by Michael Finley
Copyright © 2001 by Michael Finley

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A Master of the Wired World?

I just got my author's copies of a new book from Financial Times Management (London), MASTERS OF THE WIRED WORLD: Cyberspace Speaks Out.

What's remarkable is that this collection of manifestos about the new age a'dawning contains proclamations by Tony Blair, Al Gore, Charles Handy, Nicholas Negroponte, Arthur C. Clarke, Alvin Toffler ... and me.

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The Visit of the Magi

Finally, Rachel returns. I don't remember what we say to each other, or how I break the news of the new diagnosis to her. I just know that Carrie was right. It is pure relief to see her. We hug and kiss, and she reassures me that there are many ways the diagnosis can go, and it still might not be a tumor, and if it is a tumor, it might be nothing at all -- that it had done with the stroke all the damage it was going to do, and this was a wake-up call for our life together.

She is so great. She convinces me that this is just an exercise, an inquiry, a fact-finding junket. It is not denial -- she is fully capable of getting anxious about things. But she has a yen to know exactly what is happening, and to suspend her anxiety until that knowledge is hers.

I have always been lucky to have her, and never more than on this longest night.

Her plan is to hang around with me until several specialists visit the room, and bless us with their opinion. One by one, in the course of their rounds through the hospital, they traipse by. Having Rachel on hand to quiz them on their opinions is a blessing, because my mind has never been the sieve it is tonight.

The first visit is by a neurologist, a woman about 50 with a stiff Emily Dickinson countenance. She asks me several questions, and tells Rachel that the immediate danger for me is seizures, and suggests we consult with a doctor in her partnership after I am released. I want to ask her why my head hurts when I try to masturbate, but she seems like the wrong person to ask that question. So Rachel asks for me.

"Why does it hurt when he does valsalvos?" she asks. A valsalvo, she explains to me later, is when the diaphragm of the body "pushes" out -- we do it when we go to the bathroom, sneeze, hold our breath, approach orgasm.

"Your venous system has suffered major trauma," the neurologist says. "A major vessel that used to take blood away from your brain no longer exists. Your brain has to develop alternate routes to move that blood out. Narrow vessels will have to widen to carry the greater load. Hopefully, your body can make this adjustment in the next month or two."

The next doctor is a specialist in infectious diseases from Spain (he's from Spain, not the infectious diseases). He gives me the wildest hope because he is still wedded to the original diagnosis, that what I have is no tumor at all, but a leaching of the mastoid bone into the cranial area, caused by some infection. "You don't have a tumor," he smiles, shaking his head, as if the whole world is a moron but him. It turns out he wants to write an autobiography about his career in infectious diseases, and suggests I might perhaps talk to him about that. I say, sure -- I would love to write a book about infectious diseases.

The next doctor is the radiologist who administered the angiogram and broke the news to me about there being a tumor in my head. He looks as depleted as a cigar store Indian. He apologizes for dropping a safe on me from a seventh floor window earlier. I tell him it's quite all right. He does not seem to think the tumor, which he refers to as a meningioma, is anything to lose sleep over. "They're slow-growing, and they are located close to the skull, so they are usually operable," he says.

The next doctor is a small, tightly packed Australian neurosurgeon, still in his green scrubs. He speaks very bluntly to us about the tumor. He has no doubt about it being a tumor, nor any doubt about his ability to go in and take it out. He talks about mortality rates and complications from surgery, and about the deficits that can linger long after -- seizures, motor problems, speechlessness. Rachel and I find him terrifyingly impressive.

Finally, at about midnight, another neurosurgeon, Dr. Gregory, arrives. He only does rounds late at night, he says. Nurses call him The Vampire but he seems much nicer than that, square-faced, pale, but very, very diligent. He strikes me as the consummate workaholic, which is what you want in a neurosurgeon. "Your tumor is not small," he says. "It is about the size of a baby's fist. But it's in a good location, and from the CT images it appears to be calcified."

"Calcified is good?"

Rachel and Dr. Gregory both nod enthusiastically. She adores being in on these consults, and half the time is talking gobbledygook with specialists that I can't parse. She wants them to know she knows what they're saying.

"It means it's been there for a long time," he says. "Maybe as long as twenty years. The longer it's been there, the less chance there is that it is cancer."

"So it's not cancer?"

"We hope it isn't."

"No shit."

What we are finding, he says, is that the new imaging technologies are allowing us to spot many more tumors than we used to see. Pathologists are seeing tumors like mine, meningiomas, in nearly every brain they autopsy.

"So I'm going to be OK?" I ask tentatively.

"There's a good chance this tumor has done what it wanted to do when it caused your stroke."

"How does a tumor cause a stroke, exactly?"

"It grows next to the blood vessel and slowly corrodes the vessel's integrity. Eventually, the degraded vessel bursts."

"Why didn't my stroke do anything besides hurt like hell?"

"Good question. The location of the tumor is at the bottom of the cortex, in the venous drainage area. The vessel that burst is a vein, not an artery. Veins drain spent blood back to the lungs and heart to be refreshed. Arteries carry the charged fresh blood to the top of the brain. It's when an artery bursts that a stroke causes serious deficits. Charged blood destroys the brain tissue that it splashes on."

"So I'm going to be OK?" I ask again.

"We're going to try to get you through this," Dr. Gregory says. "But we have to keep an eye out for new growth, and seizures."

I am now under neurological watch. This means a nurse awakens me every two hours all night long to test my reflexes, look at my pupils, ask me if I know where I am, what day of the week it is, and what my name is. At the time I am merely annoyed by this procedure. On the worst day of one's life, one doesn't want to be reminded what day it is every two hours.

What do they expect -- that my brain tumor will suddenly make me insane? No, they are checking to see if I am experiencing seizures.

Primary brain tumors can only do four bad things:

1) They can encroach on vital space and destroy your brain's ability to function.

2) They can increase intracranial pressure and cause excruciating headaches.

3) They can press against blood vessels and cause strokes.

4) They can cause seizures.

My tumor is just barely pressing against my language center (1), but not enough to cause me problems yet. I have had a few headaches (2), but they do not seem especially significant. I have indeed experienced a stroke (3), which was how this story started, but apart from the pain of it, it was a nonevent -- I suffer no motor or language deficits, as most stroke victims do . And (4) I am about to learn about seizures, because strokes, brain tumors, and epilepsy go hand in hand.

Think of a seizure as an electrical short circuit. Ordinarily electricity flows through the brain in a  continuous blanket of energy. A seizure is when the flow is no longer moderate or continuous. Energy backs up and then releases in a spastic uncontrolled expenditure of energy. Ordinary flow is limited and purposeful, during a grand mal or generalized seizure, the worst kind, the flow becomes unmodulated and purposeless, and the brain freaks out. The finite energy required for me to lift my hand is like a prudent letting of water from a dam; a generalized seizure is like the same dam bursting, with energy pouring out to every part of the body, causing you to lose consciousness and violently shudder. They can kill you by themselves -- you stop breathing during them -- or they can cause your death if they happen when you are near any sort of danger, like a stairway.

Less dramatic seizures occur when a single part of the brain seizes up -- the electrical short circuit is limited to single lobe or area -- and only that part of the body that is controlled by that part of the brain is affected. A seizure affecting the language center causes you to lose the ability to speak and to understand what is spoken to you. Imagine having to think without the use of language, and you have a formula for pure fright.

Likewise, a seizure to the optic nerve will make you go blind. A seizure to the part of the brain that governs consciousness will cause you to lose consciousness. It is possible to have a seizure specific to any sense or neural activity, each one exquisitely horrifying. Imagine an assault on memory, hearing, logic, balance, sequence, personality, impulse control, the ability to comprehend the world through touch.

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