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The Tumor
Author: John Grisham

John Grisham - The Tumor

The Tumor
John Grisham




Chapter 1

The Patient

Meet Paul, a 35-year-old banker with a lovely wife, Karen, and three small children. They enjoy a nice life in the suburbs with lots of friends and the usual activities—backyard cookouts, swim parties, tee-ball, church on Sundays. They are active and enjoy great health. Paul’s parents are in their 60s and also very healthy. Paul gets a complete physical once a year, jogs twenty miles a week, plays golf and tennis at a nearby club, and avoids extra pounds. He has an occasional beer, doesn’t smoke, and takes no medication.

Chapter 2

The Tumor

But Paul has a problem. He has a tumor in the right frontal lobe of his brain, about the size of a hen’s egg.

Looking back, the first symptom was a gradual decrease in his ability to concentrate at work. Naturally curious and active, he noticed an uncharacteristic tendency to procrastinate. At times he felt listless and tired. Then the headaches arrived, and with a fury. He blamed them on stress and took lots of ibuprofen. As he drove to work one morning, his vision became so blurred he stopped the car. Karen began to notice mood swings and a loss of patience with the kids. He grew more irritable, both at home and at the office. His boss chastised him for barking at a coworker. He quarreled with Karen over his dour moods and crankiness. She knew something was changing with her husband and urged him to see a doctor. He refused.

On a Wednesday morning, as Paul is in the bathroom shaving, Karen hears a loud thump. She finds him on the floor, shaking in a full-blown grand mal seizure. She calls 911, and as she waits the seizure stops and he gradually awakens. He is confused, disoriented—doesn’t recognize Karen and doesn’t know where he is. The rescue squad arrives. Paul is loaded into an ambulance and taken to the hospital. In the emergency room, he is still drowsy and confused and complains of weakness on his left side. Upon examination, his left hand is very weak and he has difficulty lifting his left arm and leg. An MR scan reveals the tumor.

He is admitted to the hospital and started on anticonvulsant medication to prevent further seizures, as well as steroids to decrease the swelling in his brain around the tumor. Paul and Karen are not shown the MR scan. A neurosurgeon is consulted.

By Thursday morning, the confusion and disorientation are gone, as is the weakness in his left side. He feels much better, briefly, but things will change. When the neurosurgeon arrives early that morning for the initial consultation, he produces the MR scan (opposite). As they stare at it, Paul and Karen are too stunned to speak. The doctor explains that Paul indeed has a tumor in his brain and it appears to be the type known as a glioma. Surgery is needed to remove as much of it as possible and to obtain tissue to determine the type of tumor.

They talk about the operation. The doctor covers the risks. For complications like death and paralysis, the risks are very small. The most likely complication will be a weakness on the left side. The surgery will take about three hours, and if all goes well, Paul can expect to go home in three days.

MR scan of Paul’s tumor

The neurosurgeon explains that gliomas are graded one through four, with one and two being benign. Three and four are malignant. Grade four, the most catastrophic, is called a glioblastoma. The life expectancy for a grade four diagnosis is short. Regardless of treatment—surgery, chemo, radiation—the average length of survival is about one year. Left untreated but managed with pain medication only, the patient can expect to live several months. About 22,000 Americans are diagnosed each year with glioblastomas; 15,000 die within 12 months. The lucky ones, about one in ten, live for five years.

Based on the MR scan, the neurosurgeon thinks the odds are about 50–50 that the tumor is benign.

He recommends surgery at the earliest convenient time and it is scheduled for the following Monday. After the doctor leaves, Paul and Karen attempt to come to grips with what’s happening. Should they get another opinion? It seems senseless when staring at the MR scan. There is no doubt about the tumor. They like their neurosurgeon and a quick search online proves he’s one of the best. They are in the finest hospital in the city. Surgery is needed sooner rather than later. There is no time to waste.

Needless to say, the weekend is long and agonizing. Karen gives the bad news to the family but not to their children. She refuses to believe the tumor is malignant and is convinced the surgery will go well.

She spends hours online gathering frightening and depressing information about brain tumors. Ted Kennedy, Susan Hayward, Beau Biden, Lee Atwater, George Gershwin, Lou Rawls, Bobby Van, Pete Rozelle, Wilma Rudolph—they are just a few of those who died from a glioblastoma. On average, they survived a year after being diagnosed.

Well-known people who died from a glioblastoma. On average, they survived a year after diagnosis.

top left: Lee Atwater, 40

top right: Wilma Rudolph, 54

middle left: George Gershwin, 38

middle right: Edward “Ted” M. Kennedy, 77

bottom left: Joseph Robinette “Beau” Biden, III, 46

bottom right: Susan Hayward, 57

Chapter 3

The Treatment

At 6 a.m. on Monday, Paul and Karen are in his hospital room, wide-awake, fearful but trying to appear brave as they wait for the day to unfold. At 6:30, Paul is prepped for surgery and two orderlies arrive with a gurney for the short ride to the operating room. Paul hugs his wife, who’s overcome with emotion. After he’s gone, she is led by a nurse to the waiting room. His parents are already there. The nurse tells them the surgery should be over around noon. As they settle in for a long morning, the room begins to fill with other anxious families.

Paul is rolled into the operating room and put to sleep with general anesthesia.

His head is shaved and his skull fixed in a three-prong headrest to immobilize it (fig. 1).

A question-mark-shaped incision is made from the midpoint of his forehead just below the hairline to a point in front of his right ear.

Burr holes are made in the skull, and a power saw is used to fashion a bone flap more or less like the top of a cookie jar (fig. 2).

The dura mater—a membrane between the inner table of the skull and the brain—is cut (fig. 3). The surface of the frontal lobe is discolored and distorted because of the tumor.

The tumor is localized with an intraoperative navigation device to minimize damage to the motor cortex—the portion of the brain controlling movement of the left side of the body. Under the magnification of an operating microscope, an incision is made into the brain, and just beneath this the abnormal tissue is identified.

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