When the Air Hits Your Brain: Tales from Neurosurgery

13. Belonging

I stared at my coagulated corned beef hash and contemplated my first day as the new chief resident of neurological surgery. My white coat freshly starched, my index cards virginal white, and my mind well rested, I knew this state to be temporary, the lull before the storm.

Seven o’clock on a humid July morning. I awaited the arrival of my resident team for our inaugural card rounds. My assigned senior resident was Mark, who had just finished a pathology elective. The new junior resident, Dave, a University of Chicago graduate, came fresh from his internship at Penn. As I drummed my fingers nervously on the table, I felt very alone. Gone were my original mentors, Gary and Eric. I missed their guidance terribly. Although he was in the fourth year of the program, I knew Mark only from death and doughnuts conferences. I had met Dave before, when I escorted him on his residency interview, but that was over two years earlier. The intern (like all interns) was a complete unknown. A baby-faced lad named Bob, who wanted to be an orthopedic surgeon when he grew up, filled the position this month. Ugh! A team of virtual strangers assembled to help me face the lightning.

The success of a chief rests with the resident team. When in full swing, the university service carries twenty or thirty patients on the floors, another six on the porch, ten in the intensive care units, and a dozen or more followed as consults. Our surgical schedule could total nine or ten craniotomies and a dozen spine cases in a day, not counting traumas and other emergencies. The workload had increased by over 50 percent since my junior residency year, while the number of residents assigned to the university service remained the same. By way of comparison, a chief resident in the early 1960s faced an average inpatient census of eight. The great Cushing did just over two thousand brain operations in his career. Our program did that number in a year. Like other surgical subspecialties, neurosurgery grew exponentially in the 1970s.

I could not know everything that happened on the service, but this didn’t stop the faculty from expecting their chief to be omniscient. I had to rely upon the lower-level house staff for information.

The chief resident straddles two worlds. To the younger residents, the chief is just one more taskmaster who decides when they will take call, how many spinal taps they will perform, and what operative cases they are “ready” to do. To the attending staff, the chief stays a scut dog, a lackey who dances to their every whim. The chief resident is a sergeant in the surgical military, friend to neither enlisted man nor officer, endowed with great responsibilities but given little true authority. Despite the abuse heaped upon the chief by the attending surgeons, I had to stay cheerful and cooperative at all times (“Eat shit as if it’s your favorite dish,” in Gary-speak). Being less than a year from a staff job myself, I could ill afford to mistreat the staff surgeons—indispensable sources of job leads and reference letters.

At 7:15, Mark, Dave, and Bob made their way to the table with trays full of food. The charge nurse for the neuro unit joined us.

“Sooo glad to see everybody is right on time!” I moaned, glancing at my watch. “Since the boss just told me the new rule—the residents must be in their respective OR’s by twenty after seven—that leaves us with five whole minutes to cover twenty-two patients. Eat fast, gentlemen.”

The intern went first. In quick fashion, I found myself bitching at him about bowel movements, post-op headaches, and sleeping patients in the same imperious tone Carl had used in my third year of medical school. It was a weird feeling. Years later, I had a similar feeling on a driving trip. I turned to my bickering daughters and threatened to stop the car in the middle of the turnpike if they didn’t keep quiet. In that instant, I became my father. Likewise, I now became Carl, Maggie, Gary, and every other chief resident I had ever known. The wheel turns. Each generation yields to the next, leaving behind some legacy. In six years, Dave would be sitting in this same spot, sounding just like me.

We sprinted through the patient problems and headed for the operating rooms—fifteen minutes late. Needless to say, the boss was furious. So started the worst year of my life.

• • •

“Goddamn it, Vertosick, is this the same case?” The boss growled at me from outside the OR as he held the swinging door open with his right foot. In the vernacular of surgeons, asking the operator if he or she is doing the “same case” is an insult, an implication that a better surgeon would have progressed to a new patient given the same amount of time.

“Yes sir, it most certainly is the very same case. I had some bleeding from the sigmoid sinus, but it’s stopped now…I’ll be ready to open the dura in another ten minutes.”

“I sure hope so. We have a cervical disc to do in this room next and I have a medical executive committee meeting at three, so look sharp.”

So it went—day in, day out, week in, week out. Staff surgeons beating me constantly. “Same case?” “I have to be somewhere at three…” “Just what the fuck do you think you are doing?” “STAY AWAY FROM THE OPTIC NERVE PLEASE.”

I ate irregularly and my weight dropped twenty pounds. I feared exiting the hospital, terrified that I would not be there when a patient crumped or a trauma rolled in. Because the chief resident is not supposed to take “in-house” call, the surgical administration assigned me no bed in the hospital—even though I spent more nights there than the junior residents. I wandered the hospital in the darkness, like a homeless person in search of someplace warm and soft to sleep. A transplant fellow habitually occupied the sofa in the surgeons’ lounge, so I had to be resourceful. If the ward wasn’t full, I used a patient room. Otherwise, I sacked out on the residents’ pool table. Slate can be quite comfortable when you haven’t slept for thirty-six hours.

I never had the nerve to sleep in one of the OR’s, although previous chiefs often resorted to this. Given the aggressiveness of our transplantation team, I worried that I would wake up minus my liver.

Our transplant service carried a very high profile and consumed the lion’s share of our health center’s OR time and other resources. Their star status imbued the transplant surgeons with the sort of smarmy, menacing charm exuded by bandidos in old westerns. During my residency years, transplant stories became daily fare on the local television news programs, making the senior transplant surgeons into celebrities and hailing every permutation of donor, recipient, organ, and disease as a medical landmark (“Girl becomes first Asian to receive an African-American lung for the treatment of pulmonary hypertension…film at eleven!”). Our center was, and still is, a transplant center of unequaled excellence, but I grew irritated by the news media’s perception that saving a life with an organ transplant is more admirable than saving a life by draining a subdural hematoma or reversing a diabetic coma. When one popular liver-transplant recipient, who had been tracked for years by local journalists, died suddenly, the mayor declared a day of mourning. A tragic death, yes, but aren’t they all? When would the city declare a Sarah Clarke day?

Heart and liver transplants are indeed heroic affairs, requiring consummate skill to perform and extraordinary fortitude to undergo. But when viewed from a national health-care perspective, such transplants equal zero-sum games: a life saved is a life lost. Our city coaxed people into signing donor cards, although no one really wants to think about ending up young, healthy, and brain dead. Transplant programs survive on a constant diet of good-looking cadavers—people in the prime of their lives with brains extinguished by senseless catastrophe. In adults, our donor supply flowed from auto accidents and gunshot wounds; in children, donors were victims of parental shakings and beatings. By definition, a donor organ flows from some tragic and eminently preventable event.

Although transplant patients now do quite well, few recipients survive as long as the donor would have had he dodged a bullet or missed a telephone pole and kept his own organs a while longer. I support organ donation wholeheartedly—it makes the most of a bad situation—but we shouldn’t lose sight of a larger objective: preventing people from becoming donors in the first place.

The neurosurgery service suffered frequent contact with the transplant surgeons. Their potential donors were usually our patients first. Outside hospitals even transferred brain-dead patients to our neuro unit just to be evaluated as donors, a practice which irked us no end. Not only did this practice tie up our beds, but our junior residents had to do histories and physical exams, draw blood work, and manage IV fluids on living corpses—typically in the middle of the night—to spare the transplant fellows such trivialities.

Before the advent of sophisticated organ-procurement networks and transplant foundations, the task of approaching relatives for permission to harvest the organs fell to the donor’s attending physicians (and then, in turn, to the neurosurgery resident on call). Occasionally, we were surprised to learn that the family hadn’t even been told of the patient’s “legal” death. Outside physicians often sidestepped the issue, telling relatives that their dead loved ones were being transferred to the university for further “evaluation”—a true, if not completely honest, statement.

On occasion, we solicited permission for organ donation from the person who made the donor brain-dead in the first place. One of our residents had to call the county jail and obtain permission from the donor’s husband—minutes after the man had been arraigned for shooting her in the brain. The suspect later claimed that he wasn’t responsible for his wife’s death—the transplant surgeons were. He was convicted of murder.

The donor business brought other surprises. A young braintumor victim was flown in from New York for immediate donation to a dying liver recipient. The recipient was already in the OR holding area, prepped and ready to go. The transplant team had been summoned. Preliminary tissue and blood typing revealed an excellent match. One teeny problem: the donor wasn’t brain dead yet. The junior resident, Dave, called me at home and told me that the patient decerebrated to painful stimuli.

Brain death means the loss of all cerebral and brain stem function as determined by neurological examination. Although ancillary testing, such as EEG (electroencephalograms, a measure of electrical brain activity), can be used, the diagnosis of brain death remains clinical. A brain-dead patient cannot exhibit meaningful movement of the extremities, respiratory motions, response to pain, pupillary response to light, or a gag reflex. Decerebration, the rigid extension of all four limbs to pain, requires a living brain stem and invalidates the diagnosis of brain death.

I told Dave to scan the patient immediately and rushed from home to see this Lazarus When I arrived, the prospective donor was back in the neuro unit, surrounded by a jittery team of transplant fellows. Dave stood by the X-ray view box looking at the CT scan.

“This ‘donor’ has a big cerebellar tumor,” said Dave under his breath, “and we might be able to help him, but the vultures are here.” He cast a look over his shoulder. Our nickname for the transplant surgeons derived from their uncanny ability to smell impending brain death. They circled the ICU on a daily basis.

“Screw the vultures, I’ll deal with them…Just take him downstairs and we’ll take this thing out. What Massachusetts General Hospital did he come from, anyway?”

“I don’t remember. Some place in outer nowheresville…they told the family he had a cancerous tumor and was as good as dead. Of course, since they heard so many nice things about transplants from the news, they wanted to give his organs. Nice gesture, but a bit premature.”

I approached the transplant team. “Sorry, gentlemen, but, to paraphrase Mark Twain, the reports of this man’s demise have been greatly exaggerated. We get to keep him. Maybe next time.”

“Horseshit,” a transplant fellow spat with venom. “Look at him, he’s decerebrate, he’ll be dead soon. We’ll wait an hour or so and stop back.”

“What neurosurgery residency did you train in, my learned friend? Decerebration from posterior fossa lesions isn’t as ominous as you think. Our New York friend could be eating eggs for breakfast by tomorrow.”

“Eating osmolyte through an NG tube, you mean. I know a brain-dead guy when I see one, and I have a lady in hepatic failure downstairs.”

“Is this a Monty Python skit or something? He isn’t dead yet and you can’t have him. So kiss off.”

The large group flowed from the room. We removed the man’s tumor that night and he walked out of the hospital a week later. The donor pool was reduced by one, but this particular patient didn’t seem to mind. Two years passed before his tumor claimed him for real.

Clang! What sounds worse than a phone ringing in the middle of the night? When the intern took in-house call, it wasn’t worth going to bed at all. I pulled the phone receiver to my ear. Bob, the orthopedic wannabe, chattered excitedly.

“It’s a gunshot wound! Right between the eyes! What’ll I do? Should I scan the patient or take her right to the OR?”

“Slow down, Bob. Where are the entrance and exit wounds?”

“The entrance is right between the eyes, like I said. About a centimeter hole just above the bridge of the nose. The exit wound is in, the occiput, but a lot of hair and blood’s matted there and I can’t be sure exactly where the exit is…I’m afraid to look too close…”

“Relax. I wouldn’t want you to puke in the wound or anything. Is the patient intubated?”

“No. She’s awake, actually.”

“How’s that again?”

“She wants a cup of coffee…should we let her drink anything if she’s going to the OR?”

“Let me try this again. She has a bullet enter between her eyes and exit at the back of her head and she wants a cup of coffee? Is that right?”

“Yeah. She was unconscious when she came in, but woke right up! Weird, don’t you think?”

“Call the CT people in. I’m coming in, too. I have to see this. In the meantime, ask her if she wants cream and sugar. Pour one for me, too. Extra sweet. See ya.”

I dressed hurriedly. This lady couldn’t stay conscious for long, I thought. Surely the bullet must have clipped a large venous sinus. Even if it didn’t, her brain had to swell soon. When I arrived, the victim was still in the ER, awaiting her CT scan—not in a patient exam room, but sitting in the waiting room watching the late movie, her head wrapped with a bloodied Kerlix gauze. A city policewoman sat beside her.

“Are you the woman who was shot?” I asked.

“Uh-huh,” she replied trancelike, her attention still focused upon the TV.

“Could you come with me please?” I crooked my finger at her and motioned to the ER’s metal doors. She cast me an irritated glance, but obeyed. Back in an examination room, she explained what happened.

“My boyfriend was a little drunk and got real mad, you know, like really, really pissed off, so he shot me. I think I passed out right after it happened. I know he didn’t mean it…Do you think, you know, I could go back to him tonight? They say I can’t.” She motioned to the sphinxlike officer who had followed us into the room. “I know that he truly loves me. He didn’t mean it, I know he didn’t.”

The wounds were as Bob had described them. I examined the back of her head, parting the thick brown hair until I saw a jagged exit wound. As I was rummaging around, a nearly pristine bullet fell onto the gurney and was quickly retrieved by the policewoman and turned over to a homicide detective waiting outside. Neither wound was bleeding, and there was no sign of brain tissue or spinal fluid. Her neurological exam was normal. Why was this woman still alive?

The CT scan provided the answer. The bullet had fractured the frontal bone, but had not injured the brain. Between the scalp and skull at the top of her head was a mixture of blood and air which traced from the entrance wound to the exit wound. The bullet had hit the frontal bone and deflected upward, circling over the skull and under the scalp like a roulette ball before blasting out the back of the head. The woman’s skull was unusually thick, a congenital abnormality which had saved her life. She had sustained the handgun equivalent of comedian Steve Martin’s “arrow through the head” sight gag.

As amazing as her injury was, her attitude surpassed it. She held no animosity whatsoever toward a man who had jammed his revolver between her eyes and pulled the trigger. After all, he “missed,” didn’t he? She refused to believe that he had done anything wrong, save for drinking too much and losing his temper.

The skull does a marvelous job of shielding the brain. A middleaged Protestant minister with intractable depression decided that he couldn’t wait until his appointed date with destiny to meet his Maker. He borrowed a friend’s .22 caliber revolver and, placing it against his right temple, blasted himself senseless. The paramedics, believing him mortally wounded, transferred him to the hospital without intubating his trachea. He arrived in our ER still unconscious, a serene look upon his craggy face.

Because his vital signs were normal and his pupils reactive to light, I ordered a plain skull film immediately. The X ray confirmed my suspicions: the small bullet had lodged in his “pterion,” a hard ridge of bone about two inches in front of the external ear canal. The projectile had failed to enter the brain. The impact of the bullet had struck the minister like a heavyweight uppercut, temporarily rendering him unconscious, but unhurt.

I looked into his face closely as he regained consciousness, curious to see the reaction of a man who believed he was opening his eyes in Paradise. The eyelids fluttered, the eyes squinted into the fluorescent light.

“Is…is this heaven or hell?”

I overcame my irresistible urge to play some form of practical joke, like lighting a match in his face. “To tell you the truth, Reverend, it’s the emergency room. Although it can be hellish at times, I’ll admit.”

He sobbed uncontrollably, covering his face with his hands. “Oh God, I’m so ashamed…so ashamed. I can’t even kill myself…” Such a profound and desperate act thwarted by an inch of bone. The irony. Betrayed by the Maker’s own blueprint. I said nothing else, leaving him to his inner torment.

He was given a tetanus shot and transferred to psychiatry. I never saw’ him again.

Monday morning. Residents’ clinic. Failed-back patients and neck injuries littered the schedule. One patient caught my eye, however: Florence Janeway. Diagnosis: meningioma.

Three coverings wrap the brain: the dura mater, arachnoid, and pia mater. These wrappings are known collectively as the meninges. When meninges become infected with bacteria, meningitis results. A tumor of the meninges goes by the name of meningioma.

Meningiomas, nearly always benign, arise from the outer surface of the skull, not the brain, and are removed fairly easily. They may take years, even decades, to reach a symptomatic size, given their slow growth rate.

Neurosurgeons enjoy meningiomas. So much so that Mrs. Janeway’s appearance in residents’ clinic was enigmatic. Why hadn’t a staff surgeon snapped this up? It couldn’t be because of her insurance status. The staff would paypatients for the pleasure of rolling out their big, juicy tumors. Dave had already seen the woman.

“Dave, what’s a meningioma doing in our clinic?”

“Oh, you mean Janeway? She’s a pretzel lady. Had a history of depression, couple suicide attempts. Now she has Alzheimer’s disease and lives in Allison Manor Nursing Home.”

“How did they figure out she had a meningioma?”

“One of the aides at the home noticed a lump on the back of her head while combing her hair. They sent her for a scan. I have it in the office.”

“How old is she?”


We returned to the office. Dave flipped the scans onto the view box. Mrs. Janeway didn’t have just any meningioma, she had the mother of all meningiomas. A huge white ball occupied a third of her head. Meningiomas induce thickening of the skull, hence the “bump” noticed by the nursing-home aid.

When I saw her, I realized why Dave had called her a “pretzel lady.” Muscle contractures distorted her limbs. Her blank face stared into space. She said a few words and followed simple commands, but she certainly looked like someone suffering with Alzheimer’s disease.

“What are we supposed to do with her?” Dave asked.

“How do they know she has Alzheimer’s?”

“Well…look at her!”

“How do we know this isn’t from her tumor?”

“I guess we don’t.”

“Someone gave her the diagnosis of incurable dementia without doing a head scan?”

Dave rummaged through her thick outpatient chart. “That’s what it looks like.”

I thought for a moment. “The horse is out of the barn, I’m afraid, tumor or no tumor.”

“The horse isn’t just out of the barn,” commented Dave as he looked down at the twisted little frame on the exam table, “it’s at the lake getting a drink of water.”

“Send her back. Tell the nursing home ‘No, thanks.’”

I finished seeing patients and returned to the wards.

But Mrs. Janeway didn’t leave my mind that night. Or the next day. Was her dementia irreversible? Sixty-seven isn’t old, and her health was good. I called her oldest daughter.

“Mom’s been bad for two years. The depression came on about three years ago, but the memory loss and incontinence began two years ago. The last six months, she hasn’t recognized me or my sisters at all.”

“Three years ago, what was she like?”

“Mom ran an insurance office for thirty years. Sharp as a tack. Then she started having trouble with arithmetic and had to quit work. That was…hmmm…about 1976.”

I explained the situation, described the tumor, and detailed the risks of surgery—considerable, given the large size of the mass and the fact that it pressed on her left brain. She listened politely, but declined surgery.

But the issue gnawed at her as much as me, and I received a phone call the next morning. The three children had talked (Mrs. Janeway was a widow). They wanted surgery. As I suspected, neither they nor I could live with the slightest possibility that a working brain had been abandoned to the mercy of a benign tumor. I scheduled the craniotomy for the following week.

I requested the boss’s help—I needed his thirty years of experience.

It was a bloody affair. We reflected the thickened bone from the bulging mass beneath and released a torrent of bleeding. I incised the dura, located the plane separating brain from meningioma, and began pulling the mass out of her head. My slow technique, however, could not keep up with the bleeding.

“This will take forever,” I moaned.

“We need to get it out fast,” observed the boss calmly. “We’re losing about two hundred cc’s of blood every fifteen minutes.” He looked over the anesthesia screen and spoke to the anesthesiologist. “Can you folks keep up?”

“Possibly, but we don’t want to get into big fluid shifts in her.”

The boss looked back at me with a gleam in his eyes. “Frank, get some cotton balls and have your bipolar ready. We’re going to yank this thing the old-fashioned way. Quick. Are you ready?” I nodded. “Then put a great big nylon stitch through the dura over the tumor…here…that’s it…Now I’ll put my finger here…OK, PULL!”

I pulled the suture as the boss swept his large index finger beneath the tumor. The red baseball levitated from the wound as the chairman advanced his finger deeper. The bleeding increased. I jammed cotton balls between the tumor and the brain with my right hand, my left hand providing traction on the tumor stitch. As he delivered the tumor from the depths, the boss inserted another finger, then another, until Mrs. Janeway’s head swallowed his hand.

The anesthesiologist grew nervous. “We’re getting hypotension here.”

“Fix it,” the boss yelled without looking up, “that’s what they pay you for. Come on, Frank, buzz that artery…there. Keep working, we’re almost home.”

Finally, the great mass slithered out of the skull and dangled on a shred of uncut dura mater. A snip of the scissors and the tumor dropped into a steel pan. Stopping the bleeding took an hour longer. When everything was dry and the patient stable, we could at last see the horrible brain deformation left behind. The meningioma had flattened the left hemisphere into a pancake, and our surgery had chewed up the cortex terribly; I doubted that the brain would recover.

Nevertheless, the boss looked pleased.

“Nice work. That was a monster.” He shook my hand before pulling off his gloves. “You’re really one of us now.”

I still see Mrs. Janeway once a year. She comes to the office in her smart business suit and tells me about the latest Buick she drives. Her legs remain stiff, although the orthopedic procedures to release her contractures worked wonders. Her daughters claim she is every ounce the woman she was fifteen years ago.

In my career, Mrs. Janeway was truly a landmark case. If I never accomplish another thing in my life, I will go to my grave satisfied. I will not walk on the moon, or win the Nobel Prize, or live in the White House. But the rare privilege of snatching someone from a nursing home and giving back her mind, her life, her family…I wouldn’t trade that for the world.

Despite the occasional Mrs. Janeways, chief residency ground me down. Constant exposure to gunshot wounds, brain-dead donors, harried interns, pompous surgeons, patients in pain, and hospital-grade corned beef took its toll. My enthusiasm for the job waned. Some days I no longer cared who lived and who died. I just wanted to be done, to have my life back, to see my wife and baby. Like Humphrey Bogart in The African Queen, all I could do was climb back into the leech-ridden waters and keep pulling my boat toward the open sea.

My residency ended at last, and with little fanfare, I entered practice. “One of them.” Big deal. Overdosed on surgery my final year, I felt little joy for my new profession those first months as an official neurosurgeon. My training finished, I reflected upon my career choice.

We are all slaves to chaos—chaos in the scientific sense. Chaos theory predicts that the outcome of a chaotic process depends upon minuscule variations in the “initial conditions.” Example: a billiard ball rolling off the hood of a car. When placed in one spot, it rolls one way; placed one millimeter to the right or left of that spot, it rolls in a different direction altogether. Where the ball ends up depends entirely upon where we place it initially.

The impact of the initial conditions has been named the “butterfly effect,” since, in the chaotic theory of weather, the beating of a butterfly’s wings in Asia can cause a hurricane in the southern Atlantic months later. Our lives evolve from our own butterfly effects. The tiniest perturbations in our youths, our “initial conditions,” generate profound alterations in our later lives. In my case, I had wanted to be a computer scientist, but no openings in my freshman computer-science courses existed. If I had jumped one or two places ahead in the registration line, I would have made it into freshman comp sci and never become a physician. What delayed my arrival at the registration office? I don’t remember—stopping for a hamburger, maybe, or speaking to a friend—but whatever this long-forgotten event was, it changed my life. If I could have taken cardiac surgery, as I had wanted, I would probably be one of the “best in the chest” now, and not a brain surgeon.

The butterfly effect: a conversation here, a missed flight there…happenings which redirect the rivers of our lives. After buffeting about in the chaotic currents, I feared that I had been cast onto a distant shore, a place where I didn’t belong.

Three months into my new practice, a seventy-year-old widow named Grace Catalano came to my office, pushed along in a wheelchair by her burly son. She had suffered from back and leg pains for years. The pain worsened with prolonged standing and walking. In fact, she could now barely walk at all, save for the few steps from bed to wheelchair.

“Oh, Doctor, you are my last hope. I have arthritis so bad in my back and legs, so bad, I can’t go from here to the door. Now the pain bothers me even at night, even when I’m off my feet. They have me on narcotic pills. My family doctor says that it’s just arthritis and I have to live with it, but a neighbor says that maybe it’s a ruptured disc or something.. I’m afraid of surgery, Doctor, but I’ll do anything to get rid of this. Anything. I have two granddaughters—twins—they are four years old now and they want to know why their grandmama never walks with them or takes them to movies…” She began to wipe her tears away.

I examined her, but detected neither weakness nor numbness to confirm her spinal problem. Her story sounded like lumbar stenosis, arthritic narrowing of the lower spine. Lumbar stenosis results from deposition of bone spurs and thickened ligaments in the lower vertebrae. The spinal canal, which conveys the nerves to the legs, narrows during stenosis. A napkinring constriction of the nerves forms, with chronic leg pain as a result. The disease occurs in the elderly and still goes largely unrecognized, the leg pains and shuffling gait attributed to incurable arthritic deterioration of the spine, or to old age. Fortunately, even in the advanced stages the condition responds well to surgery, the overgrown bone and ligaments safely trimmed away.

I ordered a myelogram, which verified severe narrowing between her fourth and fifth lumbar vertebrae, at the base of the spine. I performed a laminectomy and decompressed her spine uneventfully, but she left the hospital in her wheelchair. Transferred to a rehabilitation center, she didn’t return to see me until months later.

Glancing at my office schedule one day, I noticed that Grace Catalano topped the list. When I entered the exam room, however, I saw her son, not Grace, seated on the exam table.

“Where’s your mother? Is she all right?”

“Mama didn’t want to come in. She wants you to go out in the waiting room.” I agreed.

There, erect as a young sapling, stood Grace Catalano, flanked by two raven-haired little girls.

“Watch,” she said. Her son swung open the waiting-room door and Grace waddled into the long corridor outside, a granddaughter on each hand. She strolled easily for twenty yards, then slowly turned around and returned. We looked at each other with matching grins.

Yes indeed, if it was easy, everyone would do it. I checked her wound, made some small-talk and said goodbye.

She strode back into the corridor, out of my life and back into her own, her precious grandchildren at her side. Mrs. Catalano was where she belonged.

And so was I.

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