Kate of Late

Say hello to my little friend - Part 1 in a three-part series

WHEN a doctor calls you, you go on high alert. Normally as elusive as legroom in coach on an international flight, their sudden insistence on the personal touch sends up an army of red flags.

My doctor called me after I’d had an MRI as a precautionary measure. I’ve got a hereditary kidney disease that may one day affect my health. There’s nothing you can do about the disease, so as long as you’re healthy you might as well ignore it. However, it sometimes comes with a side order of aneurysms (weak blood vessels in the brain that might burst), so my kidney specialist had requested an MRI to make sure there was nothing brewing in this twisted noggin of mine.

An MRI is a weird experience in itself. Being told to lie on a bed and avoid movement as a coffin-like machine scans your head isn’t painful, but it is certainly off-putting. It’s not as unnerving, however, as having your doctor phone you with the cheerful news that you seem to be aneurysm-free, but you do have a benign tumour called a meningioma, growing inward from the covering of your brain.

“Uh-huh,” I said, numbly. “Well, I must say, that’s a bummer. Is it big?”

“It’s about 3 cm by 2.5,” she said, emphasizing that meningiomas are generally not malignant and not to worry. She’d refer me to a neurosurgeon.

After a few minutes of complete shock and then a brief flurry of tears, I was quickly joking with my husband about my “tume-a,” using it as tongue-in-cheek justification to weasel out of chores and obligations.

Six weeks later, the neurosurgeon was whacking me on my appendages to test my reflexes and quizzing me about whether I’d had blurry vision or seizures or headaches. He stood before me and got me to focus on his nose while he stretched his arms out and asked me whether he was fluttering his fingers. I guess tumours can affect peripheral vision.

My doctor, a handsome youngish man with delightfully clean breath and whiter-than-white teeth, showed me images of my brain. I was, of course, relieved to see that I had one. I wished I could take the photo home so I could, once and for all, win that bet with my family. But I wasn’t crazy about the white blob that appeared in the magnetic resonance image, representing the tumour on the left side of my brain, behind my brain stem. It was deeper than meningiomas usually go, said the doctor.

Some people, he noted, would be so disturbed by the idea of a tumour in their head, whether benign or not, that they would want it out immediately, “at any cost.” Others, he said even-handedly, would prefer to monitor it over time to see if it was growing. If it was getting larger, they might like to have it removed, a 3-hour (or so) procedure that would involve cutting through skin at the back of the head, then opening up a “bone flap” and going inside. Ewwwwww!

As he spoke, I struggled to avoid a repeat of the humiliation I had recently endured with a bout of seasickness on a bouncing salmon boat -- four hours of sprawling, head in hand, eyes closed, at the table inside the cabin, punctuated by tortured bouts of retching. It would not do to succumb to feelings of nausea and fear in this immaculate office, which wasn’t heaving, after all, on wind-tossed seas. It was only my perception of my life that was lurching desperately around the room.

There was no need to start blubbering, either. It’s best to save that sort of behaviour for diaper commercials featuring slumbering infants, or any movie starring Colin Firth.

The risks involved, he said, were “on the relatively low side.” The tumour, which was “probably benign,” was close to some vessels, and, with surgery, there was the potential for visual problems, a stroke, or seizures in the short term and maybe also in the long term.

I suggested that maybe there was a magical way of poking something into the brain, like, say, a turkey baster, to ensure the tumour wasn’t malignant, as the word “probably” was not giving me the burst of confidence doctors seem to imagine it produces. No, said the neurosurgeon, there wasn’t. If he were to go that far, it would be best to do an “excisional biopsy,” removing as much of the tumour as possible. Afterward, I’d be tested frequently in the “neuro-critical care unit” (no alarm bells there), and would stay in the hospital for three to five nights.

I don’t know how doctors perfect that persona, that demeanor that suggests “I care deeply and professionally, but not so deeply or professionally that I’m going to tell you to do one thing or another.” It’s a good attitude, really. It certainly discourages you, the patient, from making a scene. After all, it’s not the doctor’s fault you are such a loser as to randomly and inappropriately hatch an egg inside your grey matter. There’s no need to drag him into your henhouse of despair.

The idea is that the doctor is holding it together with ease, so you really ought to, as well -- even though you’ve just seen a lump the size of a ping-pong ball in the brain you hardly knew you had. Meanwhile, he will be leaving the office shortly in a sleek convertible en route to a wine-tasting weekend at Sooke Harbour House.

Still, better civil aloofness than the doctor himself collapsing in a puddle of anxiety.

We decided on a course of action that involved making no immediate decision. In three months, I would have another MRI to see whether the tumour had grown.

“Any sign of progression will mean we should get on with it,” said the doctor, in a tone that he probably thought wasn’t ominous.

I had said hello to my little friend. And then, for the time being, “Au revoir.”

Part II, in which the little friend becomes irritated

WAS it Dorothy Parker who once said “I’d rather have a bottle in front of me than a frontal lobotomy?”

The original source is in dispute. It’s inarguable, however, that the prospect of any kind of brain surgery is enough to drive an Osmond to drink. I myself heartily recommend Californian Cabernets, Argentinean Malbecs, or virtuously buying “local” with Mission Hill’s Pinot Noir.

As I mentioned in last week’s column, I was diagnosed earlier this year with a meningioma, a usually benign tumour on the lining of the brain. My doctor thought it would be fine to leave it alone and monitor it to make sure it wasn’t getting bigger. So three months after our first discussion, I went in to see him again, confident I’d be told that the blob was lying on my arachnoid as lethargically as a tequila-soaked tourist on a Mexican beach.

The second MRI had been uneventful, except it took hours to begin. I was startled to discover that the waiting room in that particular section of the Lions Gate Hospital offered nothing to read but 32-year-old National Geographics. And I’m not exaggerating for effect -- out of sheer desperation, I read an article written in 1976 about the Downtown Eastside (before it was even called the Downtown Eastside), and how it had been a rough neighbourhood but was getting better. Oh, the hilarity.

Anyway, my neurosurgeon was as immaculate and dispassionate as ever. I expected him to say nothing had changed and I was to come back every year or so until this little misunderstanding with my grey matter was put behind us. Instead, he said that although the tumour hadn’t grown, it was causing some inflammation, and was “nudging” my brain to the left. (I was skeptical. If that was the case, why hadn’t I voted Green in the last election?)

“It’s not just sitting there quietly,” said the surgeon. If we continued to ignore my little friend, it might eventually cause some “neurological deficits.” This might include visual impairments and seizures. But they might come anyway, even with the surgery, since the meningioma was close to the visual centres or optic tracks.

“This tilts things more in a surgical direction,” he allowed tactfully.

If I chose to have the micro neurosurgery, two doctors would team up for three to four hours to do the deed. It involved going around the brain “following the dura” -- which sounded to me like a spiritual trek involving Gwyneth Paltrow and Madonna -- to reduce the size of the thing.

Since I’m “young” (er, 50) and “healthy” (er, iffy), risks would be on the “relatively low side.” Of course, there was always the possibility of stroke. Recovery would take three to five days in the hospital, then some indeterminate amount of time at home.

Huh.

Alrighty, then.

Apparently sending me away to a farm, like an old dog, to spend my last halcyon days chasing rabbits was not seen as a viable solution. Just the surgery. Or the potential deterioration of my brain, etcetera, at some unexpected but likely inconvenient juncture.

Still, it was totally up to me.

It struck me during this discussion that most professionals couldn’t get away with the kind of position doctors routinely take. I can’t see a Prada saleswoman saying of that $7,000 suit you’re mulling over in front of the mirror, “Every outfit has risks. I can’t guarantee that you’ll knock people out when you put it on. I can only say that if you don’t buy it, eventually you’ll look even worse.”

It didn’t take much internal debate to realize that the meningioma would be best removed. Of course, your own worry is that after brain surgery you won’t be the same, that you’ll be a diminished version of yourself. Suddenly you’ll be Suzy Sobersides, unwelcome at any event -- and by that, I mean even more unwelcome than before.

Others, however, take the opposite view. My faithful pals, for instance, see plenty of room for improvement. They seem to regard brain surgery as tantamount to a computer upgrade -- while part of your skull is cranked open, it’s the ideal opportunity to install, say, spreadsheets, or a new language. One of my snider friends asked about my surgeon, “Does he take requests?”

Another keeps inviting me to be her “date” at various parties in the days right after my surgery. I guess she thinks an “occipital craniotomy” is like a fresh haircut -- what’s the point of doing it if you aren’t going to go out right away and show it off?

All I know is, this is a freaky thing to think about. As I write this column, I am worrying about going in for surgery tomorrow.  But while I was at LGH having some tests a few weeks ago, I met a woman who gave me pause. I could tell from what she said to the nurse about how to avoid her scar tissue that she had already struggled with cancer but was back to combat something else.

“What are you in for?” asked this beautiful, elegant woman, probably about my age. I didn’t know you could ask people things like that in hospitals.

“Benign brain tumour,” I said confidently, although the benign part is really just probable, not certain.

 “Wow,” she said in a friendly tone. “Lucky. At least you know it’s benign.”

 Her comment spoke volumes about her own predicament. I wished her luck.

As for me, so far, so good.

 

Part III, in which the little friend is ousted

They saved Hitler’s brain. Mine, they’re not so sure about.

When I opened my eyes a couple of weeks ago after my six-hour surgery to remove a brain tumour, I couldn’t read, because I couldn’t make sense of words, and half my peripheral vision was gone. Letters danced around on the page like crazy raindrops. People’s faces seemed to represent Picasso’s drunk period.

I was confused about all sorts of things. Not only couldn’t I remember, for example, what a quesadilla was, it was an exercise in futility to make even the smallest talk. A typical conversation post-surgery between my extremely patient younger sister and me went like this.

Me: That nurse who was just in here is really nice. She’s from … a war-torn place. I can’t remember the name of it. You know, awful.

Fran: Iraq?

Me: No. War-torn from before.

Fran: Lebanon?

Me: No. You know, really, really awful. Notoriously bad. Lots of people died.

Fran: Is it in South America?

Me: No, the other side.

Fran: The other side of what?

Me: The, you know, the, the, the … water.

Fran: Rwanda?

Me: Who’s on first.

Etcetera.

In tough times, I feel it’s best to turn to the comedians. Not the angry ones, who are usually mad about stupid things like taxes, but the comedians we like and relate to. In this particular situation, I considered revisiting Nora Ephron. The last time I’d looked, however, she was whining about how she feels bad about her neck. I hadn’t seen my neck in days, and my semi-shaved skull, with its 48 staples, looked like something Dr. Frankenstein warmed up on before the “big show.” Middle-aged griping about wrinkles was the least of my concerns. Ephron could Eph off.

So I turned to the Davids -- Sedaris and Rakoff. I had audio books by them on my i-Pod, complements of my wondrous husband, Stanley. I used to think an iPod was a cute little perk. Now I know that when your eyes are scampering like berserk gerbils, your portable music player is one of the few things that prove there is a sane world beyond your personal nut house.

If you don’t know David Sedaris, you should. He is a short gay guy from North Carolina with an odd family. A few years ago, he moved to France with his boyfriend, Hugh. The best thing about Sedaris is his shamelessness. He just doesn’t give a damn what anybody thinks. I can easily imagine him in my position, expressing his opinion of the results of his brain surgery in his charactertistic nasal voice.

“I know my inability to read or write or taste anything may not be your fault,” he would drawl at his neurosurgeon, blinking and squinting at the way the doctor’s face seemed to slide in and out of register. “But I’m blaming you anyway.”

He would then proceed to construct riotous humour out of the experience.

David Rakoff would have a more judgmental viewpoint. He’s a gay guy from Montreal who has lived in the U.S. for decades. He became an American citizen shortly after September 11^th, 2001, mainly because he didn’t want Homeland Security to have him deported.

While Rakoff generally steers clear of lecturing, he has a definite sense of right and wrong, one that largely corresponds with my own. In circumstances similar to mine, he would censure the surgeon too, equally unfairly. But he’d throw some “logic” into it.

After all, when a doctor advises that after surgery some patients might experience seizures, fatigue, and visual impairment in the long and short term, one can be expected to assume “He doesn’t mean me!”

Surely, we patients think, such warnings are just the requisite butt covering, and everything’s going to be all right. I mean, the comedians and I are not exactly “doctors,” but we naturally believe that unpleasant after-effects from surgery of any kind are for guest stars on prime time shows like House or Gray’s Anatomy, not us commoners.

When those fast-forgotten warnings (minus the seizures) proved prophetic, I just knew that my favorite professional funnymen would be on my side, rooting around for somebody to hold responsible. I love the Davids because they lead by example -- they’re smart-aleck underdogs who you know will thrive no matter what. I like to align myself, however immodestly, with them.

At the moment, I’ll admit that it’s disconcerting to have small hallucinatory creatures -- birds and such -- flinging themselves across my line of sight all day, along with careering wires, spinning tops, and tiny, isolated weather systems that include snow flurries and rains of gold. But maybe that is the real world and the rest of you are just missing out. The evidence suggests that Sedaris and Rakoff have seen their share of wacky interior weather, although in their cases the causes were likely chemical rather than surgical.

Anyway, things are slowly getting better. The odd dish now occasionally tastes of food, for example, which is certainly pleasant for me as a food writer. And even if I can’t remember how to spell juggernaut, I can get the gist of the shorter greeting cards people kindly send. I know my ability to read will return, because it’s inconceivable that it won’t.

To that end, I have rehab to do, and appointments have been set up for me at the hospital. I can’t drive (for which you should all be grateful). As a result, I’ve come to realize that the least sexy phrase in the English language is, “Just waitin’ for the handi-dart!”

Happily, my meningioma was benign, as they usually are. The Lions Gate Hospital has treated me well. My doctor was excellent and remains encouraging. I have plenty to be thankful for.

Stanley does my reading for me at present, and helped me get this column on the page. I hope to return to this spot early in the new year and apologize for the fact that, for the next month or two, you will have to do without 1,000 words on the lamentable demise of Playgirl magazine -- at least, 1,000 words from me.

Read something good over the holiday season, will ya? It’s a funny skill to take for granted. You can’t imagine how much you’ll miss it until it’s gone.