5 May 2005
Thurs, 3:30 PM, NYC
David is in the recovery room, still heavily sedated and sleeping. He is moving his arms and legs on both sides, and is able to mumble and partially open his eyes. His Dad was able to get his ear down to David's mouth to listen, and the only word that came through clearly was "trumpet." Our feeling is that his speech will be fine, and that whatever his sedated dreams are about, they include drum corps. Speaking of drum corps, a wonderful nurse who works in recovery, Christina Brown, marched with David and Doug Rutherford. Her sister, Lisa Ferrari, is also a Garfield alumnus. She brought us lunch, and checked on us during her work breaks.
Although he went into the operating room at 7:15 A.M., surgery actually began at 9:30, due to the extensive prep beforehand. Closing began at 1:00, and David was in recovery by 3:00.
Dr. Kelly was able to remove a significant portion of the visible tumor mass, although an exact measurement will not be possible for about three months, at which time an MRI will not be affected by swelling. Results of the pathology will take several weeks, perhaps longer, as multiple opinions will be sought.
David will be in intensive care for several days. We'll be updating on David's behalf until he's able to do it himself.
5/5/05 Journal Entry Written by David Welch on 5/5/06
As with my 5/4/06 online journal entry, I am using this 1-year anniversary mark to finally write my journal entries from my brain surgery in 2005. I kept detailed notes on scrap papers, and I also interviewed various family members to make sure I had the story straight and to get details that only they would know (because they were conscious on 5/5/05, unlike me).
Again, this is very funny (i.e., odd) timing. At the VERY moment that I am typing these words, I was headed into brain surgery last year. Same time of day. And I was only miles from where I am now, just across the river. I am currently in Brooklyn, and the surgery was done in New York City.
5/5/05 - 1 year later
6 AM
My Mom & Dad arrived at the NYU Hospital to visit me before surgery. I had close to 12 hours of sleep and was well rested. I did not feel pain from the Cerebral Angiogram or the headframe surgery, both done on 5/4/05. Our visit was very brief, because I was quickly whisked away to surgery, which was expected to take a full 8 hours.
The length of this surgery was relatively long because of the location of my lemon-sized astrocytoma. This brain tumor was deep in my brain, behind the Sylvian Fissure, in a location that made it "inoperable" according to all other neurosurgical teams we had visited. The surgical procedures to just get TO the tumor was expected to take about 4 hours, in and of itself.
There was a gentleman named Ferdinand (everyone called him "Ferdy") who steered my bed to the operating room. He was very upbeat and positive, joking with me the entire time I was being transported. There, I was greeted by the Chief Nurse, Kathy Allen.
At this point, my parents had to be kept away. Later, they told me that I never looked afraid. These were the comments that my Mom & Dad shared with one another. It is interesting to hear these observations, because I really was prepared for the worst. I was actually prepared to die. I know that sounds quite dramatic, but I figured that would be the worst thing that could happen. So, if I was truly prepared for this, then anything better would be great news. This was my state of mind as I went into brain surgery.
7 AM
I remember being wheeled into the operating room. I was able to look around. There were windows on all 4 sides of the operating room. Surgery was also about to take place in the rooms to my left and right. I remember about half a dozen people from my medical team scurrying around, preparing to get me into surgery.
That is the last thing I remember prior to surgery. By 7 AM, I was unconscious.
7:15 AM
By 7:15 AM, the stereotactic headframe was attached once again. It was bolted into the holes that were created during my 5/4/05 surgery. At this point, I was truly in the hands of people I trusted. I do not have a precise list of all the things that were done to me in the next 8 hours, but if you watch the "Brain Surgery Video" on the Home Page of this website, you will see the entire surgery, reduced to 8 minutes in length.
Craniotomy
One medical team came in to do the craniotomy. They actually cut out about 4 inches of my skull, taking it out like a cork from a wine bottle. That is, the cut into my skull was at an angle rather that at 90 degrees. This allowed the skull to later be set into place without sinking into/onto my brain. Nice carpentry touch.
Sylvian Fissure
Once the craniotomy was done, another part of the surgical team started cutting my brain. They needed to pull apart my Sylvian Fissure, which was very, very dangerous. My brain tumor was behind this Sylvian Fissure, and if any blood vessels were cut or broken, this could easily cause me to not walk or talk after surgery. Needless to say, this required total studs to be at the helm.
Dr. Kelly was not yet in the room. Instead, there was a woman in charge at this point. Her name is Dr. Andrea Douglas, a fairly young African-American woman (mid-30's?). I remember talking with her before surgery. She is so bright, deliberate, well-spoken, confident, rock-steady, unabashed when people cry out for relief. She was the doctor in charge of (essentially) pulling apart my brain to expose the brain tumor for Dr. Patrick Kelly. I have never met her since that surgery. I wish I could give her a big hug for being so poised under such great pressure, with no room at all for any error.
Brain tumor resection
Once Dr. Douglas got past the Sylvian Fissure and exposed the brain tumor, Dr. Kelly held the scalpel. His job was the most delicate of all. Although Dr. Kelly had done about 7,000 brain operations in his career, I was only his 41st patient with a brain tumor this deep in the brain. Dr. Kelly used to see people like me go without brain surgery and die in short order. He got so fed up with this that he innovated and took risks (with patient consent, of course). This is what led him to invent the Stereotactic Headframe so that he would know where he is within a brain at every moment during the resection of brain tumor...when things were moving around in disorienting ways.
There was an immediate issue that Dr. Kelly had to contend with. Once he got to the brain tumor, it was a different consistency than he was used to seeing. It was a bit tougher than he was expecting. Fortunately, Dr. Kelly was able to switch tools, thus preventing abortion of surgery at this point.
Dr. Kelly saw a fairly large mass of "obviously abnormal" brain cells, which was my brain tumor. He was able to cut a circumference around these tumor cells and then suck them out using a sort of vacuum device. Dr. Kelly's experience was critical. He had to make a determination of where this "obviously abnormal" tissue ended. At a certain point, "good cells" and "bad cells" were all mixed together, which is the nature of an infusive brain tumor. If Dr. Kelly were to remove too much tissue and start cutting into healthy brain tissue, it could have resulted in paralysis or cognitive disfunction.
So, Dr. Kelly had to make these judgments during surgery. As well, he had to contend with another issue that he encountered. He found himself in a situation where blood vessels prevented him from reaching more of the brain tumor. My understanding is that these blood vessels created a wall of sorts that literally blocked his path to more of the brain tumor. So, this restricted additional resection that Dr. Kelly wanted to make. With things shifting around during resection, it sounds as if these are not unusual things to encounter.
Noon
Meanwhile, outside the surgical room, there was a nurse who was part of my NYU medical team who I happened to march with in the 1987 Garfield Cadets Drum & Bugle Corps. (What an ultimate small world story.) Her married name is Christina Brown. When we performed together in the 1987 Garfield Cadets, we ended up winning the DCI World Championships together. So, we were instantly bonded by that experience. No questions asked. Ever. Christina went above and beyond at various points throughout my brain surgery to ensure that my parents knew what the heck was happening.
The first thing that Christina did was deliver food from Todaro Brothers to my parents for lunch. She knew it was our favorite food market, so she somehow arranged for this food and personally delivered it to my parents to help comfort them in what must have been an anxious day for them.
1 PM
Christina also slipped into the waiting room at 1PM to let my parents know that the surgical team was done with resection and was in the process of closing. This involved all sorts of things, to include putting that 4 inch piece of skull back in place and using 3 titanium plates to help hold the skull still -- so bone could bond to bone during the healing process.
2:45 PM
Dr. Kelly greeted my parents at this point. He had recent surgery himself in 2005 and had been walking with a slight limp during his healing process. However, my Mom noted that this limp was gone after being in surgery all those hours. My Mom attributed this to the adrenaline rush of performing this surgery. Dr. Kelly also took the time to show my parents the "guts" of the building at NYU so they knew where things were and what happened where. It shows the degree to which Dr. Kelly becomes personally involved with both patients and caregivers.
3 PM
I was moved to the "recovery room" at this time. I was very out of it, as one might guess. (Perhaps that goes without saying.) One of the things that was mandatory for me was that I was not allowed to take any pain killers for the first 24 hours after my brain surgery. Why? Because Dr. Kelly did not want to have the confounding effects of this medication in my body. There were too many other things that were being tracked in my body...things being tracked to ensure that recovery was happening properly. So, no pain killer. Like other brain cancer patients, I had to gut it out.
3:30 PM
At 3:30, my parents and my brother Michael were able to greet me. Apparently, Michael could not handle seeing me like this. There was nothing he could do to help, and that caused him to start crying. (The irony is that my brother used to beat me up when we were kids. What a turn of the table.)
But, as long as I was asleep, I could not feel pain, so I slept as much as possible.
My family was only allowed to see me for 15 minutes at 3:30 PM. I had no idea that they were in front of me or that they were coming to see me. I tried to open my eyes, but I was very distracted. After having my head cut open and having parts of it taken out, I was drugged and in pain. Not very sexy.
In the midst of this trauma, I began trying to articulate words at 3:30 PM when family was in front of me. Nobody could hear what I was trying to say, so my Dad put his ear very close to my mouth, trying to hear the words I was beginning to form. "Trumpet." Apparently, that is the word I first articulated. (I am a closet trumpet player. I dig high notes on trumpets like there is no tomorrow.)
An hour or so later, a nurse named Sarah told my family that I had talked some more. For some reason, I said, "I have pain in my website." Not sure where that came from; perhaps I was doing some subconscious website planning or the like.
3:30 PM to 8 PM
For the rest of the day, there were severe restrictions on my time. Friends and family were only allowed to visit me 2-3 times during this period, and only 2 people at a time could see me. In fact, I was supposed to be in ICU (the Intensive Care Unit), but there was no space available for me. Instead, I was kept in the Recovery Room, which was a larger room with many patients, all separated by curtains. Still, the NYU medical staff treated me like I was in ICU, so restrictions were enforced with great discipline.
At 5 PM, my parents came into the recovery room again. That is when it was first reported that I had visual recognition of my parents.
Last thoughts regarding 5/5/05
It was a strange state of being. When I visually recognized my parents, memories began again. That is when I began remembering this brain surgery again. I could remember being wheeled into the surgical room at 7 AM. But between 7 AM and 5 PM, there is this black hole of events in my life. What I know is what I was told to me. That's it. But starting at 5 PM, I began to remember once more.
I remember being in severe pain. I would just groan out loud with short spurts of sound. I wanted pain killers. I wanted pain to go away. There was nothing cognitive in this response. Instead, it was primal. Nothing more.
I was fed via IV fluid and I slept as much as I could, which was very natural. My body demanded sleep to recover from all this surgery.
No matter how "out of it" I was, I do remember having the realization that I WAS ALIVE! That exceeded my expectations going into surgery. In that sense, I already knew that I was damn lucky to have just made it through this day.
