Locomotoring

I am stepping into a precision driven medical procedure tomorrow. If my birth was the most significant medical event of my life, this is the second most significant one.

A benign mass in my ear has been growing very slowly. For the first two decades, it was sneaky and only revealed itself the last few years. If it grows any further, it will start to get in the way of other functional areas of the brain. So we are left with no choice but to interfere with its growth. The technology is a precision radiosurgery technique called cyberknife. Weirdly named procedure, is neither a surgery nor a knife. Instead, it is an way to target radiation from thousand different angles on the tumor mass. It is designed so that no single beam of radiation has the power to disrupt the cells, but when they come together from many directions to converge on the tumor cells, they pool their damaging power together. The collated radiation disrupts the cell’s DNA and its ability to replicate.

The machine was first invented at Stanford and thousands of procedures later, it is the most non-invasive way to control a tumor. I am told that if I wanted, I could run to the clinic, get the outpatient procedure done, and run right back home.

Brain radiation has side effects like nausea and headache, but if it weren’t for the cyberknife, a neuro surgeon would be drilling into my head to carve out a piece of my skull and then scrape the tumor out and finally, glue my skull back in. I would need be in the ICU for days and in physical therapy for months. I was told that they would need to move some of my fat tissue from my belly into my brain to stop cerebrospinal leak. I don’t scare easy, but the idea of my belly in my head didn’t hold appeal.

Cyberknife has a lot of parallels with astrophotography. The ancient light from the nebula travel through the universe to reach the camera sensor. No single photon has the ability to leave a mark on the sensor. But with patience, the photons stack together and the chaotic beauty of our universe emerges. The mount tracks the movement of the celestial objects in order to undo the rotation of earth. It is further helped by a guiding software that sends small electrical pulses to the mount so the tracking stays on course. The camera sensor is effectively pinned in space with respect to the universe.

In preparation to the cyberknife, I had to get a personalized head mask done. A piece of plastic was heated up and moulded to my face. During the cyberknife procedure, my head would be held down firmly in place by this moulded plastic mask. Even then, the cyberknife will track my micro movements and adjust continuously, like the guided mount.

Unlike many interventions, this isn’t going to fix the loss of hearing or the tinnitus. Archy, my tinnitus, my muse, will be there for me in the coming years. This intervention will stop further degradation. If the radiation therapy is successful, the tumor will die a slow death over the course of the next few years. The dead tumor will stay cocooned, in place, by scar tissue.

Our experiences shape us. I am expecting this one to shape me. I am somewhat on my edge. I think about Paul Kalanithi’s book, When Breathe Becomes Air, where he, the neurosurgeon wonders at length about the risk a brain surgery presents to the patient. He felt that the person who goes in isn’t the same as the person who comes out of the surgery. In my case, the functions that lie adjacent to the site of operation may be altered. The neuroma isn’t deep into my brain, so the risk of changing the brain behavior is low to none. Yet, I am a little apprehensive of the who I might become after I walk through this one way door.