chapter 41: back in the saddle

on february 7th, i came home from the UCLA emergency room.  with Dr. M’s orders now fulfilled, i would be scheduling an appointment to discuss the results.  but first, i had a significant journey ahead:  midweek would bring with it an arranged meet-up with the distinguished Dr. S.

Selections from his various biographies:

Among just a few of Dr. S’s contributions have been the development of theories on normal perfusion pressure breakthrough and how the size of arteriovenous malformations (AVMs) is related to their rupture; the development of a heuristic grading system for AVMs; advances in the surgical treatment of complex cerebrovascular lesions based on hypothermia, barbiturates, and cardiac arrest; and the development of innovative surgical approaches for skull base surgery. Overall, he has published 405 articles in refereed journals, 291 articles in non-refereed journals, and 184 book chapters.  He has also written or co-edited 16 books, including The Color Atlas of Microneurosurgery and three other neurosurgical atlases. He established the BNI Quarterly (now Barrow Quarterly), the official journal of the BNI, and served as the Editor-in-Chief of Operative Techniques in Neurosurgery from 1998 to 2005.  From 2001 to 2008, he was Editor-in-Chief of Skull Base: An Interdisciplinary Approach, for which he now serves as Chairman.

In 1994 Dr. S was chosen as the Honored Guest of the Congress of Neurological Surgeons – the youngest member ever to receive this coveted honor. In 2004 he was the Honored Guest of the 4th International Skull Base Congress.

Dr. S played a dominant role in the use of the standstill operation in treating large or dangerous cerebral aneurysms.

Dr. S is an accomplished classical pianist.  In his free time, he enjoys extreme sports such as long distance road biking, mountain biking, rim-to-rim Grand Canyon runs, marathons, Ironman competitions, and heli-skiing.  He also enjoys swimming, horseback riding, volleyball, and sailing.

Dr. S specializes in cerebrovascular diseases and skull base tumors.  Many consider him to be the world’s most famous brain surgeon.

In February, 2007, Dr. S——- performed his 5,000th aneurysm procedure.

Dr. S was in Phoenix, so it would be a long drive through the desert and deserted world of the Old West.  Trekking over California and Arizona gunslinger territory, a companion and i passed signs toward the end of the drive for places such as Cotton Lane, Buckeye Airport, Black Rock, and Indian School Road.  i looked for any indication of an OK Corral, thinking i’d buy a six-shooter and press my luck.  or, i’m part Indian, so maybe i could yuck it up with some redskins at a teepee hangout.  this was home of the Navajo, Hopi, and Apache among others.  where trading was done.  where battles were fought.  where Ben Cartwright might’ve stopped in for a drink.  i imagined putting on my childhood Indian headband with the cool lone feather in the back.  or my elementary school holsters and badge.  but no such luck.  i slept in a bed, rather than under the stars around a fire, eating Pace Picante sauce.  the next day, i headed over to see Dr. S.

way before i made the trip eastward, i’d sent all of my previous tests to Phoenix.  in addition, on the morning of the 10th, compliments of St. Joseph’s hospital.  i got stuck and scanned, with and without contrast.  scoreboard:  around 23 scans of my brain at this point.  if there’s one thing i know by now, i definitely have a brain.  at this point, my insides have been seen more times than Paris Hilton’s.

after fun like a bun in the oven, i scurried over to the doctor’s office.  Dr. S was hunkered down professionally at the Barrow Neurological Institute, which is part of St. Joseph’s hospital.  oddly enough, St. Joseph was also the paternal holy man who’d gotten name props at the hospital in Burbank which i’d the patroned the night (and week) of my brain hemorrhage in May.  but as for this joint, let me tell you:  this was NO average Joe.  this place was NICE.  no WONDER brett michaels went here.  nothin’ but a good time.  so THIS is how rich people live.  everywhere i looked, there were ritzy furnishings and fishtanks with tropical, bug-eyed swimmers.  these gilled ornaments helped put the “scale” in upscale.  am i seeing a brain surgeon, or an interior decorator?

i suppose the answer was both, because the man with the golden hands would possibly be rearranging the furniture in my head, and so maybe that was the subtle suggestion of the above-average decor:  we know how to situate.

after about 30 minutes, i was placed in a room, where Dr. S soon joined me.  he was impressive; he seemed very knowledgeable, and he was most certainly to the point:  “risks of surgery are DEATH…




once he got that out of the way, he told me there were also risks of leaving my unwelcomed “friend” caged behind my eyes.  depending on what it turned out to be–a tumor which could be malignant, an aneurysm, or a cavernous malformation–risks could be less than or greater than those of the surgery.  but he also added, “last time, it bled inside itself.  if it bleeds outside itself:  when that happens, half the people die, and the other half are never the same.”  that seemed pretty important to note.  he recommended the operation, to get in there and check out the lesion, and then move accordingly while my head is a giant open wound.  i asked when he suggested i have it done.  “i wouldn’t wait more than maybe 2 months.  the worst thing would be to do all the research, get all your information, and then dilly-dally around until something detrimental happens.”

Dr. S made a lot of sense.  i knew i was speaking to one of the world’s most respected brain surgeons.  i knew he was no dummy.  i also knew he gets paid to operate, so he may be quick to suggest that route.  still, his argument in favor of surgery was considerably convincing.

on the drive back, i kept thinking, “i don’t want to have the surgery.  i don’t want to have the surgery.  …but it seems like i should have it…”  i couldn’t justify leaving this thing to chance, even though surgery was a chance all its own.

fortunately, being caught in a comedy of errors helped distract me from my impending operation:

after eating at Cracker Barrel–my long lost home-cooking haven–my compadre realized they’d lost their wallet.  so it was back to the hospital we went, about 25 miles east, to search between upper-class seat cushions and near well-watered ferns.  two hours later, we were passing the beloved Old Country Store and Restaurant, my dumplings having long been digested by then.  i was also digesting the fact that we were low on gas.  this came into particular focus as we passed what i remembered as being the last offramp for about 45 minutes of desolate interstate.  “i think we just ran out of gas.  last night, that was the first exit we came to after a forever of nothing.”  my co-pilot delved into the world of AAA, or at least their car insurance’s version of it, to find the nearest gas station.  i continued west because there was nowhere to turn around.  eventually, fake-AAA told us that the nearest station was 35 minutes away.  i pulled over at a rest stop and faced the facts:  we couldn’t make it.  fake-AAA called a wrecker, and we waited.  and waited.  until:  a giant, diesel powered, longbed tow truck pulled up behind me, blocking me in, and a grizzled man got out of the driver’s seat, looking like Ernest Borgnine with leather skin and a bulbous nose.  this guy had been through it.  he told us he needed a credit card.  he also told us there was a gas station “right there.”  “you see those lights up ahead?  those are gas stations, one on either side of the road.  i need your credit card.”  ???????????????





“um, there’s been some mistake.  you were only called because we were told the nearest gas station was over half an hour away.  we were told that by the company that called you.”  the man KNEW this.  fake-AAA had even told the guy we needed EXTRA gas because we were so far away from a station.

“i need your credit card.”

it was almost 1 a.m.  in the middle of nowhere.  and Burlap Bill had us blocked in.  with a 7,000 pound vehicle.  he wasn’t budging.  being that my driving partner had NOT found their wallet back at the hospital, i had to hand over my credit card.  i told the guy i was calling fake-AAA, so hold on.  too bad; he ran the credit card immediately.  i was charged $65.  for the service of nothingness.  then he had the gall–

“so, now, do you want to buy some gas?”

(in my mind, i punched him in the stomach).

i called my bank to prevent the charges, but it was too late.  i drove for 3 minutes and then stopped to gas up.

back on the road, i realized surgery was the smartest thing, of the two dumbest choices available to me.  Dr. S was the most renown and experienced surgeon i’d met with–he’d even trained Dr. G from USC, when they were both at UC San Francisco.  so i would return to Phoenix for the big deed.  it made sense:  i’d go back to back to the home of the Indians.  to get scalped.

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