I started at the skull base, and as the images flipped by, I saw the organ that made Samuel who he was. Inside that skull sat the six hundred billion or so cells that somehow harbored him—his mind, memory, personality, beliefs, intellect, everything. When I got up to the temporal lobes, the problem jumped right off the screen.
"Nasty," I said.
Stinson squinted at the screen. "What do you think it is?"
I adjusted my glasses. "Can't know for sure without a biopsy, but I'd bet it's a GBM."
Glioblastoma multiforme. Grade IV astrocytoma, malignant glioma. This tumor goes by a lot of names, but they're just aliases, a.k.a.'s for what ought to be called the brain assassin. A stone-cold killer. Takes your mind long before it takes you. GBM is pretty much the most malignant, mutated, destructive form of human cancer.
Stinson's long nose flared, and he looked a little nauseated. "Man, I hate those. My sister-in-law had one, died in thirteen months. Left my brother with three little kids. That thing's a nightmare."
"I'm sorry," I said.
I watched as the memory crossed his mind: the subtle softening of his eyes, the momentary slump of his shoulders. Her life in toto, the loss, the pain.
Then he doctored up. Back to work. He waved a hand. "Circle of life, brother. See similar stories in here every day. Have they made any progress with that disease? When my sister-in-law was sick, the doctors said it was almost always fatal."
I shook my head. "No real advances in forty years. Most everybody dies. I hope for his sake it's something else. I'll go see him and biopsy it later today."
"Thanks." Stinson straightened himself and sighed. "Good luck," he said, looking more rabbinical than presidential, "and God bless."
_ _ _
On October 7, 1939, my father was born in Idabel, Oklahoma. As if unwilling to be blamed for a population explosion, Harvey Williams Cushing died on the same day in New Haven, Connecticut, to balance things out. Harvey Cushing was not related to my family, but he is the intellectual father, or at least grandfather, of neurosurgeons everywhere.
Cushing's impact on neurosurgery and all of medicine cannot be overstated. He was world famous for his contributions to the basic science and clinical practice of neurosurgery, anesthesia, neurology, physiology, endocrinology, and other fields. He was a decorated World War I combat surgeon and even won a Pulitzer for his biography of Sir William Osler.
Thirteen years before his death, Cushing and his protege, the young polymath Dr. Percival Bailey, published a book with the exhaustive title A Classification of the Tumors of the Glioma Group on a Histogenetic Basis with a Correlated Study of Prognosis. This book presented the world with the first coherent understanding of tumors of the glioma family and their cellular structure and behavior; it formed the foundation of the modern discipline of neuro-oncology. They delineated the tumor we now call glioblastoma multiforme and set it apart from all other brain tumors as its own entity.
While Cushing and Bailey gave us seminal knowledge of what these tumors are and the cells from which they arise, by the time Cushing died, this understanding had left no meaningful impact on the survival or quality of life of the people afflicted by them. In Cushing's era surgical treatment was likely to kill the patients, and radiation treatment was in its infancy. Chemotherapy was still a fantasy in chemists' minds, and even years later when it became available, gliomas would scoff at it, hide behind the blood-brain barrier, and continue their death march through people's brains.
Cushing died, my father grew up, and thirty years later I was born. I've dealt with dozens of patients with GBM, and although I understand their disease more completely because of Cushing's work, my patients' long-term outcome is not significantly better than the outcome of his. Our diagnostic technologies and treatment strategies are superior, and our surgeries are safer and much better tolerated. Yet for the eighteen thousand or so people diagnosed with it in the United States every year, GBM still carries a ten-year survival rate of basically 0 percent.