Charlene Charles had always been a woman with a tough personality, never mincing words, and often times having ‘choice ones’ for people or situations that irritated her.
In many ways this demeanor served her well, since she had a difficult life to say the least. She survived the diagnosis and treatment for breast cancer almost twenty years ago and more recently had to undergo chemotherapy for a second cancer, lymphoma and was currently in remission.
Though she had periods of time when she saw the glass more empty than full, she managed to fight through it all.
Given this history one might feel she had been through enough, but unfortunately she had one more trial to endure.
This time, however, things progressed more rapidly and the outlook was darker than it had ever been before. One day she had been fine, and the next day, the words that came from her mouth were a jumbled mess. Speaking with her you could tell by the look in her eyes that her brain knew what it wanted to say but she just couldn’t get the words out so they made any sense.
As a result she visibly became frustrated and because of her personality she became extremely angry as well.
At times like these I kind of feel like an interpreter attempting to translate a foreign language. Because I have seen so many people with aphasia, or difficulty speaking I can almost tell what the patient wants to say just by listening to their fragmented speech even when the actual words are completely wrong.
Shortly after she was admitted an MRI scan was performed and revealed what she and her family had dreaded and I suspected...she had a brain tumor. Only it was not a metastasis from her breast cancer or the lymphoma but she had developed a third type of cancer, a malignant astrocytoma.
The following Monday I took Charlene to surgery to remove the tumor. That morning before the nurse took her back to the operating room I went and ‘spoke’ with her. Since she had been receiving a steroid medication for the brain swelling caused by the tumor, her speech was actually more clear, though still not normal. Unfortunately, because of the tumor’s location (left temporal lobe) I realized her speech might not get any better and could even be much worse.
She knew that too.
Surgery went well.
Though I knew I could not completely removed this type of cancer, I hoped that removing as much as I did would decrease the pressure on the surrounding brain enough that her speech would improve, and that her prognosis would be better as well.
I was crushed to discover that following surgery, Charlene could not speak at all. At first I believed this was probably due to my manipulation of her brain as well as the anesthesia and once these effects wore off after two or three days, she would be better. Unfortunately she still was unable to speak, and in fact she seemed to regress to the point where she would not even open her eyes or respond.
Two days after surgery I ordered an MRI scan to be performed. When I reviewed it, I had indeed removed a majority of the tumor but I clearly avoided her speech area so I was even more puzzled as to why her condition was so much worse than before surgery.
I quickly became concerned that now, she might not even make it out of the hospital alive, let alone survive for 12 - 18 months.
Her sister had arrived a few days after surgery and when I spoke to her she revealed how Charlene had on more than one occasion expressed her desire to give up fighting and just join her husband who had long since passed away.
I continued to treat her for whatever brain swelling might still be present in the hopes she would recover but after 5 days, there was no change. When I spoke with her sons later in the day, I expressed my concerns that her recovery was in doubt, as I too, began to accept the inevitable.
At the suggestion of the neurologist who had seen her I started mannitol, which is a diuretic of sorts for the brain. Surprisingly, Charlene began to awaken and become more responsive. This didn’t make sense to me from either a medical or scientific standpoint because this medication shouldn’t have had any significant effect this far out from her surgery.
What is more is that we only administered this medication for a couple of days, then stopped it, yet her improvement continued.
When I saw Charlene 9 days out from her surgery, I was dumbfounded. She was sitting up in bed speaking clearly! Not only was her speech better than before surgery, it was perfectly normal.
She then began to relate to me the ‘dreams’ she was having in the days following her surgery. The images she described sounded more like demons and monsters that were out to get her and in that moment I was reminded of a child hiding under the covers in her bedroom to escape them.
Looking back, it seemed like, to her, just a bad nightmare.
Now, how much of this was the due to the short-circuiting of the complex wiring of her brain caused by the tumor and the surgery, and how much was due to something more inexplicable, I can’t be sure.
But what is clearly miraculous is the degree to which her speech completely normalized... and I this is exactly what I told her.
At this point I am unable predict her prognosis since the post-operative MRI revealed there was residual tumor and the diagnosis was that of the worst possible primary brain tumor, a Glioblastoma Multiforme. But what is clear, is that at least for now, she has been blessed with more time to enjoy her family, and they both have the opportunity, perhaps, to say and understand the things they have been meaning to say to one another for quite some time.


