Buried Alive

On March 28, I underwent brain surgery to remove a lemon-sized glioblastoma, a form of cancer known for its aggressiveness and incurability. Median survival time after diagnosis is measured in months. One reason for the abysmal prognosis is the high speed with which glioblastomas infiltrate healthy brain tissue. Not only does this tumor grow very quickly and exhibit profound heterogeneity, but the parts that can be seen tend to be swarmed by a halo of viable, yet largely invisible cancer cells. Even if maximally resected, the tumor leaves behind a fertile field of seeds whose sprouting inevitably leads to progression.

As a result, the extent of resection (tumor removal) plays a crucial role in the future path of the disease. The more tumor that gets removed during resection, the longer a patient's likely time to progression and ultimately, death. Even so, the question is when, not if the tumor progresses after surgery.

As one doctor explained the wretched situation to me, "It always comes back."

But for patients interested in minimizing symptoms and maximizing survival time, gaining even one or two months can mean a lot. And the surest way to gain that kind of time is to pull out as much tumor as possible, but no more.

As noted previously, MRI is the alpha and omega of brain tumor diagnostic techniques. To evaluate the extent of resection, and for some other reasons I'll discuss in a future post, Dr. Assistant Surgeon explained that I'd need a brain MRI within a day or so of surgery.

Aside from the time crunch, which I believe is routine for glioblastoma resections, there was a complicating factor. Prior to surgery I'd been dosed with Gliolan, a drug that allows tumor and healthy tissue to be distinguished under fluorescent light. Gliolan was an important part of the "super-maximal" resection I'd received.

Unfortunately, Gliolan makes patients extremely sensitive to light. As Dr. Assistant Surgeon explained it to me, "You could get a sunburn just from the room's overhead lights." For this reason, the lights in my room at the ICU were turned off and the blinds were drawn. My head was partly wrapped in cloth to protect my face and eyes from damage. I'd need to scrupulously avoid exposure to light for a day or so.

Now, for reasons that were never explained, the interior of an MRI is lit, but turning the light off was a non-starter. As far as I could tell, this light served no purpose other than to allow technicians to check in on me via a camera mounted inside the tube. But this was impossible because I was wrapped from head to foot in hospital blanket. Perhaps turning off the tube's internal light wouldn't have helped due to other practical reasons. Regardless, every aspect of the procedure, from my transport to the unit, to the imaging itself, to my transport back to the ICU, would need to occur while avoiding my exposure to light.

The solution was to wrap me from head to foot with at least one layer of hospital blanket.

Thusly protected, I was wheeled from the ICU to the MRI unit sometime around midnight. Due to being wrapped in a blanket, I could see nothing. But I was very much awake and I could hear everything. I was apparently part of a convoy of patients headed to the MRI unit, which I deduced from the hubbub of clanging gurneys and the chatter of attendants. I'd arrived at a logjam.

When my turn came up, I gather that I was moved onto the MRI unit's table using using a procedure that involved inflatable air mattresses. First, I was slid from the gurney onto a deflated mattress while lying on a sheet. The mattress was then rapidly inflated using an air blower. Then, I was slid from the inflated air mattress onto another one, which presumably lie on the MRI unit's table. The second air mattress was deflated and slid out from under me. This left me on the table.

Everything I previously noted about brain MRIs applied to this one as well, but with one major difference: I was wrapped in at least one layer of hospital blanket. As the table retracted into the tube, the blanket that surrounded me on all sides pushed into and tugged against my body.

It must have been a tight fit. As I previously mentioned I'm not claustrophobic, but still find the experience of getting brain MRIs unpleasant due partly to the tight quarters. But this time around took things to a whole new level. Instead of merely seeing that the quarters were tight, I could feel it. Is this what being buried alive feels like?

Never before or since was I so relieved to hear a technician's voice as the announcement crackled over the intercom, "Ok, all done now."