Free When the Air Hits Your Brain: Tales from Neurosurgery by Jr. Frank Vertosick Page B

say. Right about here. Real sore.”
    “Thanks, Mr. Angelo.” We darted back into the hallway again.
    “Mr. Angelo has a malignant sarcoma eating into his lower back and right lumbar plexus,” Gary continued, “and he’s in agony. Does he say he has goddamned electric earthworms in his leg or some such shit like that? No. He says ‘I’m real sore.’ He also uses about one-tenth the morphine that room nine uses. Why? Because he has legitimate pain and he isn’t nuts. Another rule of thumb: The more bizarre the description of the pain, the more likely it is to be a psychiatric delusion. Phrases like ‘I have little gnomes with branding irons running all over my face’ or ‘The hooves of a thousand angry horses are thundering in my head’ should immediately make you suspicious that something else is going on. People with real pain don’t say ‘excruciating.’ The word ‘excruciating’ literally means to feel the pain of crucifixation. Since hardly anybody knows what it’s like to be crucified anymore, no one is entitled to use that word, in my humble opinion.”
    “Look at that guy!” Eric chimed in. “My kid’s pictures don’t get as much attention as his X rays! He’s becoming his pain. It’s part of his identity. He’ll be in pain until it’s time for him to make the horizontal call from a brass-handled phone booth—which won’t be long if he keeps slurping up oral morphine.”
    We proceeded down the hallway to room eleven.
    “Room eleven,” said Eric. “Mrs. Rubinstein, atypical face pain. Had a microvascular decompression of the fifth cranial nerve three days ago. Still has face pain, same as pre-op. Wound looks good, no headache—thank God for small favors…Husband Ben by her side, as usual.” A microvascular decompression is the act of padding arteries away from the cranial nerves at the base of the brain using small Teflon sponges; it was thefirst operation I had seen—or at least started to see until Gary plunged the drill into the patient’s cerebellum and made me flee the OR.
    The body has twelve pairs of cranial nerves, so named because they exit from the brain itself, not from the spinal cord. The cranial nerves mediate the sensory and motor functions of the head and neck. The first cranial nerves are the olfactory nerves, which convey the sense of smell; the second cranial nerves the optic nerves, which convey the sense of sight; and so on. The fifth cranial nerve conveys sensations from the face. It is also called the trigeminal nerve, from the Greek phrase meaning “three origins,” because the main nerve branches into three divisions: V1 (called vee-one, even though the “V” is meant to be the Roman numeral five, not the letter), which supplies sensation to the forehead and eyes; V2, which supplies the cheeks, upper teeth, and upper lip; and V3, which supplies the jaw, lower teeth, and lower lip. The trigeminal nerve is somewhat rudimentary in humans compared to the nerves of lower animals, such as mice or cats, which have whiskers and depend upon keen facial sensation for their survival.
    “ Atypical facial pain?” I asked. “Is that like trigeminal neuralgia?”
    “No.” Gary answered sharply. “It isn’t anything like trigeminal neuralgia, or tic. People with tic have stabbing pains in one, or perhaps two, divisions of the nerve. The pains are elicited by sensations in the affected area: brushing the teeth, cold air or water hitting the face, chewing. Atypical patients have pain all the time, describing it as burning or aching and not shocklike.”
    “Does surgery help this?”
    “Judge for yourself.”
    Mrs. Rubinstein, an attractive woman of about forty, wore a sexy nightgown and large, dangling gold earrings. The rightearring smacked repeatedly against the shaven, sutured wound behind her ear as she turned her head to greet us. A bald man sat in a chair beside her bed.
    “Mr. and Mrs. Rubinstein, this is Dr. Vertosick. As of today, he’s a brain