Sunday, October 10, 2021


 Op Note III

The patient presented for surgery after a long discussion of the attendant risks.  He had been referred to clinic with the diagnosis of anhedonia.  He had been deeply unhappy most of his life.  He had tried everything.  Psychotropic medications, dozens of them. Electroshock.  Talk therapy.  Group therapy.  He was psychoanalyzed by a Freudian from Antwerp.  He even did a week-long silent Vipassana retreat in Sedona.  Nothing seemed to work.  He drank alcohol to numb the pain.  But that only revealed what lay beneath the pain, which was worse.   He tried to fall in love.  Got married.  Had a few kiddos.  Even those joys didn’t last.  He received an award from his local Kiwanis Club.  It became harder and harder to smile.  He struggled to rise from bed. He began to appear unkempt. He lost his job. His wife left. He sought help from doctors from quacks from shamans from celibate monks.  He tried tripping on acid.  As in many things, I informed him, surgery is the option of last resort.  He understood the risk of death of paralysis of permanent unconsciousness.  He signed all the forms.  He felt this was his last chance.  Once he was shaved and sterilely prepped we used the saw to remove a generous bone flap.  As part of the protocol, he was kept awake.  We used probes to interrogate the amygdala.  Nothing seemed to elicit the desired response.  But then the assistant briefly lost control of the suction tip and, in the process of retrieval, the monitors lit up, the patient's heart rate surged and his eyes teared over with pleasure. His body arched in unguent ripples. He was shouting and delirious, saying yes that’s it, that’s it, that’s it yes yes yes and we came close to having to sedate him.  He kept saying please make it last.  Please do it again. Please doctor.  It became a prayer of reverential whispering.  I spent the next hour and a half meticulously probing the area of his brain where the suction tip had struck, to no avail.  It was getting late.  You can only do so much. It may have been a fluke.  The bone flap was replaced.  The scalp was reapproximated.  The patient was brought to the recovery room, shuddering and crying, shoulders heaving, shivering like he'd been left out all night, refusing to open his eyes.  


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