GBM Part 2

This is the second instalment as I write a book in public.

If you missed the first part, you can find it here.

Simon had grown more confused again at home. His cancer treatment had been planned but had yet to start. The skin around his scalp incision had become angry and he grew feverish. His family brought him to hospital and all signs pointed towards a post-operative infection. All signs except his brain scan. Three weeks after his operation, Simon’s scan should have shown a cavity inside his brain where his tumour once lived. But nature abhors a vacuum. His tumour had been replaced with a new indecipherable mass, one larger than before. It had neither the typical appearances of tumour or infection. But it was clear that without surgery to relieve the pressure inside his brain he would die even sooner than expected.

I was at the end of my eight years of neurosurgery training and had made peace with my known unknowns. A few years into my training I was handed down a heuristic as an off hand comment that I still teach to this day, “If you think you need to call for help, it means you need to call for help.” I called up the Consultant on call and we looked at the scans together. We agreed that if it was an infection, surgery to remove the pus in the addition to antibiotics could return Simon to his plan of radiotherapy and chemotherapy. It could even mean some more time, as there are a few reports of post-operative infections slowing down tumour growth for a while. Disease treating disease. Nature’s wry smile. If however, it was tumour that had returned to such a huge size in only three weeks, surgery was not only hopeless, but cruel. To remove such an aggressive tumour again would mean Simon would return to where he started in under a month. Based upon his inflamed skin and high temperature we agreed that the balance of odds leant towards infection and surgery was justified. I took him to the operating room.