Shaky Leadership

“Risin’ up, back on the street

Did my time, took my chances”

– Survivor

I’ve decided that my desire to have some sense of continuity and timing to my posts, needs to take a back seat to sharing the phenomenal experience of last week… 

How often are we presented with the opportunity to really look at and appreciate the amazing world we live in.

I perched on the edge of the uncomfortable vinyl mattress of the hospital bed; which despite its ability to raise or lower your legs, and to bring you closer to your lovingly prepared – no doubt –  yet appetite suppressing display of food; holding you forcibly upright to minimise baked bean stains on the thin bedspreads which attempt to impersonate a doona, by inadequately covering an oversized bath towel and lying atop crisp, white sheets.

My wife sits in the designated supporter’s chair, that sadly is too often left empty in many other rooms. She shoots me a puzzled look, at what would have seemed an out of context smirk taking shape on my face, which when combined with my new, excessively short back and sides hair style, was likely coming off a little more creepy than I had intended. Before the moment could become awkward, the instantly recognisable beat started. Mandy’s puzzled look melted away into a soft chuckle, which erupted into an average yet purposeful shared rocking out to “Survivor’s – Eye of the tiger”. 

The first technological marvel of the day, with no more than a mobile phone and a Spotify account we can carry with us the ability to soundtrack our lives. In the space of my short lifetime the leap from making mix-tapes by recording the radio on my brothers ‘ghettoblaster’ – to instantly streaming any one of millions of songs would be not even in the realm of possible science fiction – should I be able to attempt to explain to 12 year old me.

Our reality tv quality performance of ‘Eye of the tiger’ was cut short, by a last minute but welcome visit from my sister in law – ducking in before starting work – conveniently in the same building. Embarrassment was up there amongst many emotions, which somehow all seemed preferable to taking note of the ‘elephant in the room’, carrying satchels of fear, a grey sense of mortality and buckets of potential tears. Our embarrassed laugh was again abruptly interrupted, this time by the squeak of the wheelchair that beckoned for me to climb aboard, as hospital staff processed into the room. With the instruction given to Mandy to “Say your goodbyes” the elephant stampeded over her,  sloshishing its saltwater cargo all over my scantily gowned shoulder. 

My mindset was concreted in though, my determination steely if not cold. I had a quick cuddle and then made it clear, “It’s not goodbye. I’ll see you in a bit” and in the Spotify of my imagination, I cranked the volume up on ‘Eye of the tiger’. With slight of hand akin to a street magician, I palmed my relic of St Mary MacKillop, and climbed into the wheelchair, as though it were no more than a roller coaster cart at a theme park.

Perhaps a ghost train fits better, as I made my way up the corridor. I’m sure my imagination was in full flight, but it seemed as though every person we passed knew I was heading for surgery. Sad stares bore down on me, and I was reminded of a scene in ‘The Green Mile’; my ears pricked up almost expecting to hear someone holler: “Dead man walking”. I shook that picture out of my head – not helpful Todd.

We pulled up in the waiting bay outside imaging, where I was introduced to the first of many heroic characters – My anaesthetist and his assistant. They cleverly engaged me in conversation, achieving what I suspect were two goals.

1. To find out if there were any yet undisclosed pieces of information that might impact on the plans for administering any anaesthetics throughout the procedure.

2. (Probably most importantly) distract me as they located a suitable vein and inserted the first of many attachments to the backside of my left hand.

They were a great team and connected with me very quickly. Putting me at ease and bravely agreeing to help lighten the mood, as I again felt the caring but ominous gazes full of well-intentioned pity of onlookers as they wheeled me on into the CT scanning room. At this point the room resembled more of a Formula 1 pit, than a hospital room. A well organised and synchronised team scurried together, as I was rigged up into my head gear – a heavy ring that encircled my head with plastic ‘bullets’ that screwed right through the flesh securing it to my skull. The action of which was fore-shadowed by the nasty little pricks of local anaesthetic in six evenly spaced locations around my head. 

Firmly screwed into my frame, I had a chance to take a load off and rest on what now seemed like my ‘bed away from bed’. As I moved in and out of the CT scanner, and it whirred around me, try as I might I could not keep still. Technicians tried their best to adjust me – time and time again, to the correct position, but it seemed each time they dashed off to escape the radiation, having been off my medication for 24 hours now, my neck would go into dystonia and cramp just enough to tug the frame out of alignment. Still as frustrating as that must have been, my apologies were met graciously and – although essentially untruthful, I was politely assured “No, it’s not your fault.”

Eventually it was decided that the scan was good enough (I suspect they gave up!) and like ‘Bran the Broken’ heading to lure the Night King; on I was wheeled flanked by those charged with protecting my life into theatre. Completely reliant on the team around me, my future now lay in the hands of the experts already steeling themselves for the battle.

As I eased myself out of the chair and nurses helped me onto the operating table that presented like an altar – the clear focus of the room, where careful preparations were metitculously taking place. My frame was clamped, and I felt my neck tug as I was locked into place. From this point, my head will not be able to adjust to any motion; presenting a steady and still target for my neurosurgeon. At the same time, by limiting my head’s ability to counter movement from my body, an unlikely seizure or other violent movement, would no doubt break my neck.

Like a wobbly tooth, I couldn’t help myself from testing the clamp out. I attempted to roll my head left and then right, up and then down. Sure enough the hardware did its job and I became aware that my field of vision was restricted to only what sliding my eyes along their horizontal and vertical planes could achieve. It was then that I spotted my Neurologist standing at a computer screen in the back corner of the room. His task at that time was to analyse the CT scan taken earlier, in conjunction with the pre-surgery high definition MRI scan, to create co-ordinates for my surgeon to guide him as he probed his way from the top of my skull, through an asteroid field of vital brain functions, on the way down to the target zone, millimeters away from my brain stem.

Some memories are cloudy, though I’m sure it was ‘Gun’s n Roses – Knocking on heaven’s door’ that prompted me to roll my eyes toward my Anaesthetist, “Who’s playlist is this?” I enquired, silmultaneously appreciating the selection so far, for their quality and their irony.

“It’s Matt’s music” he responded, and although a tiny detail, the enormous weight of responsibility that sat squarely on the shoulders of my Neurosurgeon became clear to me. The consequences of a cough, a nervous twitch, a distraction…

On cue – Matt’s voice. “Okay Todd. This is probably the most painful part. It will sting a bit as I put some local in…” A good description in the end. I pictured the needle penetrating my scalp and spraying the anesthetic from left to right. My jaw tightened and I grimaced through the sting, I  adjusted the volume of the music in my head ‘…it’s the thrill of the fight, Risin’ up to the challenge of our rival’.

As I prepared myself for more injections, the delay was unnerving me. It must have been 20 or more seconds since the last jab. I cautiously opened one eye and then the other, before risking the question to my anesthetist “Is that it?’ Is he finished with the local?”

“Yep – all done Todd.” I couldn’t help but be flooded with renewed hope. If that was the hardest bit, I don’t know what all the fuss is over… I clearly misunderstood Matt’s comment.

‘Most painful’ and ‘hardest’ do not always correlate.  

“I’m still at least 10 minutes away” I sensed a little irritation in my Neurologist’s voice as the volume in the room dropped a level. I was caught between wanting my team to take their time – no need to rush this –   but also, the niggling thought of ‘How long does local last?’

“Ok, that’s it.” Rob’s targeting work in the corner was done, explaining to someone that the angle of the CT scan was out of alignment (due to my cramping neck) adding a layer of complexity to his critical targeting co-ordinates.  He relayed his list of co-ordinates to Matt, via an assistant who was transcribing on a slightly out of view whiteboard. Matt was also busy. He made a long c – shaped incision in my numbed scalp and folded it back on itself revealing my skull. I then mentally pictured him selecting his drill; as others went to work, fixing a drop sheet from the ceiling down to the front, still attached part of my scalp, to provide a barrier between the ‘messy side’ which was Matt’s domain; and the parallel dimension that I could see, which bore no resemblance to the confronting scene behind me. ‘Rob’s domain’ was clear of gore and as he settled in beside me gripping my hand with one of his own and resting his other reassuringly on my leg. My consciousness was entirely on this side of the dropsheet and would remain there for the rest of the show, effectively as far as fear and trauma goes, it wasn’t hard to distract the menacing  thoughts of my bared skull, blood, and drilling; as Rob stole my focus, talking me through each step, and his clear articulation of his expert understanding of every detail, kept me where I needed to be – on his side of the dropsheet.

It’s time. Rob shares with me that Matt will begin by drilling into the left side of my skull and as the left brain controls the right side of our bodies, we would be focussing on just that. As he made his way around to my right, I subconsciously transferred Mary into my left hand and tightened my grip. I was warned that the drill would be loud and unpleasant but would be over in a matter of minutes. In my mind I was nodding ‘…and the last known survivor stalks his prey in the night’ – though of course my head was perfectly still…Let’s do this.

Words could never adequately prepare me for the drilling. It started as one would expect with the sound of a pneumatic drill – a little too close to the ear but not terribly uncomfortable. Then, the drill bit made contact with bone.

Nothing else in the world existed.

My eyes instinctively closed. All was black.

My whole skeleton vibrated intensely and I might as well have been strapped to the engine of a Boeing 747. The only thing capable of taking the attention of my senses from the vibration, was the noise. The vibration. The noise. Maybe an exploding 747 engine…

Long minutes elapsed. The pilot relaxed the throttle. And the sounds of the theatre – able to compete again – ushered in reality. 

“Wow, yeah…that was loud.” An ironic smile escaped me, knowing that there was no way to accurately interpret my perspective – in English, at least. 

“Gee you have a thick skull!” Matt offered from behind the dropsheet, yeilding a broadening of my grin to near ‘Cheshire’ status. My brothers would have loved that. He then went about tidying up the hole with an instrument not requiring a jet engine; and inserting the first wire which would act as both a scout and electrical test, expertly piloted by Matt, to its target location deep into my sub-thalamic nucleus. Thankfully as pain free as predicted.

Rob’s look was intense, demanding my attention. He carefully and deliberately reminded me of my role. With all the imaging in the world and with the experience of hundreds of these operations behind them, it was only me who could report feelings of discomfort, tingling, numbness, or any sign that the electrode could be causing unwanted side-effects; or alert Rob to the need to adjust the target location – this was the whole purpose of staying awake. Although already tiring I committed myself to the highest level of alert that I could muster.