The Neurosurgical Rugby Team
I write this from home, feeling pretty great. I thought I’d color in what the second surgery was like, the experience, and recovery since then. Please keep reaching out, coming by, and spending time. I love you all!
Deciding
I was walking in the park along the tree line the Tuesday before my second surgery. I reserved my surgery slot for the following Monday but hadn’t yet submitted the paperwork. If I didn’t send in the papers, I could cancel and not do the surgery. I didn’t have clarity yet and was struggling to elect to have a second brain surgery just as I was starting to feel recovered from the first. I was alone, just me and my brain, mulling over the decision until a few things hit me right in the face:
I had asked some questions to figure out how many surgeries my surgeon does per year and by my estimate, he does close to 400 brain surgeries per year. Take that in and think for a moment about what you do 400 times a year. I make coffee that many times a year-- and I’m really good at it. My surgeon is a pro, and he was confident he could get more out.
The advice from the doctors and research, which I had just done a lot of that week, all agreed-- less tumor is better… Surgery is a really good way to remove tumor, and I wanted the rest of mine gone.
I already made it through one of these, I felt like I could do it again.
For the rest of my walk, I repeated that to myself as I took big, cold breaths. “I did this before, I’ll do it again.”
Going in Head First
When it clicked for me on that walk, I knew it would be OK and that we all had to go into this confident, or as I’ve dubbed it, “head first.” I mulled over how to tell my brother, Mom & Dad and all of my people that I was about to put them through another brain surgery experience and produced zero good ideas other than: “You just need to tell them and show them that you’re confident and optimistic.” So I did that, and after some big hugs, we all went in head first.
Monday Morning Meeting
We were up and out of the house by 0445 the morning of round two and checked in for surgery by 0600. If you need to commute to Philadelphia on the regular, I recommend that time slot. By 0830 I was hanging out in the OR with the rugby team of staff that it takes to run one of these procedures. Yes, when I counted, there were 12 or 15 people in the room. A nursing staff, an anesthesiology team, the neurology team, the neurosurgery team and me: their Monday morning meeting agenda. It was a party.
The anesthesia resident asked me what music I wanted to listen to as they got me set up on the table. I tried to read the room and needed to make a choice that would be a crowd-pleaser. Summer Hits of the 90s seemed like the only right choice for my brain surgery soundtrack.
Awake, with Two-Step Authentication
I’ve learned a lot of fun sentences in the last six weeks, and “We prefer to do brain surgery when you’re awake,” is probably my favorite one. The surgery team told me during my pre-op visit that I’d be awake for portions of the surgery to do neuro exams. Neuro exams are pop quizzes that doctors and nurses ask you to do to make sure your brain is working the way it's supposed to. I’ve done about 300 neuro exams, one of them was a graded written exam-- and yes, I got an A.
The second surgery is like opening a manhole cover-- they open the window in the skull they made the first time, do what they need to do, and when they’re done they put the manhole cover back on. Pretty simple. It’s a lot less home improvement work than the first round, which presents a better opportunity to resect tumor in sensitive areas.
Right before getting knocked out I reminded myself to treat the surgery like a business trip. The mission was to cooperate, be kind, stay calm and do my end of the deal to make surgery go well.
Eventually, they woke me up for my pop quizzes. Being awake was a trip-- you feel things, know what’s happening, and you’re part of the conversation. I knew exactly when and how my skull was being opened, and I was OK with it-- a strange duality.
I was in-between the dialogue of the neurologist and surgeon. When the surgeon on my right would get near what we’ll call the danger zone, he’d ask the neurologist to do an exam. He would then look at me and ask me to do a bunch of stuff with my face, leg, foot, smile, fingers, toes, and my favorite “make a muscle.” I fought back the urge to explain that I’m a bike racer, and I don’t have arm muscles, and hoped he could see the string bean between my elbow and shoulder inflate slightly each time he asked me to flex.
They put sensors on my brain to do the neurosurgical equivalent of what we know as two-step authentication. That’s right, on my brain. It’s the same idea as when you reset your password for an account and need to verify with your email and via text. The sensors measure electrical activity in my brain and are visualized on a screen in the OR. When I wiggled my toes and fingers they could see me do it in person and make sure that the electrical activity was happening where it was supposed to be in my brain via the visualization. Measure twice, cut once.
If you want the full download on what I remember from awake brain surgery we can go for a coffee and chat. Above all, it was fascinating and very successful. The surgical rugby team executed another perfect brain haircut and later presented me with this cool sentence: “There is a very minimal amount of disease left after surgery.” Be excited. That’s very good news!
What’s next?
Recovery is the name of the game right now. After two brain surgeries, my noggin has some reorganizing to do and my brain can enjoy the new real estate that the tumor was leasing. Again, we have more work to do, and we’ll figure out what that looks like, but right now is about recovery. My life is full, and my days are whole.
Here’s a taste from this week: I finished a puzzle, made five batches of granola, read Vacationland, gave a tour of Doylestown to a friend, went for many walks, taught my Mom how to drive a stick shift, spent time with dogs, and I’m trying to catch up on my backlog of emails and letters that I’ve received. I can barely keep up with the last part because I’m the luckiest man on earth.
I have visitors and outings almost daily-- these visits and trips elevate me and flavor my time. I’m lucky to be loved and I appreciate all of the time my friends and family are giving to be with me. Socializing, laughing and being with you all is a huge part of my recovery. Thank you!
