Mona Lisa

My Smile!

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During the time of Dad’s struggle with cancer Mom found an article in the newspaper about a new surgery for people with facial paralysis called Smile-Surgery. It was pioneered by two plastic surgeons in Toronto. I saw the surgeons in March, 1977, to find that I was a good candidate for this procedure. After the surgery I would be able to move the corners of my mouth outward and up to smile.

Smile-Surgery: One end of the gracilis muscle is attached to the chin and the other end to the cheek. The blood supply and nerve are connected to the jaw muscle. After 12 weeks the surgery heals enough for the “smile muscle” to start working. It contracts when the jaw muscle is tensed causing the corner of the mouth to move outward and up to smile.

“Is this the answer?” I wondered, “Would I finally have what I had dreamt of for so long?  Would I get my smile back?” I was afraid to hope. I didn’t want to be disappointed again and yet my intuition told me to have the surgery. I thought about it for months.

In October of 1997, I had Smile-Surgery on the right side of my face at the Toronto Western Hospital while Dad and Jeanne ran Tara.

The Smile-Surgery involved taking some gracilis muscle from my inner thigh and transplanting it into my face (right thigh for the right side of the face and left thigh for the left side).

The lack of a smile wasn’t my only problem. Since I didn’t have cheek muscles to support my lower eyelids they sagged. During this Smile-Surgery the surgeons made a sling for each lower eye lid from a tendon out of my left wrist to hold them up.

When I woke up after surgery the incision on my face went from my right temple, down past my ear, around the corner of my jaw and along it to my chin. I had an incision along the inside of my right thigh from my knee to my groin with drains sticking out. I had swollen, bloodshot eyes I couldn’t focus. They had taken a tendon out of my left wrist and there was an IV in my right hand. I was sore all over and all I could do was lie on my back and stare at the ceiling. Man was I ever feeling sorry for myself.

“Brian,” I said, “what on Earth were you thinking? You didn’t have to do this.” Wah wah wah.

Two days later I wasn’t as sore. I could focus my eyes again and I was glad it was over. Four days after surgery the drains came out and I could get up. Three more days in Toronto and I was back in Thunder Bay.

It took two weeks for the swelling in my face to go down. The surgeons gave me step-by-step instructions on how to strengthen my new muscle. I stood in front my bedroom mirror daily to practice twitching it by tensing my jaw muscles. There was no movement at all at first. The right side of my face looked to be more alive but, try as I might, the corner of my mouth wouldn’t budge. I was disheartened but I reminded myself that the surgeons had told me that the muscle needed time to heal before it would work. Of course I wanted the smile muscle to work right away. I kept practicing. Twelve weeks after surgery I was sure I could feel a tug in the corner of my mouth. It was also time for Smile-Surgery on the left side. In early January, 1998, I was back at Toronto Western Hospital.

Now I practiced twitching both corners of my mouth. To the surgeons practicing twitching the smile muscles every day was very serious business. I was like a kid with a new toy. Each day I stood in front of my bedroom mirror to practice twitching my smile muscles. At first I watched the corners of my mouth move slightly. The twitches got broader as the smile muscles became stronger. The joy in my heart grew and grew as I witnessed my motionless, expressionless face come to life. For the first time in 25 years I had movement in my face. I had my smile! It wasn’t the big, wide smile I would have liked but it was bigger than Mona Lisa’s.

“Why not have some fun with this too?” I thought. I discovered that, along with regaining my smile, I could make sounds again that I hadn’t made since I was a kid such as blow raspberries. Awesome!

The surgeons brought each smile muscle around under my lower lip as well. To have working muscles support my lower lip again proved to be a permanent solution to the problem of it curling down.

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The Time To Act Was Now!

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By mid October of 1972 I was having even more trouble swallowing, my balance was poorer, my speech had degraded further and Mona Lisa had a bigger smile than me. I had more air and dye studies (which they were able to complete this time). As before the results were inconclusive. The medical team decided to investigate surgically.

The last two weeks in October was a time of emotional turmoil and reckoning for me. I knew intuitively for a year before this trip to Toronto that something was wrong with me, but I wasn’t about to admit it to anyone including myself. I convinced myself that if I didn’t say anything about it or pretended it wasn’t there it would go away. I kept everything bottled up inside. Now and then something small would set me off. I became very upset and tearful. Getting away from the situation and be alone and quiet seemed the only way I could calm down. Family, friends and teachers would ask me what’s wrong when I was upset but I clammed up. How could I explain what I didn’t understand nor was willing to admit to?

At Sick Kids after enduring test after test, had many heartbreaks and shed many tears, I broke down the barriers that I had set up in my mind. I finally faced the reality of my situation.

I was moved from the general ward to the neurosurgical ward. There I found kids, some older but mostly younger than me, all waiting their turn for neurosurgery. Being with a group of kids all about to meet a similar fate made my wait easier. We quickly got to know each other exchange names and our home towns. Most of the kids were from the Toronto area. We asked each other like inmates doing time in prison, “So what are you in for?”

Our answers were always candid. I told them they were investigating my balance and speech problem which was true. By now I could admit only to myself that I couldn’t smile – a big, wide smile. I sensed that the one thing so uniquely human, to smile, was the one thing I couldn’t do. It was upsetting.

At 9:00 AM, Friday, November 3, 1972, a nurse wheeled in the gurney to take me for neurosurgery. All I could think was, “They’re taking me to the OR to cut my head open!” I was scared silly. What was about to happen to me? Was I going to wake up with a big hole in my head? I started to panic. Tears filled my eyes. I started to pant.

The nurse pushing the gurney tried to calm me down. “Take deep breaths,” she said quietly, “You’ll be all right.”

I remember being transferred from the gurney to the operating table. They placed a gas mask over my nose and mouth and the anesthetist told me to count slowly to ten.

“One, twooo, threeeeeee, fou…”

The surgeons cut from the crown of my head down the back and into my neck muscles to part my skull. They found the tumour. It was a yellowish-white mass of cells that was growing on the brainstem part of my brain, the floor of the 4th ventricle, which lead out into the spinal cord that involved cranial nerves 6 – 11. Because of my tumour’s involvement with the nerves, the cause of my symptoms, they couldn’t remove it. The surgeons took a biopsy and identified my tumour as a low grade (benign) Type II astrocytoma. The doctors wondered that since the rate of onset of my symptoms was increasing if my tumour was becoming malignant.

Astrocytoma: A brain tumour composed of astrocytes which are star-shaped cells that act like connective tissue in the brain.

Surgery lasted five hours and went smoothly. When I woke up in the ICU the first thing I sensed was a throbbing pain in the back of my head.

“My head. It hurts,” I called out.

The anaesthetic made me nauseous and I kept throwing up. I had to lie on my side and a nurse turned me every 20 minutes to prevent bed sores. The only relief from the throbbing was to lie still. It would take 20 minutes for the pain to die down which was time to turn me and the throbbing started again. Throwing up made my head throb too. Between being moved and throwing up there was no escape from the pain for two days.

As a result of exposing my brain to air I hallucinated for the first two days after surgery. People and things appeared as concretely before my eyes as if they were actually there. I interacted with whoever was at my bedside but beyond that was a world like one created on a starship holodeck. I remember seeing a crowd of people standing at the end of a short, wide hall looking at me. I spoke to them but they just stood there motionless with unchanging blank expressions on their faces. When Mom was sitting by my bed we were on a conveyer belt travelling around a large, dark wood, 1950s style gymnasium. It had a mezzanine track around it with people doing various things. We slowly moved along the floor, up onto the mezzanine, around the gym and back down again. The sensation of motion was very real.

Mom and Dad took turns sitting by my bed in the ICU. Mom and I would talk or she would sit there quietly keeping me company as I dozed in and out. Dad read to me. Unable to hide a look of concern on his face Dad said how sorry he was to see me lying there.

I said, “That’s okay Dad, I’m just the right height for when the nurses bend over.” We both chuckled. The nurses did wear their skirts a bit shorter back then and at 13 I had an eye for it.

On the fourth day after surgery the pain in my head was considerably less and my stomach had pretty much settled down. I was released from the ICU and sent back to the neurosurgical ward.

Between the kids in the neurosurgical ward the word was that you had to learn how to walk again after surgery. I resolved that there was no way I was going to have to learn to walk again after my surgery. So on the fourth morning back in the neurosurgical ward with the bed sides finally lowered and the IV out of my leg I decided that I was getting up.

I slowly sat up. It took a while to get used to being upright again after more than a week lying down. Then I gradually let my feet slip to the floor. The full weight of my body on my legs and the feeling of the floor on the soles of my feet took a minute to get used to. I held onto the bed as I gingerly walked around it. When I felt confident enough I slowly walked out of the room and down the hall. Nobody was more surprised than the nurses as I walked past their station and said, “Hi.” I was up for good and the only time I would lie down again was to sleep at night.

Two weeks after surgery I was well enough to go down to the main public area in the front of the hospital with Mom or Dad. Even though I was walking the trip downstairs was a bit far for me. So Dad pushed me in a wheelchair. Catharine hadn’t seen me since the day before surgery. As she was only nine she wasn’t allowed on the ward or in the ICU. Mom cautioned Catharine that my appearance had changed but I don’t think any amount of counselling could have prepared her. Before surgery I was thin and weighed 80 lbs. The ravages of neurosurgery and having little solid food for over a week had thinned me out even more. I was frail, gaunt and pale. When Catharine saw me she gasped and tears rolled her cheeks.

“Hi Kate,” I said and we embraced. I asked her what she had been doing the last two weeks. As we talked her shock wore off. A few days of regular food, the ability to go downstairs to change the scenery from the ward and to see Catharine and friends soon got me on the mend.

Because my brain tumour was inoperable the doctors decided to treat it with radiation therapy. Leaving it alone wasn’t an option. If my tumour went untreated my symptoms would only worsen. Eventually I wouldn’t be able to swallow at all, have virtually no balance and unintelligible speech. The biggest concern – was my tumour about to turn into cancer? One thing was for sure. Left untreated my brain tumour would kill me. The time to act was now!

Something Had To Be Done

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When the eye surgeon in Thunder Bay examined me in August, 1966, he also found that I was going blind in my left eye since I wasn’t using it. Mom had noticed this as well. She suggested to the eye surgeon that I should wear a patch over the right eye a few hours a day to make me use the left eye so I would regain the sight in it. The eye surgeon didn’t think this would work. Mom persisted. She made me wear a patch over my right eye for two hours every evening and got my teacher to make me wear it for two hours daily during class. I regained the sight in my left eye over six months.

I started Grade 3 in September, 1966, at St. Bernard’s when Catharine began Kindergarten. I liked being a big brother and proudly walked her to school until she was older and joined her friends. We met up with each other at home for lunch and often walked back to school together. I liked running into her in the school yard at recess or when school was out.

We watched out for each other during the four years both of us attended St. Bernard’s. One time Catharine slipped on the ice in the playground and sprained her arm. She was in a sling for two weeks and I walked with her into her classroom to help her with her coat. Another time Catharine saw a boy grab a ball away from me. She wouldn’t have it. She went straight up to him to retrieve my ball and got it. Catharine was always tougher than me in that way.

In July, 1969, Mom took me to Ireland, England and France to visit relatives. I don’t know why Dad and Catharine didn’t come. It seemed strange leaving them at home and I missed them.

We had just arrived at our hotel in Dublin when I decided to turn on the radio on the bedside table. I heard Walter Cronkite saying, “six … five … four … three … two … one …… lift off, we have lift off …” Apollo 11 roared from the launch pad.

Four days later I was at Aunt Gertie’s home, Mom’s sister, in Corofin on the farm where Mom was born and raised. This was the first time in my life I remember living in the same house with my Aunts, Uncles and cousins. We ate together, talked for hours and I befriended my cousins as we played. We sat in front of a small TV set to watch the dramatic first lunar landing and hear Neil Armstrong’s famous words, “The Eagle has landed.”

The lunar landing brought to life one of my favourite TV shows in the 1960s, Star Trek. Following Capt. Kirk, Mr. Spock and Dr. McCoy as they zoomed through the galaxy on their adventures captured all my imagination. By September of 1970, the crew of the Enterprise had finished their journey, but at 11 years old, mine was only beginning.

Like Dad I enjoyed working with my hands designing and building things. When I had just turned ten Dad bought a set of Do-It-Yourself encyclopedias. He and I looked through them for a project to do.

The encyclopedias had plans for a working hover craft. It was a big challenge for me at 10 years old to carefully draw all the pieces as specified in the book, cut them out of balsa wood and glue them together. When it was finished I had a 7”x4” hover craft 3” tall. I painted it silver and red with cellophane windows at the front and an airplane tail on the back. It was a really nifty looking job. Dad helped me mount a small electric motor vertically in it. I put a propeller from a toy boat of mine onto the drive shaft.

We made a box with an on/off switch to house two D cell batteries to power the motor. When I turned it on the propeller produced enough down draft to lift the hover craft up to glide over a four sheet stack of paper. I felt as if I was on my own trek of creation – an engineer like Scotty.

I entered the hover craft in the Science Fair competition at St. Bernard’s and won. Then it was off to the bigger Science Fair at the Faculty of Education building at Lakehead University. There I was up against older kids with more impressive projects and I didn’t advance. I was heartbroken. I put my heart and soul into that hover craft as I did with most things. Dad was philosophical about it. I had given the Science Fair my best effort and that’s what counted. He was right but my pride was still bruised.

The next project Dad and I built from the Do-It-Yourself encyclopedias was a wood lathe. I had just turned eleven. It was mounted on a 4×1½ ft. plywood base and driven by an old electric washing machine motor. I turned two bowls on that lathe which I stained and gave to Mom. They sat on the kitchen counter for years holding fruit and mail.

During the year I was eleven I started to become dizzy and lightheaded when I tumbled during gym class or lay flat on my back. Sometimes I was nauseous. Once I became dizzy it lasted all day.

Several times I woke up from a sound sleep and held my mouth as I tried to run to the toilet to throw up. Mom and Dad rushed to the bathroom to help me in any way they could. All they could do was be there to console me as I threw up. The first few times this happened I was frightened.

“What’s happening to me?”

Mom and Dad didn’t have an answer. Maybe my head fell off the pillow and I had a dizzy spell. That seemed like the most plausible explanation. Once the episode of nausea was over, and I regained my breath, they gave me a face cloth to wipe my mouth and a glass of water to drink. Then they guided me back to bed. My head would be swimming and I was seldom fit to go to school the next day. My parents took me to see our family doctor but he didn’t have an answer either.

Just after my twelfth birthday my parents had a photographic portrait of me made – a family tradition (a rite of passage). In it I sported a Mona Lisa smile which looked pleasant enough but it was as big a smile as I could make at the time. Throughout that summer I started to have trouble swallowing. My sense of balance was getting poor, my speech was starting to slur and I had lost the ability to expand my chest as I was only diaphragm breathing – and my facial muscles were becoming paralysed. My parents’ concern grew as they watched my health decline. By August Mom and Dad decided that there was something seriously wrong with me. Something had to be done.