How do you view your own brain? I’ve always felt mine was a “happening place”, where reality emerges on a fantastic screen. Thoughts of the nature of my brain have grown more significant to me as I contemplate brain surgery next month. When you begin planning for someone to cut into your brain, the misadventures of Anthony Weiner, A.K.A. Carlos Danger, and other similar thoughts seem very unimportant. Instead, you start thinking about the very nature of brain surgery.
First you consider the barbarity of having your head shaved, your skull drilled like a bowling ball (2 fingers only), and wires inserted from cortex through cerebellum to what some describe as “that reptilian part” at the base of the brain, allowing someone to fire electrical current through your synapses.
Then you can’t help but be amazed that medical science has reached a point where a surgeon and a team of mysteriously dressed acolytes can enter your cranium like good campers, pack it in and pack it out, and leave no trace of their presence except fine wires that allow your brain to recover lost capacities. This is all done with remote imaging combining the MRI and real-time Cat-scan imagery so precise that no blood is released, and the ancient part of your brain is connected to the marvels of modern science. It’s like Tarzan finally communicates with the chimp.
My thought process randomly switches from one view to the other as the date of the surgery looms larger on the horizon. Is this a search for perfection?
One of the interesting and perplexing problems facing those who have brain surgery for Parkinson’s or movement disorders and dystonia is that until recently there was no reasonable explanation as to why it works. It’s called DBS, which could stand for “Definitely Big Scam”, or it could stand for Deep Brain Stimulation, which sounds either erotic or New Age. The stimulation part is just a very low level of electrical impulse transmitted into your reptilian brain stem. To the best of my understanding what actually happens is a lot like the way sound canceling earphones deal with the problem of separating the signal from the noise for those centers in your brain that control movement. The electrical stimulus cancels the noise produced by Parkinson’s, leaving your brain more capable of discerning the signal to cause movement. This possibility is something abstract to most of us, but the various potential meanings of the concept have been made eminently clear by Nate Silver in his brilliant book The Signal and the Noise, which I highly recommend.
So how does one bridge between the barbaric and the amazing state of medical science? You can’t help but have a visceral response to the very idea of brain surgery. Rational friends and family member typically always say “it’s your decision…. I’ll back you up.”
But ultimately you must make the choice. I initially looked into doing the DBS (kind of sounds like a dance?) two years ago and decided against it. Recently I changed my mind, primarily because you now can have the procedure done while you are asleep. For years the procedure was performed with the patient awake so that they can tell how things are going. My fear was that I would not be reliable with 2 holes drilled in my head and my skull rigidly anchored with bolts to an operating table. It reminded me too much of strange practices with monkey brains in Southeast Asia.
The second reason I changed my mine is the improvement in precision that has been achieved with virtual imagery. The old practice of “fishing around” for the right spot has been replaced with the precise placement via three dimensional imaging. So I’m ready to go with virtual imagery and three-dimensional coordinates hoping the pilot (the surgeon) has more expertise than an Asiana Airline pilot.
The clincher is that Parkinson’s is a progressive disease and it has progressed to the point where more meds cause more trouble and less meds cause more trouble. There’s nowhere to go for relief at this time except DBS.
Luckily medical science has radically progressed in this area in just a few years. How did it happen? There was a marvelous blend of private initiative and public commitment to research, leading to the modern medical practices that have replaced the barbaric drilling of holes in skulls and bloodletting that represented best practice over the last few thousand years. Modern medical science is not perfect, as in the case where necessary medicines are not profitable, but there exists amazing people and ways of fighting.
Many of you would agree that most economists definitely need brain surgery. I asked one neurologist “while you’re in there you could figure out a way to balance the budget and achieve full employment?” He gave me a look that really said “don’t be a pain in the ass!” I nodded and proceeded to explain to him what it feels like when my medicine fails to work.
Once you’ve made the decision it is amazing how many of those close to you step up to the plate and swing for the fences on your behalf. It is an easy choice when you hear the sounds of grandchildren screeching with joy as they plunge head first down a 15 foot water slide to see who can make the biggest splash. You must get ready to join them, accepting the fact that life sometimes involves risks for the great rewards it offer.
Any 10 year old can make the decision because they are uncluttered by an obsession with perfection. I’ll get back to you on how it worked out for me
Dennis O’Donnell will undergo brain surgery on August 7th .