Thursday, August 13, 2009

a talk with the neurosurgeon

Today's drive to Dr. Leiphart's office at the George Washington University Medical Center reminded me of why I dislike driving in DC. DC's layout was originally conceived by a French-American named Pierre L'Enfant (his name is immortalized at the locale called L'Enfant Plaza). Like the French designers who laid out Paris's haphazard network, L'Enfant cursed DC with a massive hash of diagonals and circles superimposed on an otherwise-rational grid, creating some of the most awkward intersections in America. Later on, we Americans compounded the problem by messing with the simple traffic rules that govern rotaries (ronds-points in French-- circular intersections with only two rules: traffic circulates in just one direction, and those inside the rotary have the right of way), eventually leading up to the urban mess we know and love today. As far as driving goes, DC sucks.

Nerves jangling from the drive, I managed to halt the van in front of Dr. Leiphart's building. I then dropped Mom and Dad off at about 2:05PM and found parking a few blocks away; GW is a parking nightmare. I walked back to the medical building and found Mom and Dad around 2:15PM; our appointment was at 3, but we still had to wait an extra hour for Dr. Leiphart to show up; he apparently has a huge patient load. Close to 4PM, the doctor walked into the exam room.

We learned little during our conversation with the neurosurgeon that we hadn't already heard from Dr. Tonnesen. I asked some questions about what sorts of symptoms we might anticipate during Mom's final decline; I was worried that Mom might reach a point where she began to experience violent mood swings and the like. Such a thing hasn't happened thus far, thank goodness: if anything, Mom has never seemed more worry-free than she now is, and in a morbid way, that's been the one great blessing from this horrible disease.

Dr. Leiphart said that, in his experience, violent mood swings aren't part of the profile for brain cancer patients. Such patients tend to become less active and more withdrawn over time. I might be a bad person for saying this, but I find this to be a relief. Dealing with unbridled emotions on top of all Mom's other problems (many of which remain tastefully unblogged) would be an impossible burden. It's bad enough when other people we know slide into irrationality in the face of crisis. If Mom has the most level head among us, then all the better. Her calm keeps the rest of us calm.

We talked about bone flap surgery. Mom's recovery period-- if we decide to have the surgery-- is expected to be around 6 weeks. The operation should be relatively simple this time: a single major incision, then insertion of the synthetic bone, followed by suturing. (In theory, the synthetic bone is already prepped and ready to go, but Dr. Leiphart told us he needed to confirm that.) Now that we know about Mom's susceptibility to infection, we have a better idea of how to prepare for it. As to whether such surgery would be worth the effort, cost, and time, Dr. Leiphart offered no opinion, leaving such a decision up to us.

We also asked about second-line therapies. The doctor mentioned NIH/NCI as one possibility, and also mentioned Duke and UCLA as places where cutting-edge therapies were being tested. MD Anderson also got a mention, though more as an afterthought, because Dr. Leiphart couldn't recall whether the facility was currently doing clinical trials related to GBMs.

"She looks good," Dr. Leiphart noted, though he also affirmed that Mom's prospects were grim. For us, this means that Mom's relative lucidity and functionality are to be treasured while they last.

We left the office a bit after 5PM. Parking on campus was hellishly expensive, so Dad's wallet took quite a hit. All that was left for us was the nerve-wracking drive back home.


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