The Anomaly of Brain Cancer

wizards, holes-in-heads and other problems of logic

the hole in the head method, as performed in the 15th century

A few months ago, a close relative was diagnosed with brain cancer. It seems like they’re probably okay now, the doctors caught it early and a round of oral chemo has already shrunk the tumor but it was a rocky three or four months. We walked around holding our breaths because you don’t know what to do around brain cancer. It’s one of those instances where an anomaly in your world suddenly consumes your world. It scrambles your universe.

A person knows how to behave around somebody with diabetes or a missing limb or somebody fighting lung cancer; but brain cancer stands alone in the dark. It’s a tumor in your head — the thing you see/hear/taste/talk out of. If the concept of the self exists in the western world, most of us assume it exists in the head.

We don’t usually talk about things like “the concept of the self” because it’s an unquantifiable feature in our mostly well-defined world. We know basically everything else about the universe but the concept of the self is still shifty, hard to wrap your fingers around. Brain cancer occupies a similar space. It remains an anomaly in the rationality of the 21st century. Do you know, for instance, how they got a biopsy of my relative’s brain tumor? They drilled hole in the top of the skull. Then they took a little piece of the brain out and put it under a microscope. They didn’t get a good biopsy the first or second time. It took three dips into the brain before they got what they wanted. It’s 2023 but neurosurgeons — some of the most revered wizards of our time — are still out here drilling holes in skulls and rummaging around inside.

Now isn’t that a bit unbelievable? When my son is a grown man, I doubt he’ll believe us when we tell him about this — about the barbarian procedure. I expect the hole-in-the-head operation will seem absurd to him in the same way that bloodletting seems absurd to us.

During the holding-our-breath period, I studied brain cancer obsessively; not that I understood all of it, but I read just about everything I could find in the National Library of Medicine. I buttonholed a Mount Sinai neurosurgeon at a wedding in April.¹ From him, I learned that there’s a strain of the medical community pushing for a transradial approach to neurosurgery — going in through the patient’s wrist rather than cutting their head open or going through the groin (transfemoral surgery). Apparently, patients prefer the transradial method and that’s great and all but it seems like more often than not, they’re still drilling holes in heads.

I don’t mean to belabor the hold-in-the-head point, but it’s just a bit outlandish to me. We walked on the moon in 1969. We split the atom in 1932. Every time you open the newspaper, there’s a story about how some artificial intelligence program is exceeding all human capabilities. It often feels like we have mapped and conquered the observable universe. And yet, we’re still drilling holes-in-skulls.

The hole-in-the-skull method was pioneered about 10,000 years ago. The procedure was then-called trepanation² and it seems it was mostly done to fight off evil spirits. So I guess we shouldn’t really categorize it as a medical procedure but in terms of the mechanics, it’s still the hole-in-skull method.

So this hole-in-the-head business went on for a few thousand years. We’ve discovered trepanned skulls from ancient civilizations in China, the Americas, Africa and Europe. Trepanation was carried out mostly by witch doctors but a few of humanity’s familiar geniuses contributed to the process. Hippocrates formulated a method of trepanation. Leonardo de Vinci’s anatomical sketches pushed us forward a bit.

Then, in the beginning of the 20th century, this guy named Harvey Cushing started doing modern stuff. In the biography I read of him, he came off as a bit of an old WASPy prick but he figured out how pressure works in the brain and he was brilliant when he wasn’t sexist. Since then, neurosurgeons have supplanted of witch doctors — they’re basically irreproachable, occupying a space alongside theoretical physicists as the geniuses at the forefront of humanity’s collective knowledge. A neurological residency is the longest period of training we require from doctors.

With these modern wizards, we seem to finally be moving out of the hole-in-the-head era and into modern methods (see: tranradial neurosurgery). We have million-dollar machines that help them. If brain cancer is the void in reason, neurosurgeons are the people whispering into it.

Of course, it doesn’t always work out so cleanly. In Texas, there was a neurosurgeon named Christopher Duntsch who was maiming patients in the 2010s. He killed a lot of them. He’s serving life in prison now but he was active for years. And there’s a few reasons he was able to continue working for so long. But one of the major reasons is the pedestal that neurosurgeons occupy.

Now I don’t want to belittle the pedestal. Christopher Duntsch is the exception to the rule — I think neurosurgeons are some of the most brilliant minds we have. However, they are working with brain cancer, that awful anomaly in our logical universe. Brain cancer is the kind of thing that can turn a Christian into an atheist. It exemplifies the problem of evil. Because brain cancer strikes without reason. Only about five percent of brain cancers are hereditary. Brain tumors hit children with impunity. What causes brain cancer? Who the fuck knows — even our neurosurgeons are scratching their heads on this one.

So what do we do with this hole in our logic? Brain cancer isn’t like a black hole — the other thing in our universe that we can’t really explain — because you’re not very likely to get eaten by a black hole. A brain tumor can eat you in months. And so, really, I suppose there’s nothing we can do. We revert to mysticism. We pray to saints, we beg miracles from neurosurgeons. And we hope that the anomaly spares us.

1. Funnily enough, I got to talking to this neurosurgeon because he was reading a book about Proust’s invention of involuntary memory. And of course, I spent a year or two obsessed with Proust. So we started talking about Proust and then I turned the conversation to the future of neurosurgery.

2. It wasn't actually called trepanation at the time. That’s just what we call it now.