104 Chapter 5
with the patient for presurgical counseling. You have discussed with Lou the neurogenic com-
munication disorder he will likely experience following surgery, the expected course of speech
and language recovery, and the nature of the postsurgical rehabilitation. Lou was understandably
devastated by the diagnosis but showed courage and optimism. The neurosurgeon has been candid
with him about the prognosis. There are no guarantees that he will survive the surgery or that all
of the tumor can be removed. Nonetheless, there is a good chance that the surgery will give him
several more months and perhaps years of a reasonable quality of life. And there is always the
possibility of complete elimination of the cancer, given the surgery, radiation treatments, and new
chemotherapies showing the promise of cutting the blood supply to the tumor.
The operating room is cool, sterile, and surprisingly crowded. Every one has scrubbed hands
and arms and is covered from head to foot with latex gloves, masks, hoods, and cotton surgical
gowns. High- tech instruments hum and beep, and the operating field is brightly illuminated. The
atmosphere is one of exacting professionalism, and conversations are courteous and respectful.
Several lighthearted jokes are made to relax the surgical team and to defuse the profound expe-
rience of cutting into a human brain and removing a cancerous tumor. After all of the surgical
instruments are checked and double- checked, they are laid out on a stand next to the operating
table. When the anesthesiologist confirms that the patient is optimally anesthetized, the neuro-
surgeon begins the operation. Lou’s firmly secured head has been carefully shorn, and there are
markings showing where initial skin incisions are to be made. Several radiographic images are
easily within the sight of the surgeon, who parts the skin above Lou’s left ear.
For Lou, a perplexing aspect of the aphasia caused by the tumor is the tendency to con-
fuse yes and no. Most of the time, he is aware of saying the wrong word and self- corrects.
Nonetheless, it is exasperating for him to give the opposite answer when asked simple questions
such as, “Are you hungry?” “Do you want to continue therapy?” “Is this your coat?” One day,
Lou, in his typical straightforward way, asks why these words are so often interchanged. You
have never really given it much thought, and his question catches you off- guard. You promise to
research it and let him know.
Once the skin has been parted and cauterized to stop the bleeding, four holes are drilled into
the skull. The drill is a sophisticated neurosurgical instrument costing thousands of dollars, but
the shiny drill bit, trigger, and lugging, whirring sound remind you of your portable Black &
Decker. The drill holes, about one third of an inch in dia meter, form the corner borders of a square.
Another sophisticated neurosurgical device, reminding you of your Black & Decker portable recip-
rocating saw, is carefully inserted into one of the holes and, as in a game of connect- the- dots, the
skull is carefully straight- cut from hole to hole. The sawed section is about the size of a computer
mouse. The neurosurgeon carefully removes the cut section of skull and places it in a tray of liquid.
Because of the pressure caused by the tumor, the surface of Lou’s brain bulges out from the hole.
The membranes covering the brain are carefully and precisely cut and retracted. Then the
surgeon begins spreading brain tissue and peeling back gray matter until the cancerous mass is
revealed. A long, narrow probe is inserted, and the tumorous mass is excised and evacuated. A
loud suctioning sound is heard as the surgeon carefully moves the probe from one area to another.
The probe vibrates at an ultrasonic frequency that dislodges the mass but spares the healthy, more
resilient and inviolable tissue. Soon most (hopefully, all) of the out- of- control cells have been