When the Air Hits Your Brain: Tales from Neurosurgery Read Online Free Page A

surgical masks to their faces, to prevent fogging up the surgical microscope with their breath, and began to scrub their hands and fingernails meticulously. As they scrubbed, Carl swung around and spoke.
    “Our chief of neurosurgery, Dr. Abramowitz, specializes in treating pain patients. The man on the altar today”—(he motioned with a lathered finger to the OR door)—”has trigeminal neuralgia, also known as tic douloureux, or tic for short. Tic patients get sharp, stabbing pains in their faces, sort of like a dentist drill hitting a nerve. What the boss—that’s what we call Abramowitz—is doing today is the latest procedure for this condition. We’ll drill a hole in the skull, find the trigeminal nerve to the face as it exits the base of the brain, and pad it from surrounding blood vessels using some bits of plastic sponge. Itseems to relieve the pain without causing much numbness. The boss learned it from Jannetta himself, who pioneered this approach.”
    Gary and Carl backed into the OR, holding their dripping arms high in front of them. They dried their hands and gowned in dramatic fashion, aided by an OR assistant. After soaking the small patch of shaved scalp with a brown solution, Gary layered the prepped scalp areas with blue linen sheets until only the brown postage stamp of bald skin remained visible.
    I stood, my back to the wall, while the surgeons huddled over that brown patch, slicing and dicing and filling the wound with dangling metal clamps, called “dandies,” after Walter Dandy, another historical hero of brain surgery. The blue linen lining the brown patch stained purple with flowing blood. Buzzing noises and smoke filled the air as clamps cluttered the incision. Gathering my courage, I took a few steps closer to the table and peered at the wound. Beneath the pouting ruby lips of the mouthlike gash gleamed a broad white surface.
    “Is that the skull?” I asked
    “Yup,” answered Gary, “time for a drill.”
    A drill? Yikes.
    At that moment a tall, craggy, white-haired man, about seventy years old, flung open the OR door and bellowed into the room, “How much longer, goddamn it? Jesus, Carl, how long have you been here? TEN MINUTES. I’ll be back in TEN MINUTES.”
    “Yessir.” Carl didn’t look away from his work. “I was just showing Gary how to get through the occipital artery—.”
    “Great,” the craggy man answered. “TEN MINUTES and I’m back. I want the cerebellum exposed by then.” The door swung shut and the room fell quiet again.
    I leaned over to Gary. “The boss?”
    He glanced back over his shoulder. “None other.”
    “You heard the gentleman, we have TEN MINUTES to get into this guy’s head,” Carl barked. “Get the craniotome, Gary, and make a hole here, right behind the mastoid eminence.”
    Gary reached into a plastic pan and pulled out an instrument the size and shape of a flashlight. It was connected to a thick black hose which trailed down to the floor and over to a metal gas cylinder at the foot of the operating table. At the tip of the flashlight was a short steel cone topped with a spiral cutting edge.
    “This is the craniotome; we use it to punch through the skull,” explained Carl.
    “How does it know when to stop before it plunges into the brain?” I asked.
    “It has a pressure-activated clutch mechanism,” Gary said as he pushed his finger against the tip of the conical drill bit. “When it penetrates the skull, the clutch disengages and the drill stops. Simple.”
    He squeezed the trigger on the craniotome and the drill whined to life. As Gary pressed the whirling bit against the ivory bone, Carl flooded the wound with water from a plastic syringe which could have been used for basting turkeys. Mounds of white bone chips flew from the deepening hole. Carl washed the bone dust onto the sheets. The whining continued for about a minute or so; then Gary’s arm suddenly jerked forward, thrusting the still-running drill bit to the hilt into