The procedure was very similar to a coronary catheterization except that the catheter was threaded into the carotid arteries that feed the brain rather than into the coronary arteries that feed the heart. Called the Wada test, after the Japanese neurologist Juhn Wada, this clever study sorts out the activities of the right and left parts of the brain by selectively putting one or the other hemisphere to sleep. As my left brain went to sleep, I instantly went mute. I was awake, alert, focused, and trying very hard as the neuroradiologist asked me repeated questions. The words lined up in my head, wanting to be released, but instead just piled on top of one another.
I flunked the test. My speech center was located near the tumor, making the operation that much more difficult for Barnett—and yes, for me, too. One thing was now clear in my mind: However much time I had ahead of me, I did not want to wake up from surgery unable to say thank you or otherwise communicate. My husband and I, each in our own way, relieved Barnett of any urge to be heroic with his scalpel; that is, he should err on the conservative side of how much he could remove safely. As Fred put it simply: "I want my wife back."
Barnett gave me the option of being awake during the portion of the neurosurgery in which the tumor was actually being removed. By speaking aloud on the operating table, I would assure Barnett that his cutting was staying away from my speech zone. I've done a ton of public speaking in my time, but this recitation would become the most important speech of my life.
Homework. The operation began like all others, as the neuro-anesthesiologist let me peacefully doze off while trying to count to 10. This gentle sleep was abruptly broken when he brought me back to full consciousness in the midst of the operation. I had no pain, mental or physical. Barnett had already numbed my scalp with a local anesthetic and opened up a 4-to-5-inch window into the left side of my skull to expose the tumor.
My brief reverie was interrupted when neurologist Hans Luders appeared over me holding my homework—a literary passage I was to read again and again during the operation. Like a third grader reading aloud in front of the class, I tried to pronounce each word perfectly, though the words seemed odd. I asked Luders if this passage made a lot of sense to him, and he laughed. To me, it seemed out of context and very flowery, not at all a passage that I would have chosen for this critical moment in my life. But, hey, who was I to be choosy? Just as I was feeling comfortable about my ability to handle this strange experience, Barnett told me he was finishing up and all was well. He had removed about half of the tumor and had plenty of tissue for further studies.
My tumor was of the less common variety, called an oligodendroglioma, a rather obscure tumor that was just starting to make a splash because of its unusual genetics. Recent studies at the University of Toronto suggested that at least one subset of this tumor, when it carried a particular genetic profile, was surprisingly responsive to therapy—including chemo.
As the tumor diagnosis sank in, I knew the life detour that my family and I now faced would not be easy and would be drawn out. In fact, that was part of the reason I had chosen cardiology as my field of specialty and not oncology. Cardiovascular treatments seemed so precise, predictable, and relatively kind to the body. And they were just so beautifully logical: If you have a coronary blockage that is limiting blood flow to the heart, bypass it with surgery or open it up with an angioplasty catheter. If blood clots are forming, administer a blood thinner. The treatments are visible, their common-sense results almost immediate. That's what I wanted as a young doctor, and it's what I longed for as a patient as well: Lay out the treatment, get rid of the problem, and let me be on my way.
This is not the case for most patients who face invasive cancer. Cancer treatment has a risk-benefit analysis all its own; the therapy is rough and toxic to an extent that seems almost to challenge the medical precept "First, do no harm." If this is going to change, it will be for one major reason: Because cancer is a disease of genes and their proteins, we must understand their networks and interactions.