A boy with brain tumor

                                  

         There were a 5-year-old young boy, a 20-year-old big brother, a 30-year-old young doctor, a 40-year-old senior neurosurgeon and a 20-year-old intern … those are the team I remembered. Of course, there were nurses there as well. That was the first brain surgery I attended. 

           That was about over 30 years ago when I was an intern in a large hospital in China. 

           During my rotations in surgery, I was following Dr. Wang, a young surgeon in neurosurgery team. There was a 5 year’s old boy admitted for elective surgery for brain tumor. He was very active and naturally happy in general when the headache and /or localized epilepsy not bothering him. 

           Few days ago, when Dr. Wang and I were at the clinic, a 20 year’s old young man took the 5 years little boy to the biggest hospital in the area seeking help. 

          “What brings you here today young man?” Doctor Wang asked the little boy with a smile in his face at the clinic. 

         “There is a big monster in my head, and I want you to catch it.” The boy said with unquestioned trust.

           “My brother is 5 years old, and he generally is in good health. Since last year, he started complaint of headache and sometime has seizures. The local doctor checked on him and we were told that there is a tumor in his head, and it is needed to be removed. We heard Dr. Zhao is the only good neurosurgeon in this area, so we are here to see him and want him to remove the tumor.” The about 20 year’s old big brother said to the doctor. 

            “I am Dr. Wang, Dr. Zhao’s surgery team member. Dr. Zhao and I work together. Let us do some examination and to see what we can do and Dr. Zhao will be here to check on him later.” Dr. Wang said. 

            The boy was admitted to the neurosurgery floor. Then there were blood tests, electrocardiogram, X-ray, brain angiography etc. After all the tests were done, the boy was ready for surgery. 

            The evening before surgery, Dr. Wang led me to visit the boy and talked with the big brother: “Tomorrow, it is scheduled to do the surgery to remove your brother’s brain tumor. As you knew, surgery itself has lots of risks like bleeding, incision infection, surround tissue damage and anesthesia accident, each of them could result in death and/or injury. For brain surgery, there even greater risks of these because we need to open his skull to work on the toufu like brain tissue and to find the tumor and then remove the tumor. The tumor is near the sagittal sinus and there is a great risk for bleeding. Again, any surgery has risks and benefits. The surgery will remove the tumor and get rid of all the symptoms. If you are willing to take the risks and wish the doctors to perform the surgery, here is some paperwork need you to sign for consent. Do you have any question about the surgery that Dr. Zhao is going to perform for your brother tomorrow?” 

         “Will he be awake after surgery?” The brother asked. 

          “It depends. After we take him to the operation room, the anesthesiologist will admit anesthesia to him, and he will be in sleep during surgery. After surgery, he will wake up, but sometimes it takes time. It maybe takes up to half day for him to wake up.” Dr. Wang answered.

         “What should I prepare for him to eat after surgery? Will he be able to talk, and all his headache and seizure will be gone after surgery?” the brother asked. 

          “As soon as he is awake from the anesthesia, he can eat. Anything rich in protein will be good for his recovery. Yes, the goal for this surgery is for him to be free of headache and seizure and able to lead a normal life. But he will have some headaches after surgery from the incision and surgery site. But that will be temporary.” Dr. Wang answered.

          “OK. Then I will sign the paper and thank you very much Dr. Wang.” The brother said. He signed the consent for surgery. 

            Dr. Wang shaved the boy’s head and asked the brother to wash his head and no food and drink after 10PM. The shaved little boy looked like a cute little monk: clean, pure and smart. At the time we left the room, the boy waved us “goodbye” with a big smile on his face. 

           The next morning, the operation room was ready. The boy was wheeled to the OR. On the equipment table, there were army of saws, hammers, pincers, Scissors, forceps hemostatic, needles, suture lines, needle holder and forceps etc. 

           There was the famous Dr. Zhao who was wearing a heat and mask. His both hands are scribed and sterilized with disinfectant hand sanitizer (bromo-geramine solution). The solution was still dripping. And there was Dr. Wang and I, we both were scribed and sterilized. The instrument nurse was ready before the doctors and patient arrived. Of course, there were circulation nurses, the anesthesiologist. 

           The boy was already out due to anesthesia. The doctors and I dried our hands and arms with sterile towels, started to put sterile gowns and sterile gloves on. And then everybody got to their place and the surgery had begun.

            Under anesthesia, the boy’s head was prepared, sterilized and covered by sterile towels. The skin was cut, and the skull was exposed, and the saws and hammers got to work, the doctors opened the boy’s skull, and the white, toufu like brain was in front of us. 

            Dr. Zhao was very carefully examining the brain and he found the tumor. It was close to the cerebral venous sinus but still can be removed safely. The doctors worked together and smoothly removed the tumor and the surgery was a success at the point. 

           The whole process was so smooth and seemed easy even the chief neurosurgeon was satisfied. But just before wrapping up the surgery, Dr. Zhao saw a small spot of calcification on the boy’s brain. He wanted to remove the calcification spot to make the brain look perfect. It seemed easy and small. He could just take it out with a Toothless tweezers. So, he did it. The calcification spot was out but the operation area started massive bleed. “Crap! The venous sinus is broke.” The two doctors were hurrying up using every possible measure trying to stop the bleeding. 

           But venous sinus hemorrhage was far serious than one can imagine. And at that time reconstruction of the ruptured venous sinus is almost impossible. The boy’s blood pressure was quickly dropping and … 

          “Please call the director in. We need do a carotid artery ligation stat! (That will cut the blood supply to the brain! But that is the only way can get the boy out of OR alive!)” Dr. Wang, the unit director was called in and performed the ligation. The surgery site stopped bleeding. The surgery wrapped up and the patient was sent back to his room.

           He was still at "sleep" but was breathing and had a heart rate. His brother was at the bedside. 

          “We successfully removed the brain tumor. But during surgery, the venous sinus was broken, and we could not save your brother.” The doctor told the big brother. The next day, the boy died. 

         “Well, baby brother, they tried to cure your headache. Now you will never have headache again and you have lived a good life. Please Rest in peace.” That was all I remembered that big brother’s sentence.

           “I am so regret! I am regretting to die! I should leave the calcification spot alone!” Dr. Zhao was bitterly remorseful and in deep sorrow. He felt that he killed the little boy. 

           Yes, indeed, if he did not touch the calcification spot after he removed the tumor. The boy would still be alive and have a good life without headache and seizure. 

          But life does not believe in “if…” does not allow one for regret, especially in medicine. 

         “Just carefully following the plan and no more before carefully planned when you do surgery on people’s brain.” That is the lesson I learned from this tragedy.