May 28

What Comes to Mind When Researching My Mother’s Upcoming Brain Surgery

Take a look at my new toy
It’ll blow your head in two, oh boy
Truth Hits Everybody, The Police

I almost never refer to my mom as mother unless I’m joking. But as my research plunged me deeper into this awesome and awful technology, mom simply felt too informal. Whose lucid mom volunteers for brain surgery, anyway? Every little thing a mom does is magic: she bakes chocolate chip cookies; stirs corn starch into a bubbling paprikash; rolls tender leaves of cabbage around peppered beef; crochets afghan throws; knits booties and sweater vests of her own free will. Only a wacky mutha could sign on for a metal rod sunk through bony temple, smuggled past the parietal cortex, down deep to a dysfunctional sub-thalamus, the last stop before medulla oblongata.

Hearing my mother’s brain surgery had been scheduled for this June – two surgery dates actually, weeks apart (she qualified for an electrode implant in each hemisphere) – what had first come to my mind was, how will this interfere with my annual summer visit? Cheryl, wife and enlightened voice asked, why don’t you plan your trip to coincide with your Mom’s surgery? Your sister would probably like the help.

The truth hits everybody, and mine arrived like a freight. In line for brains, I thought they said trains and asked for one with frequent stops. Is there a part of the brain evolved for empathy, and if so, would a scan of mine reveal a stone cold Homo neanderthalenthis: dormant, unlit, inactive?

On the other hand, if you’d told me years ago my mother would slowly evolve a disorder of the brain, I’d have replied, Tell me something I don’t know.

Step 1: Attach stereotactic frame

The immobilizing stereotactic frame for deep brain stimulation surgery will be pinned to my mother’s skull in four places.

In college in the mid-80’s, home for the summer, I had a bud to hang with: P was a stout, salt-of-the-earth dude, shock of dark hair, the starting center and captain of our high school football team. Always in the middle of things, chick magnet and surprisingly thoughtful listener, P was the hub of our summer booze crew. He’d eventually come to marry a striking woman, have a successful career in banking, and father three thriving children. Early in his career as irrepressible loan officer, he’d befriend his newly minted clients and invite them to join us, his crew, out for brews.

One spring night, P dove head first into a shallow pool of water at a fraternity party and broke his neck.

P wore a halo brace. Seeing P after the accident was a shock. Here I was, loose-limbed and vigorous, running 10k’s, bicycling country miles, shoveling stone shirtless on township roads, yet there was P, upper body immobile, a limpness held erect, shoulders shrinking, jailed in metal. But P was part of our crew, home for the summer, and he wanted to party.

The halo fastened to his skull at four points by metal screws. Four vertical bars secured the halo to his body harness. In the nightclub parking lot, the boys and I waited as he extricated himself from the car. The contraption that imprisoned P’s body seemed a barrier, but more to us, as it turned out, than him. P surprised us when he disobeyed doctor’s orders, tossing back a Bud Light, and we enthusiastically followed, prying beer caps off his metal protuberances. We strobed to The Police’s So Lonely, bouncing off one another, surrounding P, on his toes, eyes darting left, right, doing the robot. And then, disco ball sparkling, Sting screaming – I feel so lonely, lonely, lonely, low, I feel so lonely! – P clumsily assumed the horizontal, lying on his back, pulling up his knees as one of us grabbed his halo, twirled him around, P’s own spin on break-dancing. Welcome to this one-man show. The night over, extricated from the car, P grabbed hold and jiggled his halo, undulating skin on his sweaty forehead. Clearly, P had a screw loose.

Topical ointment did not touch it. What caused a sty anyway? I asked, hoping to prevent this predicament ever again. The ophthalmologist said, eyelid hygiene. What, like washing my face? Yes.

The waiting room was busier than I expected for 6:45am. I scanned the room for condemned looks, but saw no one else waiting for their eyelid to be flipped inside-out and cauterized.

In the ophthalmologist’s chair, I tried to calm myself with the mantra: sooner it starts, sooner it’s over. I tried rationalizing: I did not want my eyelid flipped inside-out – or I did. I wanted my un-swollen eye back. So I did want my eyelid flipped inside-out. Invert both lids while you’re at it, Doc, take my pic: the horrifying underbelly of ruptured capillaries.

To cope, I imagined the feeling of awe that comes with surviving, departing a medical center, from the freedom of the parking lot, witness to a heart-swelling expanse of blue sky.

I set my chin in a cold metal stirrup. A strap cinched across my forehead. This was unexpected.

I didn’t like my opthalmologist. I resented even having one – my opthalmologist – let alone an arrogant one. He was bald and short, but behind his mask, tools in hand, imposing. I heard a sizzle, smelled burning, like meat in a hot skillet. Threads of blue smoke twisted up beyond his shiny head.

The next moment, the doctor’s mask was off. Finished already? He looked unnerved, removing his hand from my shoulder. The doctor said “You went for me.” I noticed a pin-prick of blood on the back of my swelling hand. “Not a good idea when I’m holding a knife near your eye,” he added unnecessarily. Turns out, I’d fainted. I lifted my chin from the cold stirrup untreated, eye untouched, disappointed but filled with a new sadness: I had a newly excavated facet to my identity: frail, dainty flower. A quivering petal of a man, I was a trembler who didn’t wash his face. I wondered if passing out this once left me prone to a future of fainting.

I used to like horror movies. I had watched, wide-eyed, the original Halloween with Jaime Lee and Friday the 13th. Recently, I averted my eyes at anticipated gore as blindfolded Sandra Bullock listened for birdsong, rafting with offspring as they fled the crazed, aster-eyed. I see no entertainment value, my emotions paddle-whacked, manipulated so bluntly. Is this a byproduct of fainting a decade ago? The ophthalmologist had left me with, “We’ll reschedule, okay partner? But next time, eat breakfast. And take a Valium.”

At the start of Mary Shelley’s Frankenstein, long before there were Iditarods, there was Victor Frankenstein on a quest, alone in the arctic on a sled with his dogs, emaciated and near death. Frankenstein was chasing his loosed monster (also on a sled) across the frozen plain when, upon rescue by Captain Walton aboard an exploratory arctic ship, Frankenstein had immediately collapsed and fainted.

From the arctic ship’s deck, Captain Walton had first spotted through binoculars, not Frankenstein, but Frankenstein’s monster, “a being with the shape of a man, but of gigantic stature” pulled by dogs.

The novel Frankenstein begins with a series of letters from Captain Walton to his sister. He’s explaining the mission of his trip (nothing to do with Frankenstein). He writes, “I may there discover the wondrous power which attracts the needle…” The needle is a reference to a compass needle. A major academic pursuit in Mary Shelley’s time, early 19th century, was the link between electricity and magnetism.

Step 2: MRI scan

A magnetic resonance image of the brain is required to navigate the lead wire and ultimately place the electrodes inside.

Metal jewelry and bracelets must be removed prior to entering an MRI machine. As the MRI cranks up, its changing magnetic field can induce a magnetic field in a metal loop, conceivably wrenching a bracelet from a wrist. Racing electrons cruise the periphery of the heart inducing a magnetic field around the heart. I don’t suppose an MRI is capable of magnetically lifting a heart, the force too small, but a perceptible nudge?

The brain is an electric organ too. Strong magnets waved near the brain have been shown to alter emotions.

The earth’s magnetic field protects us, its inhabitants, from the bombardment of high-speed particles. Sub-atomic space invaders with enough energy to penetrate earth’s magnetic shield do so by winding along magnetic field lines in helical paths, dive bombing at Arctic and Antarctic poles, lighting up the polar skies, creating the enchanting auroras. The ethereal swirls of released photons, courtesy of outer space, are sublime.

Life teems magnetic. Magnetotactic bacteria have magnetic particles in their bodies. Subjected to magnetic fields in solution, the dipolar bacteria, afloat, reorient themselves like compass needles. Researchers attach bar magnets to the backs of birds to test whether, navigation confused, they’ll migrate north for the winter. Electric eels detect changes in earth’s magnetic field to locate and ride ocean currents. Sharks are repelled by magnetic fields; enterprising salt-life capitalists sell magnetic anklets to beachgoers. Life travels magnetic.

Step 3: Skin and Skull Incision

I flew north to Cleveland Ohio last summer and saw P for the first time in two decades. Three decades since the accident, his forehead scars were still visible.

On the day of surgery, a strip of hair will be shaved from the forefront of my mother’s head. Two holes drilled the size of quarters.

Skull remains from 2000 years ago show evidence of brain surgery. Some patients survived the assault, their skulls showing signs of regrowth like fire scars in tree rings. In the early 1800s, a surgical technique to calm the psychotic was to drill into the upper eye socket and scrape away chunks of frontal cortex, a brutal but effective process in the sense that patients were calmed. An unfortunate side-effect, they lost significant cognitive function, in other words, became walking zombies.

In 1850 (thirty years after Mary Shelley’s Frankenstein was published) a doctor with a customized, hand-crank drill, bored into the brain of an epileptic man and removed, for the first time in medical history, his entire hippocampus. The hippocampus was not known at the time for being central to memory. The man’s seizures were reduced; his memory wiped clean.

I remember the first time I heard The Police’s “Roxanne” circa 1979. I didn’t like it. I was fourteen, way into the domestic Foreigner’s “Hot-Blooded”. Sting’s voice was cold and shrill, the reggae beat too foreign for my 14-year-old ears. But I loved the chugging chorus when Roxanne, put on the red light kicked in, the hook irresistible. Something tribal, below consciousness, I kept listening.

Located below the thalamus is the oldest, most important part of the brain, the part governing every breath you take, your swallowing, your heart rate: the medulla oblongata. It’s on a throne, in a critically fundamental position, perched atop the brain stem. To me, the words “medulla oblongata” sound like a long lost Police album in the 80’s, never released, between Zenyatta Mondatta and Regatta de Blanc. On Zenyatta Mondatta, the song “Voices Inside My Head”, consisted of just two phrases repeated:

Voices inside my head
echoes of things that you said.

You may know it by the tribal rhythms and Sting’s groovy bass beat, but mostly by the aggressive chanting: chalk! chalk! tschalk! tschalk! shock! shock! shock!

Step 4: Insert Electrode in the Brain

Frankenstein’s monster supposedly had neck bolts, like jumper cable contacts. In the 1815 novel, a lightning strike jump-started the monster, galvanized to life. In the 1931 Hollywood movie, Boris Karloff wore neck bolts. The bolts were Hollywood creations, never described in the Mary Shelley text.

The shakes occur when muscles in the arms and neck receive errant signals from a dysfunctional brain, a misfiring thalamus that shoots tiny electrical pulses every which way, scattershot, like a bumbling, former vice-president swinging on quail, signaling in error the muscle to contract. A simple act like drinking from a glass becomes an embarrassing, sloshing endeavor.

When Primidone and Propranolol cease to reduce symptoms, surgery called deep brain stimulation is considered. This involves drilling a small hole in the skull and implanting an electrode to send electrical pulses to the thalamus, blocking the impulses that cause the tremors. Fighting mis-fire with fire.

Essential tremor affects 7 million people in the US.

Early in my online research, I was astonished by a drawing of a human head fixed in an elaborate metal harness, an alien helmet, face heavenward, an electrode driver plunged into its forehead, like an arrow from the bow of some dead-eye fallen angel.

The blunt insert revolted me. I kept putting my skull inside that contraption. Before I’d seen the image, my mind had defaulted to kinder, gentler surface contacts, like electrode patches for an EKG. Or maybe a dentist’s tool, a brain plaque remover, probing, picking, scraping off neural detritus. At worse, a tiny notch cut into otherwise dormant gray matter. The drawing of the impaled head in the stereotactic frame was too much, the thin bar jutting up from its fleshy temple. It was likely a conscious decision by the website designer to cast this part of the procedure with a cartoonish drawing rather than a photograph. My problem was not lack of empathy, I put myself in that chair. I put myself there, head pinned, immobile, desperate to move, overcome by blind terror, my head a fulcrum, my torso wrenching up in a panic like the curl of an impaled insect.

I finally realized the rod dropped through the forehead wasn’t actually puncturing brain tissue. The electrode lead was directed between hemispheres, snuggled past the temporal, around parietal lobes. Like jiggling a stirring rod past cubes of stacked ice in a tall glass, or a salad tong slipped past the odd lump of fruit in a basket, past the peach, up alongside the pear, careful not to skewer and leak juices.

Step 5: Stimulate the Brain Cells

My mom will be conscious the entire six hours in surgery with minimal anesthesia. She’ll need to answer questions and perform tests as the surgeon maneuvers the electrode into various positions and plays with the pulse programming. There is a Youtube video of a concert violinist with essential tremor undergoing surgery. His career effectively over, he could not draw his bow across the strings without shaking. On his back, head immobilized in a stereotactic frame, he’s holding his violin surrounded by a team of gowned professionals. A sound engineer has mounted an accelerometer to his bow and programmed it to track the bow’s motion. A lead from the bow powers an oscilloscope for visual feedback. While the surgeon tweaks the firing rhythms of the electrode, he asks his patient to play a song.

For the surgery to be a success, I’d like to see my mom deliver a fork to her mouth, steady a full wine glass. From there, break an egg, flip over easy. Next, a deft roll of her Comfort-Stick Titanium Rotary Cutter, an essential quilting tool. To say Mom likes quilts is to say Ellen DeGeneres likes jokes or Magic Johnson likes hoops. It’s her life. Her tremors had gotten so bad, a circular cutter could’ve left her zippered like Frankenstein’s monster.

Wouldn’t it be wonderful if mom might take into surgery, not her Titanium Cutter and bolt of fabric, but two darning needles and skein of yarn. Affix an accelerometer to a darning needle, track its motion like the bow of the violinist. The surgeon, stimulator adjustment dial in hand, says, “Let’s try a single rib stitch, Sybil. Knit one, purl one.”

I recently attended the Intel International Science and Engineering Fair in Phoenix, April 13-17. The keynote speaker, Feng Zhang, a 37-year old MIT research scientist, pioneered optogenetics, the use of visible light (rather than damaging, higher energy radiation) shined on parts of the brain to modify behavior. Zhang showed a clip of a mouse controlled by a fiber optic cable burrowed in its brain. A blue dot of light shone from the translucent cable atop its tiny head. The mouse walked in circles: first counterclockwise, when the left hemisphere light activated its right legs; then clockwise, when the right hemisphere light activated its left legs.

Step 6: Closure

Once the surgeon has properly placed the electrode in my mother’s left hemisphere, the hole in her head will be capped to secure the wire lead. Extra wire from the lead is coiled and left under the cap in her scalp to be uncoiled and connected to a transmitter in a later procedure.

Mary Shelley may have written Frankenstein, in part, as closure for her own life’s tragic birthing stories. Mary Shelley’s mother died a week after Mary was born. Sixteen years later, Mary Shelley, pregnant, lost her baby, the first of three she’d lose in childbirth.

One reading of Shelley’s Frankenstein is that of unwanted birth; Victor Frankenstein was unable to care for, or love, his offspring. When the creature first rose from the table, alive, Frankenstein ran away in horror. The doctor abdicated all responsibility.

I worry about my responsibility writing this essay. Is it insensitive? Am I tempting fate, inviting bad luck? What if mom reads it before her surgery? Will it scare her or will she brush it off?

Cognitive inhibition is a term used by neuroscientists to define a person’s ability to reject supernatural explanations. Seems we all have superstitious instincts, some cling to superstitions stronger and longer than others. There are believers and there are skeptics. The right interior frontal gyrus is activated, as evident in brain scans, when skeptics fail to accept a supernatural or magical explanation.

I suppose my right interior frontal gyrus flares when I skip past the Police song, “Spirits in the Material World.” Andy Summers is quoted saying he doesn’t like the synthesizers either. It’s the first song on their third album Ghost in the Machine. Sting named the album after a book by a psychologist who’d crafted a theory of behavior based on two parts of the brain: the reptilian, emotion-driven and the logical, reason-based.

To succumb to irrational fear, that something bad might happen by posting this essay prior to my mom’s surgery date, then I’d have to believe some divine being is not only reading my blog, but seeking vengeance. Nevermind gods, I can’t even get my longtime friends, the old high school crew, to read it. One friend is a high school English teacher, advice I could actually use. Another friend, free with advice, complains my pieces are too long, this from a guy who – I am not kidding – reads Dostoyevsky and Tolstoy for fun.

Zeus was a vengeful god. He punished Prometheus for stealing fire from the gods and giving to mankind. Fire for mankind was a metaphorical mixed blessing: the power of knowledge; the curse of technology.

Not commonly known, Frankenstein has a subtitle: The Modern Prometheus.

There is a mother-daughter biography that combines the life of two Romantic writers and thinkers, Mary Shelley and her mother, Mary Wollstonecraft. The title is Romantic Outlaws.

The Police’s first album title, Outlandos d’Amour, roughly translates as Outlaws of Love.

I think of my mom unable to quilt, the social core of her life. Gifts from my mom over the years have included quilts for our bed, quilts for the wall, Halloween-themed quilts, Christmas-themed, Thanksgiving table-runners, coverlets, framed art, cup mats. Mom texted me after she’d completed the battery of personality and physical tests, tests for depression and Parkinson’s: I qualify for the surgery. I’m so happy.

Romantic literature was a movement away from the Enlightenment of the Scientific Revolution and scientists like Galvani, the Italian who searched for the hypothetical force, elan vital, that gave rise to life, by sending electricity through frog corpses and getting their legs to twitch.

The 19th century Romantics in literature and painting used their art to express tremendous emotions like horror and awe, sadness and joy. Romantic paintings often depicted ships tossed about in raging seas. Frankenstein was considered the first horror novel.

Step 7: Implant the Stimulator

The skull cap is lifted. The coil of wire stored in the skull is manipulated beneath the skin, dropped behind the ear and down the neck, like stereo wire behind drywall, to the neurostimulator. The neurostimulator, pacemaker for the brain, is implanted under the skin beneath the collarbone. Outpatient surgery. Anesthesia is required.

The stimulator runs on batteries which must be replaced surgically every 2 – 5 years.

Step 8: Program the Stimulator

To minimize risk of side effects and maximize efficacy, programming occurs over three or four more hospital visits, the stimulator program adjusted, fine-tuned, at three weeks intervals. The changes to the program are gradual and individualized. The electric pulses are varied by width (duration), rate (frequency), and amplitude (intensity).

I wonder about the pulse programming options, if there are pre-sets, programs tested and verified to work. I’m reminded of the multi-function, blink controllers for Christmas lights, the blink patterns have names. I imagine the progression of programs my mom might experience through time:

Steady On
Chasing
Flashing
Twinkle
In Waves
Slow Glow
Slow Fade
Fade to Dim

Complications include seizures, infection, and bleeding in the brain. Balance and speech impairments are possible. A do do do, a da da da, is all I want to say to you.

Some neuroscientists take brain scans of people in prayer and meditation to shed light on spiritual practices. The field is called neurotheology.

Here is where I solicit any prayers, meditations, rituals, trance states, magic, and most transcendent of all, for me, positive thoughts.

My sister took our mom to her pre-op appointment in May. I’d asked my sister to find out if there was a surgical observation area.

On The Offspring’s Greatest hits compilation, the last song, a cover of the Police’s, “Next to You”:

What can I do
All I want is to be next to you

At home one night after dinner I told my wife I’d like to observe my mom’s surgery, be next to her, in the operating room. Cheryl sipped from a brimming magnum of wine and said, “They’ll never let you do that.” A thoughtful look crossed her face and she leveled her gaze, “Besides, you’d probably faint.”