It’s one thing knowing that your operation is to take place in the autumn but quite another to know exactly the date and location. The email (or perhaps that should read THE email) arrived today, confirming in black and white, the date when I go under the knife. No, I’m not going to announce it here but let’s just say that if it goes well, there will be fireworks!
Immediately after reading the email, I begin to notice a change in myself. Suddenly things previously only discussed in the abstract are transformed subtly into tangible realities. And that makes all the difference. ‘In the autumn’ is vague and comforting. The ‘Xth of November’ is unsettlingly immediate. Okay it’s two months away. Plenty of time to pack my hospital bag and be ready. Ridiculous then, as I did, to fish out an overnight bag and start packing it. Better to make a list. And calm down.
I sat for a moment or two on the edge of my bed while I gathered my thoughts. I’d be lying if I said I wasn’t nervous. No matter how routine the procedure, how skilled the surgeon and how reassuring the statistics it is still enough to raise the heart rate a little. That’s only natural. Any procedure in which your brain is opened up to the atmosphere, however briefly, is likely to engender at least a modicum of anxiety. After all, we have evolved skulls for very good reasons – to keep the brain in and the atmosphere out. Neurosurgery respects no such distinction.
Reduced
to its basic acts, the surgery is straightforward. You could do it on the
kitchen table*.
1) Toss a coin – heads for left, tails for right.
2) Saw
a hole on one side of the skull using a drill and a circular saw attachment
(£29.99 in B&Q until the bank holiday). Oh, about the size of pound coin I
guess.
3) Jab the brain with the electrode (that’s
the one that looks a bit like a cocktail stick). You might want to practice
this stage beforehand – say with a cocktail stick and maybe a raspberry milk
jelly until you’ve got the hang of it. Better safe than sorry.
4) Fill the hole with Polyfilla (or whatever
the surgical equivalent is) and drag wires out under the skin to the chest. You
remembered the wires, right?
5) Implant the battery pack (about the size
of a Baby Bel cheese portion) on the left-hand side of the chest and connect to
the electrodes.
6) High five the surgical team, wake up the
patient and wash down the table ready for the kids tea when they’re back from
school.
7) Succumb to a brief moment of panic when
you realise one of the Baby Bels for the children’s tea is missing. Turns out
to be in your pocket.
8) Note to self: cheese has no place in the operating theatre.
Joking aside (you did realise I was joking, right), the first part of the surgery is genuinely Neolithic. Boring holes in the head (trephining) was a popular treatment for insanity, seizures and headaches in those cave dwelling times. If leeches didn’t work, opening up the skull was the next step in the Neolithic manual of medicine. Amazingly, some of those trephined survived. Well, long enough to have the procedure repeated – there are examples of Neolithic skulls with evidence of repeated trephining, some holes being partly healed.
As I write this I realise that I’m probably not painting the best possible picture for those whose enthusiasm for DBS might be wavering in the light of such revelations. I’ll stop.
Sat on
the edge of the bed, my mind wanders beyond the simple list of toothpaste,
deodorant et cetera. Soon I’m thinking of the whole surgical procedure and how
it’s assessed. For the most part, the presurgical workup involves discussion
between patient and the DBS team (neurologist, neurosurgeon, DBS nurse, and a
few others) of what to expect. We talk a lot for instance about expectation
management. That sounds like some kind of administrative or managerial term but
it’s really no more than checking that the patient has good enough insight into
their condition to know what kind of improvements to expect. In simple terms,
make sure the bar is at the right height. If a patient believes DBS is a cure,
they are on course for a disappointment. If they think that a small reduction
in tremor is their best possible outcome, then they will be pleasantly
surprised.
I like to
think that my expectations are realistic and I will go through them in more
detail in a later blog as D-Day, or should that be D(BS)-Day draws nigh. In
general, I’m more interested in numbers now. I am no longer satisfied with
verbal descriptions – ‘the chances of anything wrong are very low’. what I want to read is that the
likelihood of perisurgical stroke, heart attack or infection is X, Yand Z%
respectively. For the same reason phrases like ‘big improvements in motor
scores‘ fails to float my boat either. I want to see A% improvement in
sleep scores, a -B change in gait asymmetry and so on.
I have an
innate impatience with descriptors that don’t adequately describe. After all
one person’s ‘huge improvement’ is another person’s ‘better but no
big deal‘. So I want to see that they both had a 15% improvement in UPDRS
scores. Or whatever.
But
there’s plenty of time for that. The email detailing the date of my operation
invites me to get in touch if I have any questions about the procedure and the
time in hospital. They may regret that. Because I have questions. Boy do I have
questions.
*No, don’t actually do this on the kitchen table. Or any table. In fact, don’t do it at all. Don’t even think about doing it. This is a procedure for skilled professionals and, in case you’re wondering, no that’s not you.