Today's Reading

It's a family legacy, common to all neurosurgeons, of becoming better and better technically with each passing generation—yet with each generation equally frustrated by the seeming futility of treating this disease. Eighty years after Harvey Cushing's death, sometimes it feels as if the best thing we can do for our GBM patients is pray the diagnosis is incorrect.

You know that old question about what happens when an unstoppable force hits an immovable object?

That's close to how this situation feels to me.

I'm a brain surgeon. I'm a Christian. A man of science and a man of faith.

Years of training and experience have filled me with knowledge, facts, things that are always true. Things I know.

And I'm a firm believer in God's desire and ability to heal, to repair, to make things right when all the doctors believe there's no hope. I've seen far too many inexplicable turnarounds, impossible saves, people who beat the odds and defied the textbooks.

There are some cases in which my knowledge as a surgeon doesn't determine the outcome because God's out there doing his thing.

I believe.

So what happens when the things you know and the things you believe smash into one another like the object and force in the question above?

I was about to find out.

_ _ _

I pulled back the curtain in slot 11 after walking past the guy in the adjacent bed who had just vomited all over the place. EDs are always an amalgam of sounds and smells. Moans, tears, urine, sweat, and desperation hang in the air, competing like pheromones, trying to lure the doctor and win the battle of who gets seen first.

Samuel was lying on the bed, his wife, Christy, sitting next to him on a plastic chair. He had an IV in his arm, an oxygen tube in his nose, and a wary look I've seen a thousand times, as if thinking, Are you here to help me or tell me something awful?

He was solidly built, square jawed, with crew-cut brown hair. He had a University of Alabama Crimson Tide tattoo on his left bicep. In any other context I would have teased him about the fact that Auburn had beaten them in football that year. But on that day—really any day in the ED—scores and rivalries didn't seem as important. Because if he had a GBM, the only score that would matter to him would be GBM 1, Samuel 0.

"I'm Dr. Warren," I said. Every time I meet a patient like this, I have a decision to make: Do I go with distant, emotionally detached surgeon or with compassionate, approachable guy who happens to be a surgeon? It has to happen instantly because you really can't change it later. How will I play it?

"Hey, Doc," he said, "is the man next to me okay? He seems like he's really sick."

His gentleness disarmed me. Here he was, lying in an ED bed in a gown, surrounded by the smells and sounds of misery and fear, and having just crashed his car after having a seizure, but he was concerned about another patient.

"I don't know. I'm sure Dr. Stinson will take good care of him."

Samuel smiled. "Has anyone ever told Doc Stinson he looks just like Abraham Lincoln?"

I laughed. This guy was something else.

"What happened to you today?" I logged on to the computer next to his bed and loaded his MRI scan while he replied.

"I was driving to work, going in two hours early because we're having a get-together tonight for my birthday." He pinched the bridge of his nose. "I'm so glad it wasn't later in the morning. If there had been other cars on the road..."

Christy reached over and took his hand. Samuel let out a long breath. "I've had a weird headache behind my right eye for a couple of months now, but today it was worse."

"You never told me you've been having headaches!" Christy stood and cupped his face in her hands. "You have to tell me these things," she said. Her green eyes pooled with tears, but there were other emotions too: Anger at not knowing something that might have made a difference. Fear of the unknown medical bogeymen hiding in a headache.

He looked at her and nodded. "I know. I didn't think it was a big deal. Anyway, the last thing I remember is seeing flashing lights. Then I woke up in the ambulance."

The next part was identical to a thousand other conversations I've had with patients: "Here's your scan. This looks like a tumor, but we can't know for sure what it is until we do a biopsy. Don't worry; we're going to find out what you're dealing with and then make the best plan for getting you better."

I suspect patients don't hear a word after I say "tumor."

Samuel looked up at me, grabbed my arm, and said, "Let's do this, Doc. I trust you. I'm gonna be okay."

I nodded slowly. "All right. We'll go to surgery this afternoon."

But when I turned to walk away, my eyes crossed the computer screen again, and I saw the white-and-black image of the tumor nestled deep inside his right temporal lobe. Samuel's assertion that he would be okay echoed in my mind, and even as my words were leaving my mouth, I had a very different thought. Thousands of patients the world over, including Stinson's sister-in-law, had met the tumor Cushing and Bailey called glioblastoma multiforme. All of them, except perhaps a few whose diagnoses were inaccurate, had succumbed to its power.

In a few hours I would know, but I already knew. I kept the thought to myself and left the ED. As much as I wanted to smile and agree with Samuel—"Of course you'll be okay!"—I instead said to myself, I've seen the end of you.

This excerpt ends on page 15 of the hardcover edition.

Monday we begin the book SMOKESCREEN by Terri Blackstock.

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