Michael Palmer - The Patient

For Beverly Lewis

Acknowledgments

The many, often lonely and uncertain hours spent here in front of my Mac have been much more bearable because of my friends and family. This page is one of the ways I get to express my appreciation to them.

At the Jane Rotrosen Agency, Jane Berkey, Don Cleary, Stephanie Tade, and Annelise Robey have made writing easier for me in many ways.

At Bantam Dell, Beverly Lewis, Christine Brooks, Irwyn Applebaum, Nita Taublib, Susan Corcoran, and Barb Burg have done the same.

Sam Dworkis, Mimi Santini-Rift, Sarah Elizabeth Hull, Dee Jae Jenkins, Matt Palmer, and Beverly Tricco have been invaluable as critical readers.

My deepest gratitude to Holly Isbister, Pamela Kelly, and the rest of the crew in the Brigham and Womens Hospital magnetic resonance operating room for your hospitality, professionalism, and skill.

When blocks seemed insurmountable and another rewrite too daunting, Luke, Daniel, Matt, and Bekica have helped to keep everything in perspective, along with many friends of Bill W.

And finally, thanks beyond measure to my friends Linda Grey, who brought her genius as an editor to the final rewrites of this book, and Eben Alexander III, M.D., whose remarkable gifts as a physician, surgeon, and scientist made the whole project possible. Whenever I needed neurosurgical facts or techniques, Eben was always there. Any errors or oversights are mine, and are doubtless due to my neglecting to review them with him.

MSP

Prologue

SYLVAN MAYS, M.D., STOOD BY THE VAST WINDOW OF his fifth-floor office and gazed out at the countryside, where late afternoon shadows were lengthening across the Iowa River. At fifty, he had just gone over ten million in net worth and was one of the few physicians who had actually seen his income increase since the advent of managed care. The decision to remain in Iowa had certainly been the right one. For sure, he had his detractors. Success always brought those. He was too entrepreneurial, some saida big fish in a small pond, too intent on building himself into a neurosurgical version of DeBakey or Menninger.

Whats so wrong with that? he wondered. DeBakey and Menninger were world renowned and respected, doing good on a global scale. What was so wrong with wanting to emulate them?

The gleaming seven-story Mays Institute for Neurological Surgery had put Iowa City on the map and brought millions of dollars in research and industrial development grants to the university. Now, his robotics team was closing in on a real prizethe first microrobot to be approved by the FDA for use in neurosurgery. A preliminary application had already been submitted. Six months, maybe less, and the few remaining bugs in the system would be worked out. As it was, he was revered for cranking through more brain tumor cases than anyone else in the country. Now, with several researchers on the robotics project, and Sylvan Mays name on every scientific article the group generated, he was gaining recognition as a top researcher as well.

He checked his watch. Five minutes or so before Frederick Wilson was due. As with his previous appointment, Wilson had insisted on being the very last patient of the day. At first, Mays had been put off by his prospective patients demands. But what a find hed turned out to be! Wilson was eccentric as could be, yet ready to reward handsomely anyone who did him good service. A quarter of a million in cash just for evaluating his case. Four times that when the surgery was completed, plus a healthy donation to the Institute. Wilson was the patient of a surgeons dreams, except that his tumor was badas bad as any so-called benign tumor could be. A slow-growing subfrontal meningioma with some extension, steadily compressing normal brain tissue. Progressive neurologic difficulty had begun. Now, the only choices Wilson had were surgery or a stuttering, inexorable death.

Mays was sure he would be able to get to the tumor, but not without doing some damagemaybe a lot of damage. Then there was the actual dissection. He had probably excised more tumors like this one than almost any other surgeon in the world; if he couldnt do it, it was doubtful anyone could. But even for him, the dissection would be chancy. Wilson had come to him impressively well informed, and had asked specifically about the robotics system. Rather than risk losing him to some other surgeon, Mays had chosen to tell him that employing the robot in the OR was possible, but not definite. By no means definite . Hadnt those been his exact words? The exaggeration had been necessary initially. Now, it was time to back off.