am was like riding on a roller coaster after a night of belligerent drinking. The back of my mouth started to pool with saliva, my face must have been as pale as the top off my slick, white head. It was a short distance, but it felt like one last test of wills. I felt like I was on Toad’s Wild Ride with every twist, turn, brake, and acceleration. With the final brake applied, I peeled myself out of the cab ride from hell as I tried in vain to keep it all together. I was sweating from every pore on a cool November morning as if I forget to dry off from a shower.
We made it to the waiting room and I took advantage of the motion-sensor sliding doors as I frequently went outside to vomit in the bushes. I was still afraid that if I were in this condition, the surgery would be delayed. So instead of using the bathroom, I found a place just outside the sliding doors where I believed no one saw me. Throughout the last two months, I hadn’t thrown up once, but whether it was nerves, “my neighbor,” or the combination of the two, I was at my lowest.
As I shuffled back and forth from the waiting room, I finally heard my name being called. I followed the sound of the voice and made my way to a small office where I met the anesthesiologist, Dr. T. He performed some neurology testing drills and he told me what was about to come. This man was going to put me to sleep, wake me up so that I could feel everything, but my brain, then put me back to sleep and only to wake me up again in full after the surgery ended. On paper, that seems somewhat routine, but to this day, I am fascinated with anesthesiology. Dr. T walked me through the process with a calm demeanor as if he was conducting soft notes from the orchestra. I felt at ease, almost to a point where I was able to drift away from my troubles and fall deep asleep. Now, I am not saying I wanted to go under anesthesia, but with little choice, I was lucky to have Dr. T to ease me into trust and belief. After all, I trusted everyone to do their job and not have a bad day. A bad day at my job wouldn’t result in death, but this team of doctors didn’t have that same luxury.
I left the room and I started to prepare for the surgery. The nausea had subsided and I was able to focus again so I tried to maintain the meditative state that I had just enjoyed. I had an IV put into my arm and I knew it was game time. The next moment I recall is being on a gurney. The methodical twists and turns putting me in to a trance with the ceiling lights of the hospital corridors. This particular view is different. Imagine lying on your back as you float through your home. I guarantee that you will see your home differently; noticing things you never did before including that small patch that evaded your painting efforts. As I watched the ceiling float on, we stopped. Faces started coming into view starting with my mom and Sarah. Like floating heads against the ceiling background, I smiled and uttered my love to them and I received the same. My eyes and thoughts growing heavy with every moment as I see Dr. K appear. He stood over me with my mom and Sarah and casually drew his autograph on the left side of my head as if he were a professional baseball player signing a ball for a fan. However, I was the ball and he signed my head so they knew which side to cut into. If not for the anesthesia, I would have been concerned that my neurosurgeon needed a reminder of which side of my head to cut in to, but I smiled like a little kid at a baseball game who just met his hero.
My mind transitioned back and forth from seeing myself as a person, then as a patient. It was a surreal scene and I was losing the battle of reassuring my mom and Sarah that I was good and this was going to be a great success. My thoughts grew sparser and my eyes fought to hold onto the last views of my ladies, but it was all in vain as I slowly succumbed to the anesthesia cocktail with even heavier blinks.
The ceiling came back into focus as I felt my floating gurney make its way through the meandering halls. I remember telling Dr. K, my mom and Sarah that as long as I can wiggle my fingers and toes when this is done, then I consider this a success. I wiggled my fingers and toes as my last sense of control, holding the feeling deep inside of me. We entered the operating room with an arctic blast of cold air meeting the warmth of my blankets. “Mr. Archibald…are you comfortable?” “I’m okay, it’s just really cold in here,” I replied. Suddenly, but gently, more warm blankets were laid on my body as I faded off to a deep, deep sleep…
…Sarah loves to make cheese platters with cured meat, gourmet cheeses, and enough accompaniments to form a symphony of flavors and textures. She refers to this as “a plate.” I compare these plates to the human body, and for some reason the cheese is always the brain of the body. It is probably because everyone goes for the cheese and the other items on the platter tend to service the cheese. The crackers create a base or body, and the other items mainly comprise the body parts, with which some people find crucial (I love a good cracker) and others find to be nonessential. A person can function without a body part or even several; however, one cannot live without one’s brain. Therefore, cheese is just too necessary not to consume.
These cheeses on this platter are all different, but the one that is most useful in this comparison is any soft round of cheese. From the outside, it looks unassuming and rather benign. But when a knife is pressed through the hard rind and then into the soft inside, something changes. Another knife cut creates a wedge and now the entire wheel of cheese has changed. The inside was a mystery prior to the knife blade, but after the passes of steel, the inside becomes a new reality. If the wedge is too small, it will not cover the cracker and fellow platter companions so you would undoubtedly have to go back for seconds sooner than you may want. If the wedge is too large, the cracker is overwhelmed and hope is turned into a hot oozy mess where you wish that you hadn’t eaten it in the first place. So, it is rather important to get the right sized wedge…it is a thin line between needing to cut another wedge versus trying to stuff soft cheese back into the wheel, which is like putting toothpaste back into the tube. If cut too much I would be lucky to say the word “cheese” the rest of my life. So, now I look at a cheese platter, hyper-focusing on how large a wedge the first person cuts, which I may or may not judge you for :)…
…I awake from my slumber. Usually when I wake up from a night’s sleep, I stretch a bit, clear my eyes, and slowly let the fog of sleep burn off with the new day’s sunrise. However, when waking from anesthesia, I felt like I already at two cups of coffee, had been to the gym, and was so awake and clear-headed to start a new day. It was quite amazing and so vitally important at the same time. There was no time or ability to start this “new day” with a slow and complacent approach.
I woke to find that my head was in a steel halo attached to a surgical table. The halo was a large metal contraption that held my head perfectly still with the help of screws that had been turned into my skull. My body was propped onto my right side ever so slightly in order to allow the surgical team a grand view of my brain and tumor. Now ordinarily, if I were to wake up in this fashion, I would have thrashed about like a wild animal trying to flee a hunting trap, but in this instance, I was more calm and focused than I ever had been. There was not an ounce of doubt in my mind of what my job was and I could feel every square centimeter of my body…well, except for the left side of my head. This was not a test. The bar exam was a hard test and while my “occupational life” depended on it, this did not even come close. This was my life. How I acted and interacted in these moments would define the rest of my life; however long or short that may be.
Funny, somewhat that people use idioms to accomplish a profound statement…”we’re not sending anyone to the moon” and “this isn’t brain surgery”. Well, now when I hear the latter, I harbor this internal chuckle having had some experience. Brain surgery to me is something profound and not something I ever thought I would participate in. I can’t remember the first time I was told that this would be an “awake craniotomy,” but I am pretty sure it skipped across my brain like shale rocks thrown from the shore of a glassy pond; as a passing thought. However, when it came time for the actual brain surgery, “awake craniotomy” meant something much more meaningful and important. For those not familiar with the term or practice, an awake craniotomy is basically like having the most important conversation in your life all while being pinned to a table and talking with a bunch of strangers about the most serious of consequences.
So, once my eyes were open and I settled into my new space, the work began. I am not sure how many doctors were staring at my brain. I had a sheet covering my vision to my left, which limited me to only seeing two people in the room; one right by my side and another whom appeared to be just off in the corner, but in clear view. The woman next to me was attending to me and monitoring my pain, sensations and anything else I spoke about. The gentleman in the corner was closely monitoring my brain activity on some device. To this day, I do not remember their faces, but I could pick their voices out in the middle of a large fireworks show on the 4th of July. I was focused and ready for whatever was about to happen.
Dr. K spoke to me and asked me if I was doing ok. I wanted to reply, “for sure, this is the vacation I always wanted! Who wouldn’t want to be screwed to a table, surrounded by strangers, with my skull cracked open and the side of my head peeled back?!” Instead, I replied that I was good and ready. The first step was to cut a small section of the tumor to send over to pathology for a more precise diagnosis. I was told prior to surgery that I most likely had a Grade II Oligodendroglioma, but that was based on the initial MRI results and the thoughts of my neurosurgeon. The pathology report would either confirm or deny that diagnosis, but at that point in time I was focused on the task at hand.
A week prior to my surgery I did what is called a “functional MRI” where I performed different tasks while in the MRI tube. The contrast from the fMRI along with my brain activity from the designated tasks would help pin point the tumor location and help guide Dr. K and his team to hone in on the tumor and not remove brain matter that would impair my life. My tumor rested at the tip of my parietal lobe, but luckily it did not cross into any other lobe of my brain. If Dr. K resected too much, it would have impaired my speech, writing, memory, sensory and movement functions. That is a serious wedge of cheese there!!! I hoped he would approach this like the baby bear in Goldilocks…not too little and not too much…I like my brain like I like my porridge, “just right.”
The surgery started and Dr. K took a probe and placed it on the tumor or brain. This probe sent signals to the gentleman in the corner and also directly to my body. If the probe reaction showed no reaction then it was thought to be tumor and therefore something to cut and remove. On these occasions I felt nothing, but with the silence, I knew what was happening. That first cut into the cheese would be the first margin and my brain now and forever would be changed. The process repeated itself a few times until we started getting to a place where the tumor and brain boundary were so intermeshed that even the thinnest of cuts could be problematic. This is where my participation increased and I entered the game ready to win. The next couple of hours went something like this: Probe…and I would reply with silence or “I feel that.” The next question was always, “where do you feel it,”…my reply varied anywhere from my toes to my tongue. At one point, I asked to stop as I instantly started to have a very cold sensation on my neck. I said just that to the room and there was a somewhat comical sigh as someone had placed a metal instrument down and it was touching my neck. The room was so cold and I was so focused that any meniscal change in the environment alerted me like a guard dog. The probing and cutting continued as I interjected more and more. At one point, my tongue started to twitch spastically, but the crazy (or crazier) part was it was only the right side of my tongue. There was a perfect invisible line down the middle of my tongue where the left side was a placid lake and the right side a turbulent sea.
I never could have imagined that I would have a brain tumor, and there I was lying in a metal head cage with half of my tongue vibrating without my control. Needless to say, this was a “don’t cut” reply from me. Someone was able to tap into my central nervous system and control me like a puppet on strings. Think about that for a moment and get back to me when you process the craziness of it all. I tried not to process anything but physical feelings during the surgery, but in one instance, the gentleman in the corner and I had a difference of opinions. Dr. K had probed and the gentleman in the corner replied, “cut” while I replied “don’t cut.” I know he is a trained professional, but I also know when some part of my body is acting different from the rest. He tried with the probe a couple more times, and I was determined to “win.” I was willing to take the risk that not all of the tumor would be resected as the other risk was that I would not feel or be able to move parts of my right leg. Dr. K did a little more probing until he was satisfied that there was nothing left to cut in a safe manner…the wedge was complete.
Dr. K announced the surgery was over, which made the 6 hours feel like 10 minutes. He told me that I would be put back under anesthesia while they put me back together. I thought about how hard it is to build anything from IKEA, and how it is twice as difficult to take it apart and put it back together again. I hope Dr. K kept the instructions as I always end up with an extra washer or screw and hope for the best.
With the announcement that I would be patched up, I knew it was anesthesia time when Dr. T came by my side and calmly asked if I liked to drink tea. I hardly thought this was the time for a cup of tea as I quickly tried to imagine how I would consume it in this apparatus, but I responded, “yes, I do enjoy drinking tea, green tea in fact.” He asked if I liked honey with my tea and I started feeling drowsy. “Yeeeeeessss, tea with honey…thank you.” Before I succumbed to the dreaming cocktail that was now apparently coursing through my veins, I started to softly cry as I thanked everyone in that room. I thanked them without knowing what my fate would be. I thanked them for caring and for doing the best they could for this human they barely knew. I smiled to my dad and silently thanked him too as I faded into another sleep.
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