The beauty of awake brain surgery

The New York Times, for whatever reason, dispatched Karl Ove Knausgaard to write about patients who are conscious during brain surgery. Much of it is, typically, about how awkward Knausgaard feels in life but then you get some beautiful paragraphs like this:

We were fitted with surgical gowns, caps and face masks and taken to the second floor, through a small labyrinth of corridors and into the operating theater.

To my horror, an operation was in progress.

The silence was total. The single focus of attention was a head clamped in a vise in the middle of the room. The upper part of the skull had been removed, and the exposed edge covered in layer after layer of gauze, completely saturated with blood, forming a funnel down into the interior of the cranium. The brain was gently pulsating within. It resembled a small animal in a grotto. Or the meat of an open mussel. Two doctors were bending over the head, each of them moving long, narrow instruments back and forth inside the opening. One nurse was assisting them, another was standing a few yards away, watching. A whispery slurping sound issued from one of the instruments, like the sound produced by the tool a dentist uses to suck away saliva from a patient’s mouth. Next to us was a monitor showing an enlarged image of the brain. In the middle, a pit had been scooped out. In the center of the pit was a white substance, shaped like a cube. The white cube, which appeared to be made of firmer stuff, was rubbery and looked like octopus flesh. I realized that it must be the tumor.

One doctor looked up from a microscope that was suspended over the brain and turned to me. Only his eyes were visible above the mask. They were narrow and foxlike.

And this lovely anecdote:

Standing there in the darkness, beneath the stars, while the sounds of the city below us came rising up through the air, Petrela then told me a story about his former boss: that he used to remove certain types of brain tumors with his index finger. No instruments, nothing, he just poked his finger down into the brain and — plop! — out came the tumor.

Petrela gave a demonstration. He held his long index finger up in the air, bent it like a hook and pretended to jerk something out while he laughed.

As he did it, I knew I would remember the gesture for the rest of my life.

The best part about brain surgery while the patient is conscious is that you can see the causation between ‘electrical brain activity’ and behavior. I watched this famous Penfield video when I was in 4th grade:

And here is Knausgaard:

He asked the nurse to set the strength at Level 3 and touched the brain with the fork. There was a humming, electric sound. I positioned myself so that I could see Hasanaj.

“Dashi?”

“Nothing.”

“Set it to 4.”

The nurse turned the power up. Marsh touched the brain again. Dashi spoke to Hasanaj, who said something.

“Feeling,” Dashi said.

“Sensing here, face here,” Marsh said, as if to himself. “Turn it up to 5.”

Dashi spoke to Hasanaj.

“Left arm, face, tongue,” he said.

Marsh touched the brain again. This time, Hasanaj lifted his arm rapidly into the air, as if it had been pulled by the string of a puppeteer, and it shook for a few seconds, then lay down again.

I couldn’t believe my eyes. It was like a robot had been switched on.

“Left arm, movement,” Dashi said.

Marsh moved the instrument. Hasanaj’s eye blinked a couple of times.

“Left eye, movement,” Dashi said.

Marsh brought out the stimulator again. This time it was turned up to 8 before there was a reaction, and Dashi said, “Face.”

Marsh waved me over.

“See this? This little spot here. That’s the center for facial movement. We have to leave that in peace.”

Were all the expressions the human face could make supposed to originate in this little spot? All the joy, all the grief, all the light and all the darkness that filled a face in the course of a life, was it all traceable to this? The quivering lower lip before tears begin to flow, the eyes narrowing in anger, the sudden cracking up into laughter?

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