As the chairman of the neurosurgery department at the University of California at Davis, Paul Muizelaar saw patients on Wednesdays, at a clinic housed in a former cannery in East Sacramento. Among the people waiting to see him on the afternoon of November 10, 2010, was Terri Bradley, a fifty-six-year-old woman on whom he had operated the previous May, to remove a malignant brain tumor the size of a lime. Sitting in his office, Muizelaar reviewed Bradley's file. He read a letter from her oncologist, asserting that Bradley was doing well: a brain scan had found no evidence of the tumor. "I think, This sounds great," Muizelaar, a sixty-eight-year-old Dutchman, recalled. "So I go to her exam room with a big smile on my face, and there she is with her daughter, crying, not able to speak."
Muizelaar hadn't seen Bradley's latest test results. Her condition had suddenly deteriorated, and new scans revealed that her tumor—a deadly type known as glioblastoma multiforme, or GBM—had returned. It had spread from the right side of her brain to the left frontal lobe, acquiring an ominous winged shape that doctors refer to as a butterfly glioma. A second tumor had sprouted in the region of her brain associated with speech. Bradley, partially paralyzed and dependent on a wheelchair, had already undergone chemotherapy and radiation; her doctors believed that more drugs were pointless. "The radiologist said, 'I've never seen anything grow so fast,' " Bradley's daughter Janet recalled. "He said, 'Call hospice.' That scared the hell out of me."
Bradley, a fiercely self-reliant woman who had raised four daughters on her own, refused hospice care. Finally, Janet took her to Muizelaar, who said that he was unable to help. "It's a blessing to most patients not to linger," Muizelaar, who practiced medicine in California under a license reserved for eminent foreign-trained physicians, told me. "Within four weeks, this woman had regrown a massive tumor, plus a second tumor. There was clearly nothing I could do about it."
Yet the conversation did not end there. An hour before Bradley's appointment, Muizelaar had received tantalizing news about a patient on whom he had performed an exceedingly unusual procedure. The previous month, he had operated on Patrick Egan, a fifty-six-year-old real-estate broker, who also suffered from glioblastoma. Egan was a friend of Muizelaar's, and, like Terri Bradley, he had exhausted the standard therapies for the disease. The tumor had spread to his brain stem and was shortly expected to kill him. Muizelaar cut out as much of the tumor as possible. But before he replaced the "bone flap"—the section of skull that is removed to allow access to the brain—he soaked it for an hour in a solution teeming with Enterobacter aerogenes, a common fecal bacterium. Then he reattached it to Egan's skull, using tiny metal plates and screws. Muizelaar hoped that inside Egan's brain an infection was brewing.
Muizelaar had devised the procedure in collaboration with a young neurosurgeon in his department, Rudolph Schrot. But as the consent form crafted by the surgeons, and signed by Egan and his wife, made clear, the procedure had never been tried before, even on a laboratory animal. Nor had it been approved by the Food and Drug Administration. The surgeons had no data to suggest what might constitute a therapeutic dose of Enterobacter, or a safe delivery method. The procedure was heretical in principle: deliberately exposing a patient to bacteria in the operating room violated a basic tenet of modern surgery, the concept known as "maintaining a sterile field," which, along with prophylactic antibiotics, is credited with sharply reducing complications and mortality rates. "The ensuing infection," the form cautioned, "may be totally ineffective in treatment of the tumor" and could cause "vegetative state, coma or death."