Week 2: Goose

A 17 year old boy entered the OR shedding tears with his mom tightly holding his hand. The boy was very nervous, I could tell, and he seemed to know exactly what problems he had in his brain and  the surgical procedures he was about to go through. He could not stop weeping. The mom and the son hugged and cried until the anesthetician started the preparation and the nurses escorted the sobbing mother out of the room.

The boy had a benign tumor in the middle of his left cortex and had to go through an open brain  intracranial surgery. The surgical procedure began by making an incision to open up palm size skin on his left side of the head. As the underneath skull revealed, the surgeons cleaned up the blood and drew a line where they were planning to cut the skull open. I did not see any measurement or any calculation being done-the line was drawn entirely by guessing. From the surface of the brain, the surgeons started performing the procedures while looking through a huge magnifying scope to see the sites better. As the surgeon carefully made their way through the brain tissues to the tumor by carefully making small incisions, he decided to cut the skull a little bit more. The surgery lasted a long time. Finally the tumor was out and the physicians closed the brain up.

I could tell that the surgery was one of the routinely performed procedures for the neurosurgeons. But for the boy it clearly wasn't. The rest of his life depended on it. Other patients I have seen were pretty different cases than him, either they were very young and little or old, and all of the procedures had to be done on the cerebral ventricles which involved the use of minimally invasive endoscopes. However, he was old enough to understand what disease he had, what procedures were to be done on his head, and what consequences he may face after the surgery--I could see it in his shedding tears. For his case minimally invasive technique was not an option. Although the surgeons did their best to avoid any loss in cognitive or motor functions, they could not get to the tumor without making incisions. The boy's brain, the left cerebral cortex, was left with a permanent cavity-he will not be the same as he was before. 

As I saw the procedure I kept thinking and asking why would a tumor form in young patients. Is there a way to prevent it? Is it their lifestyle, genetics, or just a bad luck? Is there any other method to kill the tumor without such a surgery? Why would not the surgeons carefully plan before making incisions and cutting to avoid opening more later? I was bombarded with thoughts like these and was irritated to realize that this may be just about the edge of human knowledge and technology. Of course the boy would otherwise have died by the tumor if we did not have surgeons and techniques that we have. We could praise the current era of advanced technology and health care for sure with a young boy's life just saved. But I could also see that we were just too far from where we could say it is good enough yet.