THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, December 4, 1995 TAG: 9512040046
SECTION: FRONT PAGE: A1 EDITION: FINAL
SERIES: Brain Surgery: The Decision
Part II
SOURCE: Marie Joyce
LENGTH: Long : 158 lines
The monitor shows a black and white picture of Jack H. Pearce Jr. He sits on a hospital bed, a Medusa's tangle of wires jutting out from electrodes attached to his head. Down the left side of the screen, a column of about two dozen wavy horizontal lines monitors his brain waves.
Suddenly, some of those lines jump. Jack's body jerks.
``Notice how he's licking his lips,'' says Dr. Joseph Hogan, Jack's doctor. He is talking to a half-dozen doctors, nurses and technicians gathered around a table in a Sentara Norfolk General Hospital meeting room on a July evening.
Jack is a candidate for surgery - a doctor would remove a chunk of his brain, the part that seems to be causing his seizures. The people in this room must decide: What sections of the brain should they take, and how much?
Jack's body shakes. He grunts. He clutches at his own left arm as though it belonged to someone else who was trying to leave the room.
``Notice how he's holding his left arm,'' says Hogan. His left arm springs free and shoots straight up, rigid. It's known as ``fencer posturing.'' People rush to his side. ``You all right? What's your name?'' one of them asks, voice faint on the tape.
``Jack,'' he says. He takes a breath and sighs.
``Do you know what today's date is?''
``The 4th.''
``He remembers exactly,'' says Hogan.
These images were recorded during eight days Jack spent in the hospital, off his medicine and attached 'round the clock to a machine that measures brain waves.
Hogan feels certain what they should do. The electrodes show activity starting in the right temporal lobe, a section that extends in a horizontal strip a few inches above the right ear. And the mannerisms - the lip-smacking, the hip jerks - are significant. Seizure movements differ, depending on where the attack starts.
Yet Hogan knows other things could be clouding his objectivity. He came to South Hampton Roads several years ago to set up a program for this type of surgery. A version of this operation has been around since just after World War II, but insurance companies only started paying for it routinely a few years ago.
Over the past few years, Hogan has focused on controlling his patients' conditions with medication, trying to cull people like Jack who truly have intractable cases. Not all those people can have the surgery. In some cases, the seizures apparently don't start in a specific region of the brain, or they start in an area that can't be removed.
Jonathan P. Partington, the surgeon who will do the operation, isn't as certain. Yes, Jack has a lot of damage in the right temporal lobe. But he's also got damage to the right frontal lobe, the section that stretches from the forehead and across the top of the skull. And electrodes aren't always accurate. The skin and bone between electrode and brain muffle things.
Maybe the seizures start in his frontal lobe and travel to other parts, said Partington. In that case, removing the temporal lobe won't do any good.
And Partington doesn't know how far back on the brain the affected area is. The farther back he cuts, the more likely he'll destroy fibers connecting Jack's eyes to his vision center, damaging his sight.
``It makes me very nervous,'' he says. ``I would want more assurance.''
Jack's going to have one more test.
Jack breathes heavily, sometimes groaning and moving fitfully in half-sleep. A small bloody patch has soaked through his turban of bandages. His shorn hair sits in a plastic bag on a shelf.
High on the wall of the hospital room, the television shows Charlton Heston and Ava Gardner scurrying around while chunks of buildings tumble around them. ``Earthquake.'' The sound is off to spare Jack's pounding head.
Earlier, Partington drilled two nickel-sized holes in Jack's skull and slid in several paper-thin strips of plastic with tiny electrodes in them. They rest over the right temporal and frontal lobes, between the underside of the skull and the tissue that covers the brain. These electrodes, free of interference, will give a much more accurate picture of where the seizures are starting.
Jack will spend up to a week or so here, off the medication he has been taking to control his seizures.
Jack's favorite videotapes, mostly action flicks, sit unused in a bag on the windowsill.
He's too sick for the food on his meal tray.
By now, Laurie, Jack, Ruth and Betty - Laurie's daughter from her first marriage - know the quickest route to every snack machine. They know where the hospital volunteers offer free coffee, and know that the bacon cheeseburger is pretty good at the cafeteria downstairs.
Jack and Ruth are here all day. Laurie spends every night on a cot, running home to shower and change. When Ruth and Jack leave, Laurie sits and watches her husband.
She doesn't let herself cry. She'd drive Jack around forever, if he'd let her, so he wouldn't have to do this.
She is the only one there when the first seizure comes, in the evening while watching television. Later that night, she is sleeping when he hollers for her, in a certain voice that she knows.
A few more, and doctors have seen enough. The seizures are starting in the right temporal lobe, the right side above the ear. And they don't start too far back, which means Partington can operate without doing much to Jack's vision.
Deep circles line Jack's eyes.
The electrodes burned coming out, even though Jack had been given a strong sedative. Then Hogan visited Jack in his room for a talk about risks. Some people can lose some vision, or hearing, or even memory, though, he said, Jack would probably only lose a little peripheral vision.
The surgery might not even work. One of six who undergo it aren't cured.
Jack ponders as the evening wears on.
Suppose he loses his memory? That's too much to ask.
But Laurie knows different. ``He's gone too far to run scared.'' She perches on the edge of the bed. It's like having a baby, she says. ``You're thinking, `Oh, gosh. It's so bad. I'm never going to have another one.' '' But once it's over, you forget about the pain. ``Give him another week. He'll bounce back to his old self.''
``You're probably right,'' says Jack.
``I know I'm right.''
Jack gazes out the window by his desk at First Merchants Acceptance Corp. near Lynnhaven. It's Aug. 21, and the memory of the pain of three weeks ago has faded. The day after tomorrow is the day.
He's making a few last phone calls, arranging to have his accounts handled while he's out.
``You try to think about how it's going to be,'' he says, contemplating life after surgery. ``My singing - am I going to have the same voice I have now? Am I going to have the same skills as far as playing ball?''
It would still be worth it, even if he lost that stuff.
Even if he lost some of his memory. People can fill him in about what he's forgotten.
That night, Jack sleeps.
Laurie doesn't. ILLUSTRATION: Color photo by Martin Smith-Rodden/The Virginian-Pilot
Dr. Joseph Hogan looks at scans of Jack Pearce's damaged brain
during a conference in which they discuss whether to pursue surgery.
It has been done only once before in Hampton Roads.
Photo by Martin Smith-Rodden/The Virginian-Pilot
Jack Pearce's wife, Laurie, and her daughter Betty hug as Jack
Pearce Sr. shaves his son in his hopital room. Electrodes have been
implanted surgically to monitor Jack's seizures.
Graphic
Text by Marie Joyce
Graphic by Robert D. Voros
Anatomy of a seizure
The Injury
The Seizures
The Surgery
For copy of graphic, see microfilm
Black and white photos
During testing to find out more about Jack Pearce's Epilepsy,
Doctors videotaped a seizure during his sleep.
KEYWORDS: SERIES BRAIN SURGERY EPILEPSY
by CNB