For the schoolteacher, the changes had come slowly. First, his walking had grown unsteady; then his hearing had worsened. He had become stooped, and had begun walking with a cane, even though he was only in his late fifties. Now he sat with his wife and son in the consulting room of Henry Marsh, a London neurosurgeon, looking at a scan of his brain, which showed a tumor growing near the base of his skull. The question was whether it could, or should, be removed. Marsh, who had been practicing neurosurgery for only a few years, was unsure. The tumor was massive—he was startled by its size—and it was situated in the brain stem, a vital area. Left to itself, it would destroy the schoolteacher's hearing, rob him of his ability to walk, and, eventually, kill him. But, Marsh explained, surgery could leave him paralyzed, or worse. The family faced a difficult choice, between the certainty of a slow, predictable decline and the possibility of an immediate cure—or catastrophe.
They decided to seek a second opinion from an older, eminent neurosurgeon. A few days later, the surgeon phoned Marsh. "It's a young man's operation," he said. "I've told them you should do it." Flattered, Marsh agreed to go ahead. The surgery began at nine in the morning and continued late into the night. Brain surgery is slow and dangerous, and removing a tumor can be like defusing a bomb. Often, surgeons look through a microscope and use long-handled, fine-tipped instruments to pull the tumor away from the brain before removing it with a sucker. A quarter of the body's blood courses through the veins and arteries of the brain; if one of them is torn, bleeding and stroke can result. It's also possible to remove important parts of the brain by accident, because brain tissue and tumor tissue look pretty much the same. Unlike the rest of the body, the brain and the spinal cord rarely heal. If a neurosurgeon makes a mistake, the damage is often permanent.
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