Conferences differed in atmosphere as well as content, and taken together, they offered a multimedia spectacle which, on subjects one had thought to be consistent, rivaled Proust in shifting points of view. At Neurosurgery Conference on Friday afternoon, videotapes of difficult operations...were presented, mistakes and solutions discussed, surprises shared.
"We got behind the optic nerve and found the cyst, but just when we thought we were done, we saw this mass of tumor --- see it there? --- behind the cyst and had to go after it."
"I was moving the tumor back and forth with my bayonet and suddenly --- watch this! --- it popped out in one piece, purple as a plum."
The mood here was what I'd come to expect from neurosurgeons, much joking and laughter, very little boredom or restlessness or fatigue. Descriptions were economical and unambiguous, concrete and merciless in their exactitude.
"We approached the lesion through a Faulkner flap. In between the two branches of the vein of Labbé we made our incision, as you see. Then we bluntly dissected the white matter."
"She was taken to the O.R., where we simply reelevated the previous bone flap, opened the dura inferiorly, did a partial right frontal lobectomy, as had been done on the previous occasion, then retracted the brain and readily exposed the optic nerve."
"After his lumbar puncture he complained of headaches and was told to lie down. Five minutes later there was a commotion in the room, and he was noted to be banging his arm on the side rail, pointing to his plegic right side, which had been fine before. In front of our eyes he became decerebrate on the right side..."
It was possible to hear the same patient discussed at both the neurology and the neurosurgery conferences, then later at Brain Cutting and, if he didn't make it, at Death Conference too. Patients were usually admitted and worked up by the neurologists, who'd present their cases at Neurology Conference to determine, among other things, whether they were surgical. If they were, tapes of their operations might be shown a couple of weeks later at Neurosurgery Conference. And then, if a tumor was removed successfully, you might see slides of it the following week at Brain Cutting; or, if the patient died, a slice of his brain, bathed in formalin and tagged with a red identity card: BRAIN 2339.
Brain Cutting was a trip in the direction of the Grand Guignol, a reduction to the other side of zero. Tumor slides were beautiful, lyrical, hallucinatory birds or insects, aerial photographs of deserts or mountain ranges, visions of the microcosm or the macrocosm, images to feed your dreams. While they were displayed, pathologists and surgeons took turns describing them, surgeons summarizing the patients, pathologists the tumors. Steeped in detachment and glib as newscasters, their voices accompanied the light show like the sound track of a surrealist film. "Usually with grade-five astrocytomas you don't see this sort of configuration, but the cell density is consistent with that diagnosis." If patients were dead and their brains or spinal cords presented, they were passed around the room on yellow plastic lunch trays. Dreadful as it sounds, there was something benign and anticlimactic about this procedure, as if --- now that the mind-matter paradox was finally resolved and the brain merely a piece of meat on a yellow tray --- it lacked all power and resonance. Devoid of its ambiguity, it was also devoid of mystery. You'd touch it and smell it, waiting for cracks in your perception, some seizure of fear or flash of intuition, but nothing came. It was just a smelly piece of brown and white meat, a bit like a veal cutlet, with a texture like foam rubber and the shape (really beautiful) of a butterfly. It made a lot more sense to speak of it aesthetically than to consider it as the organ that might once have made aesthetics possible.
Death Conference, of course, offered another kind of reduction, another shift in the kaleidoscope, this one retrospective like Brain Cutting but denied the luxury of its fragmentation. It was the long shot you got here, a quick summary of the denouement, a peek over the shoulder at the last dark corridor, but unlike Brain Cutting, the brain under consideration was yet haunted by the being it had once inhabited. Exclusively for neurosurgeons, Death Conference was held on the first Monday of every month, and its mood, perhaps because it was held in the evening, was relaxed and informal, more at odds with the material discussed than any other meeting. Sandwiches and soft drinks and beer were laid out in a lovely spread next to the slide projector, and while everyone ate, catastrophes were reconsidered and debated so that their causes could be ascertained and the principal question --- avoidable or not? --- be laid to rest. In addition to the sandwiches, everyone was provided with a sheet that summarized the cases in medicalese, the amazing language of all the conferences which seemed here to emerge in its ultimate flower.
Forty-seven-year-old Caucasian male readmitted for recurrent acoustic neuroma initially operated a year prior to admission. Did well postoperatively for one year but began to have gait difficulty, lethargy, anisocoria, nystagmus in all directions. Left-central facial weakness, dysmetria, bilateral spasticity with hyperreflexia bilaterally, bilateral papilledema and confusion.One could actually put the case together from the sheet, but it was a bit more palatable to listen to the resident in charge of the presentation, who read from the sheet and interjected salient material:
"On the fourth day subsequent to admission, he was taken to the O.R --- for total removal of a right-cerebello-pontine angle recurrent neuroma with profuse bleeding at the final stage of tumor removal."(Translation: he hemorrhaged on the table.)
Occasionally, when death was unexpected, as with this patient, questions came from the floor. And since the surgeon, in this case, was the Boss, a certain euphemistic strategy was required.
"Unusual, isn't it, Boss, to get the artery at this point"
"Ah, shit, it was just a technical error. We were pulling with a pituitary forceps, thinking we had it clear, but there must've been a loop of tumor hooked around the artery. No way to see the sonofabitch at all."
© 1979, J. P. Lippincott Co.