Chapter 1. You Have a Decision to Make

Glioblastology, the Book

On January 1, 2025, we began my 2025 project, Glioblastology, the Book—or whatever we’ll call it. Excerpts and other fun surprises from the book are available to paid subscribers.* General posts continue to be available to everyone. If you want to read along, I shared the book Introduction on January 1. Readers of the introduction will see a cliffhanger pick back up in Chapter 1. xx. <3 -a.

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Fluorescent lights hummed overhead while we moved quickly down the corridor. I squinted my eyelids and pulled my chin toward my chest when passing each bright light interrupted by ceiling tiles every three feet. I think about the sun shining through tall California palms down a long stretch of highway. The chill of the OR strikes me immediately as the Stryker gurney throws open the double doors, but quickly I adapt, or at least, I am distracted.

Whitney and I entered the vacant parking garage at five that morning, our tires squeaking, rubber against finished concrete. Oil spots dot the empty spaces, and the unmistakable smell of fuel hangs low.

Five a.m. is a lifetime ago. I scoffed to my wife when heaving our duffle bag into the hospital, “Five in the morning! For brain surgery?! Can’t they let a guy sleep in before his skull is cracked open?”

The OR is bathed in bright white light. My eyes dart with the urgency of a first-year medical resident, an “intern,” is the right name, or PGY1 (post-graduate year one). I have rehearsed the scene, but it all looks differently from the stage. Scanning the room, I see several flat screen monitors at eye level. These monitors display signs, symbols, numbers, letters, only a few that I recognize. The hard lights expose us, and I search the room for faces. I see a digital vitals monitor. Discolored wires capped with silver ends, ridged like a tire valve, twist to connect the main device to its components; each component tethered to my body. The buttons are covered by vinyl, and the labels are well-worn from use. The machine automatically performs programmed tasks, and for tasks requiring manual operation, the practitioners hardly pause while executing the rote and mindless protocols.

Motor memory.

Alarm fatigue.

Too many sounds to isolate one, except for a digital melody to signal the completion of an electronic cuff inflation and release, measuring my blood pressure.

The tones refrain in my sleep.

I hum them in my daydreams.

Nurses and assistants bustle about in the near distance, their silhouettes backlit against a thin curtain and the aura of fluorescence. They are chatting while performing preoperative procedures; they float with a levity that resists the weight of the room. Medical students file in for observation, some of them fresh from the lecture hall, “short coats,” my wife calls them, given the distinct lab coats they wear over their collared shirts and ties. These formally clad medical students joke nervously with each other, beginning their practice, but not yet reaching residency. I notice a senior resident, now in his neurosurgical fellowship, scrubbed, masked, and at attention. He and I swapped book recommendations last week, before the senior physician, the “attending,” arrived with his own agenda. A nice guy, that resident fellow, but no book club today; things are more urgent.

At least three or four of these medical professionals-in-training considered their career specialties, and they resolved themselves to a life of removing sections of skull, drilling into spines, and slicing into the fragile, folded flesh of the brain, a place where few may go, where dreams shake us awake at night, and the primitive brain stem keeps a heart thumping by a mysterious selective adaptation hard-wired into life itself.

The sheen of cold steel, or the idea of it glimmering in my mind, would incite fear, were it not for an interruption. A nurse speaks sharply, “You know whose case this is, right?” She issues a nonverbal command instructing another nurse to exchange instruments on the surgical tray for those of another size. I note the beautiful, sordid humanity that contaminates even the most sterile environments: Gossiping, bickering, and syncing notes before the boss arrives. We operate with disdain for hierarchy while simultaneously fueling its perpetuation through subversive remarks about those with greater authority and contempt for those with less. This tension is an irreducible quality of life. I eavesdrop until a nurse notices my darting eyes. She is reminded of me and asks, “Did you want to see this?” gesturing toward the beeps, blips, waves, and spikes of lines tracing the landscape orientation on the left monitor in a three-arm mount.

“Sure!” I reply energetically, masking my anxiety with enthusiasm. The hell if I know where to look or what I want to see. I split myself experiencing and myself, observing, viewing the world from my own perspective, conscious of my being a part of the whole. This viewpoint blends subjectivity and objectivity, exploiting the unique ability of the human body: neither internal to consciousness nor external to it in the environment. Not trapped by our experience, we are aware of our experiencing. Our bodies mediate our conscious awareness of the world.

Here we are, bodies moving in space and aging through time, our biological processes sustaining our lives, this is the mechanical body that runs quietly in the background of our lives. We usually pay little attention to our bodies, unless something has gone wrong. Our experience of the warm mug in our hands, the soft carpet beneath our feet, the short breath and hastened heartbeat of a new experience presents our body to us in a private and personal experience. Our experiences and our biological bodies are unified into one complete system. Medicine, despite its interest in care, fractures the unity of the body and our experience.