Gifted Hands: The Ben Carson Story (30 page)
Read Gifted Hands: The Ben Carson Story Online
Authors: Ben Carson
All protons give off different signals, and the computer then translates them into an image.
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PET (Positron Emission Tomography) uses radioactive substances that can be metabolized by cells and gives off radioactive signals that can be picked up and translated. Just like the magnetic resonance imagery picks up electronic signals, this picks up radioactive signals and translates them into images.
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The position of senior registrar doesn't exist in America but lies somewhere between being a chief resident and a junior faculty member. The senior registrars run the service and work under the consultant. Following the British medical schools, Australia has what they call consultants, who are unquestionably the top men. Under this system, a doctor remains a senior registrar for many years.
A doctor can become a consultant only when the encumbent dies; the government has a fixed number of such positions.
Although they had only four consultants in Western Australia, these men were all extremely good, among the most talented surgeons I've ever seen. Each had his own area of expertise. I benefited from all their little tricks, and they aided me in developing my skills as a neurosurgeon.
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The salary was so attractive because I didn't have to pay exorbitant malpractice insurance. In Australia it was only S200 a year. I know a number of prominent physicians who pay $100,000 to $200,000 a year in America. The difference lies in the fact that in Australia relatively few malpractice cases arise. Australian law forbids lawyers to take malpractice cases on a contingency basis. People who want to sue have to take money from their own pockets. Consequently the only people who sue are those upon whom doctors have made the most terrible mistakes.
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My official title was Assistant Professor of Neurological Surgery, Direction, Division of Pediatric Neurosurgery, the Johns Hopkins University and Hospital.
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The procedure known as
hemispherectomy
was tried as long as 50 years ago by Dr. Walter Dandy, one of the first neurosurgeons at Johns Hopkins. The three biggest names in neurosurgical history are Harvey Cushing, Walter Dandy, and A. Earl Walker, who were, consecutively, the three people in charge of neurosurgery at Hopkins dating back to the late 1800s.
Dandy tried a hemispherectomy on a patient with a tumor, and the patient died. In the 1930s and 1940s a number of people started doing the hemispherectomy. However, the side effects and mortality associated with the surgery were so great that hemispherectomy quickly fell out of favor as a viable surgical option. In the late 1950s the hemispherectomy reemerged as a possible solution for
infantile hemiplegia
associated with seizures. Skilled neurosurgeons started doing the operation again because they now had the sophisticated help of EEGs, and it seemed in a lot of patients that all the abnormal electrical activity was coming from one part of the brain. Although the results of previous hemispherectomies had been poor, surgeons felt they could now do a better job with fewer side effects. So they tried and did at least 300 of the surgeries. But again, the morbidity and mortality turned out to be high. Many patients hemorrhaged to death in the operating room. Others developed hydrocephalus or were left with severe neurological damage and either died or were rendered physically nonfunctional.
In the 1940s, however, a Montreal doctor, Theodore Rasmussen, discovered something new about the rare disease that affected Maranda. He recognized that the disease was confined to one side of the brain, affecting primarily the opposite side of the body (since the left side of the body is controlled mainly by the right side of the brain, and vice versa). It still baffles doctors why the inflammation remains in one hemisphere of the brain and doesn't spread to the other side. Rasmussen, who had long believed that the hemispherectomy was a good procedure, continued to do them when virtually everyone else had stopped.
In 1985 when I first got interested in hemispherectomy, Dr Rasmussen was doing a diminishing number and recorded quite a few problems. I suggest two reasons for the high failure rate. First, the surgeons selected many inappropriate patients for the operation who, consequently, did not do well afterward. Second, the surgeons lacked competence or effective skills. Again the hemispherectomy fell out of favor. Experts concluded that the operation was probably worse than the disease, so it was wiser and more humane to leave such procedures alone.
Even today no one knows the cause of this disease process, and experts have suggested possible causes: the result of a stroke, a congenital abnormality, a low-grade tumor, or the more common concept, a virus. Dr. John M. Freeman, the director of pediatric neurology at Hopkins, has said, “We're not even sure whether it's caused by a virus, although it leaves footprints like a virus.”
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This is not her real name.
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In 1988 Beth's parents reported to me that she has continued to improve. She was number one in her math class.
Beth has a slight left limp. In common with other hemispherectomies, she has limited peripheral vision on one side because the visual cortex is bilateral—the one side controls vision to the other side. For some reason vision doesn't seem to transfer. The limp has been there in every case.
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For the sake of privacy I have changed his name.
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See Genesis,
chapter 22
.
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What's ahead for Craig? We expect Craig to get back to his preoperative state. That means that he will be highly functional. As long as I've known him, he has been neurologically impaired. He has tremors, and he still has problems with swallowing that resulted from the devastating neurological effects of the second surgery, in which he almost died.
Unfortunately, Craig will probably have other tumors. But I think the odds of one recurring in the brain stem are small. He is currently working on an MA in pastoral counseling.
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Siamese twins occur once in every 70,000 to 100,000 births; twins joined at the head occur only once in 2 to 2.5 million births. Siamese twins received their name because of the birthplace (Siam) of Chang and Eng (1811–1874) whom P.T. Barnum exhibited across America and Europe.
Most cranio pagus Siamese twins die at birth or shortly afterward. So far as we know, not more than 50 attempts had previously been made to separate such twins. Of those, less than ten operations have resulted in two fully normal children. Aside from the skill of the operating surgeons, the success depends largely on how much and what kind of tissue the babies share. Occipital cranio pugus twins (such as the Binders) had never before been separated with both surviving.
Other Siamese twins joined at the hip or chest had been done successfully. Even so, when any two children are born with their bodies together, an attempt to separate them is an extremely delicate operation with chances of survival normally no greater than fifty-fifty. The twins share certain biosystems and, if damaged, would result in both their deaths.
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On March 6, 1982, Alex Haller and a 21-member Johns Hopkins medical team had performed a successful separation of twin girls born to Carol and Charles Selvaggio of Salisbury, Massachusetts, in a ten-hour operation. Emily and Francesca Selvaggio were joined from the chest to the upper abdomen, sharing an umbilical cord, skin, muscle, and rib cartilage. Haller's team had their major problem with intestinal obstructions.
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Benjamin and Patrick would have to make another 22 trips into the operating room for the complete closure of their scalps. While I did a few of the operations, Dufresne did most of them, including some fancy flaps to cover the back of Benjamin's head.