of her brain we had removed!

The news rippled down the corridor, and the whole staff, including ward clerks and aides, ran up to see with their own eyes.

“Unbelievable!”

“Isn't that great?”

I even heard a woman say, “Praise the Lord!”

T
he success of the surgery was terribly important for Maranda and her family, but it didn't occur to me that it was particularly newsworthy. While it was a breakthrough event, I saw it as inevitable. If I hadn't been successful, in time another neurosurgeon would have. Yet it seemed as if everybody else thought it was a big item for the news media. Reporters started coming around, calling, wanting pictures and statements. Don Colburn from the Washington
Post
interviewed me and wrote a lengthy and remarkably accurate major article, chronicling the surgery and following the family afterward. The TV program
Evening Magazine
(called
PM Magazine
in some areas) did a two-part series on hemispherectomies.

Maranda developed an infection afterward, but we quickly cleared that up with antibiotics. She continued to improve and has done extraordinarily well. Since the surgery in August 1985, Maranda Francisco has had her one wish. She has had no more seizures. However, she does lack fine motor coordination of the fingers on her right hand and walks with a slight limp. But then, she walked with a mild limp before the operation. She's taking tap dancing lessons now.

Maranda appeared on the
Phil Donahue Show
. The producers also wanted me on the show, but I turned down the invitation for several reasons. First, I'm concerned about the image I project. I don't want to become a show-business personality or be known as the celebrity doctor. Second, I'm aware of the subtlety of being called on, acknowledged, and admired on the television circuit. The danger is that if you hear how wonderful you are often enough, you begin to believe it no matter how hard you try to resist it.

Third, although I'd done my written examination for certification as a neurosurgeon, I hadn't yet taken my oral board exams. To do the oral examination, candidates sit before a board of neurosurgeons. For a full day they ask every conceivable kind of question. Common sense told me that they might not look too kindly on someone they considered a media hotdog. I considered that I had more to lose than to gain by appearing on talk shows, so I turned it down.

Fourth, I didn't want to stir up jealousies among other professionals and to have my peers say, “Oh, that's the man who thinks he's the greatest doctor in the world.” This has happened to other fine doctors through media exposure.