Hi William: What a fascinating chapter, both of your
life and of your book. Where can I get a copy of "My
Second Life"?           Carole H.

--- William Harshaw <[log in to unmask]> wrote:
> Debbie,
>
>     When I had my pallidotomy in Dec '93, as Dr.
> Ronald Tasker, my
> neurosurgeon, made the lesion in my right globus
> pallidus, I could feel the
> rigidity leave the left side of my body.  It has not
> returned.
>
>     I attach Chapter Eight of my book: My Second
> Life.
>
> copyright 1999 The Harfolk Press
> may not be reprodced without permission
> Monday, November 30, 1998 revise
>
>  Chapter Eight
>
>  NEUROSURGERY
>
>   ... the brain is the most interesting, complex and
> wonderful thing in the
> universe ... and it's a wonderfully exciting thing
> to study and be in
> contact with. ... The brain is you, it's not just
> biologically or
> genetically, it has all your experience, it's you.
>   -Oliver Sacks
>
>
>
> When I returned to the hospital on Tuesday, December
> 7, 1993, I was ready
> for surgery, eagerly looking forward to the
> operation even though I was
> apprehensive. Other than my overnight doing the
> pre-op testing I hadn't
> stayed in a hospital since I was twelve years old
> having my tonsils out, and
> I enjoyed the novelty. I brought a good supply of
> books and music tapes.
> Because the operation was unusual, everyone seemed
> to want to know about me
> and I was being paid a lot of attention. I felt
> quite important.
>  I was sharing a room with a man from Huntsville who
> had an inoperable brain
> tumour. His wife was with him constantly, and I
> sensed, from overhearing the
> doctors and nurses, that he did not have long to
> live. Even so, there was a
> sense of calm surrounding the couple as they
> prepared for his inevitable
> death.
>  For the first few hours after I was admitted, I was
> too busy having my
> medical history taken, for what seemed the nth time
> by a nurse and then
> again by a surgical resident, and then being visited
> by Jan Duff, Dr. Lang
> and Esther and Howard to take in the reality of what
> was going on beside me.
> I dimly recognized that this couple were preparing
> for the husband's death,
> but there was no weeping and gnashing of teeth;
> rather, there was hope. As
> the wife left that Tuesday evening, she turned to me
> and said, "You will be
> in my prayers tonight. God bless you."
>  She had enough room in her heart for me, when I
> would have thought her
> whole being would be focused on her husband, on her
> family. I was touched
> and inspired by her generosity of spirit.
>  Later in the evening, Dr. Lozano and Dr.Tasker, the
> neurosurgeons, came to
> see me and discuss the operation. Dr. Andres Lozano
> is tall, with
> close-cropped black hair and wears plain wire-rimmed
> glasses. If anything,
> they made him look younger than his thirty-six
> years. He had the aura of an
> ascetic about him. He was the expert in
> pallidotomys, having done thirteen
> previous ones at the hospital. Dr. Tasker, known
> behind his back as "The
> Lone Ranger", and with a reputation for iconoclastic
> brilliance, was
> Lozano's mentor, having pioneered the thalamotomy,
> where lesions are made in
> the thalamus, another procedure used to reliving
> Parkinson's tremors. In my
> operation Dr. Tasker, although the senior, would be
> the number two surgeon,
> learning the pallidotomy procedure from Dr. Lozano.
> With me they were a
> "good guy, bad guy" team as they discussed the risks
> and potential benefits
> of the operation. Tasker spelled out the negatives,
> while Lozano emphasised
> the potential benefits.
>  The operation I would be having was a stereotaxic
> pallidotomy. Stereotaxic
> refers to the finely calibrated metal frame that
> would be fixed to my skull
> for the operation. It fulfils two functions: it
> provides precise three
> dimensional co-ordinates for the positioning of
> surgical instruments within
> the brain; and it is bolted to the operating table,
> immobilizing the frame,
> and, therefore the head. Pallidotomy refers to the
> globus pallidus,
> literally "pale globe", a part of the basal ganglia
> which is the deepest in
> the skull. The pallidus regulates the braking action
> of the brain; in
> Parkinson's patients the brakes are being applied
> too heavily, causing
> poverty of movement and clumsiness. (Parkinson
> himself had noted that
> sometimes, if patients of "his" disease had a
> stroke, the characteristic
> Parkinsonian tremor was less evident, although
> muscle weakness more than
> made up for the eased tremor.) In the pallidotomy,
> the neurosurgeons make
> some lesions on the pallidus which would result in
> scarring. When properly
> placed, the scars relieve the patient's symptoms.
>  Stereotaxic surgery dates back to the nineteenth
> century when its use was
> pioneered by veterinary surgeons. It was not until
> the 1930s that the frame
> was used for surgery on Parkinson's patients. By
> today's standards, these
> early procedures were crude, even barbaric. The
> procedure was little more
> than trial and error and the results were often less
> than satisfactory. In
> one American case reported in 1951, first the motor
> cortex was disconnected,
> then other connecting fibres were cut and finally
> the head of the caudate
> was severed, which finally relieved the Parkinson's
> symptoms. It is hard to
> imagine that there was much brain function left.
>  Meanwhile, in the 1960s, the potency of L-dopa
> medications became
> recognized as far superior to herbal extracts and
> their synthetic clones,
> and to some extent replaced surgery as a treatment
> for Parkinson's. But
> L-dopa has its limitations. In my case and many
> others, it produces
> dyskinesia as a side-effect. As these limitations
> became recognized,
> stereotaxic surgery was undergoing a revolution in
> technique resulting from
> the application of computer technology and
> miniaturization of surgical
> instrumentation. Technology assisted as well in
> understanding the geography
> of the brain and the specific function of many of
> the parts of the human
> brain.
>  As the two neurosurgeons discussed the operation
> with me, I realized for
> the first time how much responsibility for its
> success would fall on my
> shoulders. I would have no aesthetic because there
> would be no pain. I
> needed to be alert and mentally clear so I could
> give timely and accurate
> responses to the surgeons' questions, particularly
> about the location of the
> optic tract, a scant one millimetre from the globus
> pallidus, and itself
> only one millimetre in diameter. Should the probe
> damage the optic tract, my
> vision could be impaired. If the procedure resulted
> in bleeding, a stroke
> could result, with all the complications that come
> with it, including the
> possibility of death.
>  Somehow, all the cautions and potential problems
> that Dr. Tasker discussed
> were insignificant when Dr. Lozano described the
> potential benefits of the
> operation: moderation of dyskinesia, easing of
> muscular rigidity on my left
> side (the operation was going to be on the right
> side of my brain ) and a
> lessening of the reptilian appearance my
> Parkinsonian mask had given me. Dr.
> Lozano had estimated the risk of something going
> seriously wrong at between
> two and three per cent. The two surgeons were
> putting benefits and possible
> hazards of the operation clearly so that so that I
> would be able to sign a
>
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