Medicine Under Coronavirus Meant Rushing My Wife’s Brain Surgery

(Bloomberg) -- For months, we had a running joke when we went out to eat: “Whose turn is it to read the menu to mom?” one of our daughters would tease. My wife, Adriana, had a habit of leaving her glasses in the car. “That’s what happens after you turn 40-something,” she’d say,  shaving a few years off her age, and I’d laugh.

Then came the diagnosis. An MRI revealed a lesion pushing hard on Adriana’s optic nerve. A fluid-filled cyst, almost an inch long and shaped like a snowman, was growing in her pituitary gland. Without surgery, she could go blind.

But getting that operation meant confronting a medical system just as it was beginning to ration hospital beds in the face of the coronavirus. Across the U.S., administrators, doctors and patients are debating which procedures should wait until the Covid-19 pandemic passes and which should go forward.

Our family struggled with that dilemma less than an hour after President Donald Trump warned that the virus may disrupt daily life for months.

For us, Covid-19’s impact hit on the afternoon of March 16, when neurosurgery staff at Jefferson University Hospitals warned Adriana her first meeting with a surgeon would be by phone later in the week unless she could make it to Philadelphia by 5 p.m.

We left work early, thankful for flexible jobs that provide great health care. Not everyone can drop everything and dash out the door in the middle of the day, secure in the knowledge that their jobs will still be there and their insurance will cover them.

We checked in at the neurosurgery center by 2:30 p.m., just as employees were discussing plans to shutter the office and treat non-urgent patients through telemedicine appointments. We waited with a handful of others, listening to the live broadcast of Trump’s press conference. For the first time, we heard him acknowledge that the economic impact of the virus might stretch into summer.
 

Two surgeons talked to us about the options, which boiled down to surgery sooner or surgery later. Philadelphia had imposed restrictions designed to limit public gatherings, and hospitals in the region were delaying as many procedures as possible. Covid-19 hung in the room.

After a lot of back and forth, we all realized that sooner meant immediately and later, in the worst case, meant months later — a delay that could permanently damage Adriana’s optic nerve. Her vision had deteriorated quickly enough to justify action, but the doctors simply had no way of knowing how long they could wait. “I have to be courageous,” Adriana said at one point. “I don’t have a choice.”

In the end, James Evans, the surgeon who co-founded the Jefferson Minimally Invasive Cranial Base Surgery Center, agreed to ask administrators to find a bed for Adriana. They did and by early evening, she was in it, preparing for a night of pre-surgery tests that are typically spread out over a week or more.

The lobby of Jefferson University Hospital was deserted when we arrived, 30 minutes after our meeting with Evans. The information desk was unmanned. After we waited a few bewildering seconds, a guard came in and lead us into the admissions office — we were so flustered we’d missed the large sign.

The nursing assistant who took Adriana to the ninth floor in a wheelchair said the hospital was busy, but virus precautions had emptied it of visitors. Some of the nurses in that wing wore masks. Others, like the nursing assistant, did not.

No Visitors Allowed

Over the next few hours, nurses came and went, more than once gently reminding us that because of the coronavirus, visitors have been barred. I stayed as long as I could, promising Adriana’s nurse, Danielle, that if she loaned us a phone charger for the night, I would leave; we’d been in such a rush we didn’t bring one for Adriana’s phone. Danielle wore a mask, so I couldn’t tell if she smiled at my negotiating ploy. She did bring a charger and I headed home, leaving Adriana to face the last round of testing alone.

The next day, I talked to Adriana by video call. In normal times, I would have been in the room while the nurses got her ready for surgery. Instead, I caught glimpses of her face and random shots of the ceiling and medical equipment as she moved from one bed to another so they could wheel her away to the operating room.

Dr. Evans lead a team of surgeons who inserted a probe into Adriana’s nose, drilled a small hole in her skull and peered into her brain. There, they found the problem: a Rathke cleft cyst. It probably had been there for years, growing slowly between the two parts of her pituitary gland. Usually the two parts merge as the brain develops. In Adriana’s case, the merger was imperfect, leaving a minuscule cleft into which the cyst grew.

Fortunately, Rathke cysts are not only very rare but also less threatening than a cancerous tumor. Dr. Evans punched a hole in the bottom and let the honey-thick fluid flow out. He left the hole in the cyst so any liquid that might form in the future can drain harmlessly.

Within hours of the surgery, Adriana’s vision started to improve as her optic nerve, which had been bent into an inverted V, began to return to normal.

Evans looked for me in the hospital afterward, to report the results, as he has done for thousands of other families. He didn’t realize I would not be allowed back in. We played telephone tag for the rest of the day as I waited to learn details. I knew the surgery went well and there were no complications, but for several hours, that was all I could learn.

Adriana stayed overnight to ensure there were no unexpected issues. Our daughters and Adriana’s mother gathered around my computer for a video call with her. She was groggy, but happy.

“I can see,” she said. “I can see!”

At home, we laughed and clapped.

Her recovery will take a few weeks, as her sinus cavity heals and the headaches subside. Eventually, assuming we can find a restaurant that is open, we’ll go to out to eat to test her improved vision.

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