10 brain surgeries give patient unusual perspective
From his hospital bed, Charles Stuart stretches out his long, muscular arm to shake hands; his grip is warm and firm, and the handshake...
Seattle Times staff reporter
From his hospital bed, Charles Stuart stretches out his long, muscular arm to shake hands; his grip is warm and firm, and the handshake lingers. And lingers.
"You'll have to let go, because I can't do that," quips Stuart, still recovering from brain surgery — his 10th, not counting two encounters with a radiation-beam machine called the Gamma Knife, five sessions of another type of radiation, and a couple of bouts of chemotherapy.
Stuart has just had his 13th tumor excised. His head, scarred from surgeries gone by, sports a new row of stitches and staples. And though his hand's not cooperating, he and his neurosurgeon, Dr. Laligam Sekhar at Harborview Medical Center, aren't concerned. Stuart has worked his way back from much worse.
These days, Sekhar says, patients and neurosurgeons alike expect perfect results from brain surgeries. Thirty years ago, when surgeons first sawed open Stuart's skull to remove a tomato-sized tumor, that wasn't true.
Flying nearly blind, without the 3-D mapping provided today by CT and MRI scans and computers, neurosurgeons expected paralysis and speech impairments — damage they call "residual deficits."
Stuart, now 67, has lived through an era of immense technical and technological advancements, says Sekhar, an accomplished neurosurgeon who developed many procedures now used in surgery.
Quite possibly, he adds, Stuart is unique. "He's the only one I know who has had surgery for this length of time, this many surgeries, and is in good condition," says Sekhar, who has operated on Stuart eight times.
"He's a strong guy, physically and mentally."
First tumor "inoperable"Stuart was in his early 30s, a strapping 6-foot-4, 210-pound young man living in Maryland, when the seizures began in 1971. He'd gone to a party, stayed up all night and then driven five hours for an early start on a daylong deer hunt. That night, a grand mal seizure bounced him out of bed. The doctor attributed the incident to exhaustion, and Stuart put it out of his mind.
Three weeks later, another seizure left no doubt something bad was happening. He was president of a development company at the time and was in a lawyer's office negotiating a deal. "I, I, I, I, I, I" he blurted, unable to stop.
Doctors found nothing, but the seizures continued. Looking for ways to control his runaway words, Stuart discovered that by concentrating on Samuel Coleridge's famous poem "Kubla Khan," he could temporarily distract his malfunctioning speech center.
Soon, other problems arose. Fork in hand, he couldn't decide whether to spear peas or scoop mashed potatoes. Once, he had a seizure driving down his long driveway, plowing into the bushes. He awoke 45 minutes later.
His journey to the clean white sheets of the operating table took nearly four years.
Ultimately, he faced what he called his Hobson's choice, a choice that is no choice at all: die within months as the tumor grew or find someone to operate on a tumor deemed "inoperable" by the first surgeon he saw. That doctor assured Stuart that anyone who dared remove it would turn him into a vegetable.
Stuart recalls much mental and physical pain leading up to his first surgery, in 1975. One doctor told him, "Young man, you've got the biggest brain tumor I've ever seen." He recalls an injection of contrast dye into his arteries so doctors could better see the tumor, a procedure that today is usually nearly painless. "It was the worst experience I ever had," he says. "It felt like they had poured gasoline or liquid lava into my brain."
During his 12-hour surgery, he bled and received nine pints of blood, nearly his whole supply. After three days in intensive care, he found his right arm paralyzed, but he could talk. "I like to talk," he says with a grin.
He wasn't allowed to drive for a year. But his arm came back, and he was good — for 11 years.
The tumors, however, weren't done with him. His were a type called meningiomas, which typically are not malignant, and it's not unusual for a patient to have more than one. But Stuart's were popping up like mushrooms, sometimes in difficult places.
He endured another surgery and some sessions with a then-brand-new machine called the Gamma Knife, which focuses beams of low-level radiation.
But the tumors continued to cause problems. In 1998, he found Sekhar, said to be one of the world's top neurosurgeons.
"Trapeze artist" of surgeryStuart, who was once a White House assistant to President Nixon's adviser, John Erlichmann, and later, to his chief of staff, H.R. "Bob" Haldeman, ("I left before Watergate," he is quick to say) had connections. And those connections knew neurosurgeons. The word came back: Sekhar was so good his colleagues were embarrassed to operate with him.
In 2000, a Washington Times article described Sekhar (pronounced Shaker) as "one of the trapeze artists" of neurosurgery. His first-of-its kind aneurysm bypass, facilitated by drastic body cooling, was fictionalized on TV.
Sekhar's first surgery on Stuart, in 1998, wasn't easy. Radiation had created scar tissue between the tumor and the brain, Sekhar recalls. After nine hours of surgery, Stuart awakened nauseated, his right side paralyzed and his speech garbled.
With therapy, Stuart worked his way back. But since then, the tumors — and the surgeries — have come nearly every year. The operations pushed past the limits of Stuart's insurance; his wife, Constance, estimates they've spent $200,000 out of pocket on his care. He's now on Medicare.
In 2003, surgery for a brain infection affected his balance.
It was the end of hiking, hunting, horseback riding and the fox hunts he enjoyed so much.
Bored, he took up writing and found it immensely enjoyable. His book about Nixon-era White House life, tentatively titled "Never Trust a Local," is scheduled for publication this fall.
He began working on a book on brain tumors from the patient's perspective but put it down to write another, a fictional thriller. He was nearly done when his latest tumors — Nos. 13, 14 and 15 — popped up in January.
Seven times, he had entrusted his brain to Sekhar, who had in the meantime moved from a university medical center in Washington, D.C., to one in New York.
Last month Sekhar, a native of India, moved across the country to Harborview Medical Center to become vice chairman of the neurological-surgery department.
For Stuart, there was only one choice: follow Sekhar.
Prayer and technical skillHis surgery last week used many advances of neurosurgery not available when Stuart first began his odyssey, Sekhar says. For example: embolization, using particles to block the tumor's blood supply, curtailed bleeding.
Stuart's brain was cooled before the surgery, and electronic monitoring helped Sekhar avoid damaging Stuart's brain; infrared neuronavigation helped guide Sekhar as he removed the tumor.
Success in brain surgery, Sekhar says, isn't just technical skill and technological advancement, but team effort and "people being nice" to patients.
And just in case, before every surgery, he holds his patient's hand and prays. "Whether they believe it or not, my experience is that everybody believes in something when they're sick," Sekhar says. "The bottom line is, it seems to help, so I do it."
Sekhar took only one of Stuart's three tumors last week. One of those he left appears not to be growing; the other probably will need surgery later, Sekhar says, but can wait.
Stuart went back to Maryland this week — by train, so pressure changes wouldn't affect his still-sensitive tissues enclosed inside a temporary titanium mesh "skull." He'll be back within a few months for a new, plastic prosthetic skull section to better protect his brain.
He's eager to get back to his thriller. While recovering, he thought of a new ending. He's also planning a third book, about an FBI agent with a brain tumor.
Stuart has no doubt he'll finish his books. "I'm a real miracle," he says.
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org