7:50 A.M. Toby Eagle, the nurse anesthetist, and Steve Derrer, the
anesthesiologist, bring Matthew in and transfer him to the CT scanner bed
where he will stay, anesthetized, throughout the operation. They gently
explain the tubes.
"Matt, I'm going to give you some medicine through the tube,"
Derrer says. "It'll feel hot for a second," adds Eagle. Matthew whimpers
for an instant and then is quiet. Eagle puts a nose and mouth mask
quickly over his face. "Just a little oxygen," she fibs to him. It's
really nitrous oxide, and in just moments, he is asleep. Derrer has
injected a cocktail of drugs through the tube -- Pentothal, fentanyl,
flourane. "Have a good rest, Matt," Eagle says gently. He can't hear
her.
7:56 A.M. Eagle passes a breathing tube into Matthew's throat, adds
more line. The front part of his hair is shaved from his forehead to
about halfway back. They leave the rest, including beard and sideburns.
"He cares a lot about his hair," says Gerry. "Most young guys do."
Matthew's eyes are taped shut now and the supporting part of the
stereotactic frame is placed under his head and shoulders, clamped to the
bed that supports him and screwed into his skull with four white screws
at the temples.
8:35 A.M. Vince clears everyone out of the room so he can turn on
the CT scanner, which hums. The surgeon, Sumio Uematsu, along with the
radiologists, neurologists, and technicians, are crammed into the CT
monitor room on and off for most of this first hour. At about 9 A.M.,
Uematsu looks at reconstructed scans that highlight an important
landmark: the telltale butterfly-shaped structure of the corpus callosum.
From there, it's only about two centimeters back to the cingulum -- the
target. He also locates, among the varied shades of white, gray, and
black, the cerebral artery he must avoid.
More than 35 scans are done. "It's got to be right, perfect,
absolutely right. We need to check and recheck, check and recheck," says
Uematsu. He keeps saying this aloud, yet to himself, almost like a prayer
or a mantra.
9:30 A.M. A neurologist who has cared for Matthew for many years
arrives with a copy of a medical-journal article written by Tom
Ballantine, a Massachusetts neurosurgeon who has done more than 600
cingulotomies for chronic pain. In it are detailed photographs of the
sites in the brain where Ballantine recommends placing lesions.
Still holding the article, he gazes at Matthew's draped form
through the glass. He does not go into the operating room even when this
first round of scanning is completed at 10: 15. Instead, he leaves the
suite to see Matthew's family. He will come and go often during the
day.
10:16 A.M. Physician's assistant Debbie Mandelblatt places a white
stretch cap on Matthew's skull, and over the cap a clear, stretchable
plastic -- not unlike thick Saran wrap -- and fastens it down like a sausage
casing. The wrap holds the scalp skin taut and sterile and isolates the
slits the surgeon will cut in it to reach the skull and brain. "We'll
make two burr holes, or entries," Uematsu tells onlookers. "The right
side first." Two hours and 15 minutes into this operation, the first real
surgery is about to happen.
Five separate times the surgical team validates the settings on a
mockup before the coordinates are locked down on the stereotactic frame.
Now the electrode probe is positioned on every plane: It can be moved in
any direction and the target will always be in the center of the
probe.
10:30 A.M. Uematsu makes a one-inch cut in the Saran wrap and skull
cap, the slices the skin and underlay scalp. He uses a retractor to hold
the skin back and stitches it in place. It's quiet in the room as Uematsu
picks up a hand drill, and drills the burr hole, beginning slowly and
building to a vigorous circular motion with the handle. He drills and
drills into the skull. With suction and irrigation, pieces of bone and
tissue gush out on the table under Matthew's head, but very little blood.
He sleeps peacefully.
10:45 A.M. Drilling Stops. Uematsu uses currettes (tiny, sharp,
curved knives) to clean out the hole. The top half of the stereotactic
frame is fastened over the hole. There is a faint smell of burning as he
electrically seals the covering of the brain, or dura. Now it's time to
set the electrode needle into the brain. The necessary apparatus, already
locked into the right place, is lifted from the mockup frame and placed
over the bottom half of the device affixed to Matthew's skull. The
surgeon will not need to make any judgments about where to put it. The
probe will go through the holder and stop automatically at the target
area.
He selects the right-size probe from the stainless-steel tray held
by Gerry Beveringen, and sets it aside. The frame is ready, the
coordinates have been checked a dozen times.
"No," he says. "We'll scan again." Another cross check. He will
inject air into the brain, take more scans and make sure the frame's
positioned for exactly the fight spot. "Then," Uematsu says, "if we are,
I put the needle in."
Vince clears the OR for the scans.
11:30 A.M. It has taken 45 minutes and two injections of air to
learn that the black dots of air highlighted in the scanning images are
right on target. "Better than textbook, better than perfect," Uematsu
exclaims for the first of many times this day. "Now. Now we're ready to
go."
Tags:
bad reputation,
belief,
brain surgery,
dilemma,
horizon,
human brain,
human subjects,
lobotomy,
mental illness,
nam,
neurology,
philosophers,
pretension,
psychiatric disorders,
psychosurgery,
record keeping,
safeguards,
scientists,
strict regulations,
successes,
surgery,
worth the risk,
wretched excess
