I am brought into the operating room.
A tube is gently shoved down my throat for breathing purposes. Someone holds my intravenous line like a beer bong. A brain-relaxing drug called Mannitol is administered.
With a mechanism involving tiny goalposts and clusters of labeled spheres attaching and detaching very specifically to the goalposts that I saw on a PowerPoint Slide once in AP Psychology, I am encouraged to fall asleep and feel no pain. In this state, with my head placed in a three-pin Mayfield skull clamp, my head is shaved with an electric razor. In this state, I am encouraged not to mourn the loss of my hair. I offer little resistance, anyway. I am shaved, given preoperative antibiotics, and draped in the usual sterile fashion.
The Mayfield clamp attaches to the operating table to hold the head absolutely still during this delicate procedure.
The surgeon takes a Ten Blade, a very sharp and very small-looking hockey stick, to break the skin.
He makes a partial coronal incision, biased to the left, using the Ten Blade. He uses Raney Clips for hemostasis, that is, to stop my brain from bleeding all over, and then opens my scalp in the left frontal region. The surgeon attempts to ensure a good cosmetic result for after the surgery.
It’s been four days since the craniotomy and I still have a sore throat from the post-surgery breathing tube addition and removal. Every time I cough or sneeze there is this unsettling slosh in my head with intense pressure around my ears. Like someone tossed a sun-baked Sno-cone against the back of my eyes while their friend plugged my ears with candles from the local cathedral. Is something rolling around up there? I consider, briefly, mentioning it to a nurse, so I play it safe and ask Krystin, who is both a nurse and my sister. She will give it to me straight. She gestures the word eek with her mouth and says bring it up in a few days to the people here if it keeps happening.
Every two or three hours somebody new comes in. The hospital purveyor of faith and hope, the hospital troubadour, doctors, nurses, specialists who give me referrals to talk to other doctors. The person who just walked in is an occupational therapist, named Sarah, here to test my basic brain functions, teach me how to live a valued and productive life post injury. And she is definitely not in a good mood.
Sarah looks like she recently got put on hold by a customer service rep. Her cell phone bill had a mysterious two-hundred-dollar upcharge this month. Or her cable TV subscription cut out during the Super Bowl. Either way, it most definitely wasn’t Sarah’s fault. And now Sarah needs someone to take it out on.
The skin and muscles are lifted off the broken bone and folded back. Next, one or two burr holes are made in the skull with a drill. Inserting a special saw through the burr holes, the surgeon cuts the outline of a bone flap like a paper doll with surgical scissors. The bone flap is lifted and removed to expose the protective covering of the brain, called dura. Skull fragments are stuck to my dura. The bullet put them there. These are lifted off in one piece as multiple comminuted, that is, pulverized, segments are removed. My brain flap is safety stored off to the side somewhere, like car keys when one arrives home from work, until the end of the procedure.
Taking the scissors again, the surgeon cuts the dura to expose the brain. My brain. He looks at all those pygmy-sized pink vessels. A supercomputer disguised as ground beef molded into a fist. When I wake up, he tells me kindly, “You have a very good-looking brain.” Retractors placed on the brain gently open a corridor to the area in need of repair or removal.
Sarah introduces herself and I try to respond, but speaking has never been this embarrassing. Free flowing common phrases are no longer that. I want to say, Oh, I’m hanging in there, thank you, and yourself? But instead I produce a butchered slurry of consonants and vowels, loosely strung together. It takes me almost a full minute to respond. I hate hearing myself stuck and confused. I used to talk so swiftly, tongue firmly planted in cheek, always quick-witted and clever. Mom is on the couch pretending not to notice the change. I imagine we are both praying, please, don’t let this be how things will be.
The occupational therapist puts a tray on my lap, lays down a couple worksheets and some coins. Then we begin with general questions.
“What’s your birthday?”
“12. 21. 94.”
“Who’s the current president?”
“Donald Trump, regretfully.” She doesn’t grin like the others did.
“Where are you right now?”
“Obviously. Do you know which one?”
I don’t. I was never told nor do I remember seeing any signs or overhearing any clues. I do not maintain an active database of all the hospitals in the Greater Twin Cities area. I’ve never needed to go to the hospital. I’m not reckless. I’m not sick. I don’t play sports. I don’t party.
“No,” I say.
I feel bad for not knowing? I get defensive. I think Sarah is grading me and I’m losing points.
“Think,” she snaps. Like she is still on hold, now late to some other, more important obligation. “Make a guess.” This doofus, this dummy, I think she thinks. As if I’m wasting her time.
I’m taking too long, hitting a wall. The customer service rep just told her it might be another hour, at least, sorry.
“Minneapolis?” I pick one of the Twin Cities, fifty-fifty chance.
“No. R- Hospital in St. Paul.” Sarah is disgusted at my lack of familiarity. “I’m going to test your short-term memory by giving you three words to remember. After the next few tests, I’ll ask you to recall the words, okay?”
I sneeze while giving a shaky thumbs up. Brain sloshed against the inside of my forehead. I think of crash test dummies and get the shivers.
“Purple. Zebra. Clock,” she says. “Repeat.”
“Purple. Zebra. Clock.” With roadblocks, galore.
The surgeon then drills down to the portion of the skull that the bullet made contact with, to minimize infection. This is technically an open wound. He excavates a left frontal hematoma using suction, irrigation, and micro instruments.
Since the brain is tightly enclosed inside the bony skull, neurosurgeons use a variety of small tools that resemble larger, landscape architecture tools. One might think of a craniotomy as landscape architecture on a very small scale. These instruments include long-handled scissors, dissectors and drills, lasers, ultrasonic aspirators, as well as computer-aided guidance systems. The surgeon picks debris out of my head like weeds in a garden.
Sarah picks up a pen and tells me to track it with my eyes. I don’t know the desired outcome. Is it a pass/fail exercise? I’m extraordinarily dizzy. After thirty seconds she writes something down. Without any feedback, I try to regain my center of gravity by blinking a lot.
“Let’s go through some money scenarios.”
I do all right making a dollar out of two quarters, four nickels, a couple dimes, and ten pennies. I do less well with the, if a baseball card costs sixty-seven cents, how much change would you give me, situations. Anything that isn’t a zero or five, I suck.
We move to that nightmare. Sarah tells me to subtract seven from one-hundred.
“Seven from that?”
Frozen. Beet red. A kindergarten math problem. I’m overwhelmed. Embarrassed ten-fold. Could I even count to ten? Mom is witnessing her son’s brain damage. Watching an occupational therapist cross her arms at my silence. Roll her eyes. Isn’t this her full-time job? Is she somehow devoid of sympathy? She leans back in her chair as a form of protest.
“Eighty-four?” I say. So, so sorry. We all know it’s wrong.
“Seven from that?”
Mom lets out a burst of frustrated, hot air. She so badly wants to chew Sarah out. You are aware he just had neurosurgery, right? Shot in the head? He is an English major for Christ’s sake, he doesn’t need to know numbers!
With the problem removed or repaired, the retractors holding the brain are removed and the dura is closed using sutures. The bone flap is replaced back into its original God-given position and secured to the skull with titanium plates and screws. The joke is that I am slower now, only because I have added mass folded into my head like an overstuffed dumpling. I can’t run as fast, mom! We will laugh much later.
My incision incorporates the macerated entry site of the bullet. This area is carefully debrided using penfield dissectors, that is, the dead tissue is removed, and then reapproximated using vicryl suture and staples.
The incision scar will resemble the lightly massaged crease of dumpling dough. In some cases, the titanium may be felt under the skin. In some cases, a drain may be placed under the skin for a few days to evacuate blood or fluid from the surgical area. Muscles and skin are sutured back together. The surgeon places vancomycin powder and closes the incision in stepwise fashion using absorbent suture with skin staples. Many metal teeth bite down to help hold my head together like a bad animal with good intentions.
I don’t know why but we move onto task management. Haven’t I suffered enough? I have to designate an order of events for a simulated day. I am given multiple happenings, some of high importance, time sensitive, some not. It’s torturous. I am allowed scratch paper.
“You have a doctor appointment at three, birthday party at five, you have to cook and eat breakfast, fill up your gas tank, purchase a cake, pick up a prescription, and get fitted for new slacks. What order would be the most efficient and why?”
Honestly, I’d rather be shot again. But I give it a whirl to appease her sadism. She scoffs, taps her foot as I begin, truly trying to work it out and pick the right answers. My simulated day is royally fucked. I run out of gas. Eat breakfast at lunchtime. Show up to the party without a cake. Miss my doctor appointment. And ask for pills at the slacks store. I have one chance left to semi-redeem myself.
I am wheeled to a recovery room to lie next to other people whose spheres are attaching and detaching specifically to a tiny goalpost, encouraged to wake up and feel pain again. Some people want to get back to it sooner than others. I wake up fairly quickly. I’m asked to move my arms, fingers, legs, and toes. I don’t remember if I’m successful. A nurse with a flashlight that could double as a ballpoint pen asks me the following:
What’s your birthday?
Who’s the current President?
Do you know where you are right now?
I don’t remember if I’m successful in answering.
I take a medicine to temporarily prevent seizures. I cannot lift more than five pounds. I cannot drink alcohol. Housework and yardwork are not permitted. There may be swelling, which would require a second craniotomy. There may be loss of mental functions. There may be weakness, or paralysis. There may be permanent brain damage, and associated disability. The results depend on the underlying condition being treated, really. It all takes about two hours. That will be thirty grand, for saving your life.
Moment of truth.
“Can you repeat to me those three words I had you memorize?”
But I can think of three new ones. And that is a miracle among miracles.
STORY IMAGE CREDIT: Flickr Creative Commons/ToolDude