The Tumor: A Non-Legal Thriller (2 page)

Chapter 3

The Treatment

At 6 a.m. on Monday, Paul and Karen are in his hospital room, wide-awake, fearful but trying to appear brave as they wait for the day to unfold. At 6:30, Paul is prepped for surgery and two orderlies arrive with a gurney for the short ride to the operating room. Paul hugs his wife, who’s overcome with emotion. After he’s gone, she is led by a nurse to the waiting room. His parents are already there. The nurse tells them the surgery should be over around noon. As they settle in for a long morning, the room begins to fill with other anxious families.

Paul is rolled into the operating room and put to sleep with general anesthesia.

His head is shaved and his skull fixed in a three-prong headrest to immobilize it (
fig. 1
).

A question-mark-shaped incision is made from the midpoint of his forehead just below the hairline to a point in front of his right ear.

Burr holes are made in the skull, and a power saw is used to fashion a bone flap more or less like the top of a cookie jar (
fig. 2
).

The dura mater—a membrane between the inner table of the skull and the brain—is cut (
fig. 3
). The surface of the frontal lobe is discolored and distorted because of the tumor.

The tumor is localized with an intraoperative navigation device to minimize damage to the motor cortex—the portion of the brain controlling movement of the left side of the body. Under the magnification of an operating microscope, an incision is made into the brain, and just beneath this the abnormal tissue is identified.

A portion is cut out and sent to the pathology lab for a preliminary diagnosis (
fig. 4
). The tumor is removed by suction and the bleeding is controlled with coagulation (
fig. 5
).

The surgeons are able to remove everything that appears abnormal.

They then suture the dura mater, secure the bone flap with screws (
fig. 6
), and staple the skin flap (
fig. 7
).

After three hours of surgery, they are confident things went as well as possible. Paul is taken to recovery.

The surgeon goes to the waiting room and meets with Karen and Paul’s parents. He reports that everything went as expected: the tumor was removed, there were no complications, and they should be able to see Paul in about an hour. The initial results of the biopsy are not good—it looks like a glioblastoma, but it will take several days for the final report.

Meanwhile, Paul is waking up, and there are problems. He has profound weakness in the left side of his body. He cannot lift his left arm or leg off the bed. He has only a flicker of motion in his fingers. The surgeon immediately orders a CT scan to make sure the weakness is not caused by hemorrhaging or a blood clot in his brain from the surgery. It is not. The CT scan is unremarkable.

Early Monday evening, Paul and Karen meet with the neurosurgeon, who has a preliminary pathology report; the final one is a few days away. While the tumor was successfully removed, it is the type of tumor that will likely recur.

Post-operative MR scan

The next day another MR scan confirms that there was total removal of all visible tumor, a rare bit of good news (above).

Chemotherapy and radiation will be necessary to slow its regrowth. As for the weakness in Paul’s left side, the doctor says it is undoubtedly the result of surgical manipulations and should get better.