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.
“Lisa,” said Dr. Ranade. “I want you to recite as many nursery rhymes as you can.”
Lisa complied, hoping that by helping the whole affair would soon be over. She started to speak, but as she did so Dr. Mannerheim touched the surface of her brain with the stimulator. In mid-word her speech stopped. She knew what she wanted to say, but couldn’t. At the same time she had a mental image of a person walking through a door.
Noting the interruption in Lisa’s speech, Mannerheim said, “There’s your answer! We don’t take the superior temporal gyrus on this patient.”
The heads of the Japanese visitors bobbed in understanding.
“Now for the more interesting part of this exercise,” said Mannerheim, taking one of the two depth electrodes he’d gotten from Gibson Memorial Hospital. “By the way, somebody call X ray. I want a shot of these electrodes so we’ll know later where they were.”
The rigid needle electrodes were both recording and stimulating instruments. Prior to having them sterilized, Mannerheim had marked off a point on the electrodes four centimeters from the needle tip. With a small metal ruler he measured four centimeters from the front edge of the temporal lobe. Holding the electrode at right angles to the surface of the brain, Mannerheim pushed it in blindly and easily to the four-centimeter mark. The brain tissues afforded minimal resistance. He took the second electrode and inserted it two centimeters posterior to the first. Each electrode stuck out about five centimeters from the surface of the brain.
Fortunately, Kenneth Robbins, the Chief Neuroradiology X-ray technician, arrived at that moment. If he had been late Mannerheim would have thrown one of his celebrated fits. Since the operating room was outfitted to facilitate X ray, the chief technician needed only a few minutes to take the two shots.
“Now,” said Mannerheim, glancing up at the clock and realizing he was going to have to speed things up. “Let’s stimulate the depth electrodes and see if we can generate some epileptic brain waves. It’s been my experience that if we can, then the chances of the lobectomy helping the seizure disorder are just about one hundred percent.”
The doctors regrouped around the patient. “Dr. Ranade,” said Mannerheim. “I want you to ask the patient to describe what she feels and thinks after the stimulus.”
Dr. Ranade nodded, then disappeared under the edge of the drapes. When he reappeared he indicated to Mannerheim to proceed.
For Lisa the stimulus was like a bomb blast without sound or pain. After a blank period that could have been a fraction of a second or an hour, a kaleidoscope of images merged into the face of Dr. Ranade at the end of a long tunnel. She didn’t recognize Dr. Ranade nor did she know where she was. All she was aware of was the terrible smell that heralded her seizures. It terrified her.
“What did you feel?” asked Dr. Ranade.
“Help me,” cried Lisa. She tried to move but felt the restraints. She knew the seizure was coming. “Help me.”