In Deep Brain Stimulation (DBS) Surgery, a thin electrode is implanted into the brain, targeting motor circuits that are not functioning properly. Small electrical pulses from a device similar to a cardiac pacemaker are then used to stimulate a small brain region and block the signals that cause some Parkinson’s symptoms. DBS may be targeted to the globus pallidus or subthalamic nucleus to improve motor function. The stimulator is adjusted as necessary to optimize the effects of the surgery. This blogger has watched it on the distant horizon for quite some period. Has his time come?
Scene: Two neurosurgeons confer at the bedside of a patient who has just had DBS surgery.
Dr. Zeus: "It’s a tragedy Parkinson’s struck him at such a young age. I understand he had such a promising career as a pole dancer."
Dr. Dubinhoeffer: "Yes, his dismounts were flawless. Oh yeah, his wife warned me that he might act like a bit of a goof when he comes to. She said something about him likely doing some sort of shtick - not really sure what she meant but we’ll see."
Patient: "I ffeee..." (patient grimaces)
Patient: (rubs his eyes, wipes nose on his sleeve) “ Wo! I feel good!!”
Dr. Zeus: “That’s great!”
Patient: “I knew that I would now”
Dr. Zeus: “Why is that?”
Patient: “I feel good, I knew that I would now”
Dr. Zeus: “The nausea should wear off i...”
Patient: “So good”
Dr. Zeus: “Ah ha”
Patient: “So good...”
Dr. Zeus: "Dubinhoeffer, we may have nicked the repeat utterance node. Might require an adjustment on the stimulator - unless he will be working as a greeter following recovery.
Patient: “I GOT YOU!!!”
Dr. Zeus: “No, you don’t have me - you have your wife Judy. And I’m guessing it’s a miracle that you still have her.”
Dr. Zeus: “Mr. Rasmussen, The DBS surgery was a success by any measure - except possibly some that may be important to you.”
Patient: “I thought the surgery was to be performed with me awake?”
Dr. Zeus: “That was the original plan. You know, you did seem to endear yourself to my surgical team for a time - but eventually your relentless verbal diarrhea wore on them. We took a quick poll at the 8 minute point and all agreed your surgical outcome would be markedly better by being put down… ummm, under.
Patient: “Yes, since day two of frosh week, 1983. The song is Wooly Bully by Sam The Sham and The Pharaohs. It is not a painful condition, (unless you’re listening to the Joan Jett or Bruce Springsteen cover) but I often find myself in very awkward social situations where I, I,...,”
Dr. Zeus: “Blurt out random lyrics uncontrollably?”
Patient: (a tear runs down cheek) “Yes – People laugh, but it’s no joke. The stress on the marriage can be enormous. Imagine going to your partner’s elementary school staff party - a normally staid affair. You are just minding your own business trying as hard as you can to contain yourself as you note how many remind you of Alvin the Chipmunk - one cheek puffed out full of Christmas goodies – the other chock full of educational acronyms. You can’t stand it any longer and you break out into chorus:
Matty told Hatty about a thing she saw
Had two big horns and a wooly jaw
Wooly bully, wooly bully...
Dr. Zeus: “What is the reaction?"
Dr. Zeus: “They either lock you in one of the spare rooms, or they think if you are that crazy they offer you a job in Admin.”
Dr. Zeus: “The songs that get stuck in people’s heads tend to be melodically and rhythmically simple. Would that be fair description?"
Patient: "Uh, yeah"
Dr. Zeus: “While earworm remediation is generally not our forte, we took the liberty of attempting treatment. Phil from radiology mentioned that he had one of the classic earworm extraction CDs: Dan Hill’s “Sometimes When We Touch”. We followed the directions carefully - as the side effects can often exceed the severity of the original condition. Results may take up to two weeks – but do contact the hospital, your family Physician, or call 911 immediately if sometimes when you touch the honesty is too much, and you have to close your eyes and hide…
Dr. Zeus: “Our next “value-added service” was to switch on the “badboy” control in your prefrontal cortex, as per your personality change request detailed in your draft cartoon. Do note change in terminology from the less-than-palatable wording used in your draft request.Patient: "That was not meant to be serious! It was a cartoon, that’s all."
Dr. Zeus: "That may be so, I’m guessing you will be extremely interested in our findings. Your “bad boy” switch looked like it had been stuck in the “on” position for sometime. We are talking years, if not decades. From a clinical perspective, this is absolutely remarkable."
Patient: “Why do you say that?”
Dr. Zeus: "What this means is that nurture has triumphed over nature!"
Patient: "What exactly does this mean?"
Dr. Zeus: "Well, it would seem that right from birth you have been totally wired to be a “bad-boy”. You know, Mick Jagger, James Dean, Ben Mulroney, etc. Have you ever spent any time in the Big House? Left women at the altar? Trashed hotel rooms on tour?"
Patient: "I don’t think so. I have a collection of soap and towels. Do those count for anything?"
Dr. Zeus: "I’m guessing you’ve had some pretty solid female influences in your lifetime - ?"
Patient: Yes, Mom, my late sister Linda, my wife...Life-affirming role models
Dr. Zeus: "Well, here’s the thing. We found that bad-boy lever to be frozen solid. We couldn’t budge it. I have read your blog and understand your brothers, well, they’re not perfect - who is? But they might just be part of your social fabric that is so effectively keeping you on the straight and narrow. You’d be well advised to keep them around. Your Mom? The fact that you can’t lie to her face might be precisely the reason she likes to face time you. Your wife - all can say is do not screw that up as she is your last line of defense between your current domestic bliss and having a new roommate named Vinny…”
”Another non-Parkinson’s related task we performed came from the fact that virtually everyone on our surgical team found your writing in the blog to be murky, unintelligible at times, and well, nonsensical.”
Patient: “You’re telling me you’re offering me a blog review after reading for five minutes?”
Dr. Zeus: “Oh no, we were extremely thorough - we took a two hour lunch to go over it.”
Patient: “You’re kidding me…”
Dr. Zeus: “Not at all. Bernie put your MRI up on the screen, Myrna would read a blog entry of yours, and we would take turns guessing what part of the brain was impaired enough to produce that level of dysfunction.”
Dr. Zeus: “I know, exactly my reaction. Mr. Rasmussen. When lunch was finally over we all come to an agreement about what treatment location would maximize results. We deftly placed the lead in the temporal lobe, specifically in the Blogospheric Inflatius where rogue electrical activity was producing nonsensical blog entries."
Patient: “You stole that from my draft! That’s not even a real structure - I made it¬up!
Dr. Zeus: “That is a pretty serious accusation! In any event, your directions were excellent - we found it exactly where you said it would be. We think your readers will be pleased with results.
Dr. Zeus: “Our last non-Parkinson’s issue we dealt with arrived via a request from one of your brothers concerned that some of your content (notably a few of the cartoons) were coming from quite a dark place. Have you read Amir and Biederman’s landmark research on comedy in the brain – specifically the finding that the temporal lobe is the source of humour?"
Patient: “Yes, they believe that jokes are made there"
Dr. Zeus: “How do I put this delicately…? We couldn’t find many lights in that region of your brain. Your brother was right on. Indeed, it was pitch black in there."
Patient: “My dad always told us to turn out the lights when we are not using the Temporal Lobe."
Dr. Zeus: “That was only moderately funny. Sir, there were zero lights on. We could not even find a nightlight on."
Patient: “You think that might be because you guys knocked me out?"
Dr. Zeus: “Good point. So What is your next blog topic?
Patient: My current project is a short tale of a blogger with Parkinson’s who has the brain stimulation surgery (at least he thinks that they got that done :-). He wakes up in the recovery room with his two surgeons hovering over him, seemingly more interested in the “extra” surgical tasks they accomplished while they were rummaging around in his noggin. The blogger is fascinated by the science and potential for those operating in the brain in the future. He speculates whether in the future these medical professionals will be viewed more as the “plastic surgeons” of the day operating from an ala Carte menu with such spectacular results that the whole concept of elective and non-elective surgery needs to be revisited."
Patient: “Soooo, my blogging is nonsensical, you say? Is there something wrong with that ?"
Dr. Zeus: “You are so predictable - I knew you'd come back to that :-) Absolutely, they should make sense, shouldn’t they?"
Patient: Nonsense! You expect me to make sense out of nonsense? I tried long ago to make sense out of the disease and failed miserably."
Dr. Zeus: “What doesn’t make sense to you?"
Patient: Not a whole lot. The fact the Parkinson’s was discovered in 1817 – and you guys haven’t cracked the nut yet? That mystifies me. The fact that my days are so predictably unpredictable - that puzzles me. The fact that after 10 years of the disease my only option is like Dylan, to go electric, disappoints me."
“I like nonsense, it wakes up the brain cells. Fantasy is a necessary ingredient in living, It’s a way of looking at life through the wrong end of a telescope. Which is what I do, and that enables you to laugh at life’s realities.” - Dr Seuss -
Patient: Writing nonsense makes sense for me right now, and the space that I am in. Reality doesn’t always make pleasant writing (nor reading)."
Dr. Zeus: “I may not be the sharpest scalpel on the table, but I think I'm piecing together what's going down here - you’ve been looking at DBS through the wrong end of a telescope - that the surgery has been a dream of sorts that it never really happened? That I’ve been just a bit player in one of your productions?"
Patient: Hey, if you were a bit player in this production, you would've been Phil from radiology, or Dr. Dubinhoeffer who had only one line in the whole show. This show was built around you/for me. This is been one good bout nonsense therapy for me. Good mental prep for my real date in mid June."
Dr. Zeus: “Best of luck Mr. Rasmussen. Keep your sense of humour, eh?"
Patient: (presses nurses call button)
Wooly Bully, Wooly Bully…
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