Gifted Hands: The Ben Carson Story (22 page)

“There is nothing that can be done for her,” a doctor finally told her parents.

Those might have been the final words except that a family friend read one of the articles about Maranda Francisco. Immediately she called Denise's parents. The mother, in turn, called Johns Hopkins.

“Bring Denise here, and we'll evaluate her situation,” we said.

Transporting her from New Mexico to Baltimore was no easy task because Denise was on a respirator, which required a med-e-vac—a special transport system. But they made it.

After we evaluated Denise, controversy broke out here at Hopkins over whether to do a hemispherectomy. Several neurologists sincerely thought we would be crazy to attempt such an operation. They had good reasons for their opinions. Number one, Denise was too old. Number two, the seizures were coming from areas that made surgery risky, if not impossible. Number three, she was in terrible medical condition because of her seizures. Denise had aspirated, so she was having pulmonary problems as well.

One critic in particular predicted, “She'll likely die on the table just from the medical problems, much less from a hemispherectomy.” He wasn't trying to be difficult but voiced his opinion out of deep and sincere concern.

Doctors Freeman, Vining, and I didn't agree. As the three people directly involved with all the hemispherectomies at Hopkins, we had had quite a bit of experience, and we were confident that we knew more about hemispherectomies than anyone else. We reasoned that, better than anyone else at Hopkins, we ought to know her chances. She would certainly die soon without surgery. Further, despite her other medical problems, she was still a viable candidate for a hemispherectomy. And, finally, we reasoned that we three ought to be the ones to determine who was a candidate.

We talked with our critic through several conferences, supporting our arguments with the evidence and experience from our background cases. We have a conference office where we invite more than just our inner circle. Over a period of days, we presented all the evidence we could and involved any of the staff at Hopkins whom we thought might have an interest in Denise's condition.

Because of the controversy, we delayed doing the operation. Normally we would have gone ahead and done it, but we faced so much opposition we took this one slowly and carefully. Our opposition deserved a fair hearing, although we insisted upon the final word.

The neurologist-critic went so far as to write a letter to the chairman of neurosurgery, with copies to the chairman of surgery, the hospital president, and a few other people. He stated that, in his medical opinion, under no circumstances should Johns Hopkins allow this operation. He then carefully explained his reasons.

Perhaps it was inevitable that bad feelings developed over Denise's case. When these issues become important it's hard to keep personal feelings out of the picture. Because I believed in the critic's sincerity and his concern for not involving Hopkins in any extraordinary and heroic ventures, I never took his arguments as personal indictments. While I was able to stay out of any personal controversy, a few of our team members and supportive friends did get heatedly involved.

Despite all arguments he brought forth, the three of us remained convinced that Denise's only chance lay in having the surgery. We had not been forbidden to do the surgery, and no one higher up had taken any action on the objection, giving us the freedom to make our decision. Yet we hesitated, not wanting to make this a personal issue, feeling that if we did, the controversy could erupt and affect the morale of the entire hospital staff.

For days I asked God to help us resolve this problem. I pondered it as I drove back and forth to work. I prayed about it as I made my rounds, and when I knelt by my bed at night. Yet I couldn't see how it would work out.

Then the issue resolved itself. Our critic left for a five-day overseas conference. While he was gone, we decided to do the operation. It seemed like a golden opportunity, and we wouldn't have any loud outcries.

I explained to Mrs. Baca as I did to others. “If we don't do anything, she's going to die. If we do something, she may die, but at least we have a chance.”

“At least the operation gives her a fighting chance,” her mother said.

The parents were amenable and had been all along. They understood the issue perfectly. Denise was seizing so much and deteriorating so badly, it was becoming a race against time.

After the hemispherectomy Denise remained comatose for a few days, and then she awakened. She had stopped seizing. By the time she was ready to go home, she was starting to talk. Weeks later, Denise returned to school and has progressed nicely ever since.

I
didn't have any animosity toward the fellow who caused the opposition, because he strongly believed that surgery was the wrong thing to do. It was his prerogative to raise objections. By his objections, he thought he was looking out for the patient's best interests as well as those of the institution.

The situation with Denise taught me two things. First, it made me feel that the good Lord won't allow me to get into a situation He can't get me out of. Second, it confirmed in me that when people know their capabilities, and they know their material (or job), it doesn't matter who opposes them. Regardless of the reputation of the critics or their popularity, power, or how much they think they know, their opinions become irrelevant. I honestly never had any doubts about Denise's surgery. In the months afterwards, although I didn't know it at the time, I would do other and more controversial surgeries. Looking back, I believe that God had used the controversy over Denise to prepare me for the steps yet ahead.

CHAPTER 17

Three Special Children

T
he resident flicked off his penlight and straightened up from the bedside of Bo-Bo Valentine. “Don't you think it's time to give up on this little girl?” he asked, nodding toward the 4-year-old child.

It was early Monday morning, and I was making rounds. When I came to Bo-Bo, the house officer explained her situation. “Just about the only thing she has left is her pupillary response,” he said. (That meant that her pupils still responded to light.) The light he shone in her eyes told him that pressure had built inside her head. The doctors had put Bo-Bo in a barbiturate coma and given her hyperventilation but still couldn't keep the pressures down.

Little Bo-Bo was another of the far-too-many children who run out into a street and are hit by a car. A Good Humor truck struck Bo-Bo. She'd lain in the ICU all weekend, comatose and with an
intracranial
pressure monitor in her skull. Her blood pressure gradually worsened, and she was losing what little function, purposeful movement, and response to stimuli she had.

Before answering the resident, I bent over Bo-Bo and lifted her eyelids. Her pupils were fixed and dilated. “I thought you told me the pupils were still working?” I said in astonishment.

“I did,” he protested. “They were working just before you came in.”

“You're telling me this just happened? That her eyes just now dilated?”

“They must have!”

“Four plus emergency,” I called loudly but calmly. “We've got to do something right away!” I turned to the nurse standing behind me. “Call the operating room. We're on our way.”

“Four plus emergency!” she called even louder and hurried down the corridor.

Although rare, a plus four—for dire emergency—galvanizes everyone into action. The OR staff clears out a room and starts getting the instruments ready. They work with quiet efficiency, and they're quick. No one argues and no one has time to explain.

Two residents grabbed Bo-Bo's bed and half-ran down the hallway. Fortunately surgery hadn't started on the scheduled patient, so we bumped the case.

On my way to the operating room I ran into another neurosurgeon—senior to me and a man I highly respect because of his work with trauma accidents. While the staff was setting up, I explained to him what had happened and what I was going to do.

“Don't do it,” he said, as he walked away from me. “You're wasting your time.”

His attitude amazed me, but I didn't dwell on it. Bo-Bo Valentine was still alive. We had a chance—extremely small—but still a chance to save her life. I decided I would go ahead and do surgery anyway.

Bo-Bo was gently positioned on an “egg crate,” a soft, flexible pad covering the operating table, and was covered with a pale green sheet. Within minutes the nurses and anesthiologist had her ready for me to begin.

I did a craniectomy. First I opened her head and took off the front portion of her skull. The skull bone was put in a sterile solution. Then I opened up the covering of her brain—the dura. Between the two halves of the brain is an area called the falx. By splitting the falx, the two halves could communicate together and equalize the pressure between her hemispheres. Using cadaveric dura (dura from a dead person), I sewed it over her brain. This gave her brain room to swell, then heal, and still held everything inside her skull in place. Once I covered the area, I closed the scalp. The surgery took about two hours.

Bo-Bo remained comatose for the next few days. It is heartbreaking to watch parents sit by the bedside of a comatose child, and I felt for them. I could only give them hope; I couldn't promise Bo-Bo's recovery. One morning I stopped by her bed and noted that her pupils were starting to work a little bit. I recall thinking,
Maybe something positive is starting to happen
.

After two more days Bo-Bo started moving a little. Sometimes she stretched her legs or shifted her body as if trying to get more comfortable. Over the course of a week she grew alert and responsive. When it became apparent that she was going to recover, we took her back to surgery, and I replaced the portion of her skull that had been removed. Within six weeks Bo-Bo was, once again, a normal 4-year-old girl—vivacious, bouncy, and cute.

This is another instance when I'm glad I didn't listen to a critic.

I
've actually done one craniectomy since then. Again I encountered opposition.

In the summer of 1988, we had a similar situation except that Charles,
*
age 10, was in worse shape. He had been hit by a car.

When the head nurse told me that Charles's pupils had become fixed and dilated, that meant we had to take action. The clinic was especially busy that day, so I sent the senior resident to explain to the mother that, in my judgment, we ought to take Charles to the operating room immediately. We would remove a portion of his brain as a last-ditch effort to save his life. “It may not work,” the resident told her, “but Dr. Carson thinks it's worth a try.”

The poor mother was distraught and shocked. “Absolutely not,” she cried. “I can't let you do it. You will not do that to my boy! Just let him die in peace. You're not going to be playing around with my kid.”

“But this way we have a chance—”

“A chance? I want more than a chance.” She kept shaking her head. “Let him go.” Her response was reasonable. By then Charles wasn't responding to anything.

Only three days earlier we had regretfully told her that Charles's condition was so serious that he would probably not recover, and she should come to grips with the inevitable end. Then suddenly a man stood before her, urging her to give her consent to a radical procedure. The resident could give her no assurance that Charles would recover or even be better.

After the resident returned and repeated the conversation, I went to see Charles's mother. I spent a long time explaining in detail that we weren't going to cut the boy in pieces. She still hesitated.

“Let me tell you about a similar situation we had here,” I said. “She was a sweet little girl named Bo-Bo.” When I finished I added, “Look, I don't know about this surgery. It may not work, but I don't see that we can give up in a situation where we still have even a glimmer of hope. Maybe it's the smallest chance of hope, but we can't just throw it away, can we? The worst thing that could happen is that Charles dies anyway.”

Once she understood exactly what I would do, she said, “You mean there really is a chance? A possibility that Charles might live?”