Death Be Not Proud

by John Gunther

  Of all the doctors, the chief was this gentle and sensitive man whom we drove to Deerfield that first evening, Tracy Putnam. I had no idea then of his eminence. I didn’t even know he was a surgeon. As of that time—he has since moved to California—he was Professor of Neurology and Neurological Surgery at Columbia University and Director of the Neurological Institute of Columbia-Presbyterian Hospital, commonly known in New York as Medical Center. That a man of this rank should leave his desk and go to a child’s bedside hundreds of miles away on five minutes’ notice is sufficient indication of his character. Probably Putnam is the most delicately fastidious expert in his field I have ever met. He has a great quality of sensitive reserve also; brain surgeons seldom give themselves away. Johnny used to say—or perhaps it was Frances—that he resembled Buddha.

  Again that scene—the white frame building with the tall Deerfield elms outside, beaten by a howling wind; Johnny’s small room with the bed stuck sideways from the wall because there was so little space; the lights dim as it became midnight, and the doctors tiptoeing and the nurses whispering; the first talk the doctors had when they wouldn’t let Frances or me into the room, and how long it lasted, while an unbelieving sickness, a bewildered stupefaction, rose in our protesting hearts; Johnny’s own dazed smile and one murmured sentence, “ I know it can’t be really serious or they would have taken me to a hospital.”

  Putnam ordered Johnny to be brought into New York by ambulance; we made the arrangements, and set out early the next morning. To keep Johnny warm as we lifted him into the ambulance, the nurse pulled a gray blanket over his face. Frances helped her. I did not want to watch. It was a long ride in the cold, sullen, slippery rain. Frances held Johnny’s hand while he dozed. The Neurological Institute rises stiff and tawny near the Hudson just below the silvery spindles of the George Washington Bridge. That building!—it became the citadel of all our hopes and fears for more than a year, the prison of all our dreams. A comfortable room with a broad view of the river was ready, Johnny was transferred gently to a bed, and we found ourselves sucked at once into the vast mechanism of a modern hospital, with all its arbitrary and rectilinear confusion.

  The next morning Johnny was well enough to ask me how much the ambulance had cost.

  I told him, and he replied, “A gyp.”

  The nurse asked him if he had had a bowel movement the day before. He replied, “Nominal.”

  His eye looked better. It did not have that dreadful droop. But later that day he developed an excruciating headache, the only fierce and intense pain he suffered during the whole course of his illness—a small mercy, perhaps, but one to be devoutly grateful for. The brain controls pain in other parts of the body, but there are no sensory nerves in brain tissue itself; you could cut a person’s brain apart bit by bit, and there would be no pain. What causes headache is swelling or inflammation of the membranes surrounding the brain, or pressure on the tissue from a foreign mass; this is what happened that day and Johnny muttered angrily about the savage pain and tried to analyze it. “Pop, I feel a sword go through my head at every pulse beat.” The usual painkillers were forbidden, because they might interfere with the tests remorselessly going on. Finally, an injection of caffeine relieved him somewhat, and he had some medicaments by mouth. He asked the doctor for the chemical formula of one that, he said, “was, of all the concentrated essence of bitterness ever invented, the bitterest.” It was something quite simple chemically—and he was disappointed!

  A great number of intricate tests were necessary, including X-rays, an electroencephalogram, and visual field tests, all exhausting in the extreme, but necessary so that the tumor might be located as accurately as possible. The surgeon, when he went through the bowl of skull, wanted to hit the exact right spot. One of these tests, the ventriculogram first used successfully by the late Dr. Dandy of Johns Hopkins, actually entails drilling holes through the skull—of course it can only take place on the operating table before the actual operation. Meantime at least five doctors, all neurosurgeons, asked us questions. Any record of a blow? Any propulsive vomiting? Any chills or tremors? Any double vision, headaches, abnormal involuntary movements, dizziness, or disturbances in gait, taste, smell, or hearing? We answered, horrified, “No . . . No.” This vicious invader had given us practically no warning. Several of the doctors were Latin Americans; their English was imperfect, and it was a trial for Johnny to answer so patiently what they asked, and then be unsure that they understood the answers. Above all, what he suffered from was lack of water. He was allowed only a bare minimum of fluid, since dehydration would tend to decrease the pressure inside his head. Came more and other tests. Johnny said wearily, “All this red tape—why can’t those doctors get together?”

  After the violent headache the first day, the only thing that really hurt him was the haircut when Tony, the barber, shaved his skull the morning of the operation. This can be very painful when the razor scrapes against the grain. Johnny gave out a fierce “Ouch!” and grabbed for my hand. Then he asked how he could go back to Deerfield inasmuch as crew haircuts are forbidden there. He looked at his shaven skull. “Papa, they aren’t going to electrocute me, are they?” He tried to laugh, but his voice was a nervous little giggle.

  Johnny’s operation—this first operation—took place on Monday, April 29, 1946. He went upstairs at 11:10 A.M. and came down at 5:20 P.M. Brain operations take an eternity because of the laborious procedure necessary. One of the doctors told me that its effect on Johnny would be approximately that of the explosion of a .45-caliber bullet against the head. Those six hours were the longest Frances and I ever spent. A couple of nurses asked us with the deadly casualness that nurses have, “Is he your only child?”

  Between the Friday and the Monday I had tried to find out something about brain tumors. I prodded through several texts full of the frightful jargon of medical writers, and consulted Traeger almost hour by hour. Let me pay tribute now to the steadfastness of this splendid physician, with his tough, cheerful, realistic mind, and his intense devotion to Johnny, who acted as a kind of chief of staff for all the other doctors during the entire illness. A tumor is a growth. What I asked about first of all was whether or not Johnny had cancer. All cancers are tumors, but not all tumors are cancers by any means. By one definition, Johnny did have cancer; by another, he did not. That is, a brain tumor (though it may strike the spinal cord in some rare cases) never metastasizes, i.e., spreads through the body to attack liver or bones or what not. It is not like a tumor of the breasts that may become a tumor of the lung. But if malignant, it will spread within the cranium itself like a spot in an apple until the brain is destroyed. Therefore, it must be removed at once. Also, inasmuch as the brain rests within the hard shell of skull, there is no room for expansion; if a foreign growth is present, the skull itself must be opened or death will be caused by pressure. The only other accepted means of therapy for brain tumors are X-ray and, rarely, radium. Now, to open the skull and extract all or part of a brain tumor is a refinement of surgery of the most elaborate kind. The operation, in fact, did not exist as a practical possibility until the advent of the late Dr. Harvey Cushing. Almost all the great contemporary neurosurgeons—like Putnam himself and Wilder Penfield— are Cushing men, Cushing trained.

  The technique (of course I am oversimplifying vastly) is to locate the tumor with exactness, open the skull and remove as much of the tumor as possible by suction and other devices, meantime preventing hemorrhage by various means and so keeping the patient alive. In blunt fact the operation itself, though prolonged, may not be violently dangerous, and though the technical preparation may be difficult, the actual surgery is of the most primitive type—simple extrication of an alien mass. Everything depends on the type of tumor the surgeon may discover, and there are half a hundred different kinds, some comparatively benignant, some malignant in varying degree. The location of the tumor is also of prime importance. Obviously a tumor close to the surface, in the so-called silent areas of the brain, w
ill be easier to extract than one deep down. At first it was thought that Johnny’s tumor was of the fourth ventricle. When, up in Deerfield, I asked Dr. Johnson what kind of operation this entailed, he simply shook his head and replied, “There have been very few successful operations in that area.” Actually Johnny’s tumor turned out to be near the surface and in the right occipital parietal lobe, which made the procedure some-what less formidable, though, God knows, formidable enough. Another difference among tumors is that some have a greater velocity of growth than others and a tendency to recur. It was a bad sign that Johnny’s had apparently developed with such speed. Another difference is that some are encapsulated, and so can be lifted out in a piece, like a marble stuck in jelly. These are comparatively easy to remove. But others are of an infiltering spidery type that creep and burrow along the minute crevasses of the brain, slowly but inevitably destroying function, and almost impossible to remove. If the surgeon goes too deep, the patient dies of loss of blood or, worse, so much healthy brain tissue has to be destroyed that he will be better dead.

  Traeger gave up his practice for a day, no small sacrifice for a busy doctor, when Putnam asked him to attend the operation. We hoped desperately for good news to the last. Putnam had explained that he would know little until he actually went in. For all anybody really knew, Johnny might not have a tumor at all. What caused the pressure might be a blood clot. It might be a mere cyst. It might, even if a tumor, be the most innocent kind. At about 4:30 that afternoon, while Putnam was still washing, Traeger (who had stood up hour after hour during the entire operation) came down and found us in the solarium near Johnny’s room. I took one look at his face, and knew the worst. Traeger had aged five years in those five hours. He was as gray and seared as if drawn by Blake. He could hardly control his features. Nor was I controlling mine. I took him aside and asked him just one question. “Was it encapsulated?” He answered, “No. ”

  Putnam came down a few minutes later, briskly but looking like officers I have seen after a battle. I heard him call, “Where are the parents?” He walked me down the hall after a word of encouragement to Frances. “It was about the size of an orange. I got half of it.”

  What, in all sanity and conscience, is a brain? How in the name of heaven or all that is reasonable could an evil thing the size of an orange have existed in Johnny’s head without making him sicker? The answer is, I daresay, suggested by the fact that immediately after the operation, he became tolerably well, even though half the tumor was still there. Part of the brain is nonsensitive tissue, and Johnny’s tumor lay in a comparatively inactive region.

  There was a bustle at the elevator and Johnny’s bed was wheeled in. Frances, who was magnificently composed, took a brief walk. I was sick with fright when I saw the oxygen and all the paraphernalia for transfusion. Already Johnny had had a couple of pints of blood, we were told. But this was routine, more or less. The doctors said that he would be unconscious at least till the next morning, and that we might as well go home. I elected to stay. Soon I got my first look at Johnny’s face, sideways on the pillow with a huge turban of bandage marked THIS SIDE UP. I retreated in dumb shock. Both his eyes were stuck closed and he looked as if he had two enormous shiners; his whole face was the size and almost the color of a football. But this was nothing to worry about, since it was the result of edema, swelling, following the shock of operation—so I was told. Then I noticed the emergency instruments on the bed table and learned that a needle (it stayed there for some days) was actually taped into the vein in his arm, in case an emergency transfusion should be necessary. This, too, was routine—or so I heard. Putnam, in a rain-coat, just preparing to leave the hospital, came up at a run, after a nurse called him. An injection of some stimulant was necessary. Johnny was still in shock. Another doctor said airily, “Oh, he’ll last the night all right.”

  At about nine that evening, only a few hours after the operation, Johnny gasped and stirred, making a weak groping gesture with his enormously swollen mouth.

  “Spit it out,” the nurse said.

  He replied in perfectly understandable words, “You know perfectly well I can’t spit. I’m completely dehydrated.”

  The nurse stared at him dumbfounded.

  He asked then for Dr. Miller, one of Putnam’s assistants, with whom he had been talking about chemistry just before the operation. I told Miller that Johnny had asked for him, and Miller could scarcely believe that a child who had just gone through such an ordeal could be capable of speech.

  Johnny recognized me after a while and whispered, “Hello, Pop.” Pause. “Are there going to be any more tests?”

  “Good Lord, no! You’re all through with tests. Don’ t you realize you’ve had quite a serious operation?”

  “Of course,” Johnny answered. “ I heard them drilling three holes through my skull, also the sound of my brains sloshing around. From the sound, one of the drills must have had a three-eighths of an inch bit.”

  I slept sitting up in the visitors’ room. I kept remembering the way he had looked when we hoisted him into the ambulance at Deerfield, with the gray blanket across his face.

  Johnny made a very brisk recovery. Six days after the operation he ate a beefsteak sitting up; on the eighth day he was busy drawing a series of parabolas and on the eleventh day he walked the length of the corridor alone. But do not think he didn’t suffer.

  His eyes were stuck absolutely shut the first day or two; and he spent forty-eight hours fearing that he was blind. The very day after the operation he asked me to bring his physics text to the hospital, and then demanded that we read him the questions at the chapter ends. Thank goodness, he knew the answers! He thought, since something drastic had happened to his brain, that he might have lost his memory. Then he announced suddenly that he knew what he had—schizophrenia! He thought he was crazy. This was because he had once read in a medical book that electroencephalograms and similar tests were used to treat schizophrenia. We brought Traeger in right away, who showed him that although he was dead right in associating this test with schizophrenia, he had nothing at all to fear inasmuch as this disease is never treated by actual operative procedure—and certainly he had had an operation! But Johnny’s torture left us blanched. O n successive days he thought he was going to lose his eyesight, his memory, and his mind.

  But nothing whatever had gone wrong with his faculties. One evening, within a week of the operation, he listened to the Quiz Kids on the radio, and was quicker answering one mathematical and one historical question than the children on the program. He read in Bertrand Russell’s ABC of the Atom and once he asked Frances to make clear to him the distinction between the words unmoral, immoral, nonmoral, and amoral. He worked out equations of a sort far too abstruse for me, and kept asking for more and bigger textbooks.

  Later he became depressed and excitable and worried about the schoolwork he was missing. He wanted to demonstrate that he was far beyond the simple mathematics he was taking. We, on the other hand, told him that routine cramming was part of every education and that he might as well face this now as later. Suddenly he announced on May 10 — twelve days after as serious an operation as a human being can undergo—that he wanted to write a letter. Frances thought it might be to Mr. Boyden or to one of the Deerfield boys. But it was to Dr. Einstein. Frances had to persuade him to dictate it to her, and she took it down word for word, comma for comma, exactly as he said it; then he was surprised and impressed at the way it came out:

  DEAR PROFESSOR EINSTEIN,

  For some time during free periods at school, I have been struggling, I am afraid rather unsuccessfully, with Eddington’s Space, Time and Gravitation, and the rather fantastic idea occurred to me—here comes the presumptuous part—whether it would not be reasonable to assume that the number and curvature of dimensions of the universe be considered, if not variable, at least “relative.” The properties of an event would then be determined by the number and curvature of the dimensions which govern it. Electric and magnetic
attraction would then be considered merely a type of gravitation through electric and magnetic “dimensions.” This attraction would then continue to follow your law of gravitation. Of course this theory would have to be tested by determining whether it checks mathematically with the equations of Clark Maxwell, and your law of gravitation. But unfortunately I do not yet have the mathematical training to compute this problem.

  If by some wildly and impossibly fantastic coincidence, this weird idea should coincide with any ideas you may have had or will have, please do not think of giving me any credit for suggesting it, as I would not deserve it any more than would Newton’s apple for catching the great scientist’s eye.

  Thank you for reading this.

  Sincerely yours,

  JOHN GUNTHER, JR.

  I sent this letter to Einstein with a brief covering note and, making us very happy, Einstein replied to Johnny promptiy as follows:

  DEAR MR. GUNTHER:

  I have read with interest the remarks contained in your letter of May 10th. They were, however, too brief to give me a clear understanding of your ideas. I hope to see you when you have recovered so that we may have a conversation about it.

  With my best wishes for your speedy recovery, I am,

  Yours very sincerely,

  ALBERT EINSTEIN

  When we gave way to the temptation to boast about this correspondence, Johnny begged us not to. His subsequent acknowledgment was, we thought, a model of grace and gentlemanliness:

  DEAR PROFESSOR EINSTEIN,

  Thank you so much for your very kind letter. I am afraid that in my letter I must have implied that I know a great deal more about this whole subject than I actually do.