was a phenomenon of considerable interest. Putnam interrupted his holiday, and he, Penfield, Traeger, and another doctor spent the morning in consultation. We had told Johnny casually how eminent Penfield was, and his greeting to him was quite characteristic. He measured Putnam and Penfield together, and then asked, “Where’s Cushing?”
Frances often helped Johnny to time or rehearse his little jokes, but this one caught us unawares. He knew perfectly well where Cushing was. He was meeting two of the three greatest brain surgeons, and would probably be meeting the third quite soon.
Penfield said something about the fine recovery he was making, in order to reassure him.
Johnny replied, “I’m not so much interested in the spectacular nature of my recovery as in the exact seriousness of my complaint.” That held everybody for a while.
Penfield spent an hour on the slides; always, in a thing of this hideous kind, the possibility exists of mistaken diagnosis, and the tumor might have changed for the better or worse. We waited, and then with everybody listening Penfield cut through all the euphemisms and said directly, “Your child has a malignant glioma, and it will kill him.”
He wrote in longhand on Johnny’s chart:
The neoplasm is obviously a malignant glioma. The removal and decompression has given him some longer lease of life, and it has been a happy interval. The presence of two small cysts within tumor, as proved by Dr. Putnam’s puncture, is consistent with glioblastoma and it is apparently present beneath and outside the dura. The scalp defect is obviously the result of pressure necrosis, not primary infection.
I would recommend healing the area if possible in a few weeks. Further X -ray treatment only when radiotherapist decides the skin and brain will not suffer from it.
If operation is decided upon, occipital lobe amputation might be carried out with some sort of skull closure. This would not prolong life much if at all. It might make him able to be up and active over a greater portion of the life.
I can see nothing that could have been done up to date that has not been done. This is the tragedy of such cases.
Of course no one told us that complete occipital lobe amputation would mean blindness.
We asked people the next few days how the end would come, and once more new horrors, new dreadfulnesses, were disclosed. One of the nurses said that in tumors of this type the patient gradually lost all function, even that of control of his own secretions, and died in the end like a kind of vegetable.
Johnny did not lose function. He lived almost a year after this, and he did not die like a vegetable. He died like a man, with perfect dignity.
Now we struck out hard on new paths. The rest of the summer is the story of pillars in a search. There might be some ray of hope somewhere despite Penfield’s death sentence. But we must act quickly. Frances thought that physicists or atomic scientists who worked in the medical field during the war might have discovered something new about brain tumors unknown to the public at large, and I wrote or telephoned to doctors all over the country to investigate this possibility. The thought never left us that if only we could defer somehow what everybody said was inevitable, if only we could stave off Death for a few weeks or months, something totally new might turn up. What we sought above all was time. Our search was, to put it mildly, further stimulated because at least two doctors, after the Penfield consultation, urged us to put a cap in Johnny’s skull, which would eliminate the bump. Also, by driving the tumor inward, it would kill him. Euthanasia is, of course, forbidden in the United States. But the doctors wanted to be merciful.
I wrote to Hutchins at the University of Chicago, to both Lawrences at the University of California, to the head of the tumor clinic at Michael Reese in Chicago, to a splendid physician in Boston who had just come back
Frances often helped Johnny to time or rehearse his little jokes, but this one caught us unawares. He knew perfectly well where Cushing was. He was meeting two of the three greatest brain surgeons, and would probably be meeting the third quite soon.
Penfield said something about the fine recovery he was making, in order to reassure him.
Johnny replied, “I’m not so much interested in the spectacular nature of my recovery as in the exact seriousness of my complaint.” That held everybody for a while.
Penfield spent an hour on the slides; always, in a thing of this hideous kind, the possibility exists of mistaken diagnosis, and the tumor might have changed for the better or worse. We waited, and then with everybody listening Penfield cut through all the euphemisms and said directly, “Your child has a malignant glioma, and it will kill him.”
He wrote in longhand on Johnny’s chart:
The neoplasm is obviously a malignant glioma. The removal and decompression has given him some longer lease of life, and it has been a happy interval. The presence of two small cysts within tumor, as proved by Dr. Putnam’s puncture, is consistent with glioblastoma and it is apparently present beneath and outside the dura. The scalp defect is obviously the result of pressure necrosis, not primary infection.
I would recommend healing the area if possible in a few weeks. Further X -ray treatment only when radiotherapist decides the skin and brain will not suffer from it.
If operation is decided upon, occipital lobe amputation might be carried out with some sort of skull closure. This would not prolong life much if at all. It might make him able to be up and active over a greater portion of the life.
I can see nothing that could have been done up to date that has not been done. This is the tragedy of such cases.
Of course no one told us that complete occipital lobe amputation would mean blindness.
We asked people the next few days how the end would come, and once more new horrors, new dreadfulnesses, were disclosed. One of the nurses said that in tumors of this type the patient gradually lost all function, even that of control of his own secretions, and died in the end like a kind of vegetable.
Johnny did not lose function. He lived almost a year after this, and he did not die like a vegetable. He died like a man, with perfect dignity.
Now we struck out hard on new paths. The rest of the summer is the story of pillars in a search. There might be some ray of hope somewhere despite Penfield’s death sentence. But we must act quickly. Frances thought that physicists or atomic scientists who worked in the medical field during the war might have discovered something new about brain tumors unknown to the public at large, and I wrote or telephoned to doctors all over the country to investigate this possibility. The thought never left us that if only we could defer somehow what everybody said was inevitable, if only we could stave off Death for a few weeks or months, something totally new might turn up. What we sought above all was time. Our search was, to put it mildly, further stimulated because at least two doctors, after the Penfield consultation, urged us to put a cap in Johnny’s skull, which would eliminate the bump. Also, by driving the tumor inward, it would kill him. Euthanasia is, of course, forbidden in the United States. But the doctors wanted to be merciful.
I wrote to Hutchins at the University of Chicago, to both Lawrences at the University of California, to the head of the tumor clinic at Michael Reese in Chicago, to a splendid physician in Boston who had just come back
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