Historic brain surgery - Woman sings through procedure at KPH as doctors remove tumour
Published:Sunday | June 28, 2020 | 12:00 AMErica Virtue - Senior Gleaner Writer
When 49-year-old Marjorie Pearson went into surgery three weeks ago at the Kingston Public Hospital (KPH), it was not lost on her and the medical team that the high-risk brain procedure could go horribly wrong.
Dr Dwaine Cooke, consultant neurosurgeon at KPH, and a team of anaesthesiologists, residents and specialist nurses were about to pull off a first-of-its-kind brain surgery in the island’s public health sector.
As they painstakingly conducted the craniotomy – removing part of Pearson’s skull to operate on her brain – the patient talked to and responded well to the team of medics as they removed a tumour during the hours-long procedure, even bursting into song at one point.
The operation went exactly as planned, to the relief of Pearson and the medical team, with the patient requiring minimal post-surgery assistance. By the next day, she was up and about.
Cooke said Marjorie was the ideal patient for such a surgery.
“The anaesthetics that she got intravenously were mostly short-acting painkillers that would be enough for her to be comfortable and relaxed, but not making her sleep,” Cooke said of the procedure, adding that Pearson was briefed on what to anticipate.
“To open the skull, we had to use a drill. So we had to make sure that she was not scared by the humming sound. And once we were ready to take out the tumour, then we asked questions,” he told The Sunday Gleaner. “We asked her to count, and at one point, she began singing a song from church.”
Last week, a smiling Pearson expressed gratitude to the Cooke-led team and gave a rendition of a part of the song she belted out during surgery.
“I wonder what I have done that makes this race so hard to run. Then I say to my soul, ‘Take courage, the Lord will make a way somehow’,” she sang.
“I told my daughter not to worry because what God wants for me, He inspired Dr Cooke to do it. So I told her I would be okay. I love that song. I am not a Christian, but I always sing it in church,” Pearson told The Sunday Gleaner.
Staying awake critical to success of procedure
A history of headaches and occasional arrest of speech was accompanied by numbness and heaviness in the right side Pearson’s face, triggering alarm bells. Coupled with that, she was also diabetic and hypertensive.
A scan confirmed the presence of a tumour on the left side of her brain, which is considered the dominant hemisphere for 90 per cent of right-handers and 70 per cent of left-handers.
Cooke said it is the hemisphere that also controls speech, adding that sometimes tumours present symptoms mimicking strokes.
An initial CAT scan confirmed the presence of the tumour, and an MRI was later done for closer analysis.
When the COVID-19 pandemic disrupted the schedule for surgeries, emergency cases like Pearson’s were still allowed to go ahead.
“With the surgery considered groundbreaking, a team of four anaesthesiologists, who worked closely with the neurosurgery team, which included myself and my junior staff (residents), four other doctors, and specialist nurses working hand in hand, carried out the surgery,” Cooke told The Sunday Gleaner.
“If we are going to take out a brain tumour or an aneurysm, we normally put them to sleep. So they would get a full general anaesthetic, and at the end, you wake them up and assess to see if their function is intact,” he explained. “In this scenario, we knew that this tumour was close to areas where if they were affected during surgery, she would have problems speaking and [restricted] movement in her face. We did not want to take that risk.”
Cooke was exposed to the procedure while working with a senior neurosurgeon at Yale University in Connecticut, USA, and in Nova Scotia, Canada.
“These were the exact reasons why they would do this type of surgery. So while you are about to resect the tumour, you want to test the patient’s ability to speak or move a body part. She was very much aware of everything that was going on in the procedure,” disclosed Cooke.
He said that while the team could do a “pretty operation”, if the patient’s speech was impaired, the entire procedure would have been for naught.
‘A credit to calibre of skills at KPH’
Pearson sought medical attention after an early-morning seizure left her without speech and feeling in her face, as well as weakness in her feet. The situation paralysed her with fear and she was unable to notify relatives of her dilemma. After what seemed like eternity, one sister woke up and saw her distress. After quick consultations, they decided to take her to KPH.
During the journey, her speech returned and went again by the time she reached the hospital.
When Cooke was called, after consultations, emergency surgery was recommended and the medics would then start making their assessments to perform the operation, the first in the public sector in the island.
Similar surgery done at UHWI
Medical chief of staff at the University Hospital of the West Indies (UHWI), Dr Carl Bruce, said a similar surgery was conducted months ago at his St Andrew-based institution, the region’s teaching hospital.
Bruce, who is also a consultant neurosurgeon, led the team of medics during that operation. However, the UHWI does not participate in the Government’s free healthcare programme, unlike the KPH, which provides free services to the public.
“When I explained to him (Cooke) about the seizures, he said, ‘Oh, my God! If I put you to sleep, we won’t know if there is brain damage, which will further damage your speech’,” Pearson told The Sunday Gleaner.
“So he explained to me what he would do, which is to do the surgery while I am awake, and I said, ‘Yes, Doctor. Whatever is good for me, I will do it’,” she said with a smile.
Last week, she sang the praises of the KPH team.
“Dr Cooke is a good doctor,” she said. “I will recommend Public (KPH) to anyone, and I would recommend my doctor and my nurses to anybody, anywhere in the world. Public Hospital is the best in Jamaica.”
The soft-spoken Cooke was also full of praises for his colleagues.
“The surgery is a credit to the calibre of skills at the hospital,” he said.