Робин Кук - Brain

Rinsing the suds, Mannerheim caught sight of Lori McInter, the Assistant Director of the OR. He shouted her name and she stopped in her tracks.

“Lori, dear! I’ve got two Jap doctors here from Tokyo. Could you send someone into the lounge to make sure they find scrub clothes and all that?”

Lori McInter nodded, although she indicated she wasn’t pleased at the request. Mannerheim’s shouting in the corridor irritated her.

Mannerheim caught the silent rebuke and cursed the nurse under his breath. “Women,” he muttered. To Mannerheim, nurses were becoming more and more a pain in the ass.

Mannerheim burst into the OR like a bull into the ring. The congenial atmosphere changed instantly. Darlene Cooper handed him a sterile towel. Drying one hand, then the other, and working down his forearms, Mannerheim bent over to look at the opening in Lisa Marino’s skull.

“God damn it, Newman,” snarled Mannerheim, “when are you going to learn to do a decent craniotomy? If I’ve told you once, I’ve told you a thousand times to bevel the edges more. Christ! This is a mess.”

Under the drapes Lisa felt a new surge of fear. Something had gone wrong with her operation.

“I...” began Newman.

“I don’t want to hear a single excuse. Either you do it properly or you’ll be looking for another job. I got some Japs coming in here and what are they going to think when they see this?”

Nancy Donovan was standing at his side to take the towel, but Mannerheim preferred to throw it on the floor. He liked to create havoc and, like a child, demanded total attention wherever he was. And he got it. He was considered technically one of the best neurosurgeons in the country, if not the fastest. In his own terms he said, “Once you get into the head, there’s no time to pussyfoot around.” And with his encyclopedic knowledge of the intricacies of human neuroanatomy, he was superbly efficient.

Darlene Cooper held open the special brown rubber gloves that Mannerheim demanded. As he thrust in his hands, he looked into her eyes.

“Ahhh,” he cooed, as if he were experiencing orgastic pleasure from inserting his hands. “Baby, you’re fabulous.”

Darlene Cooper avoided looking into Mannerheim’s gray-blue eyes, as she handed him a damp towel to wipe off the powder on the gloves. She was accustomed to his comments, and from experience she knew that the best defense was to ignore him.

Positioning himself at the head of the table with Newman on his right and Lowry on his left, Mannerheim looked down on the semi-transparent dura covering Lisa’s brain. Newman had carefully placed sutures through partial thickness of the dura and had anchored them to the edge of the craniotomy site. These sutures held the dura tightly up to the inner surface of the skull.

“All right, let’s get this show on the road,” said Mannerheim. “Dural hook and scalpel.”

The instruments were slapped into Mannerheim’s hand.

“Easy, baby,” said Mannerheim. “We’re not on TV. I don’t want to feel pain each time I ask for an instrument.”

He bent over and deftly tented up the dura with the hook. With the knife he made a small opening. A pinkish gray mound of naked brain could be seen through the hole.

Once under way, Mannerheim became completely professional. His relatively small hands moved with economical deliberation, his prominent eyes never wavering from his patient. He was a physical person with extraordinary eye-hand control. The fact that he was short, five-foot-seven-inches, was a constant source of irritation to him. He felt he’d been cheated of the extra five inches to match his intellectual height, but he kept in excellent condition and looked much younger than his sixty-one years.

With small scissors and cottonoid strips, which he inserted between the dura and the brain for protection, Mannerheim opened up the covering over Lisa’s brain to the extent of the bony window. Using his index finger he gently palpated Lisa’s temporal lobe. With his experience the slightest abnormality could be detected. For Mannerheim, this intimate interaction between himself and a live pulsating human brain was the apotheosis of his existence. During many operations, the sheer excitement made him sexually erect.

“Now let’s have the stimulator and the EEG leads,” he said.

Dr. Newman and Dr. Lowry wrestled with the profusion of tiny wires. Nancy Donovan, as his circulating nurse, took the appropriate leads when the doctors handed them to her and plugged them into the nearby electrical consoles. Dr. Newman carefully placed the wick electrodes in two parallel rows. One along the middle of the temporal lobe and the other above the Sylvian vein. The flexible electrodes with the silver balls went under the brain. Nancy Donovan threw a switch and an EEG screen next to the cardiac monitor came alive with fluorescent blips tracing erratic lines.

Dr. Harata and Dr. Nagamoto entered the OR. Mannerheim was pleased not so much because the visitors might learn something, but because he loved an audience.

“Now look,” said Mannerheim, gesturing, “there’s a lot of bullshit in the literature about whether you should take the superior part of the temporal lobe out during a temporal lobectomy. Some doctors fear it might affect the patient’s speech. The answer is, test it.”

With an electrical stimulator in his hand like an orchestral baton, Mannerheim motioned to Dr. Ranade, who bent down and lifted up the drape. “Lisa,” he called.

Lisa opened her eyes. They reflected the bewilderment from the conversation she’d been overhearing.

“Lisa,” said Dr. Ranade. “I want you to recite as many nursery rhymes as you can.”

Lisa complied, hoping that by helping the whole affair would soon be over. She started to speak, but as she did so Dr. Mannerheim touched the surface of her brain with the stimulator. In mid-word her speech stopped. She knew what she wanted to say, but couldn’t. At the same time she had a mental image of a person walking through a door.

Noting the interruption in Lisa’s speech, Mannerheim said, “There’s your answer! We don’t take the superior temporal gyrus on this patient.”

The heads of the Japanese visitors bobbed in understanding.

“Now for the more interesting part of this exercise,” said Mannerheim, taking one of the two depth electrodes he’d gotten from Gibson Memorial Hospital. “By the way, someone call X ray. I want a shot of these electrodes so we’ll know later where they were.”

The rigid needle electrodes were both recording and stimulating instruments. Prior to having them sterilized, Mannerheim had marked off a point on the electrodes four centimeters from the needle tip. With a small metal ruler he measured four centimeters from the front edge of the temporal lobe. Holding the electrode at right angles to the surface of the brain, Mannerheim pushed it in blindly and easily to the four-centimeter mark. The brain tissues afforded minimal resistance. He took the second electrode and inserted it two centimeters posterior to the first. Each electrode stuck out about five centimeters from the surface of the brain.

Fortunately, Kenneth Robbins, the Chief Neuroradiology X-ray technician, arrived at that moment. If he had been late Mannerheim would have thrown one of his celebrated fits. Since the operating room was outfitted to facilitate X ray, the chief technician needed only a few minutes to take the two shots.

“Now,” said Mannerheim, glancing up at the clock and realizing he was going to have to speed things up. “Let’s stimulate the depth electrodes and see if we can generate some epileptic brain waves. It’s been my experience that if we can, then the chances of the lobectomy helping the seizure disorder are just about one hundred percent.”