The Brain Doctor
Doctor Gail Rosseau had cut a patient’s head open; I was standing beside the operating table, peering into the cavity made by the neck muscles she had wrenched apart with two steel spreaders. Earlier I had watched as she drilled two holes, each the size of a dime, at the base of the young woman’s skull and then pinched away at the bone with snippers, gradually enlarging the hole to expose the cerebellum in its grayish sac of dura mater. She cut the dura, folded it back and at last revealed the cerebellum itself, sheathed in luminous blood vessels, shimmering beneath the intense surgical lights. She gently lifted one lobe with a smooth, blunt tool to show me a bundle of radiant white nerves. Then she whispered, "Look. They call this the seat of the soul. It controls heartbeat and breathing. I don’t touch it unless I have to."
Any damage to the thin white fibers and the patient may never wake up again. To open the skull, to touch the brain, is one of the most daring achievements that anyone can undertake. Rosseau calls it "the ultimate trust" between human beings. And she would do it a half-dozen times that week alone.
As I waited for Rosseau in her office at the Neurologic and Orthopedic Institute of Chicago, where she is chair of surgery, I noticed an 8-by-10-inch color photograph on top of a pile of papers. It showed a formal group of about 30 august-looking men with the words "American Board of Neurological Surgery, 2006" at the bottom. In the top row of doctors was a small female face that I recognized as Rosseau’s. Just then she walked in, saw me studying the photograph and laughed. "That says it all, doesn’t it?" she said.
Rosseau, 50, who teaches neurosurgery at Rush-Presbyterian-St. Luke’s Medical Center, is on the staff of several hospitals in the area. A specialist in pituitary brain tumors, she is now turning her attention to breast cancer. She recently announced a pioneering trial screening program aimed at spotting breast cancer that has spread to the brain — before patients show any symptoms — and treating it with a powerfully effective new scalpel-free technology. If a brain scan reveals a tumor, "you lie on a table, and you have this device put on [your head] while you’re awake," she says. "You feel nothing and go home that afternoon."
This year about 170,000 people in the United States will have some type of cancer that spreads to the brain. Between 20 and 30 percent of women who have had breast cancer will be among them. But even as clinics promote full-body "peace of mind" CT scans to perfectly healthy consumers, the lifesaving potential of preemptive scanning for breast-cancer survivors is in dispute.
"Intuitively, the idea of screening makes sense," says Maria Carolina Hinestrosa, executive vice president for programs and planning at the National Breast Cancer Coalition and a survivor of the disease herself. In fact, breast cancer patients used to get all sorts of follow-up scans to see if cancer had spread, or metastasized. The only problem, Hinestrosa and others say, is that scans didn’t make a difference in how long people lived. Rosseau is aware of the controversy and that the American Society of Clinical Oncology does not recommend this kind of follow-up. But she argues that, in the case of brain metastases, technology may be changing that picture. And, in any case, shouldn’t patients have a chance to decide — if only to improve the quality of their final months or years?
So the questions, ultimately, for all of us, will be: How much do you really want to know, how soon do you want to know it, and will that knowledge actually be helpful?