A Brain

by Robin Cook

  The automatic doors closed behind them as Lisa began her fateful journey down the corridor to OR #21. Neurosurgery was usually done in one of four rooms: Number 20, 21, 22, or 23. These rooms were fitted out with the special needs of brain surgery in mind. They had overhead mounted Zeiss operating microscopes, closed-circuit video systems with recording capabilities, and special OR tables. OR #21 also had a viewing gallery and was the favorite of Dr. Curt Mannerheim, Chief of Neurosurgery, and Chairman of the Department for the medical school.

  Lisa had hoped that she’d be sleeping at this point, but such was not the case. If anything, she seemed particularly aware and all her senses sharp. Even the sterile chemical smell seemed exceptionally pungent to her. There was still time, she thought. She could get out of the bed and run. She didn’t want to be operated on, especially not her head. In fact, anything but her head.

  The movement stopped. Turning her gaze, she saw the nurse disappear around a corner. Lisa had been parked like a car at the side of a busy thoroughfare. A group of people passed her, transporting another patient who was retching. His chin was being held back by one of the orderlies pushing the bed, and his head was a bandaged nightmare.

  Tears began to run down Lisa’s cheeks. The patient reminded her of her own upcoming ordeal. Her central being was going to be rudely cracked open and violated. Not just a peripheral part of her, like a foot or an arm, but her head . . . where her personality and very soul resided. Would she be the same person afterward?

  When Lisa had been eleven she’d had acute appendicitis. The operation had certainly seemed scary at the time, but nothing like what she was experiencing now. She was convinced that she was going to lose her identity if not her life. In either case, she was fragmenting, and the pieces were there for people to pick up and examine.

  Carol Bigelow reappeared.

  “Okay, Lisa, we’re ready for you.”

  “Please,” whispered Lisa.

  “Come now, Lisa,” said Carol Bigelow. “You wouldn’t want Dr. Mannerheim to see you crying.”

  Lisa didn’t want anyone to see her crying. She shook her head in response to Carol Bigelow’s question, but her emotion switched to anger. Why was this happening to her? It wasn’t fair. A year ago she’d been a normal college girl. She’d decided to major in English, hopefully to prepare for law school. She loved her literature courses and had been a superior student, at least until she’d met Jim Conway. She knew she’d let her studies go, but it had only been a month or so. Before meeting Jim she’d had sex on several occasions, but it had never been satisfying and she’d questioned why there was so much fuss about it. But with Jim it had been different. She knew immediately that with Jim, sex was the way it was supposed to be. And she hadn’t been irresponsible. She did not believe in the Pill, but she’d made the effort to be fitted with a diaphragm. She could remember very distinctly how hard it had been for her to find the courage to make that first GYN clinic visit and go back when it was necessary.

  The gurney moved into the operating room. It was completely square, about twenty-five feet on a side. The walls were constructed of gray ceramic tile up to the glass-faced gallery above. The ceiling was dominated by two large stainless steel operating room lights shaped like inverted kettle drums. In the center of the room stood the operating table. It was a narrow, ugly piece of equipment, reminding Lisa of an altar for some pagan rite. At one end of the table was a round piece of padding with a hole in the center, which Lisa instinctively knew was to hold her head. Totally out of keeping with the environment, the Bee Gees crooned from a small transistor radio in the corner.

  “There, now,” said Carol Bigelow. “What I want you to do is slide over here onto the table.”

  “Okay,” said Lisa. “Thank you.” She was annoyed at her response. Thank you was the farthest thing from her mind. Yet she wanted the people to like her because she knew she depended on them to take care of her. Moving from the gurney to the operating table, Lisa held on to the sheet in a vain attempt to retain a modicum of dignity. Once on the table she lay still, staring up at the operating lights. Just to the side of the lights she recognized the glass partitions. Because of reflections, it was difficult to see through the glass, but then she saw the faces staring down at her. Lisa closed her eyes. She was a spectacle.

  Her life had become a nightmare. Everything had been wonderful until that fateful evening. She had been with Jim and they both had been studying. Progressively, she had become aware that she was having difficulty reading, particularly when she came to a specific sentence beginning with the word “Ever.” She was certain she knew the word but her mind refused to give it to her. She had to ask Jim. His response was a smile, thinking she was teasing. After she persisted, he told her “ever.” Even after Jim had told her the word, when she looked at its printed form, it wouldn’t come to her. She remembered feeling a powerful sense of frustration and fear. Then she began to smell the strange odor. It was a bad smell, and although she sensed she’d smelled it before, she could not say what it was. Jim denied smelling anything and that was the last thing Lisa remembered. What had followed was her first seizure. Apparently it had been awful, and Jim was shaking when she regained consciousness. She had struck him several times and scratched his face.

  “Good morning, Lisa,” said a pleasant male voice with an English accent. Looking up behind her, Lisa met the dark eyes of Dr. Bal Ranade, an Indian doctor who had trained at the university. “You remember what I told you last night?”

  Lisa nodded. “No coughing or sudden movements,” said Lisa, eager to please. She remembered Dr. Ranade’s visit vividly. He’d appeared after her dinner, announcing himself as the anesthesiologist who was going to take care of her during her operation. He had proceeded to ask her the same questions about her health she’d answered many times before. The difference was that Dr. Ranade did not seem to be interested in the answers. His mahogany face did not change its expression, except when Lisa described her appendectomy at age eleven. Dr. Ranade nodded when Lisa said she’d had no trouble with the anesthesia. The only other information that interested him was her lack of allergic reaction. He nodded then too.

  Usually Lisa preferred outgoing people. Dr. Ranade was the opposite. He expressed no emotion, just a quiet intensity. But for Lisa, under the circumstances this cool affectation was appropriate. She was glad to find someone for whom her ordeal was routine. But then Dr. Ranade had shocked her. In the same precise Oxford accent he said: “I presume that Dr. Mannerheim has discussed with you the anesthetic technique which will be used.”

  “No,” said Lisa.

  “That’s odd,” said Dr. Ranade at length.

  “Why?” asked Lisa, sensing trouble. The idea that there could be any breakdown in communication was alarming. “Why is that odd?”

  “We usually use a general anesthesia for craniotomy,” said Dr. Ranade. “But Dr. Mannerheim has informed us that he wants local anesthesia.”

  Lisa had not heard her operation described as a craniotomy. Dr. Mannerheim had said he was going to “turn a flap” and make a small window in her head so that he could remove the damaged part of her right temporal lobe. He’d told Lisa that somehow, a part of Lisa’s brain had been damaged, and it was that section that was causing her seizures. If he could take just the damaged part out the seizures would stop. He’d done almost a hundred such operations with wonderful results. At the time Lisa had been ecstatic because up until Dr. Mannerheim all she could get from her doctors was compassionate head shaking.

  And the seizures were horrible. Usually she knew when they were coming because she would smell the strangely familiar odor. But sometimes they came without warning, descending on her like an avalanche. Once in a movie theater, after she’d been given a long course of heavy medication and assurances that the problem was under control, she smelled the horrid odor. In a panic she’d jumped up, stumbled to the aisle, and ran back toward the lobby. At that point she became unaware of her actions. Later she “came to” p
ropped up against the lobby wall by the candy machine, with her hand between her legs. Her clothes were partially off, and like a cat in heat, she’d been masturbating. A group of people was staring at her as if she were a freak, including Jim, whom she’d punched and kicked. Later she learned she’d assaulted two girls, injuring one enough to be hospitalized. At the time she’d “come to” all she could do was close her eyes and cry. Everyone was afraid to come near her. In the distance she remembered hearing the sound of the ambulance. She thought that she was going insane.

  Lisa’s life had come to a standstill. She wasn’t insane, but no medication controlled her seizures. So when Dr. Mannerheim appeared, he seemed like a savior. It wasn’t until Dr. Ranade’s visit that she began to comprehend the reality of what was going to happen to her. After Dr. Ranade, an orderly had arrived to shave her head. From that moment on, Lisa had been frightened.

  “Is there some reason why he wants local anesthesia?” asked Lisa. Her hands had begun to tremble. Dr. Ranade had thought carefully about his answer.

  “Yes,” he said finally, “he wants to locate the diseased part of your brain. He needs your help.”

  “You mean, I’ll be awake when . . .” Lisa didn’t finish her sentence. Her voice had trailed off. The idea seemed preposterous.

  “That’s correct,” said Dr. Ranade.

  “But he knows where the diseased part of my brain is,” protested Lisa.

  “Not well enough. But don’t worry. I’ll be there. There’ll be no pain. All you have to remember is no coughing and no sudden movements.”

  Lisa’s reverie was cut short by a feeling of pain in her left forearm. Looking up she could see tiny bubbles rising up in a bottle over her head. Dr. Ranade had started the IV. He did the same thing in her right forearm, threading into her a long thin plastic tube. Then he adjusted the table so that it tilted slightly downward.

  “Lisa,” said Carol Bigelow. “I’m going to catheterize you.”

  Picking up her head, Lisa looked down. Carol was busy unwrapping a plastic covered box. Nancy Donovan, another scrub nurse, pulled back Lisa’s sheet exposing her from the waist down.

  “Catheterize?” questioned Lisa.

  “Yes,” said Carol Bigelow, pulling on loose rubber gloves. “I’m going to put a tube into your bladder.”

  Lisa allowed her head to fall back. Nancy Donovan grasped Lisa’s legs and positioned them so that the soles of her feet were together while her knees were widely apart. She lay exposed for the world to see.

  “I’m going to be giving you a medicine called mannitol,” explained Dr. Ranade. “It causes you to make a lot of urine.”

  Lisa nodded as if she understood while she felt Carol Bigelow begin to scrub her genitals.

  “Hi, Lisa, I’m Dr. George Newman. Do you remember me?”

  Opening her eyes, Lisa gazed into another masked face. These eyes were blue. On the other side of her was another face with brown eyes.

  “I’m the Chief Resident in Neurosurgery,” said Dr. Newman, “and this is Dr. Ralph Lowry, one of our Junior Residents. We’ll be helping Dr. Mannerheim as I explained to you yesterday.”

  Before Lisa could respond she felt a sudden sharp pain between her legs, followed by a curious fullness in her bladder. She took a breath. She felt tape being placed on the inner part of her thigh.

  “Just relax now,” said Dr. Newman without waiting for her to respond. “We’ll have you fixed up in no time.” The two doctors directed their interest to the series of X rays that lined the back walls.

  The pace in the OR quickened. Nancy Donovan appeared with a steaming stainless steel tray of instruments, and with a loud crash she heaved it on top of a nearby table. Darlene Cooper, another scrub nurse, who was already gowned and gloved, reached into the sterile instruments and began to arrange them on a tray. Lisa turned her head when she saw Darlene Cooper lift out a large drill.

  Doctor Ranade wrapped a blood pressure cuff around Lisa’s right upper arm. Carol Bigelow exposed Lisa’s chest and taped on EKG leads. Soon the sonar-like beeps from the cardiac monitor competed with John Denver on the transistor.

  Dr. Newman came back from studying the X rays and positioned Lisa’s shaved head. With his pinky on her nose and his thumb on the top of her head, he drew a line with a marking pen. The first line went from ear to ear over the top of her head. The second line bisected this one, starting at the middle of the forehead and extending back to the occipital area.

  “Now, Lisa, turn your head to the left,” said Dr. Newman.

  Lisa kept her eyes closed. She felt a finger palpate the ridge of bone that ran back from her right eye toward her right ear. Then she felt the marking pen trace a looping line that began at her right temple and arched upward and backward ending behind her ears. The line defined a horseshoe-shaped area with Lisa’s ear at its base. This was to be the flap that Dr. Mannerheim had described.

  An unexpected drowsiness coursed through Lisa’s body. It felt like the air in the room had become viscous and her extremities leaden. It took great effort for her to open her eyelids. Dr. Ranade smiled down at her. In one hand was her IV line; in the other hand a syringe.

  “Something to relax you,” said Dr. Ranade.

  Time became discontinuous. Sounds drifted in and out of her consciousness. She wanted to fall asleep but her body involuntarily fought against it. She felt herself being turned half on her side with her right shoulder elevated and supported by a pillow. With a sense of detachment she felt both wrists bound to a board that stuck out at right angles from the operating table. Her arms felt so heavy she couldn’t have moved them anyway. A leather cinch went around her waist securing her body. She felt her head scrubbed and painted. There were several sharp needles accompanied by fleeting pain before her head was clamped in some sort of vise. Despite herself, Lisa fell asleep.

  Sudden intense pain awoke her with a start. She had no idea how much time had passed. The pain was located above her right ear. It occurred again. A cry issued from her mouth and she tried to move. Except for a tunnel of cloth directly in front of her face, Lisa was covered with layers of surgical drapes. At the end of the tunnel, she could see Dr. Ranade’s face.

  “Everything is fine, Lisa,” said Dr. Ranade. “Don’t move now. They are injecting the local anesthetic. You’ll only feel it for a moment.”

  The pain occurred again and again. Lisa felt like her scalp was going to explode. She tried to lift her arms only to feel the cloth restraints. “Please,” she shouted, but her voice was feeble.

  “Everything is fine, Lisa. Try to relax.”

  The pain stopped. Lisa could hear the doctors breathing. They were directly over her right ear.

  “Knife,” said Dr. Newman.

  Lisa cringed. She felt pressure, like a finger being pressed against her scalp and rotated around the line drawn by the marking pen. She could feel warm fluid on her neck through the drapes.

  “Hemostats,” said Dr. Newman. Lisa could hear sharp metallic snaps.

  “Raney clips,” said Dr. Newman. “And call Mannerheim. Tell him we’ll be ready for him in thirty minutes.”

  Lisa tried not to think about what was happening to her head. Instead she thought about the discomfort in her bladder.

  She called to Dr. Ranade and told him she had to urinate.

  “You have a catheter in your bladder,” said Dr. Ranade.

  “But I have to urinate,” said Lisa.

  “Just relax, Lisa,” said Dr. Ranade. “I’ll give you a little more sleep medicine.”

  The next thing Lisa was conscious of was the high-pitched whine of a gas-powered motor combined with a sense of pressure and vibration on her head. The noise was frightening because she knew what it meant. Her skull was being opened by a saw; she didn’t know it was called a craniotome. Thankfully there was no pain, although Lisa braced for it to occur at any moment. The smell of scorched bone penetrated the gauze drapes over her face. She felt Dr. Ranade’s hand take hers, and she was thankful for it
. She pressed it as if it were her only hope of survival.

  The sound of the craniotome died. The rhythmic beeping of the cardiac monitor emerged from sudden stillness. Then Lisa felt pain again, this time more like the discomfort of a localized headache. Dr. Ranade’s face appeared at the end of her tunnel of vision. He watched her as she felt the blood pressure cuff inflate.

  “Bone forceps,” said Dr. Newman.

  Lisa heard and felt bone crunching. It sounded very close to her right ear.

  “Elevators,” said Dr. Newman.

  Lisa felt several more twinges, followed by what seemed to her a loud snap. She knew her head was open.

  “Damp gauze,” said Dr. Newman, in a matter-of-fact voice.

  While still scrubbing his hands, Dr. Curt Mannerheim leaned over to look through the door into OR#21 and see the clock on the far wall. It was almost nine o’clock. At that moment, he saw his chief resident, Dr. Newman, step back from the table. The resident crossed his gloved hands on his chest, and walked over to study the X rays arranged on the view box. That could mean only one thing. The craniotomy was done and they were ready for the Chief. Dr. Mannerheim knew he didn’t have much time to spare. The investigative committee from the N.I.H. was due to arrive at noon. What was at stake was a twelve-million-dollar research grant that would support his research activities for the next five years. He had to get that grant. If he didn’t, he might lose his entire animal lab, and with it, the results of four years of work. Mannerheim was certain he was on the brink of finding the exact spot in the brain responsible for aggression and rage.

  Rinsing the suds, Mannerheim caught sight of Lori McInter, the Assistant Director of the OR. He shouted her name and she stopped in her tracks.

  “Lori, dear! I’ve got two Jap doctors here from Tokyo. Could you send someone into the lounge to make sure they find scrub clothes and all that?”

  Lori McInter nodded, although she indicated she wasn’t pleased at the request. Mannerheim’s shouting in the corridor irritated her.