What It Is

“It was tough, but I got you in to see Dr. Smith tomorrow morning”

I was sitting in the waiting room of the Neuro-ophthalmology office, waiting to hear the results of the MRI I had just undergone. Unfortunately I received the bad news through the scheduler. I knew who Dr. Smith was, I knew he was a neurosurgeon and I also knew that in order to see a neurosurgeon there had to be something to take out. Moreover, the fact that I was seeing one the next morning meant that it was something relatively urgent.

Let me explain what brought me to that moment: It was Monday March 18th,, 2013 that I awoke with double vision. I frequently get asked about the double vision- thinking back to that time the only way I can describe it is that there were two side by side images of everything I looked at. It wasn’t bad at first; in fact I was able to work for two days with the vision changes. I work as a resident physician in a clinic in Lansing, Michigan. The double vision was mild enough that I could trudge through Monday and Tuesday of my clinic, only complaining to the medical student once or twice about the double vision and resulting headaches. (I’m one of the lucky few who has never had a headache before but I have to admit that this was causing me to finally realize what nearly 75% of individuals have felt). [1] The visual disturbance kept progressing until finally on Wednesday of that same week I pulled my Family Doctor aside and told him about my symptoms. I told him that I had originally thought that this was some form of a complex migraine, but I thought that he should know. I had seen many Complex Migraines during my training and they had often manifested with visual complaints (that is one of the few downsides to having an MD after your name, you’re taught not to first think of rare conditions, i.e.: a brain tumor. I can picture one of my medical school professors telling me, “Always think of common conditions first!”). Fortunately in his experienced eyes this was no complex migraine. “You need to be seen by a neurologist right away, let me give Dave a call.” I could not hear this neurologist on the other line but Dr. Pearson’s responses told me all I needed to know (Dr. Randy Pearson, my family doctor). “You can see him right now? Ok, I’ll put that in.” He hung up the phone and turned to me “Chris, Dr. Kaufman will see you right away, he wants to get an MRI of your brain first.”

————————- The Neurologist’s Office ———————–

That brings me to that visit with me sitting in the waiting room, getting news through their scheduler. “Christopher? Dr. Kaufman will see you now” a medical assistant told me before she took me back to an exam room. I was nervous, I knew it was bad news but I didn’t know exactly what the news was. My wife arrived, my heart rate went down. I’d never admit this to her but she has a calming effect on me. I hated to worry her but I needed her there so I finally called her to tell her of the upcoming MRI and appointment. She is also a Family Medicine Resident, in the same year of training as me. I could hear the concern in her voice when I called her- she is much smarter than me, so I’m sure she knew something was wrong from the get-go.

My family: From left to right: Christian, Zoe(my dog), Fleur, me
My family: From left to right: Christian, Zoe(my dog), Fleur, me

Dr. Kaufman walks in and breaks the news to me. “Chris, let’s talk about your MRI. Why don’t you have a seat?” He tells me as he shakes my hand. “Fleur? Good to see you. Are you comfortable?” I’m used to this question as she’s 8 months pregnant. “Chris. They found something on your MRI,” he went on, “the good news is that it looks benign, but there is no way to absolutely know unless it is taken out.” He was good, there are whole courses in medical school designed to teach students how to deliver bad news, I’m sure if he had been graded on our encounter he would have received perfect marks. The rest of the visit seemed like a blur to me, but I do remember him saying that the appearance on MRI led him to believe it as an Epidermoid Cyst. The reason I remember him saying that is that my little sister had a similar growth in one of her ovaries. “Was this genetic?” I thought to myself. “I’ve scheduled you to see the neuro-surgeon right away tomorrow morning”

Dr. David Kaufman, MSU Neurology
Dr. David Kaufman, MSU Neurology
A schematic of the brain- my tumor was in the posterior fossa next to the cerebellum
A schematic of the brain- my tumor was in the posterior fossa next to the cerebellum

——————————- Telephone Calls ——————————–

Once I stepped out of the office I turned on my phone and called my mother. Whenever I meet someone else from either Taiwan or China, the topic of our mothers inevitably comes up. The words “she’s a tiger mom’ ultimately comes out of both of our mouths. But as I say this to others I know I’m selling her short. It’s a gross understatement. This is a mother of three, who devoted her career to Emergency Medicine, working 24 hour shifts in the Emergency Department as the lone physician. Her eldest daughter, my older sister Amy, was so talented in her violin skills that she was accepted to Julliard. However to mention her talent seems to detract from her hours and hours of hard work, pushed by my mother. She declined Julliard in favor of pursuing a career in medicine, at the prestigious Yale University. To her, Yale did not cut it, so she pushed me to excel in both my tennis and my academics so I could attend Harvard University, and also eventually into medicine. My youngest sister, probably the smartest of the bunch, rebelled and went into finance. This was all accomplished because my mother pushed us in every aspect of our lives. This, though, was out of her control: a brain tumor could not be outworked. That is why her reaction to my news was so memorable, “’I’m going to call your sisters. When is the neuro-surgery appointment? I’m on my way there.” (She has the habit of throwing questions in between statements. I attribute it to the millions of thoughts that must be racing through her head).

I then call my sisters to tell them of the news. Somehow my mother has managed to call them first. My older sister answers the phone in tears, telling me that everything will be alright, that a good friend of hers is now a neurosurgery attending physician at The Massachusetts General Hospital. She tells me that she is going to call him right away. My younger sister, also in tears, tells me that she has already booked airline tickets to get in the next day.

My family: From left to right: Amy, Pearl (my mom), me, Alice
My family: From left to right: Amy, Pearl (my mom), me, Alice

————————Neurosurgeon(s)———————

The next morning, Thursday, I go to see Dr. Smith, the local neurosurgeon. He tells me not to worry and that this is a benign tumor, with the only true ‘cure’ being to take the mass out via surgery.

“What will you do in the surgery?” My wife asked him

“I’ll literally go in and suction out the mass.”

“What’s the recovery process like?”

“Pretty quick. You’ll be in the Neuro- Intensive Care Unit for a couple of days, then I’ll have you moved to the [General Medical] floor for approximately 3-4 days.”

“How long will the recovery take?”

“Should only take 2 weeks.”

He scheduled the surgery to be done the next Tuesday.

We still thought that we ought to get a 2nd opinion, so we went to the neighboring University of Michigan, with a world renowned neurosurgery department. We were lucky in that we got in quickly with an appointment with one of their top neurosurgeon’s Dr. Stephen Sullivan. He walked into the room and warmly greeted us. He went over the MRI with us (this seemed like the 50th time I had seen it) and ultimately said, “Chris, I’m a very experienced neurosurgeon but if it were my son I’d want the best possible surgeon performing this particular surgery. That’s why I’ve called Dr. [Cormac] Maher, one of our best pediatric neurosurgeons to come see you. He does these types of surgeries way more than me, albeit on younger patients.”

I was completely blown away. In the span of two days I had seen two different neurosurgeons. As a practitioner I have acted as both the physician giving the second opinion and been told that after seeing me the patient wishes for a 2nd opinion. My assumption was that both scenarios ended the same: the physician giving the second opinion says the same thing as the first one. I assume this for a few reasons- 1. Even though we may go to different medical schools, or get our residency training at different places we still learn from the same textbooks; thus our a medical opinions will be the similar. And 2. Medicine is a very algorithmic profession. There are countless numbers of papers and ‘decision rules’ that serve to guide physicians. (For example if a 63 year old male smoker, with type 2 diabetes comes to the Emergency Department complaining of chest pain there is an algorithm that tells the physician exactly what to do[2]). Thus I deduce that most of our decisions are the same. But here were two physicians in the same field with two very different responses.

Dr. Maher walked in, smiling warmly with one of the first things he said to us being an apology. “I’m sorry for making you wait, my name’s Dr. Maher, I’m one of the pediatric neurosurgeons here,” he went on, “Chris what we know is that you have a mass in your brain, unfortunately we don’t know what exactly the mass is. It looks benign on the MRI but until we get it out and look at it under the microscope we won’t know if it’s a malignant tumor or not.” The rest of the visit was a blur to me. Up until now I had assumed that this was a benign, harmless tumor (If there is such a thing). Even the chance that this could be an invasive, malignant tumor scared me.

“I’d like to operate sooner rather than later, how does next Thursday sound?”

I don’t even remember saying ‘yes’ or even signing a consent (which I must have done) because my mind was spinning. A malignant tumor could mean chemo- or radiotherapy . It would also mean that my lifespan was significantly shortened. This was the first time during this ordeal that I as faced with the prospect of death. Even after first hearing of this mass in my brain, because the words ‘probably benign’ were always connected to it, it had not crossed my mind that this could end my life. What was strange was I did not fear death for myself I feared it because the effects it could have on my family.

Dr. Cormac Maher University of Michigan Neurosurgery
Dr. Cormac Maher University of Michigan Neurosurgery

According to the Center for Disease Control (CDC) approximately 40,000 people took their own lives in 2010.[3] I’ve often told people that I believe suicide to be the most selfish act that someone can commit (yes, more than theft, adultery, or even murder). I’ve had to deal with suicide many times (before a career in Family Medicine I trained in the Emergency Department for a year where suicide attempts are a daily occurrence), and my thoughts always immediately go to the suicide victim’s family. They are left to deal with the aftermath. Thus the thought of my own death made me think of my family.

On the drive home my phone was flooded with texts as news of my tumor had spread throughout my program. One of these texts was from one of my phone was flooded with texts as news of my tumor had spread throughout my program. One of these texts was from one of my closest friends in the program, Megha Tewari saying “I’ve looked up this Epidermoid tumor, and it looks pretty rare. What did the surgeon say?” I did not and have not done any research on the tumor, which goes against my normally inquisitive nature, but I figured the less I knew the better. I did not want to read about the prognosis of the tumor, or even the surgery itself (which I found ironic, I always tell my patients to try and gain as much knowledge as they can about their medical conditions). The double vision was getting worse, the surgery day could not come soon enough.
[1]World Health Organization, http://www.who.int/mediacentre/factsheets/fs277/en/
[2] Gerber, Thomas, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848418/
[3] CDC, http://www.cdc.gov/nchs/fastats/suicide.htm

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