Neil's Brain - CHP 1 THE TIMED SCRUB is an operating room...

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CHP 1 THE TIMED SCRUB is an operating room ritual, and I’m a little out of practice. Keep those elbows down, I remind myself, so that the water drips off them rather than running the other way, from dirty to clean areas. Scrub, scrub. Three more minutes to go on the scrub, then my grand entrance into the O.R. Though I have to think about it because I do it so infrequently, this scrub is automatic for a surgeon, requiring as little thought as riding a bicycle. A surgeon gets ten quiet minutes to think about the patient, contemplate the novelties of the case, reflect on what the patient said when asked about preferences. In this type of neurosurgery, there may be a lot of on-the-spot tailoring of the surgery to the unique aspects of the patient’s brain. And there are often serious value judgments to be made, ones that the patient will have to live with ever after. Conflicts can arise, between getting rid of the patient’s epileptic seizures and preserving his language and memory abilities intact. One of the neurosurgical principles in such matters is, "Better some seizures than a loss of language abilities." That’s a consideration that could arise later today, when some of Neil’s brain is being removed. There is a window next to the scrub sink, and I look into the O.R. to see how things are going. I see the big blue-green tent, created with sterile sheets, but it mostly hides Neil. I remember seeing him at the pre-op conference: the one patient, and twenty inquisitive doctors. Not the usual patient-to-physician ratio, even hereabouts. The conference brings out many people like me who are interested in how the brain normally works, crowding in with the usual specialists in treating epileptics. Before the conference, when Neil and I were talking about writers, he said that he was becoming a rather specialized kind of writer himself: writing letters-to-the-editor about wearing seat belts. The skull fracture that caused his epilepsy came from a collision with the steering wheel fifteen years ago, during one of those quick trips to the grocery store. Like most epileptics who are surgical candidates, Neil is highly motivated. A long day of surgery, he said, was nothing compared to coping with a seizure almost every week. And besides, he added, he had always wondered how his brain worked; maybe he might learn a little. Unlike many of the mentally ill, epileptics often have quite a bit of insight into their problem. Seizures are only temporary, with little in the way of problems between them. A single seizure usually won’t hurt you, unless you are driving a car or flying an airplane. It’s all the repetitions that make it a serious problem. About one in four epileptics isn’t helped by anticonvulsant drugs. If the epileptic "pacemaker" area can be identified, and is in a place where it is doing more harm than good, it can sometimes be surgically removed. This requires a lot of testing, once the brain’s surface is exposed to the light of day, to identify the troublesome region.
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