There’s a certain sound the scalp makes when it’s being ripped off of a skull—like a large piece of Velcro tearing away from its source. The sound is loud and angry and just a little bit sad. In medical school they don’t have a class that teaches you the sounds and smells of brain surgery. They should. The drone of the heavy drill as it bores through the skull. The bone saw that fills the operating room with the smell of summer sawdust as it carves a line connecting the burr holes made from the drill. The reluctant popping sound the skull makes as it is lifted away from the dura, the thick sac that covers the brain and serves as its last line of defense against the outside world. The scissors slowly slicing through the dura. When the brain is exposed you can see it move in rhythm with every heartbeat, and sometimes it seems that you can hear it moan in protest at its own nakedness and vulnerability—its secrets exposed for all to see under the harsh lights of the operating room.
The boy looks small in the hospital gown and is almost swallowed up by the bed as he’s waiting to enter surgery.
“My nana prayed for me. And she prayed for you too.”
I hear the boy’s mother inhale and exhale loudly at this information, and I know she’s trying to be brave for her son. For herself. Maybe even for me. I run my hand through his hair. It is brown and long and fine—still more baby than boy. He tells me he just had a birthday.
“Do you want me to explain again what’s going to happen today, Champ, or are you ready?” He likes it when I call him Champ or Buddy.
“I’m going to sleep. You’re going to take the Ugly Thing out of my head so it doesn’t hurt anymore. Then I see my mommy and nana.”
The “Ugly Thing” is a medulloblastoma, the most common malignant brain tumor in children, and is located in the posterior fossa (the base of the skull). Medulloblastoma isn’t an easy word for an adult to pronounce, much less a four-year-old, no matter how precocious. Pediatric brain tumors really are ugly things, so I’m OK with the term. Medulloblastomas are misshapen and often grotesque invaders in the exquisite symmetry of the brain. They begin between the two lobes of the cerebellum and grow, ultimately compressing not only the cerebellum but also the brainstem, until finally blocking the pathways that allow the f luid in the brain to circulate. The brain is one of the most beautiful things I have ever seen, and to explore its mysteries and find ways to heal it is a privilege I have never taken for granted.
“You sound ready to me. I’m going to put on my superhero mask and I’ll meet you in the bright room.”
He smiles up at me. Surgical masks and operating rooms can be scary. Today I will call them superhero masks and bright rooms so he won’t be so afraid. The mind is a funny thing, but I’m not about to explain semantics to a four-year old. Some of the wisest patients and people I have ever met have been children. The heart of a child is wide-open. Children will tell you what scares them, what makes them happy, and what they like about you and what they don’t. There is no hidden agenda, and you never have to guess how they really feel.
I turn to his mother and grandmother. “Someone from the team will update you as we progress. I anticipate it will be a complete resection. I don’t expect any complications.” This isn’t just surgeon-speak to tell them what they want to hear—my plan is for a clean and efficient surgery to remove the entire tumor, while sending a small slice to the lab to see just how ugly this Ugly Thing is.
I know both Mom and Grandma are scared. I hold each of their hands in turn, trying to reassure them and offer comfort. It’s never easy. A little boy’s morning headaches have become every parent’s worst nightmare. Mom trusts me. Grandma trusts God. I trust my team.
Dr James Doty is a Clinical Professor in the Department of Neurosurgery at Stanford University, and the Director of the Center for Compassion and Altruism Research and Education, which he cofounded with the Dalai Lama. As the Director of CCARE, he has spearheaded many research projects on compassion and altruism, and their relationship to the brain. He is also an inventor and philanthropist, sitting on the board of a number of charities, including Friends of New Orleans (FONO) and the Dalai Lama Foundation of which he is Chairman.