Chapter 29: COVID and Craniotomies. We can do this!

Snacks for Suki. Chiang Mai, Thailand

Tuesday, March 17th, 2020: Typing some thoughts between patient visits in clinic, T-2 days before my next brain surgery:

Our beautiful, messy world has always been full of uncertainty and suffering. This is not new.

Everyone in this world experiences suffering; however, it is not always as visible, as palpable, as it is right now.

In the midst of COVID-19, the first pandemic of this magnitude most of us have ever experienced, we are constantly being reminded of just how much the world is suffering. We are reminded by our own symptoms if we are infected, by our community as restaurants/gyms/bars/stores shut their doors around us, by social media with constant terrifying updates, and by our isolating situation as we distance ourselves from others and try to settle into a new way of living within the walls of our homes.

To add to the fun, this week I will have brain surgery. Great timing! My incredible neurosurgery team will perform my second craniotomy on Thursday, 3/19 (2 weeks sooner than initially planned due to many factors in the setting of this pandemic) in an attempt to remove more of the tumor invading my brain. In the meantime, I continue to work. I am a physician and my patients come first.

I have a type of brain tumor called a diffuse astrocytoma. This is a treatable but incurable tumor. The optimal way to treat this is with maximal surgical resection. This will not cure me, but will (hopefully) improve my prognosis and give me more years to live.

In the middle of a pandemic, a craniotomy is not ideal for many reasons. I will be exposing myself to COVID while immunosuppressed. Even worse, I fear that I will become an asymptomatic carrier while I am in the hospital and expose my family to this virus while they help me recover at home. I had already decided not to allow my family or friends to visit me while in the hospital after surgery; however, the hospital has now made an official "no visitor" policy so that's that. Pandemic + physician + cancer + brain surgery + no visitors. Honestly, nothing can surprise me anymore!

I've quoted the Dalai Lama on this before and I'll quote him again, "we must generate courage equal to the size of the difficulties we face." I keep thinking, but wait! I can't generate any more! Then life throws me another curveball, so I keep going.

I am riddled with guilt about having this surgery on Thursday. I will be using up PPE (personal protective equipment, such as masks, gloves, etc), a ventilator, and an ICU bed. Hopefully, I will only use these supplies for 24 hours, but regardless, this causes me inner turmoil and suffering.

As you now know, I am also a physician. I hope you have heard the worldwide pleas to stay home and help "flatten the curve." I hate that I will be utilizing vital hospital resources in the middle of the up-trending curve in the United States. Here is a great graphic from The Washington Post if you happen to live under a rock and don't know what "the curve" is. https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

I have been having quite a stressful and hilarious inner dialogue between the patient in me and the physician in me over these concerns. To keep you entertained during your time at home, I'll give you a (slightly scary) sneak peak into what's currently going on in my brain:

Patient: F***, I'm getting brain surgery in 2 days. I'm terrified!

Physician: I have a duty to work right now. Why would I use vital hospital resources on myself during a pandemic?

Patient: If I don't have surgery, I'm not treating my cancer. Use the damn resources!

Physician: I see your point. So if I get surgery now, I can try to recover in 2-3 weeks just in time to get back on the "front lines" when (unfortunately) it's looking like the medical system may be facing a dire situation.

Patient: I have a freaking brain tumor. It needs to come out!

Physician: Shut up patient self. You are just one small person and there are many other people suffering far worse than you are. If I have surgery this week, even though I'll use up some hospital resources for 1-2 days, I'll recover in a few weeks and be ready to help in the hospital when it needs me most.

Patient: So I'm getting brain surgery this week? During the middle of a pandemic? Cool, cool.

Physician: Surgery this week. Recover. Then back to work. We have things to do.

Clearly, my mind is a scary place sometimes!

In the end, I have decided to proceed with surgery this week. Getting this surgery now while there are still enough ICU beds and ventilators is right decision for me. By cutting out more tumor, my neurosurgeons think I will have many more years to live. With more years to live, I will have more years to help patients. Because of this fact, I will proceed with surgery.

My first craniotomy was 6 weeks ago (I didn't even know I had cancer 7 weeks ago- wow how things have changed!). During my first hospitalization, I received an overwhelming amount of support. I had so many visitors and received cards/gifts/flowers from all over the place. Thank you from the bottom of my heart. I have never felt so loved and supported.

This time, however, I don't want any of that.

In lieu of cards and flowers, the only gift I want is for you to help our country "flatten the curve" by staying the F at home!!! Thank you, thank you for taking social distancing seriously.

Back to my initial point- remember, everyone is suffering. Not just now, but in many moments of their lives. If you're feeling anxious, scared, fearful, stressed during this unprecedented time; remember "you are not the only person who suffers." (Thich Nhat Hanh states this in "Going Home").

Thich Nhat Hanh goes on to say, "You may believe that your suffering is greater than anyone else's, or that you are the only person who suffers, but this is not true. When you recognize the suffering around you it will help you to suffer less."

If you can see the suffering not only in yourself, but in everyone around you, you will find understanding. The Buddha teaches us that by understanding the suffering of others, we will develop love and acceptance. Love and acceptance of your own situation, but also of all other's.

Today, T-2 days before my own brain surgery, my thoughts can be summed up as follows:

We are in this together. Suffering is not new. We are all suffering in our own ways. If you understand this, your own suffering becomes less important than the suffering of others.

Also, as a physician, let me reiterate:

COVID-19 is a pandemic. This is real. This is not media hype. If you feel sick, stay home. If you don't feel sick, stay home. Wash your hands. Distancing is key, but we can still be "social" in other ways. If you feel lonely or isolated, know that I am thinking of you. I will be laying in bed, alone in the ICU before and after brain surgery, and I will be thinking of you. I am sending love and healing thoughts to all of you, all of the time. For now, this is how I will help. Surgeons, please get this damn tumor out so I can help on the front lines too!

Fondly, Courtney

© CB2020