Brain Surgery
Yesterday was the big day. 4am wake up, shower with antibacterial soap, 5:45am check-in time at the hospital. We checked in and got situated in the pre-op room with all the prep lines, IVs, etc.
We had the same phlebotomist (a health care professional specializing in drawing and analyzing blood) that we had 2 weeks ago when Paul was first admitted to the hospital. At that time I was sleeping in the little hospital bed with Paul and she barely even woke us up to draw blood. She was so fast and efficient (you really start to notice the difference with blood draws every 2 hours) that I commented on what a pro she was.
She smiled and said, “I’m the best of the best.” She is not wrong.
We met Dr. Ryan Figueroa, Paul’s brain surgeon and went over the procedure and our questions. As much as I would not recommend brain surgery in general, if you’ve got a brain tumor you need out, this is your guy. Mostly I don’t require a brain surgeon to have a great bedside manner (just be damn good at your job, please) but he was warm and really cared to take time for questions and Paul’s care.
They then took him back to the operating room around 7:45 to start putting him under for the surgery. My dad waited with me for the 5 hours with my sister waiting in a coffee shop near by. Covid restrictions limited waiting room visitors to 2 people.
The surgery itself was a craniotomy with an incision roughly temple to temple over the top of his head. Dr. Figueroa said the tumor was well-defined and he could see, feel, and hear the difference in working with that tissue over Paul’s normal brain tissue. He used the MRI as a reference, but it was his skill and experience that guided his hand. An MRI last night showed that he got all of the tumor.
Another risk, other than of course the major brain surgery, was to a particular artery that ran through the tumor. This artery supplies blood flow to the part of the brain that controls movement to Paul’s left side. He risked weakness to the left side of his body if that if that artery was damaged. At the end of the procedure Dr. Figueroa showed me a video of the artery light up like a glow-in-the-dark rope; strong and fully open with no damage or loss of blood flow.
Time is a funny construct. The day Paul first seized, sending us to the hospital and inciting this journey, had no concept of time for me. It was one moment to the next. Waiting in the family consult room (the one with a pretty window, a bible, and a box of tissues) for the 20 minutes between the notice surgery was the longest day of my life.
Dr. Figueroa discussed the procedure and findings; full tumor resection and great prognosis from the surgery. The tumor was C-shaped and grew through the right frontal cortex, the part of the brain that controls executive function, planning, and general cognition. It consumed the brain tissue that had been in that place rather than pushing it aside which is one of the many reasons they know it to be cancerous. Good news is that this area of the brain is elastic and has many redundancies. Paul’s brain had learned to compensate over the years it took the tumor to grow so he’s expected to have the same, if not better, cognitive function than before the brain surgery.
We’ve seen no changes to motor function, strength, balance, or personality. He is his usual, gregarious self and while he’s in a lot of pain (remember that major brain surgery?) he is on the mend. As I write this we’ve already been cleared to leave the ICU and move to a general care room. We’ll stay overnight again tonight for observation and pain management and are likely to go home tomorrow.
The neuro oncologist, Dr. Robbel, will be our main doctor once Paul is discharged from post-surgical care. She is one of the leading specialists in her field and we will meet with her in a few weeks to discuss the pathology of the tumor and create a treatment plan.
For now we are looking hopefully to the future under the best medical care in the area, and with the love and support of our family and friends around us. Next stop, new hospital room; then tomorrow, home!