Caring for Oligo

He consulted me for the first time when he was nineteen years of age. I remember that first consultation very clearly. Jack attended with his mom. His dad had abandoned them when Jack was very young. I remember making a mental note at the time of the high incidence of emotional and physical illness in males who had been abandoned at a young age by their fathers. Jack had been experiencing worsening headaches over a period of six months. And then on the day prior to making the urgent appointment to see me, Jack had suffered a grand mal seizure.

An examination at the time revealed a subtle weakness over the left side of the body with evidence of raised intra-cranial pressure (raised pressure in the head). I referred Jack for an urgent MRI scan. The scan revealed a large right sided parietal tumor with calcification. This was in all probability an oligodendroglioma, or ‘oligo’ as it’s ‘affectionately’ known in neuro circles. It is one of the only tumors that calcifies early on, at a young age. Essentially a benign tumor, it nevertheless is very difficult to eradicate and achieve a cure when it reaches a large size. It is slow growing, but relentless and often is not well demarcated from the surrounding normal brain.

As was expected, Jack and his mom were devastated when I broke the news to them. It would require formidable brain surgery to try and remove most, if not all of the tumor. And then there was no guarantee that the whole lesion could be removed. And so the day arrived for the planned surgery. I met Jack and his mom at the red-line, marking the sterile access to the OR complex. Even though I attempted to reassure them that all would be well, there was still great anxiety. After a tearful parting I escorted Jack to the OR where the anaesthesiologist took over. Thereafter followed the craniotomy (opening of the skull) and several hours of intensive surgery directed at removing the tumor. It was densely adherent to the surrounding brain tissue and I recognized at the outset that this would not be a total removal or cure.

Post operatively, Jack had a more pronounced weakness of the limbs on the left. Over time and with ongoing physiotherapy, the weakness improved almost to the point of normality. However the six month follow up scan revealed the presence of some residual tumor. I maintained a long term follow up and over the ensuing two years observed the tumor slowly re-growing. This necessitated further surgery, but once again it was incomplete due to the nature of the tumor and its deep attachment to surrounding brain tissue.

Somewhere into the third year of follow up it became apparent that a novel relationship was developing between Jack, his mom and his tumor. They had in fact become a threesome! In this dynamic, the tumor had become the focal point of their existence. It was all about Jack’s ‘oligo’. My staff became friendly with Jack and his mom and well acquainted with Jack’s oligo. And so ‘Oligo’ became the focus of their collective existence. It was Oligo that legitimized Jack’s potentially fatal medical status and in spite of the fact that he was neurologically able to function in a supervised environment, Jack made no attempt to work or study. Mom appeared quite satisfied with the situation and in fact promoted it. A bizarre situation therefore emerged in which meaning and purpose was being derived from the existence of Oligo! A thought crossed my mind at the time that it was not inconceivable that if I re-operated on Jack and successfully removed Oligo, he may lose his meaning and purpose and spiral into a terminal hopeless-helpless life crisis, with mom following shortly thereafter.

This bizarre dynamic was to play itself out in a very dramatic fashion some time towards the end of the third year. I was having lunch one day when my phone rang. After confirming that it was indeed me on the other end, I was notified that an emergency situation was unfolding as we spoke. Apparently Jack was standing on an outer ledge of the roof of a tall building downtown, with the intention of jumping off. I inquired whether they had a mediator in place to establish dialogue with Jack. This was confirmed. On learning of this I inquired therefore why it was that they were contacting me, since I was neither a psychologist nor psychiatrist. The answer that I received was that I was being contacted because Jack had indicated that I was his doctor. Without having to think much about it, I fired back that they needn’t worry too much since it was highly unlikely that Jack would in fact jump.

“And how can you be so sure of your evaluation of the situation, doctor?”, came the response from the contact person.

“Because if he jumps my dear, he’ll kill Oligo!”, I answered.

Without too much persuasion, Jack abandoned his suicide attempt shortly thereafter. Following routine post-traumatic counselling Jack returned to his ‘normal status’ and I continued caring for Jack, his mom and of course, dear Oligo!