As a surgeon, I am relatively aggressive in my thinking. Confronted with a problem I decide whether surgery is possible and if it is likely to be beneficial, I do it. I rarely waste time thinking too much. Having done this for more than 20 years, I make a decision quickly. Years ago, a professor of surgery told my medical school class, “A good surgeon is not always right but never in doubt”. A truer thought was never professed. Uncertainty leads to a paralysis of thought and action which leads to an inability to deal with the problem at hand…often in the operating room with the patient’s life on the line. Before an operation I may contemplate the best way to approach a tumor, or the path I will take through the skull but otherwise I have long since decided whether or not to do the surgery in the first place.
Taking care of Jennifer Blake, however reminded me of the value of careful thought and that my surgical skill is not always the only answer. In other words, that I need to trust in what I am able to accomplish safely in the first place and that other physicians have an ability to help too.
Primary malignant brain tumors or those that arise from the brain itself, the so called astrocytomas in most cases recur even after a successful removal. The reason for this is that, arising from brain cells, they send out tentacles into the surrounding brain that are invisible even to the surgical microscope.
I always try to remove all of the tumor that I can see, but invariably this kind of tumor comes back, often like an angry bear on which I inflicted merely a flesh wound. If the patient is young enough, otherwise healthy enough and the recurrent tumor is accessible I will once again charge into battle with this beast!
So, when I reviewed Jennifer’s post op MRI after my initial surgery and realized I left some of the tumor behind, I contemplated re-operating immediately, but knowing I could not get it all anyway, I decided to hold off. I told Jennifer the radiation and chemo would take care of what remained, although I was fairly certain the tumor would be back and then I would have another chance to cut out the part of the tumor that eluded me the first time around.
Jennifer returned to see me 6 weeks after her surgery. She and her husband Rick told me 4 weeks or so earlier she had developed significant paralysis on her left side. An MRI had been performed and revealed what I would have expected…the tumor had grown back. What was worse was brain swelling filled the entire right side of her brain. She had been receiving radiation and chemotherapy so this sudden deterioration in her condition was worrisome to say the least. Her oncologist decided to increase the dexamethasone, a steroid medication which would control and hopefully reverse the brain swelling, and she added another chemotherapy drug hoping this would shrink the regrowth of the tumor. Somewhat surprisingly, her weakness completely reversed. When I saw her I merely assumed the steroid had worked but that the tumor likely remained and the only thing that would help now was my surgical skill.
To be sure, I ordered a follow-up MRI. When I looked at the scan, I was shocked. The swelling was completely gone and the tumor had shrunk to a size that was no different than the scan I got immediately after her surgery. In fact I double checked to be sure I wasn’t looking at THAT scan, but no, it was the MRI that I had just ordered. I had never seen this before. It was truly miraculous.
After her surgery, I asked Jennifer if she was religious. She told me ‘no, not really’; although another girl whom I didn’t recognize who was sitting next to her bed, shook her affirmatively and said ‘I am’. I looked at Jennifer and told her that I was too and that I felt God was with me while I operated on her and had guided me.
When I had looked at her post op scan and realized I had left some tumor behind I felt I had let Jennifer down. And besides how could God have let me down like that, letting me stop without getting a more complete resection. As I think about it, two things are possible. One, that I didn’t listen closely enough or more likely, if I had removed that additional amount of tumor I would have irreparably damaged those brain fibers traveling towards the left side of her brain.
Trust. That is what I must have. Trust in my skill to do what is right and not harm my patients. Trust in others to help take care of the problem that may be beyond my reach to cure. And most of all, to be humble enough to trust in God to lead me in what I do.
Make me to know thy ways, O Lord;
teach me thy paths.
Lead me in thy truth, and teach me,
for thou art the God of my salvation;
for thee I wait all the day long.
Psalms 25:4-5
Miracles like this are just enough to keep you doing what you do. I'm so glad you see them and cherish them. Love you tons
Posted by: Ashley | 01/16/2010 at 11:24 PM