Tale of Two Sisters

Some time ago I operated on two patients. Both were women. Both were in there 60’s. Both had meningiomas of the brain. And in both cases their tumors grew back after surgery. Interestingly both had elderly husbands that passed away during the course of their illnesses.

Both were happy women, full of life…they could have been sisters.

Miriam Wilson had been developing some memory problems for some time. When she initially saw her primary care physician he told her husband what he had feared…she might be developing Alzheimer’s disease. Towards the end of 2006, however an MRI scan was performed which revealed that in fact she had a large ‘benign’ brain tumor.

She had an appointment to see a neurosurgeon after New Years day, 2007, but because her condition deteriorated so quickly in late December, her husband Carl brought her to the Emergency Room at my hospital. On arrival the physician on duty found she had significant paralysis of the right side of her body and was so difficult to arouse, he reported to me by phone, she was somewhat comatose.

In fact her condition was so serious within hours of arriving at the hospital she had to be intubated and placed on the ventilator. I made plans to take her immediately to the operating room to remove her tumor.

Following surgery, Miriam woke up and in time she became her usual happy, almost comical self. Her weakness improved as well.

Unfortunately, because the length of her surgery was so long, 7 hours to be exact and because I had to replace her natural skull with an artificial plate she developed and infection which persisted despite antibiotics. So, two months after her initial emergency surgery, I had to take her back to the operating room and remove this plate.

I tried to avoid doing this because I knew it would leave a large sunken area in the frontal part of her head. In spite of this obvious cosmetic defect, Miriam was her usual carefree self.

Fortunately I would able to reconstruct her skull once the infection cleared but Miriam would have to wait 6 months before that could take place.

Inexplicably, while Miriam waited to have this surgery, she began developing memory problems once again, but not because the tumor had grown back.

Ultimately I replaced the defect in her skull and her memory problem reversed within 6 weeks.

Miriam then continued to do well, and I did not hear from her for about two years. It was then that she developed an inability to speak. A repeat MRI scan showed that the tumor had come back. Not only that but it was larger than it was when I had first operated on her.

This surgery was without complication and ultimately she recovered and once again brought a smile to my face every time I saw her.

You would think being through everything she had she would have become somewhat bitter or even angry. But this was never the case. She always had a smile and laughed through it all.

At this point I thought for sure I had seen Miriam for the last time.

This was not to be the case, however.

Two years later almost to the day, Miriam wound up in the hospital once again. This time she had developed not only a recurrence of the infection, but it had spread to the surface of her brain as well.

Once again I took her back to surgery, this time, to clear up the infection.

Two days after surgery she was sitting up in her bed laughing and making me smile as she shook off having had to undergo her fifth major brain operation in less than five years.

Carla Winters was the other ‘sister’ I had operated on. She had a similar course that Miriam had, having developed an infection after a very long brain operation. She too had to have a portion of her skull removed although it wasn’t as damaging cosmetically.

Her tumor, too, recurred and I had to perform another surgery to remove it, although Carla’s tumor was much more difficult to remove completely because of where it was located.

The tumor had grown in between the two halves of the brain straddling a major vein. Any damage to this vein would result in either a major stroke or death.

As time passed, this vein gradually occluded to the point where the brain developed alternate paths of circulation. Because of this, I believed it was possible to remove that section of the occluded vein along with the remaining tumor without causing any complication.

Within a week of Miriam’s last surgery, I operated on Carla Winters for her fifth major brain operation as well. The surgery went extremely well. I was able to remove the entire remaining tumor. Unfortunately, the outcome was not what either of us had expected.

After surgery, I was completely shocked to discover Carla was completely paralyzed on the left side of her body. Because of this she would never walk again.

Initially I had hope she would recover and I encouraged her to work hard at rehabilitating but after a month of intensive physical therapy, she did not have any meaningful improvement.

Three months after her surgery she was hospitalized again.

When I went into see her she appeared weak, discouraged, and completely exhausted.

After speaking with her and her family it was clear she had accepted the finality of her condition. She was tired of fighting, and in this moment I think she missed her husband most of all. Collectively they had decided to move her to inpatient hospice.

As I talked to her and held her paralyzed left hand I felt sorrow. Carla was in this condition because of a surgery I had performed and there wasn’t anything I could do to reverse it.

Not knowing what to say I looked at her and told her I would see her again someday. Her eyes seemed to tear up a bit as she thanked me for all I had done.

As tears began to well up in my eyes, I told her I loved her and she replied the same. I leaned over and gave her a kiss on her cheek and turned and walked away.

Carla was in hospice less than a week before she passed.

Several weeks later, Miriam returned to the hospital because of a seizure. After she was placed on an anti-seizure medication a follow-up MRI scan was performed. I was dismayed and saddened to discover her tumor had recurred again. Not only that but the tumor had spread all over her brain.

Had I not known her initial diagnosis I would have thought she had cancer.

I sat down with her to discuss her options. She smiled broadly as she always did, but as I revealed to her the true nature of her condition she stopped smiling and began to get a bit choked up as she realized there wasn’t much I could do.

So, rather than risk a major degree of paralysis or loss of speech she decided to go home, be comfortable, ready to accept the inevitable whenever that would be.

She thanked me as I stood up. I leaned over and gave her a hug and said goodbye.

Miriam and Carla were two amazing women who were inspirational in so many ways. They were both vibrant and determined. They were hopeful and both persevered despite seemingly overwhelming odds. In the end, they accepted the inevitable and even embraced it, I believe, as part of God’s plan.

Soon, these ‘sisters’ would meet each other.

And one day, I too, hope to see their smiling faces once again.

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