DBS Surgery #2
by Gary Turchin
On Nov 12, 2020, a good eight months into the pandemic, I found myself checking in to Kaiser Hospital, Redwood City, for brain surgery. I arrived at the hospital in terrible pain. I had stopped taking my medications for Parkinson’s disease (PD) four days earlier—doctor’s orders were for 24 hours off the meds, but I wanted to do more. Why? To prove something I guess, but I’m not sure what. But now I was four days in to my med fast and it wasn't going well. The worst symptoms had manifested. Not tremors, I can deal with tremors, they’re annoying but not painful; not dyskinesia, the herky jerky motions we people with Parkinson’s live with, again, annoying but not generally painful. My current symptoms involved dystonia, intense muscle spasms in my right hand, arm, and neck, spasms from which there was no relief, other than medication, which I couldn’t take now without jeopardizing the surgery itself. so as you can tell, I’d painted myself into this painful corner
The surgery plan was simple enough, in a brain surgery sort of way. They were going to drill deeply into the left hemisphere of my brain, to a region called the substantia nigra (STN), where they’d deposit an electrode, connect it to the battery in my right breast that had been installed six years earlier—when I had a deep brain stimulator implanted in my right hemisphere. To give you a scorecard: Left hemisphere of the brain manages the right side of the body, right hemisphere, the left side of the body. Keep this scorecard handy as we work our way through this story.
I find myself in this predicament because of the ineffectiveness of my Parkinson’s medications. Upwards of 20 pills a day and, after 18 years, they were doing me more harm than good. I am also in the predicament because my condition had progressed and I was growing desperate for relief.
DBS, or deep brain stimulation, is kind of a mystery to modern medicine. They aren’t 100% sure how or why it works; they just know it does work. They figure by putting a current in the right spot in your brain it intercepts the messages that cause tremors and other disruptions to the nervous system caused by PD. The surgery in my right brain had gone reasonably well but now the left hemisphere (affecting what side of my body?—correct, the “right” side) needed the same intervention.
“I need pain killers, NOW” I pleaded to everyone I encountered, including the receptionist, who told me, “take it up with your surgeon Mr Turchin,” and Ivan, the physician’s assistant who greeted me as I entered the surgery ward, “How are you doing today Mr. Turchin?
“Terribly. I need pain medication now! PLEEEEEASE”
I wasn't beyond begging “in a few minutes, Mr. Turchin. “We need a pharmacist or physician to sign off on the prescription first” he explained.
Meanwhile, Brenda, the blue-eyed Irish nurse assigned to my case, got me into a hospital gown, and washed my body down with antiseptic.
“Gary, you’ve got lovely skin, ya’ know that don't ya’, hon? So smooth…How do ya’ manage that?”
She’s trying to distract me, I know she was, but I was having none of it…
“There won’t be any more smooth skin if I don't get some pain medication right away,” I muttered.
“Gary needs his pain meds!” Brenda called out across the ward, to nobody in particular.
“WE’RE WAITING FOR A DOCTOR TO SIGN OFF ON THE PRESCRIPTION,” came the response, again from the physician’s assistant.
Finally, more than an hour and a half into surgery prep, a needle-full of blessed painkiller was procured. It didn't put a dent in my pain, however. A second dose was administered. It barely registered.
“NEED SOMETHING STRONGER,” I demanded.
“They can’t give you anything stronger, luv,” Brenda explained, “because they have to be able to talk to ya’ during the surgery, get clear-eyed feedback from ya’, hon.”
I knew that was going to be the case. During the last surgery, I was reciting poetry to make sure that my voice wouldn't be damaged, an occasional side-effect of the surgery and one I was most nervous about.
But damn it, poetry and my voice were the last things on my mind at the moment. I wanted, needed pain relief, NOWWWWWW!
Dr. Sedrak, my surgeon, to the rescue. Sedrak looks a little younger than you want your brain surgeon to look, but his dark eyes were brimming with confidence. He took one look at me, bent neck, glassy eyed, grimaced, writhing, “Gary, you’re in terrible shape, I see that,” he acknowledged. “I don't think we can even get you into the crown, nevertheless operate on you like this.”
They screw your skull onto a metal crown that looks like a medieval torture device, then screw the crown to the operating table so your head is held at the right angle and doesn't move.
“Well doc, if you can’t operate, I’ll be disappointed, but I understand. Can I at least get that painkiller now instead?”
“Well, there is another option,” Dr Sedrak offered. “We can do the surgery under general anesthesia.” In other words, just knock me out and operate, without getting any live feedback from me.
“Doc, can you get the electrode in the exact spot it needs to go?”
That's the whole ballgame with DBS. Even a millimeter off can have dire consequences (like the damaged voice mentioned earlier). It’s so important that a specialized biomedical engineer, in this case a guy named Siddhartha, was in the operating room to make sure the placement was spot on.
“Sure!” Dr. Sedrak assured me. “We’ve done this surgery under general anesthesia before. We’ll get it right, but its up to you.”
“If you can get it right doc, then go for it,” I said. As I said it, I knew the risk I was taking. A decision made in pain that promised relief of that pain is by definition a risky one. This is the same surgeon who came around before the last surgery saying we were going to operate on the left hemisphere when the plan was to operate on the right hemisphere (thereby affecting the ???? side of the body—that’s right, the “left”). The error was caught in time, but still…
Before I could rethink my decision, my pain and I were wheeled into the operating room. Dr. Sedrak was explaining to his team the change of plans. An anesthesiologist was at the head of my table holding a mask above my face and telling me to breathe deeply, breathe deeply. breathe d…
I have zero recollection of what happened to me the next six hours. They were six hours spent in suspended animation; six hours that disappeared into the fabric of spacetime; six hours just plain missing from my memory bank. Well not completely missing: I had a few wounds in my skull that stiches had closed. That's a remnant of my lost six hours, a residual, a residue. Oh, and I had no pain, no dystonia. My scalp was sore, but I didn't even have a headache!
I woke up as suddenly as I had gone out. I was being wheeled into a recovery room, Siddhartha was standing near me, a Buddha-like smile on his face. “Everyt’ing went well, Mr. Turchin,” he said.
“You got it in a good spot?” I asked him.
“Oh yes, we found the sweet spot, for sure,” he assured.
After some time in the recovery room, I was wheeled into a hospital room to spend the night. I called the relatives to let them know I was OK. Because of Covid restrictions, they weren’t allowed to visit. The nurse brought in a dose of Parkinson’s meds, I didn't feel like I needed them now, I could already feel I was in a honeymoon period where the surgery itself masked the symptoms, without the new DBS being turned on. But when you’re in the hospital and the doctor orders you to take medication, you don't argue, you take. So I took it, and again in the morning. And those turned out to be the last doses of medication I’ve taken to this day. Two weeks later, they turned the stimulator on. It locked the dystonia out, knocked out the tremors and dyskinesia on my right side, and restored to some degree my balance, which I had been losing regularly. I no longer suffered from sleep deprivation nor fatigue, two other side effects of the medication.
I made it to the other end of the pandemic medicine-free. Yes my movements are less fluid than they would be on the meds. but that's a small price to pay for medication liberation and all its benefits.
It’s been two years since the pandemic began and time, like a patient under general anesthesia, has been locked away in suspended animation; two years to wake up and see the same but different world; two years for some Siddhartha or other to tell me ‘You’re okay. We put it in the sweet spot.’ Two long years of being packed away on ice, separated by masks and vaccines and paranoia. Now as we peel the masks away, will we ever return to the way it was? Equipped with the new stimulator, and medication free, I know I won’t.
My experience with DBS (Deep Brain Stimulation) Surgery 
GOING INTO DBS SURGERY
DBS surgery for Parkinson’s patient.
