The Room Where It Happens

My husband and I listened to the Hamilton soundtrack ad nauseam during the peak of the pandemic. I cannot listen to it these days, not because I do not love the songs (I do). While we were indulging Hamilton, I had two out of three miscarriages. The songs, with their catchy rhythms and flawless harmonies, were inextricably linked with loss.

But “The Room Where It Happens” persists as a favorite despite that association. This felt true especially looking back at the eve of my husband's surgery. I came to his room in the evening, planning to stay with him overnight until he was taken to the operating room. He was due to get 5-ALA, also known as Gleolan. This is a relatively new technique within the skull base/brain tumor surgery realm where the patient drinks the contrast a couple of hours ahead of the surgery. By the time he was in the operating room, skull and brain exposed under blue lights, the contrast (having made its way into the rest of the body after being digested and processed) would glow pink within the tumor. This would help the surgeons to better see what they needed to remove, and what tissue was still healthy.

I remember him sitting upright the night before his surgery, working on his laptop, focused on some leftover work from earlier in the day. Had it not been for the hospital gown and hospital bed it could have been a normal day. Even his long scruff, like grayscale paddy fields, felt normal. I don’t remember what we spoke about or what we might have eaten. I remember the warmth of his form and his arms around me, and less so the discomfort of the lounge chair and the way I slept in Trendelenburg with my feet angled upward. 

In between bouts of fitful sleep, I would peek every so often at his head, the back of which faced me as he slept facing the door. How could it house something so vile, so profane? How could William the Bump rest, after he had come crashing in like a battering ram just hours earlier? The repugnant miscreant, sapping blood and energy from my husband for its devious purposes.

And suddenly, the nurse came in, Gleolan in hand. It was a small dark amber bottle, and as though the room needed to match its appearance, the lights were turned off and the curtains were drawn closed in anticipation of its consumption. Darkness reigned as my husband downed the contrast like a shot of Fireball. 

“Tastes like s**t,” he said, as we wrapped him in blankets until barely his eyes were seen. No patch of skin could feel the light, not for forty-eight hours. The contrast, after all, was activated by light. The tumor would glow under the lights in the OR but his skin would be primed to scream even with the softness of sunrise. 

He was loaded onto a waiting stretcher an hour later. Though his room had been dark, when he stepped out into the hallway under layers of blankets, the overhead lights were harsh and threatened to cut through all his layers to the delicate skin underneath. Once positioned and made comfortable on the stretcher, he was brought down to the pre-operative area ahead of the surgery.

I never was drawn to surgery, not after having stood during multiple surgeries as a medical student, feeling my joints rust in place as the sweat dripped down my back from under my surgical cap. But I wanted to be in the room. I wanted to be there when William in all his gelatinous glory would breathe the air and see the light as the covering dura gave way. I wanted to be the scalpel dissecting him from the normal, pink healthy brain tissue surrounding it. I imagined he howled as the blade pierced him, and I relished the sound of his wails. I wanted to bear witness to his excision, watch as his mangled form was hauled away to pathology to be identified for what it was: a high-grade glioma by some definitions, but a plague by others. 

I wanted the air of the operating room to catch in his throat as he realized that I helped him to see the end of his stay.