Published: Sunday, May 20, 2007
Chatting while under the knife
Patients remain conscious during a form of surgery that removes brain tumors.
COLUMBUS (AP) — The masked man bends at the waist and lowers his head to peer under the blue tent.
"Hello, Amy. Open your eyes. Here we go."
Amy Norris mumbles as if talking in her sleep.
Something about her wig. She's not wearing it. Where is it?
Where is she?
On this table. On her side. Cocooned in pads. Her shoulder hurts. She's cold and thirsty.
Her head is bolted, front and back. Unmovable.
"Ohhh!" she says, remembering.
Surgery.
Brain cancer.
The guy in the surgical mask is Dr. Sergio Bergese, who first dripped into her veins a cocktail of drugs to put her to sleep and kill her pain.
Then he weaned her off just enough of them to bring her into this room filled with people charged with guarding her safety as they try to take something frightening from just inside her skull, above her left ear.
Following instructions
For the moment, Dr. Bergese, director of neuroanesthesia at Ohio State University Medical Center, stays by her side and makes her count.
One to 10. Then 10 to one.
Perched on a stepstool is Dr. E. Antonio Chiocca, chairman of the neurosurgery department and the brain surgeon in whom Norris has put her trust. To his left is his chief resident, Dr. John Ogden.
Dr. Chiocca's Italian accent booms as he lets Norris know he's up there, working.
"Amy? How are you? Are you good?" he asks.
Annita Paolucci takes a seat under the tent, next to Norris. She's the speech pathologist who will monitor Norris' verbal abilities while Ddr. Chiocca and Dr. Ogden remove the mass.
"How are you?" she asks.
"Better when the guys are around," Norris answers.
Good sign: Sharp wit intact.
Paolucci asks for the date.
"March 9."
"May 9?" Paolucci guides.
"Oh, yeah."
"Who are your parents?"
"Lowell and Shelbie."
She keeps talking, answering Paolucci's questions. She talks about her children, Janelle, Juli and Jason. Her lips tremble, but she keeps going.
"I'm freezing.
"I need to move! I need to move. I need to move."
Moving isn't encouraged, but Paolucci tries to ease the pressure on Norris' shoulder.
Norris recalls her graduation year, her first marriage.
Dr. Chiocca calls down from above: "We found this thing and we're getting it out, OK?"
Norris responds in a soft voice.
"OK."
She can't feel Dr. Chiocca and Dr. Ogden prodding and cutting. But she's helping them with their work.
As long as she keeps talking, keeps making sense, they know they aren't hurting her.
They are working in the middle temporal gyrus, an area associated with the brain's ability to retrieve words.
Eight months ago, Norris woke up one day, and some of her words didn't make sense. She became uncharacteristically quiet and had three seizures. Two months later, Dr. Chiocca removed cancer from her head. She was awake for that, too.
A recent MRI revealed a possible problem. Norris, who has been undergoing chemotherapy, hoped it was just scar tissue from the first surgery, but Dr. Chiocca is concerned there might be cancer cells there as well.
The procedure
Since Dr. Chiocca came to Ohio State three years ago, he's performed dozens of these surgeries.
Awake craniotomy is a technique used at medical centers nationwide by surgeons looking to remove as much bad tissue as they can without impairing brain function.
Depending on the location of a tumor, a surgeon can damage vision, movement, speech or memory with an overly aggressive approach.
In most cases, the answer is to be a tad conservative.
Paolucci's not looking to quiz Norris on trivia or make her do math problems. She just wants to make sure Norris keeps talking, that her brain keeps retrieving words and telling her mouth how to make them.
Some patients get going and won't stop. One college professor talked and talked and talked. Others give one-word responses.
Paolucci's been working on these surgeries for about a year. "I still find it amazing," she says.
"Tell me about your girls," Paolucci coaxes Norris.
Norris is quiet at first, but complies. She talks about her girls, their school. She says she lives in Coldwater, a town in Mercer County.
She ate tacos for dinner last night, with lettuce, tomato and cheese. No guacamole.
"You're doing fantastic!" Dr. Chiocca encourages.
Not everyone can have this surgery. Take, for instance, the anxious patient. Some people become so agitated when they awake that the doctors have to put them under again.
Norris is calm and funny and strong and just wants whatever is in her head out so she can get on with being a momand a friend and a daughter.
She grows tomatoes in her yard, she says.
"What would you put on a hamburger?" Dr. Paolucci asks.
"I can't remember."
Dr. Chiocca calls from above, "Hang in there, Amy."
Norris says she doesn't like roller coasters. She says her parents were married in 1959, that her dad served in Korea, that she's 41.
As she discusses family, Dr. Chiocca pulls out a cherry-size mass, mottled white, gray and pink.
"Amy? We've got this thing all out, OK?" he says.
"OK."
Dr. Paolucci holds on to two of Norris' fingers.
"I'll see you later. You did a great job."
Dr. Bergese, the anesthesiologist, makes some adjustments and Norris' eyes close.
Dr. Chiocca places five dime-size disks into her brain, where the tumor was. They will dissolve within a month, releasing chemotherapy drugs designed to attack any remaining cancer cells.
After the surgery is finished, and Norris starts to come out of anesthesia, Dr. Chiocca walks to the waiting area.
Norris' mom, Shelbie, stands to greet him. With her are Lowell, Juli, Janelle and Jan Layman, Norris' best friend.
They are relieved to hear that Norris is safely through surgery, that they can see her soon. Dr. Chiocca says goodbye and that he'll see them again.
"I don't want to see him again," Layman says.
"I hate to crush his ego, but I really don't want to see him again."
Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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