When the headaches first began for David Buckley they were different from the usual overall ache; it was a piercing and localized pain that was new and frightening. The pain could be handled with heavy doses of Advil but the stabbing sensation was alarming. So when Buckley visited his doctor he was puzzled and annoyed by the doctor’s focus on stress in his life.
“But David, you are in the prime demographic for heart and stress issues,” Dr. Lewis argued during the visit. “White male, 55 to 60, poor diet, high BMI, too much alcohol, too much caffeine, too many carbs, no exercise, yes? Every day I see someone like that, high lipid levels, hypertension, work stress, maybe family stress, sedentary lifestyle. I call it the ‘slow congeal’. It’s not like a bunion on your foot. It’s not obvious. But you will get clues. The headaches might indicate restricted blood flow to the brain, or muscle tension in the neck or back from stress.”
“This doesn’t seem like just a clue,” Buckley said.
Dr. Lewis shrugged. “Let’s take inventory and see. You are quite busy with your company, yes?”
That’s complicated, Buckley thought. Yes, but it was more like his company was busy with him. For the last few months the company’s board of directors had been trying to ease Buckley out of his position as company president, out of the firm he had started 20 years previously, a component design company for consumer tech products. So far it had been a friendly attempt. “Yes,” he answered simply after a pause.
“That’s one stress point for being busy and another for not being able to talk about it,” said Dr. Lewis with a genial smile. “Now, I don’t like to bring it up, but have you and your wife separated, again?”
“Yes,” Buckley said without elaborating. If Lewis wanted him to do a People Magazine questionnaire on health, he was the doctor. But Buckley didn’t see the connection between the conversation and the localized jabs inside his head.
“Are you getting a divorce?” Dr. Lewis persisted.
“I guess so,” Buckley said. “It’s been about six months and things aren’t much different.”
“You are probably sitting for 16 hours a day, yes? And how long has it been since you did any of your own sculpting or modeling?”
Buckley just shook his head. “Years, I guess,” he replied. Buckley had been sculpting since his teens. As an adult he found that his ability for designing laptops and other tech products was much stronger than his talent with abstract sculpture. His company had been a rapid success and his personal artistic time was swallowed up by the time needed to run the business.
Dr. Lewis persisted: “When did you last have a good hard exercise?”
“Hell, I don’t remember,” Buckley said. “I don’t smoke,” he added almost aggressively, trying to balance the scales.
“You see where I am going. The points, if we add them up, will likely indicate high levels of stress and stress-related tension headaches. We’ll also want to look at how well the heart is supplying the brain with oxygen. So the question is not just ‘why do you have headaches’ but also ‘what else is going to go wrong.’ We’ll do all the tests, David. We’ll do the neurological exam and the imaging. But it won’t matter as much if the underlying problems are still there.”
First things first, Buckley said to himself, feeling like this visit had added a problem instead of fixing one. It was a mistake coming here. It’s not like I expected that I would come away with a special pill that cleared it up, he thought. No, that’s exactly what I was hoping for. But instead Lewis has just piled on something else. “Doctor, checking the other health stuff is fine,” he said firmly, “It’s time. But I need to figure out these headaches now.
”Look, I will get a stand-up desk for work,” he said in a more friendly tone. He rose and started to pantomime the action of standing at a desk but suddenly felt faint and slumped back down in the chair. He felt the familiar stab in his head and turned to Dr. Lewis with a troubled look. “Is there a test you can do now?” he said weakly. “I am getting a headache right now.” But I haven’t felt faint like this before, he worried. He saw Dr. Lewis go to the door and call for a nurse to help him. Buckley felt himself fainting away altogether but managed to clamber onto the exam table. “I don’t think this is just a clue,” he mumbled before he blacked out completely.
* * * *
They checked him into the ER and ran a series of scans and tests that morning. After a few hours in the hospital bed, with occasional trips to Radiology and tedious vision tests with a neurologist, Buckley was feeling back to normal and ready to leave. He had missed a couple of critical meetings at work (although he acknowledged that they could not have been that critical after all) and he was non-stop on his phone talking to his staff. “No, don’t come down here yet,” he told his assistant Gail during one call. “I don’t think it will be much longer. I don’t think there are many tests left to do.”
But I may have added to the list of tests myself without meaning to, he acknowledged. A little while after he was admitted, when he had been wired up with a heart monitor and blood pressure meter, Buckley had stopped worrying somewhat about his fainting spell and what it meant and remembered his schedule for the day. He sat up sharply and cursed himself for forgetting a call to one of the board members, a potential ally in his effort to remain as president. “God damn it!” he shouted aloud in the small room. I can’t have missed that call, he thought. I didn’t even tell Gail to notify her I can’t make it. He had previously postponed the call once already, no doubt annoying the board member. Now her support is really at risk. Shit. His stomach churned and he could feel sweat beading up on his forehead and back. He had started dialing his phone when one of the ER doctors came into his room, swishing aside the curtain and walking briskly up to the monitor. “Are you feeling okay, Mr. Buckley?” she asked, looking concerned. “The readout from the heart monitor is looking erratic, I just saw it at the desk. And your pulse is jumping up.” She felt his wrist.
“No, I am fine,” Buckley tried to explain, still upset but surprised that his physical reaction was noteworthy. “Okay, maybe I am not fine overall, but I was just now thinking about something at the office. Maybe that’s why.” Buckley was still kicking himself. I can’t believe I forgot that, he thought. I have to call her office now. The doctor looked down at him. “You were thinking about work and that spiked your pulse like this?” She looked at his chart. “No, we had better check if something else is going on. I don’t think work would be that big a deal.” Buckley started to protest – yes, it literally is a big deal, get out! – but decided that an argument would only delay the call to the client. He kept quiet even though it meant more tests on top of all the other ones.
Two hours and several tests later Buckley was still in the hospital bed. He still hadn’t seen or heard anything about test results, but he was feeling better about the day’s disruption. Over the phone with his staff he had been able to reschedule some things, had dealt with a few fires which couldn’t be rescheduled, and had even talked with that sympathetic board member, smoothing things over and arranging for a personal meeting later in the week. Plus, he realized, I am feeling okay physically at the moment. And even more ready to get out of here. And as for not hearing about the test results, he took that to mean the hospital was just being thorough before they got back to him with the minor issue which it probably was. If it was an immediate problem they would have said or done something by now, he reasoned.
Buckley was still reasoning when the curtain to his little room was swept aside and his ER doctor came in. The curtain, hanging from a ceiling track, swung back and was pushed aside again by a second doctor coming in the room, followed by a third doctor. The three doctors with their white lab coats filled up the small room as they stood around his bed and among the monitors and IV pumps. The fluorescent lights in the ceiling seemed to get brighter with the doctors’ entrance. Buckley felt the blood drain from his face and he started perspiring. You don’t need three for a minor issue, he realized.
The ER doctor, Dr. Heller, smiled and spoke first. “Hello, Mr. Buckley, how are you feeling?”
“Feeling outnumbered,” Buckley answered somberly. It had started out as a joke but ended up a solemn observation. He felt unkempt and disheveled in his hospital gown next to the clean and manicured doctors. Dr. Heller had her long hair pulled back tightly into a ponytail, and the other two male doctors looked like they had just shaved. All three smelled of antiseptic soap.
Dr. Heller nodded and looked at her clipboard. “Well, we were wondering if you had a relative or friend with you, in the waiting room or somewhere, to even things up?” She was smiling but Buckley felt the weight of what was coming, before it came. “No, no one right now,” he said. Not that it would change anything, he thought. “What’s the story?” he forced himself to add. Let’s hear it.
Dr. Heller looked over to the second doctor. He said, “Mr. Buckley, I am Dr. Steinberg, radiologist here at the hospital. You know we’ve done a lot of testing, and scanning, and poking and prodding today.” Again Buckley started to reply but then fell back almost immediately. He simply nodded. Dr. Steinberg continued: “We wanted to be as certain as we could when we say: We’ve identified an operable and resectable tumor on your brain, emphasis on operable. Mr. Buckley, you have a small brain tumor which can be, and in all likelihood will be, safely removed.”
Dr. Steinberg looked over at the third doctor. “Dr. Woolsey is a resident neurosurgeon here at the hospital. We asked him to come down and look at the images and talk to us about removal.” The third doctor started talking but Buckley didn’t hear the words at first. There was a strange whooshing in his ears and a flooding of fear sinking down into him. He felt stunned and he watched the doctor’s lips moving without hearing for a moment.
“…and this will involve a different kind of monitoring, using electrodes on your scalp, to measure brain wave activity. Based on the images, it should be a relatively straightforward procedure to remove the glioma,” Buckley finally heard.
The three doctors looked down at Buckley. Dr. Heller, serious now, said “We know that is a lot to take in. Do you have any questions?”
* * * *
After two more days in the hospital with more testing and scanning and poking and prodding, Buckley was doubtful whether his situation was as clear as the doctors had told him. At first the staff had recommended that he remain in the hospital to monitor the headaches and to see if the blackout would reoccur. For a “wait and see” regimen however, there had been an awful lot of testing and scanning. He was paging the nurse to summon someone who could tell him what was going on when Dr. Cain, another neurosurgeon, came into his room. Buckley’s stomach instantly clutched with anxiety. I thought I wanted to talk to him, Buckley thought, but maybe not. It’s bad if he comes in before I even ask.
“Good afternoon, David,” Dr. Cain said in a pleasant manner, “so how do you feel today?” Cain was tall and lanky, and even with a pleasant manner seemed to tower ominously over Buckley in his hospital bed.
“Doctor, I don’t know,” Buckley said, trying to sound assertive and to show that he was critical of the hospital performance so far. “The headaches are worse. But really, I am not able to think about anything other than the tumor and what you can do about it. Why so many tests, so many scans? Is the tumor changing? Can’t you see what’s going on?” The questions burst out by themselves. Buckley had tried to sound like he did in a conversation with his staff: direct, to the point, leading things. Instead he sounded fretful and uncertain. He wondered whether Cain would pull up a chair to talk in depth. No, he kept standing. To keep it brief.
Cain smiled and Buckley tried to reassure himself from that. “The testing is normal in this situation,” Dr. Cain said. “And those tests are still indicating that this is a treatable tumor, perhaps not as clearly defined as we first thought, but that we can absolutely take it out with a normal resection process. Maybe some follow-up radiation for the tiny bits remaining.”
Buckley felt his stomach clench all over again. “But…” he said softly. He could hear it when one was coming.
Dr. Cain reached over to put his hand on Buckley’s shoulder. “There is a ‘but’ “, he said, “a minor one. The EEG results, from all those stylish electrodes on your head, show unusual brain activity. Unusual even for glioma patients.”
Buckley took a breath and tried to keep calm. Tried to use the doctor’s calm for himself. There is more? he asked himself.
“The EEGs tell us that there may be something else going on and it might be a type of epilepsy,” said Dr. Cain. “It’s called a partial or focal type of epilepsy. Most likely generated by the tumor, which is common. But maybe not, and if not then we need to understand it better. Where it’s coming from. Before we tackle the tumor we want to make sure there’s not another potential problem. We’re recommending an open brain mapping procedure. Followed by a second procedure for a very standard tumor resection.” Cain smiled confidently as if he was talking about removing a wart instead of a major skull-cracking operation.
“I have a brain tumor and I have epilepsy?” Buckley asked. “I have both?” He understood the two things individually but the combination somehow didn’t make sense.
“Probably not. I don’t think you do,” Dr. Cain replied. Meaning there are others who do think I do, Buckley realized. “But that’s what we need to confirm,” continued Dr. Cain. “This first procedure which we are recommending has three benefits: one, rule out a separate cause of focal seizures, two, a more thorough brain mapping to better avoid any damage during surgery, and three, a better look at the glioma itself. The tumor definition is not particularly sharp and this will give us a direct look at it, and at any threatened arteries.”
Dr. Cain explained further but Buckley was having trouble following. It was moving too fast. They had gone from ‘we can remove the tumor no problem’ to ‘the tumor has a fuzzy boundary’ and then to ‘there may be a separate problem with epilepsy.’ He wondered what the next conversation with the next confident doctor would reveal. He thought he had done a reasonable job of coping with the initial news of cancer. How much more coping was there? It was hard to keep his thoughts in order, and random, unwanted things popped up in his mind.
A doctor tells a patient: You have a month to live. The doctor looks closer at his chart. Oh, sorry, that was a note from a week ago.
He had to cope with losing his business. As president of his component design company, Buckley had spent most of his waking hours directing the path of the company and handling obstacles and problems. Making key decisions every day. In the last three days his world had been upended and he suddenly had no business at all. The board of directors, which had been moving to oust Buckley, preferably in a friendly fashion they said, quickly put him on leave and named a temporary successor. She’ll be named permanent, Buckley considered. She came from a prominent social media company, almost 20 years younger than Buckley. No design or creative background, but that was less important to the board, he knew. His role was over, abruptly. It was jarring and made him feel untethered and more anxious, more scattered.
A cancer doctor reviews his busy appointment schedule for the day. “So many patients,” he says, “and so little time.”
He hadn’t had many visitors, hadn’t wanted many visitors. It made him nervous to discuss what little he knew about his condition, and knowing so little, it felt forced and aggravating for him to go along with the dutiful optimism which was offered. He found himself grateful to his wife Melissa, for the first time in a long time, after a brief and uncomplicated visit in which she acknowledged his illness and offered help without bringing up any of their conflicts. But as for friends and other relations…better to just get the surgery done first and then figure out afterward what to tell people.
Before Dr. Cain had come in with his news, Buckley had had enough of waiting. The thought of living with the slimy tentacled thing growing in his head, even for a few more days, had seemed unendurable. The threat of epilepsy, though — that made him stop and reflect. Even if it was unlikely, as Dr. Cain said, it set his readiness for surgery back a little. It gave him another source of anxiety, another worry.
A woman from Kilimanjaro
With no time left to borrow
Said “I need one more day
“So fix it some way
“You can lay me down tomorrow”
After Dr. Cain left his room Buckley reached up and felt the electrodes which were stuck on his shaved scalp. The wires weren’t connected to the monitor at the moment and he lay back in the hospital bed and considered these little sensors. He tried to visualize what they would capture, the electricity, or the brain waves (whatever a brain wave was), whirling about in his skull. He wondered how the electrodes could tell the difference between the normal thoughts — well, not exactly normal he acknowledged, but rather the quietly frantic thoughts about the cancer – and the electricity surges or sine waves or whatever it was that signified epilepsy. Did the electrodes pick up the headache? The sporadic and localized pains had become more frequent. If that wasn’t enough, the intermittent jabs had combined somehow to form a dull underlying ache that was by now continuous. Can you tell pain from the brain waves? He wondered.
Buckley was reflecting on this and idly picking at one of the electrodes, as if it was a scab on his head, when a new doctor came into the room. “Sorry,” she said in a friendly voice, “you can’t keep those as souvenirs. They are solid silver with gold plating and we will need them again.” He looked up at her, a trim shortish figure, Indian or Pakistani descent. She had a pleasant face and relaxed manner and he briefly considered a lighthearted response. No, he thought, I’m not there. I am not there.
“Doctor… ?” Buckley inquired.
“Nigam. Dr. Nigam. I am a neurologist here at the hospital, Mr. Buckley.”
“Dr. Nigam, what is your news?” He wasn’t trying to be rude. He just wanted to get to the point.
Dr. Nigam nodded her understanding and pulled a chair over to sit next to his bed. She opened a tablet. “Mr. Buckley, as you know, the surgery which we are recommending, the resection, will be in the occipital lobe of your brain where the tumor is. What we need to go over now is the potential tissue damage from the procedure, if the removal affects other functioning areas. We can view images if you would like to get a better idea of this.”
Buckley’s head sagged a little. “Are you confident?”
“I don’t know what you mean, Mr. Buckley.”
“Sorry, never mind. You said ‘potential damage.’ What do you mean by ‘potential’ ?”
“Well, any open-brain surgery has the potential to damage adjoining tissue.”
“Not that all or any of these would be affected,” Dr. Nigam prefaced, “but the occipital lobe controls vision processing, depth perception, color recognition, and other functions.”
“Blindness,” Buckley construed. “The damage would be blindness.”
“No, not blindness. There would still be sight. But the visual processing and recognition of what is being seen may be affected.”
“That doesn’t seem any better,” Buckley said, realizing it sounded as if he was contradicting the physician, the expert, but he had to understand what was happening. “No comprehension, no depth perception. What’s the risk for this … damage?” He was going to say “potential damage” sarcastically but realized it would just get in the way. He needed to make sure about this.
“That’s hard to say. Every patient is different.”
“Please, Doctor, say anyway. You have the experience. I have no idea and you have some idea.”
Dr. Nigam looked steadily at him. “Very roughly, 75% chance of vision impairment and dizziness, or vertigo. But a good chance – maybe 50% — of the brain adapting to the tissue loss and recovering the functions. So overall a little less than 50% chance of permanent damage. Let me add that there is a 100% chance, as the tumor continues to grow, of a fatal cerebral hemorrhage.”
Her words fed the whirlwind of thoughts within him, the thoughts that kept circling, bringing fear anew each time they made a circuit and were again foremost in his mind. The headaches, the tumor, the epilepsy, the surgery, the separation from the business – each of these menaces would alight in front of him, cause a burst of anxiety, and then would swirl away to be replaced by the next one. Buckley took a minute to absorb this additional bad news on top of everything else he had heard. Potential blindness, he thought. End of my business, if I still had it. End of just about everything I live for.
I guess I appreciate her candor, he thought. I don’t know if the percentages she talked about were accurate but it seems better somehow to put numbers on it rather than have no idea at all. For Buckley the terrifying but nebulous threat of ‘cancer’ was taking shape, coalescing, into the sharp knives of ‘glioma’ and ‘occipital damage’ and ‘potential blindness’.
“That is the purpose of the initial procedure,” said Dr. Nigam after Buckley had been quiet for some time. “The brain mapping will help minimize any damage.”
“ ‘Minimize’, “, Buckley repeated. A wiggle word. It meant nothing, it meant only ‘We’ll do the best we can under the circumstances.’
Dr. Nigam was willing to go into more detail, to show the images of the occipital lobe and the specific parts which might be affected, the ‘Brodmann area 17’ and the ‘ventral stream’ and the other, all apparently vital, areas. But Buckley didn’t see how that would affect the choice. Like Dr. Nigam said, the choice was 50% blindness versus 100% death. He asked for the consent form and signed it. Which was what Dr. Nigam had come for.
* * * *
The doctors had planned to send Buckley home for two days while the initial surgery was scheduled but the headache and blackout episode happened again, this time with some convulsions. After that the first operation was moved up. The next morning Buckley was prepped for surgery, most of his shaved head buttoned with electrodes and a portion toward the back waiting to be lifted off so the doctors could look directly at the tumor and do the brain mapping with electric probes. The electrodes would help show how the epileptic-like signals were originating, and from where.
In the little pre-op area, curtained off from the other surgery patients, Buckley lay back in the small bed and tried not to look directly at the bright overhead lights. It was cold and the thin pre-warmed blankets they brought lost their heat quickly. Outside the curtain he could hear snippets of overlapping conversations by the staff, and the intermittent bells and chimes and paging messages which made him wonder if they signaled patients in distress. Occasionally one nurse or another came in to check on him, sometimes asking the same questions. When the curtains were pushed open he would get a glimpse of the hospital staff outside along with visitors walking around looking out of place. He didn’t regret having no visitors of his own. It was too soon for Emily, a new friend to him, and too late, he knew, for Melissa.
Dr. Cain swept open the curtains with his long arms and came into the room with the anesthesiologist. Cain was good, Buckley thought. Totally professional and serious now that it was cutting time. Tall one, though. I wonder if he’s got that foot pedal to pump up the table, like a barber. “Let’s review, David,” he said, getting to the point. “Nothing that we haven’t talked about already.
“We do this all the time,” he reassured Buckley. “We know how it will go. We’re going to put you under a light anesthesia just briefly. That way you won’t feel anything we’re doing on the scalp and the incision. The brain itself has few pain receptors. Once we’re ready we’ll bring you up and get you started on the mapping. Dr. Wentworth will handle that. She’s our neurophysiologist, a real pro. She’ll ask some questions, and you will feel some novel sensations. Strange but not too unpleasant. Then you go back to sleep, and then next thing you know we will be looking at the results. Make sense? Do you have any questions?”
Buckley looked at him. “Am I going to die?” he asked, before he knew it. It just came out.
Dr. Cain leaned his tall frame down toward the hospital bed and put his hand on Buckley’s shoulder. “Not today, David. Not today.” With this reassurance Buckley breathed hard and started to well up. Dr. Cain smiled and said “Dr. Patel, get this patient under before we start hugging.” Buckley gave a combination laugh and sigh and he saw the anesthesiologist hit the plunger on the syringe. They wheeled his bed out into the corridor and he was out in seconds.
Buckley’s next thought was that he was flying to Seattle on a commercial jetliner. That he had been napping on the plane just after take-off as he often did. The background roar of the engines muffled other sounds but he could still hear them, voices murmuring and various beeps from the cockpit and the flight attendants. But he was dizzy and felt nauseous. Then things started to fit together and he heard recognizable sounds.
“Hello David,” he heard from someone. While the doctors were talking, still indistinctly, Buckley felt the impact of the sedative. They could give me more sedative, he thought, feeling afraid and anxious. That would be okay.
“We’re just now connecting, David. We’ll get started in a minute or two.”
Buckley tried to nod but his head was held firmly by some clamping device. After that he didn’t even want to move his jaw at all. He was still groggy and wondered how much of his brain was open to the air.
“Tine,” he said weakly without moving his jaw. He wasn’t sure if anyone heard him. Dr. Wentworth talked a little about the probing and the questions they would ask him but he was still disoriented and didn’t understand much of it. The probing, the stimulus with the needles on his cortex, started with a tiny feeling, almost imperceptible, but he could tell that something was happening and his vision was being distorted. The questions from Dr. Wentworth began about what he saw as she placed large cards with different shapes and forms and colors above him. The tests made him more dizzy and he became unable to tell shapes or colors. He would see a square on a large card and then, without the card moving, the shape would disappear. Each card seemed to make the nausea worse.
“Okay, moving on,” he heard. He still felt dizzy and sick and hoped that ‘moving on’ would change that.
The next jolt to hit him was sudden and strong. It started like a mild electric shock that cleared his head after a second or two. No grogginess at all. He had a keen awareness of himself, his body, and then a flood of pleasing sensation. It was like being in full sunlight but instead of the warmth of the sun he basked in pleasure and euphoria. The dizziness and nausea were gone, completely. It was like every cell in his body, every neuron in his brain, felt alert and felt good, no, felt sublime. And every cell was communicating this feeling to every other cell. It was like the nerves all the way down his spine to his feet were glowing with pleasure, with sheer aliveness. It was almost too much to bear, this feeling of euphoria. He thought his heart might burst. But it went on and on.
After some time – Buckley couldn’t have said how much, just that it seemed a long time – the feeling subsided. Not like a light switch, it was like water draining in a bathtub. Buckley felt himself breathing deeply but he was only dimly aware of his surroundings. That’s some test, he thought. He heard fragments of conversations from the doctors.
“What is that? Are you on it?”
“Nowhere near it.”
“What does the trace look like? Slow waves?”
“No. And not a spike. Staying elevated.”
“Where did that surge come from?”
Buckley drifted away from that talk and seemed to float away, float upward with thousands of tiny sparks swirling in a gentle spiral. Again he felt the euphoria and glowing pleasure throughout his body. It seemed like the sparks, first outside, were drifting through his body, touching blood vessels and nerves and muscles within him, sparking them in turn to further sensation. As before the feeling lasted for a long, indeterminate time, and then slipped away gradually.
“David.” He heard distantly. “Mr. Buckley.”
He opened his eyes and saw the bright lights above him and two masked doctors peering down at him. “How long hazz been?” he asked softly, slurring the words.
“What do you mean?” one of the masked doctors said, a woman. Her voice seemed harsh to him, grating.
“Uhh, how long since you start probing?”
“You’ve been out for about two minutes,” he heard. He recognized the voice, Dr. Wentworth. Two minutes? He thought. That can’t be right.
“It seened like hours,” he tried to explain, “intense feeling hours.”
“Yes, we saw quite a bit of brain wave activity,” Dr. Wentworth said. “It might have seemed longer to you, that’s normal.”
“You mean etilesy? The waves show etilesy?” He still slurred a little. He wondered whether it was strange for him to ask questions of the doctors in this peculiar situation, disrespectful or presumptuous. But he had to ask.
“No, we didn’t see any seizure activity or any pre-seizure patterns,” he heard a man’s voice. “But we did see a lot of brain wave activity. We’ll continue with the testing but we won’t repeat that.”
Buckley was confused. “It’s not that I don’t want to repeat it…” he began but was interrupted. “We can come back to that area if needed,” Dr. Wentworth said briskly. “But we’ll move on now. Further on up, where we should be in spatial perception. So you might feel dizzy or like you are falling, let us know. We’re getting great information, you are doing great.”
“Okay,” said Buckley, not understanding anything and more apprehensive. After a few seconds he felt the initial jolt again and the piercing, pleasurable sensations flowed through him a third time. “It’s happened again, he’s out,” Buckley heard faintly as if it were on an intercom down the hall. It was not as confusing this time and the euphoric feelings were just as strong and seemed to last forever.
A long, long time later he felt a tap on his cheek. “David,” he heard. “David Buckley?”
He opened his eyes and saw that he was out of the operating room, on a hospital bed. Dr. Cain was sitting at his bedside, typing on a workstation keyboard.
“David,” he said cheerfully. “How are you feeling?”
“Surgery is over, I guess?” Buckley wanted to reach up and feel his head but was afraid to. His neck and head were in some kind of huge clamp.
“Yes, the initial procedure is over and went well. You are in great shape and everything looks good for the tumor resection.”
“What happened? Did you finish?”
“Yes we did. You did just great. We completed the view of the tumor, and we ruled out epilepsy. The probing did cause a surge in brain activity, kind of an overload, so we stopped the probing for the mapping.”
“That was an overload?” A hell of an overload, he thought.
“It was a seizure induced by the probing. It’s not common in these procedures but it can happen. The tumor may have affected how the probing is received by the neural tissues.”
“What does that mean, a surge in brain activity?”
“A burst of unexplained activity, primarily in the higher frequency waves – beta mostly and alpha. The lower amplitudes weren’t affected. It’s similar to brain activity when the oxygen supply is shut off. That is, when the brain is dying. Not that your brain was dying, but it had a similar impact.”
“What does that mean?” Buckley asked, apprehensive again.
“Well, nothing to do with dying, don’t worry about that. Your brain was stimulated, at high levels, by the probing. Probably because of the tumor and its own connections to the brain. We’re not quite sure why but we won’t proceed with the probing in any case. And it’s not an independent epilepsy, good news. So we can concentrate on the tumor.”
“I got that intense feeling again,” said Buckley, still unsure. “It’s intense … it’s very intense. Is that a bad thing?”
“It’s not good. The brain surges can send all kinds of signals to the body. Spasms, choking, tongue biting. We don’t want that, even to map the brain.”
“I was in spasms? Choking?” He didn’t remember any of that but anything could have happened, he realized. He had been in a unique state.
“Just now, in surgery? No. It was still a seizure though. We can still go ahead with the resection, don’t worry about that. We have a pretty good idea of the brain functions there.”
Buckley hesitated, not wanting to ask. “And damage from the surgery?”
Dr. Cain nodded slightly. “As you have already discussed with Dr. Nigam, there’s a chance that vision might be affected. You would still see but wouldn’t order the images like you do now. Balance…we might affect balance. Could result in dizziness or vertigo-like feelings.”
“Are these temporary?” He was hoping for a different answer than Nigam’s.
“It varies by patient. But some changes may be permanent, yes.” Again Buckley thought about the implications. The whirlwind of thoughts in his mind had subsided from the surgery and from being unconscious, but had now started back up with even more to think about and to try to understand.
Just then his wife, Melissa, came in. Buckley was surprised and instantly tense. I don’t think she will make me feel better, he thought. Just more anxious. “Hello Melissa,” he said after a moment, trying to sound normal. At least, normal for being in a hospital for brain surgery. Well, she won’t complain about the tone in his voice anyway. She’s looking good, he thought, slim and well dressed, not flashy. It’s like she had a special outfit just for the IC unit. And here I am with my head cut open and in this grotesque head clamp, right in front of her.
“Yes,” said Dr. Cain, “We asked your wife to come in. Hello, Mrs. Buckley.”
“Hello, Doctor,” she said in a pleasant voice. “Hello, David,” more warmly. She walked over to stand next to Dr. Cain, so Buckley could see them both.
Buckley looked at his wife for a minute, taking her in. I suppose it’s right that she be here, he thought. Closest family member. But bringing up everything about the divorce, the resentment and overall feeling of failure…just adding to the stress. Then he turned his face, as well as he could in the clamp, to Cain. “So not doing the surgery…that’s not an option?”
“I wouldn’t think that’s an option,” Dr. Cain said. “The tumor is advancing on key areas. Enveloping a major artery. Once the tumor encircles the artery we won’t be able to remove the tumor without damaging the artery, which would probably be fatal. For tumors like these, neither chemotherapy nor radiation have shown to be effective as the first treatment. If we don’t operate then it’s just a matter of time before the artery is invaded and the artery wall ruptures.”
“A matter of time,” Buckley repeated. “How much time if you don’t operate?”
“David?” Melissa said, questioning his remark.
Dr. Cain was a little surprised too. “Well at the current rate of growth, maybe 12 months. Maybe sooner.”
“But maybe longer?”
Dr. Cain looked at Buckley. “Hard to say, but yes maybe longer.”
“The rate of growth,” Buckley said, “calculated on what two points? I mean, how much time between the first measurement and the latest?”
At this Dr. Cain was clearly annoyed. “Over … over four days, when you first were admitted to today. And also based on what you have said about your headaches and other symptoms. And what we know about countless other tumors of this type.”
Buckley tried unsuccessfully to nod, to show his agreement. “So it’s measured over the last four days. Does the growth rate change? I mean, we have one measurement but we don’t know if that has changed.”
“Generally the growth rate stays the same or increases,” Dr. Cain said brusquely. “And even at the current rate a rupture would be expected within a year.”
Buckley tried to express understanding with his face, unable to move his head. “ ’At the current rate’,” he repeated. “Doctor, why did the probing produce such as intense feeling?”
“We’re close to key centers of the brain,” said Dr. Cain, relieved to get a more familiar question. “Anxiety, panic, loneliness, hyperawareness, these can be the results. We didn’t expect such a reaction from the probing, so we won’t persist.”
“It wasn’t anxiety that I felt,” Buckley said, wondering how to describe it.
“Don’t worry, we won’t do that again,” said Dr. Cain. “We won’t risk another brain surge.”
“Doctor it was a good feeling, not a bad one.”
Dr. Cain nodded, looking at the workstation monitor. “Yes it can be.”
“I … I would like to try the probing again,” said Buckley, sounding a little timid and annoyed at himself for that. I want to know more about what that feeling meant, he thought.
“No we can’t risk the brain surge again,” answered Dr. Cain, not understanding. “And we wouldn’t get any better mapping of the surgery area.”
“Not for the mapping. You do the… the brain stimulation for other patients, right? I mean for Parkinson’s patients?”
“David!” exclaimed Melissa again, surprised.
Dr. Cain looked away from the monitor and studied Buckley. “For severe late stage Parkinson’s, yes. Where other therapies are not effective. It’s not a casual treatment, and it is not what we did today,” he said stiffly.
Buckley was trying hard to understand what had happened and what was going to happen. The option given to him, the surgery, could have an enormous cost. Virtual blindness…worse than blindness, he considered, since he would still see but wouldn’t understand what he was looking at. And constant dizziness. He didn’t think he could handle that.
“Could the probing itself, the electrical stimulation, slow the tumor growth?” he asked.
“No, there is no evidence of that. We really don’t have a reason to delay the surgery, Mr. Buckley,” he said, misunderstanding him.
“I just realized,” Buckley said, partly talking to himself, “the headaches…the sharp pains and the dull ache – they’re gone. It was almost constant. I don’t feel it now. The pain is completely gone.”
Dr. Cain looked pleadingly at Melissa, as if to get her help with Buckley’s non-compliance. “The pain medication is responsible for that, not the probing,” he said to Buckley. “Let us know if you need more medication. And, Mr. Buckley, you won’t find another doctor who will continue the probing when it is contra-indicated for the brain mapping.
“And certainly not for other reasons,” he added sternly.
Melissa squeezed Buckley’s hand briefly. “Let’s go with the experts, David. I know they will do the best possible.” Buckley nodded as much as he could which wasn’t much. He felt pinned down on the bed with the heart monitor attached to his chest, and the IVs in his arm and the oxygen monitor on his finger and the clamp on his head, and even Melissa’s holding of his hand. He was unable to move and maybe unable to think, he wasn’t sure. “I understand,” he said vaguely, not wanting to argue but not wanting to agree either.
After his wife and Dr. Cain left Buckley turned the TV on. He didn’t want to be alone with the thoughts whirling in his mind. But after a few minutes he turned the TV off. He realized that the things that had been spinning through his mind were a little more ordered, distinct, not so chaotic and out of his control. The tumor, the epilepsy, the surgery, the blindness, the probing, the euphoria. The odds. These had been circling around without meaning other than anxiety, without being associated to the rest of his consciousness. Now these concepts were more understandable in relation to everything else, more in place. He felt more in control of his thoughts. And as he considered them, as he thought about his situation and his options, his choice seemed clear, even obvious. He really didn’t really have to think much more about it. He would need to make a couple of calls, to his lawyer and to a good friend of his, the wealthy owner of a successful Silicon Valley business.