Introduction to The Hydrocephalus Owner’s Manual
I am a brain surgeon.
Several years ago, I was confronted with a young man in the emergency room who had earlier that morning been found unconscious by his college roommates. In fact, when I met him he was essentially comatose, that is, unresponsive in any meaningful way. Fortunately, one of his roommates recalled something about him having a shunt. With this piece of information, the emergency physician quickly called for a stat head CT and a diagnosis of shunt malfunction was made. I was called, took the patient to surgery for an emergent shunt revision, and he recovered and lived happily ever after.
Well almost. It turned out he was a college student and the ordeal left him rather exhausted, though neurologically normal, and he would spend several months recovering from his near death experience. His mother, who lived in a city 160 miles away, drove over immediately and was waiting for me when I came out of the operating room. I have seldom seen a mother so grateful as that woman—unless it be virtually every other mother I have ever dealt with as a neurosurgeon.
Largely because of their children, parents are special people.
The bond between parent and child is like no other. I have seen octogenarians break down while recalling the death of a forty-year-old son or daughter—never mind that the death occurred fifteen years before. Perhaps the only bond in all of nature that can never be fully broken, it continues beyond divorce, separation, abandonment, illness, and even death. At its best, the parent-child bond drives us to be our best, to meet our full potential. Even when it is missing, entire lives are predicated, even formulated, on the basis of such a loss.
Almost without exception, the parents I meet would gladly exchange places with their child in these moments of extreme stress. These parents feel helpless and at the mercy of the situation. I am often asked What could I have done? Or Is there anything I can do to prevent this from happening again?
I know the feeling.
I am a brain surgeon. I am also a parent. Several years ago, my oldest son died suddenly. In my years on this earth I have lost people close to me—a brother, a half-brother, both parents, several close friends—but all of their deaths paled in comparison to losing a child of my own. It was and remains the single most difficult event of my life, the defining moment if you will.
A bond which cannot be broken.
Which brings me to the first subject of this blog.
Hydrocephalus—loosely defined as a build-up of fluid in the brain—is a life-threatening, fairly common, and relatively easily treated condition. Unfortunately, with existing medical technology, the treatment requires a lifelong diligence on the part of loved ones as well as the patient himself/herself. But that being said, the treatment is not onerous on a daily basis and the benefits are dramatic. Most patients with hydrocephalus live normal lives in virtually every respect. They play sports (even extreme ones), marry, have regular jobs, carry babies through labor and delivery, and die as an old man or woman (or at least we expect they will—the technology is only fifty or so years old and thus people shunted as young children are only now reaching late middle age). With the possible exception of the more remote parts of Alaska, if you live in the United States you almost certainly have at least one friend, acquaintance, student, or co-worker with a vp shunt—though you may not know it.
So why this blog?
Because, to put it in the simplest terms possible, failure to recognize a shunt malfunction can be fatal. The boy I took care of above had failed to get out of bed for class one morning. When his roommates returned home for lunch, they found him unresponsive and still in bed. They called an ambulance and he was taken to my hospital, where a CT of the brain showed the problem. He received prompt medical attention—but only belatedly and it nearly cost him is life.
Had his roommates known the gravity of his failure to arise that morning, his brush with death would likely have been avoided. His mother recognized this fact. She knew how close to the edge he had come. She was one of those who asked What could I have done? Is there anything I can do to prevent this from happening again?
The advice I gave her became the substance of the first subject I shall discuss in this blog. Call it Hydrocephalus: An Owner’s Manual.
One more thing. Neurosurgery 101 ~ The Blog isn’t only about neurosurgery, or surgery. It’s about life. I’ll periodically post other things here, like reviews of books, interesting articles, and maybe a few other things besides. Whatever enters my head I guess. So come back often. It should be interesting.
Disclaimer: The information contained in this blog is simply that, information. I am not doling out specific medical advice. Nothing contained herein is meant to replace a complete evaluation by a qualified member of the medical establishment.