Lisa tried not to think about what was happening to her head. Instead she thought about the discomfort in her bladder.'
She called to Dr. Ranade and told him she had to urinate.
"You have a catheter in your bladder," said Dr. Ranade.
"But I have to urinate," said Lisa.
"Just relax, Lisa," said Dr. Ranade. "I'll give you a little more sleep medicine."
The next thing Lisa was conscious of was the high-pitched whine of a gas-powered motor combined with a sense of pressure and vibration on her head. The noise was frightening because she knew what it meant. Her skull was being opened by a saw; she didn't know it was called a craniotome. Thankfully there was no pain, although Lisa braced for it to occur at any moment. The smell of scorched bone penetrated the gauze drapes over her face. She felt Dr. Ranade's hand take hers, and she was thankful for it. She pressed it as if it were her only hope of survival.
The sound of the craniotome died. The rhythmic beeping of the cardiac monitor emerged from sudden stillness. Then Lisa felt pain again, this time more like the discomfort of a localized headache. Dr. Ranade's face appeared at the end of her tunnel of vision. He watched her as she felt the blood pressure cuff inflate.
"Bone forceps," said Dr. Newman.
Lisa heard and felt bone crunching. It sounded very close to her right ear.
"Elevators," said Dr. Newman.
Lisa felt several more twinges, followed by what seemed to her a loud snap. She knew her head was open.
"Damp gauze," said Dr. Newman, in a matter-of-fact voice.
While still scrubbing his hands, Dr. Curt Mannerheim leaned over to look through the door into OR #21 and see the clock on the far wall. It was almost nine o'clock. At that moment, he saw his chief resident, Dr. Newman, step back from the table. The resident crossed his gloved hands on his chest, and walked over to study the X rays arranged on the view box. That could mean only one thing. The craniotomy was done and they were ready for the Chief. Dr. Mannerheim knew he didn't have much time to spare. The investigation committee from the N.I.H. was due to arrive at noon. What was at stake was a twelve-million-dollar research grant that would support his research activities for the next five years. He had to get that grant. If he didn't, he might lose his entire animal lab, and with it, the results of four years of work. Mannerheim was certain he was on the brink of finding the exact spot in the brain responsible for aggression and rage.
Rinsing the suds, Mannerheim caught sight of Lori Mclnter, the Assistant Director of the OR. He shouted her name and she stopped in her tracks.
"Lori, dear! I've got two Jap doctors here from Tokyo.
Could you send someone into the lounge to make sure they find scrub clothes and all that?"
Lori McInter nodded, although she indicated she wasn't pleased at the request. Mannerheim's shouting in the corridor irritated her.
Mannerheim caught the silent rebuke and cursed the nurse under his breath. "Women," he muttered. To Mannerheim, nurses were becoming more and more a pain in the ass.
Mannerheim burst into the OR like a bull into the ring. The congenial atmosphere changed instantly. Darlene Cooper handed him a sterile towel. Drying one hand, then the other, and working down his forearms, Mannerheim bent over to look at the opening in Lisa Marino's skull.
"God damn it, Newman," snarled Mannerheim, "when are you going to learn to do a decent craniotomy? If I've told you once, I've told you a thousand times to bevel the edges more. Christ! This is a mess."
Under the drapes Lisa felt a new surge of fear. Something had gone wrong with her operation.
"I…" began Newman.
"I don't want to hear a single excuse. Either you do it properly or you'll be looking for another job. I got some Japs coming in here and what are they going to think when they see this?"
Nancy Donovan was standing at his side to take the towel, but Mannerheim preferred to throw it on the floor. He liked to create havoc and, like a child, demanded total attention where-ever he was. And he got it. He was considered technically one of the best neurosurgeons in the country, if not the fastest. In his own terms he said, "Once you get into the head, there's no time to pussyfoot around." And with his encyclopedic knowledge of the intricacies of human neuroanatomy, he was superbly efficient.
Darlene Cooper held open the special brown rubber gloves that Mannerheim demanded. As he thrust in his hands, he looked into her eyes.
"Ahhh," he cooed, as if he were experiencing orgastic pleasure from inserting his hands. "Baby, you're fabulous."
Darlene Cooper avoided looking into Mannerheim's gray blue eyes, as she handed him a damp towel to wipe off the powder on the gloves. She was accustomed to his comments, and from experience she knew that the best defense was to ignore him.
Positioning himself at the head of the table with Newman on his right and Lowry on his left, Mannerheim looked down on the semi-transparent dura covering Lisa's brain. Newman had carefully placed sutures through partial thickness of the dura and had anchored them to the edge of the craniotomy site. These sutures held the dura tightly up to the inner surface of the skull.
"All right, let's get this show on the road," said Mannerheim. "Dural hook and scalpel." The instruments were slapped into Mannerheim's hand.
"Easy, baby," said Mannerheim. "We're not on TV. I don't want to feel pain each time I ask for an instrument."
He bent over and deftly tented up the dura with the hook. With the knife he made a small opening. A pinkish gray mound of naked brain could be seen through the hole.
Once under way, Mannerheim became completely professional. His relatively small hands moved with economical deliberation, his prominent eyes never wavering from his patient. He was a physical person with extraordinary eye-hand control. The fact that he was short, five-foot-seven-inches, was a constant source of irritation to him. He felt he'd been cheated of the extra five inches to match his intellectual height, but he kept in excellent condition and looked much younger than his sixty-one years.
With small scissors and cottonoid strips, which he inserted between the dura and the brain for protection, Mannerheim opened up the covering over Lisa's brain to the extent of the bony window. Using his index finger he gently palpated Lisa's temporal lobe. With his experience the slightest abnormality could be detected. For Mannerheim, this intimate interaction between himself and a live pulsating human brain was the apotheosis of his existence. During many operations, the sheer excitement made him sexually erect. "Now let's have the stimulator and the EEG leads," he said.
Dr. Newman and Dr. Lowry wrestled with the profusion of tiny wires. Nancy Donovan, as his circulating nurse, took the appropriate leads when the doctors handed them to her and plugged them into the nearby electrical consoles. Dr. Newman carefully placed the wick electrodes in two parallel rows. One along the middle of the temporal lobe and the other above the Sylvian vein. The flexible electrodes with the silver balls went under the brain. Nancy Donovan threw a switch and an EEG screen next to the cardiac monitor came alive with fluorescent blips tracing erratic lines.
Dr. Harata and Dr. Nagamoto entered the OR. Mannerheim was pleased not so much because the visitors might learn something, but because he loved an audience.
"Now look," said Mannerheim, gesturing, "there's a lot of bullshit in the literature about whether you should take the superior part of the temporal lobe out during a temporal lobectomy. Some doctors fear it might affect the patient's speech. The answer is, test it."
With an electrical stimulator in his hand like an orchestral baton, Mannerheim motioned to Dr. Ranade, who bent down and lifted up the drape. "Lisa," he called.
Lisa opened her eyes. They reflected the bewilderment from the conversation she'd been overhearing.