Into the Magic Shop

by James R. Doty, MD

  Brain surgery is difficult, but surgery in the posterior fossa is even more so and in a small child excruciatingly difficult. This tumor is large and the work painstakingly slow and precise. Eyes looking through a microscope for hours focused on one thing. As surgeons we are trained to shut down our own bodily responses as we operate. We don’t take bathroom breaks. We don’t eat. We have been trained to ignore when our backs ache and our muscles cramp. I remember my first time in the operating room assisting a famous surgeon who was known not only for being brilliant but also for being a belligerent and arrogant prima donna when he operated. I was intimidated and nervous, and as I stood next to him in the operating room, sweat began pouring down my face. I was breathing heavily into my mask and my eyeglasses began steaming up. I couldn’t see the instruments or even the operating field. I had worked so hard, overcome so much, and now here I was, doing surgery just like I had always imagined, but I couldn’t see a thing. Then the unthinkable happened. A large drop of sweat rolled off my face and into the sterile field. He went ballistic. It should have been a highlight of my life, my first time in surgery, but instead I contaminated the surgical field and was summarily kicked out of the operating room. I have never forgotten that experience.

  Today my forehead is cool and my eyesight clear. My pulse is slow and steady. Experience makes the difference, and in my operating room I am not the dictator. Or a belligerent prima donna. Every member of the team is valuable and necessary. Everyone is focused on his or her part. The anesthesiologist monitors the boy’s blood pressure and oxygen, his level of consciousness, and the rhythm of his beating heart. The surgical nurse constantly monitors the instruments and supplies, making sure whatever I need is within reach. A large bag is attached to the drapes and hangs below the boy’s head collecting blood and irrigation fluid. The bag is attached to a tube connected to a large suction machine and constantly measures the fluids so we know how much blood loss we have at any given moment.

  The surgeon assisting me is a senior resident in training and new to the team, but he is just as focused on the blood vessels, and brain tissue, and minutiae of removing this tumor as I am. We can’t think about our plans for the next day, or hospital politics, or our children, or our relationship trouble at home. It’s a form of hypervigilance, a single-pointed concentration almost like meditation. We train the mind, and the mind trains the body. There’s an amazing rhythm and flow when you have a good team—everyone is in sync. Our minds and bodies work together as one coordinated intelligence.

  I am removing the last piece of the tumor, which is attached to one of the major draining veins deep in the brain. The posterior fossa venous system is incredibly complex, and my assistant is suctioning fluids as I carefully resect the final remnant of the tumor. He lets his attention wander for a second, and in that second his suction tears the vein, and for the briefest moment everything stops.

  Then all hell breaks loose.

  The blood from the ripped vein fills the resection cavity, and blood begins to pour out of the wound of this beautiful little boy’s head. The anesthesiologist starts yelling that the child’s blood pressure is rapidly dropping and he can’t keep up with the blood loss. I need to clamp the vein and stop the bleeding, but it has retracted into a pool of blood, and I can’t see it. My suction alone can’t control the bleeding and my assistant’s hand is shaking too much to be of any help.

  “He’s in full arrest!” the anesthesiologist screams. He has to scramble under the table because this little boy’s head is locked in a head frame, prone, with the back of his head opened up. The anesthesiologist starts compressing the boy’s chest while holding his other hand on his back, trying desperately to get his heart to start pumping. Fluids are being poured into the large IV lines. The heart’s first and most important job is to pump blood, and this magical pump that makes everything in the body possible has stopped. This four-year-old boy is bleeding to death on the table in front of me. As the anesthesiologist pumps on his chest, the wound continues to fill with blood. We have to stop the bleeding or he will die. The brain consumes 15 percent of the outflow of the heart and can survive only minutes after the heart stops. It needs blood and, more important, the oxygen that is in the blood. We are running out of time before the brain dies—they need each other—the brain and the heart.

  I am frantically trying to clamp the vein, but there’s no way to see the vessel through all the blood. Although his head is fixed into position, the chest compressions are moving it ever so slightly. The team knows and I know that we are running out of time. The anesthesiologist looks up at me and I see the fear in his eyes. . . . We might lose this child. Cardiopulmonary resuscitation (CPR) is like trying to clutch-start a car in second gear—it’s not very reliable, especially as we are continuing to lose blood. I am working blind, so I open my heart to a possibility beyond reason, beyond skill, and I begin to do what I was taught decades ago, not in residency, not in medical school, but in the back room of a small magic shop in the California desert.

  I calm my mind.

  I relax my body.

  I visualize the retracted vessel. I see it in my mind’s eye, folded into this young boy’s neurovascular highway. I reach in blindly but knowing that there is more to this life than we can possibly see, and that each of us is capable of doing amazing things far beyond what we think is possible. We control our own fates, and I don’t accept that this four-year-old is destined to die today on the operating table.

  I reach down into the pool of blood with the open clip, close it, and slowly pull my hand away.

  The bleeding stops, and then, as if far away, I hear the slow blip of the heart monitor. It’s faint at first. Uneven. But soon it gets stronger and steadier, as all hearts do when they begin to come to life.

  I feel my own heartbeat begin to match the rhythm on the monitor.

  Later, in post-op, I will give his mother the remnants from his first haircut, and my little buddy will come out of the anesthetic a survivor. He will be completely normal. In forty-eight hours, he will be talking and even laughing, and I will be able to tell him that the Ugly Thing is gone.

  PART ONE

  Into the Magic Shop

  ONE

  Real Magic

  Lancaster, California, 1968

  The day I noticed my thumb was missing began like any other day the summer before I started eighth grade. I spent my days riding my bicycle around town, even though sometimes it was so hot the metal on my handlebars felt like a stove top. I could always taste the dust in my mouth—gritty and weedy like the rabbitbrush and cacti that battled the desert sun and heat to survive. My family had little money, and I was often hungry. I didn’t like being hungry. I didn’t like being poor.

  Lancaster’s greatest claim to fame was Chuck Yeager breaking the sound barrier at nearby Edwards Air Force Base some twenty years earlier. All day long planes would fly overhead, training pilots and testing aircraft. I wondered what it would be like to be Chuck Yeager flying the Bell X-1 at Mach 1, accomplishing what no human had ever done before. How small and desolate Lancaster must have looked to him from forty-five thousand feet up going faster than anyone ever thought possible. It seemed small and desolate to me, and my feet were only a foot above the ground as I pedaled around on my bike.

  I had noticed my thumb missing that morning. I kept a wooden box under my bed that had all my most prized possessions. A small notebook that held my doodles, some secret poetry, and random crazy facts I had learned—like twenty banks are robbed every day in the world, snails can sleep for three years, and it’s illegal to give a monkey a cigarette in Indiana. The box also held a worn copy of Dale Carnegie’s How to Win Friends and Influence People, dog-eared on the pages that listed the six ways to get people to like you. I could recite the six things from memory.

  Become genuinely interested in other people.

  Smile.

  Remember that a person’s name is
, to that person, the sweetest and most important sound in any language.

  Be a good listener. Encourage others to talk about themselves.

  Talk in terms of the other person’s interest.

  Make the other person feel important—and do it sincerely.

  I tried to do all of these things when I talked to anyone, but I always smiled with my mouth closed because when I was younger I had fallen and hit my upper lip on our coffee table, knocking out my front baby tooth. Because of that fall my front tooth grew in crooked and was discolored a dark brown. My parents didn’t have the money to get it fixed. I was embarrassed to smile and show my discolored crooked tooth, so I tried to keep my mouth closed at all times.

  Besides the book, my wooden box also had all my magic tricks—a pack of marked cards, some gimmicked coins that I could change from nickels into dimes, and my most prized possession: a plastic thumb tip that could hide a silk scarf or a cigarette. That book and my magic tricks were very important to me—gifts from my father. I had spent hours and hours practicing with that thumb tip. Learning how to hold my hands so it wouldn’t be obvious and how to smoothly stuff the scarf or a cigarette inside it so that it would appear to magically disappear. I was able to fool my friends and our neighbors in the apartment complex. But today the thumb was missing. Gone. Vanished. And I wasn’t too happy about it.

  My brother, as usual, wasn’t home, but I figured maybe he had taken it or at least might know where it was. I didn’t know where he went every day, but I decided to get on my bike and go looking for him. That thumb tip was my most prized possession. Without it I was nothing. I needed my thumb back.

  • • •

  I WAS RIDING through a lone strip mall on Avenue I—an area not on my usual bike circuit because apart from the strip mall there was nothing but empty fields and weeds and chain-link fences for a mile on either side. I looked at a group of older boys in front of the small market but didn’t see my brother. I felt relieved because usually if I found my brother in a group of kids it meant he was getting picked on and I would be getting into a fight to defend him. He was a year and a half older than me, but he was smaller, and bullies like to pick on those who can’t defend themselves. Next to the market was an optometrist’s office and next to that was a store I had never seen before—Cactus Rabbit Magic Shop. I stopped on the sidewalk in front of the strip mall and stared across the parking lot. The entire storefront was five vertical glass panes with a glass door to the left. The sun glinted off the dirt-streaked glass, so I couldn’t see if anyone was inside, but I walked my bike to the front door hoping it was open. I wondered if they sold plastic thumbs and for how much. I didn’t have any money, but it couldn’t hurt to look. I leaned my bike against a post in front of the store with a quick glance down at the group of boys in front of the market. They didn’t seem to have noticed me, or my bike, so I left it there and pushed against the front door. It didn’t budge at first, but then, as if by a magician’s wave of his wand, it gave way and opened smoothly. A little bell rang above my head as I walked in.

  The first thing I saw was a long glass counter full of packs of cards and wands and plastic cups and gold coins. Against the walls were heavy black cases that I knew were used for stage magic, and large bookcases filled with books about magic and illusion. There was even a mini guillotine in the corner and two green boxes that you could use to saw a person in half. An older woman with wavy brown hair was reading a paperback book, her glasses perched at the end of her nose. She smiled, still looking down at her book, and then she took her glasses off and lifted her head and stared straight into my eyes the way no adult ever had before.

  “I’m Ruth,” she said. “What’s your name?”

  Her smile was so big and her eyes so brown and kind that I couldn’t help but smile back at her, forgetting completely about my crooked tooth.

  “I’m Jim,” I said. Until that moment I was called Bob. My middle name is Robert. I can’t remember why I was called Bob. But for whatever reason, when she asked I replied, “Jim.” And this was the name I would go by for the rest of my life.

  “Well, Jim. I’m so glad you walked in.”

  I didn’t know what to say back and she just continued to stare into my eyes. Finally, she gave a sigh, but it was more of a happy sigh than a sad kind of sigh.

  “What can I do to help you?”

  My mind went blank for a second. I couldn’t remember why I had come into this store and I felt that same feeling you get when you lean too far back in a chair and suddenly catch yourself right before it tips all the way over. She waited patiently, still smiling, until I found the words to answer.

  “My thumb,” I said.

  “Your thumb?”

  “I lost my plastic thumb tip. Do you have any?”

  She looked at me and kind of shrugged her shoulders as if she had no idea what I was talking about.

  “For my magic. It’s a magic trick. You know, a TT, a plastic thumb tip.”

  “I’ll tell you a little secret,” she said. “I don’t know anything about magic tricks.” I looked around at the endless display of gadgets and tricks of every kind and then looked back at her, no doubt surprised. “My son owns the store, but he’s not here at the moment. I’m just sitting here reading, waiting for him to return from an errand. I know absolutely nothing about magic or thumb tip tricks, I’m sorry to say.”

  “That’s OK. I’m just looking anyway.”

  “Of course. Feel free to look around. And then be sure to tell me if you find what you’re looking for.” She laughed, and while I wasn’t sure why she was laughing, it was a nice laugh that made me feel happy inside for no real reason.

  I wandered around the store looking at the endless rows of magic cards and props and books. There was even a display case full of plastic thumbs. I could feel her eyes on me as I browsed, and while I knew she was staring, it wasn’t in the same way the guy who owns the market next to our apartment would stare at you when you were in his store. I’m pretty sure he thought I was going to steal something, and every time I went in there I could feel his suspicious eyes tracking my every step.

  “Do you live in Lancaster?” Ruth asked.

  “Yes,” I said, “but on the other side of town. I was just riding around looking for my brother and I saw your store and decided to come in.”

  “Do you like magic?”

  “I love it,” I said.

  “What do you love about it?”

  I wanted to just say that I thought it was cool and fun, but something else altogether came out of my mouth. “I like being able to practice at something and get really good at it. I like that I am in control. Whether the trick works or it doesn’t work is only up to me. It doesn’t matter what anyone else says or does or thinks.”

  She was quiet for a few moments, and I immediately felt embarrassed that I had said all that.

  “I understand what you mean,” she said. “Tell me about the thumb trick.”

  “Well, you put the thumb tip on your thumb and the audience thinks it’s your real thumb. You have to kind of hide it a bit, because it looks really fake if you take a good look at it. It’s hollow inside and you can move it from your thumb into the palm of your other hand like this.” I made a classic magic gesture—grabbing one hand with my other hand and sliding my fingers across each other. “You move the thumb tip secretly into your other hand and you can stuff a small silk scarf or a cigarette inside it and then make the moves again and put the thumb back on your finger. But now deep inside is whatever you’re concealing. It looks like you made something magically disappear or you can use it the opposite way and make it look like you’ve made something magically appear out of thin air.”

  “I see,” said Ruth. “How long have you practiced these tricks?”

  “A few months. Every day I practice, sometimes for a few minutes, other times an hour. But every day. It was
really hard at first, even with the instruction book. But then it just gets easier and easier. Anyone could do it.”

  “It sounds like a good trick, and that’s great that you practiced, but do you know why it works?”

  “What do you mean?” I asked.

  “Why do you think this trick works on people? You said the thumb looks really fake, so why does it trick people?”

  She looked suddenly very serious, and like she really wanted me to teach her something. I wasn’t used to anyone, especially not an adult, asking me to explain or teach them anything. I thought about it for a minute.

  “I guess it works because the magician is so good he fools people. They don’t see his sleight of hand. You have to keep people distracted when you do magic.”

  She laughed at this. “Distracted. That’s just perfect. You’re very wise. Would you like to hear why I think the magic trick works?” She waited for me to answer, and again it felt strange to have an adult ask my permission to tell me something.