Brain Surgery

I finally fell asleep late last night despite my intention to get to bed early. Instead I spent the evening sitting bedside for several hours waiting to hear the results of a late evening CT scan. I had just finished reading Lance Armstrong's book "It's Not About the Bike" to Phil from his Kindle around 5:30 p.m. yesterday when Phil started twitching his arms and legs and squeezing my hand. This continued and increased and it became obvious that he was having a generalized seizure. He was unable to respond to me although his eyes were open. The nurses came in immediately and started taking vitals, etc and the doctors were called. In summary, it only lasted about 2 minutes and he had no lasting effects. His CT was normal and he's had none since. It was just another indicator of the infection and swelling in his brain and the need for immediate surgery.

Surgery got underway at 7:30 this morning as planned and Phil was smiling and mellow, ready for what was ahead of him, yet subdued.

By 9:45 he was finished and Dr. Ghosh came to give us his report. He had indeed found a large abscess (3cm or about 2 inches) in the frontal lobe and was able to remove all of it. In doing so he confirmed that the source of the infection in the brain came from the eye and sinus infection. Although he had wanted to identify the infectious pathology in the OR he was unable to so we won't have those results for another 2-3 days. Phil did very well in surgery and had no complications and we are all breathing a huge sigh of relief.

So, Dr. Ghosh debrided the abscess and put in a paracranial flap to increase the efficacy of the antibiotics. Phil got his titanium plate and is now a million dollar man. He will have a repeat CT scan tomorrow to see that everything is holding steady and once the pathogen(s) been identified and a plan of treatment is in place, he could come home as soon as Monday.

When he wakes up in the Medical ICU I will tell Phil how he's been covered by the prayers of hundreds. And I will tell him how God works through people like Dr. Ghosh to perform nothing short of a miracle today.

All In

We are no longer living day to day around here, time is now marked in 12 hour increments. That's how quickly things are changing and progressing.

Phil had another MRI this morning and the cultures have yielded more definitive results. Today has been a big and unfortunately, very difficult day. The cultures show absolute evidence of a mixed bacterial and fungal infection in the sinuses and henceforth in the brain. The fungus is called Mucormycosis and is very common in diabetics and immunosuppressed patients. The MRI shows advancement since yesterday of the infection to involve new portions of the brain. So despite having been on high doses of antibiotics and antifungals, ground is not being gained.

The optimal treatment for this fungus is surgical debridement, which although radical, is Phil's best chance for eradicating the infection. Combined with his antifungals, tomorrow morning he will be having a very involved neurosurgery to remove his left sinuses, his left eye and orbit and portions of his left brain that are infected and non-functioning anyway. It's hard core -- as if it wasn't before. During the next several weeks his chemotherapy will have to be put on hold lest any further immunosuppression allow the Mucor to take the upper hand.

We are awaiting the final debriefing from the team of surgeons and are covering Phil with our prayers and love. We (Jeff, David, Anita and I) are also telling stories and laughing a bit too. Phil is tired and a bit fearful for tomorrow's events but he is also ready to go. He's not one to sit back and do nothing if there's something to be done. He's going for it. Bravest man I know, facing down terrible odds and "fighting a raging fire in the middle of a hurricane".

If Phil were playing poker, I'd say he was all in. Trusting God, and all in.