A beam of pure intelligence

Posted in Uncategorized by Sean Holton on August 27, 2009
My personal Novalis BrainLab...
My personal Novalis BrainLab…
...and the control room to operate it
…and the control room to operate it









 Each day, thousands of commuters drive past the M.D. Anderson Cancer Center at 1400 S. Orange Avenue in Orlando, FL, without giving a second thought to the amazing things that go on in there. Just a few decades ago, simply getting access to such a bustling hub of cutting-edge technology would have required the derring-do of James Bond. You would have had to strip to your underwear, put on a facemask and snorkel, then dive into a forbidden pool of water before swimming underwater into a mountain hideout with Ursula Andress at your side. Once inside, you would then have been required to deliver a couple of judo chops to the neck of a clueless, clipboard-carrying worker drone, drag his unconscious body from view, quickly change into his gray coveralls and white hardhat and grab the keys to his evil, golfcart-like transporter. Oh…and then you’d have to knock out some other worker drone to get some duds for Ursula.

Now imagine doing all that with cancer. But at M.D. Anderson, you don’t have to judo-chop anyone. These are the good guys. You just walk right in through some automatic doors, walk past a player-piano that’s filling the lobby with soothing jazz and then scan your very own “I’m-A-Cancer-Patient” card through a barcode reader at the front desk. Then you head down polished hallways straight past all the smiling workers and technicians to your personal radiation machine. It’s waiting there for you each day at your own appointed time, as if it were nothing more complicated than a dryer at the laundromat.  Mine is called the Novalis BrainLab, and it’s an instrument designed to treat brain tumors with minimally invasive technology that kills all the bad stuff without harming the surrounding good brain tissue. It does this by aiming several precisely shaped beams of radiation from various directions so they intersect one another right at the targeted point of treatment.  Each beam by itself wouldn’t be strong enough to hurt anything (which is why it can safely travel through all the healthy stuff). But at the point where two or more beams intersect, it creates enough energy to fry the cancer cells. In my case, the doctors are zapping an area that extends about 2 centimeters outward from the area where the tumor was surgically removed. The idea is that the powerful radiation in conjunction with my chemotherapy medicine will destroy the gazillions of microscopic cancer cells in that area as if they were expendable worker drones fleeing the exploding mountain lair in the climactic finale of that James Bond movie.

Dr. Ramakrishna

Dr. Ramakrishna

The man who programmed Novalis to perform my specific treatment is Dr. Naren Ramakrishna, who is my radiation oncologist and who also happens to be M.D Anderson’s Director of Neurologic and Pediatric Radiation Oncology.  His resume is pretty impressive, even if you leave out all the stuff about his training at Cornell University, Mt. Sinai Hospital in New York and The Johns Hopkins Hospital Oncology Center. Because after that: 

“Dr. Ramakrishna served for eight years on the faculty of Harvard Medical School where he was an Instructor in Radiation Oncology. He was also the Chief of Central Nervous System Radiation Oncology at Dana-Farber Cancer Institute and Brigham and Women’s Hospital, and the Director of the CNS Radiation Oncology fellowship program. He is a diplomat of both the United States Medical licensing Examination and the American Board of Radiology. Dr. Ramakrishna’s extensive research is published in numerous medical journals and textbooks and he is often invited as a guest speaker to conferences and universities.”

Those are some of the most prestigious cancer-fighting credentials one can have. So I’m figuring that getting Dr. Ramakrishna to M.D. Anderson was somehow part of the same deal that sent Shaquille O’Neal to Cleveland, and may even be part of the reason the Orlando Magic no longer have star forward Hedo Turkoglu on their team anymore.  Whatever the case, even though I’m a major Magic fan, I don’t care. I’m just glad he’s the guy in charge of zapping my head.

The title of this post (“A Beam Of Pure Intelligence”) is as much about Dr. Ramakrishna as it is about all the fancy Novalis hardware. Because when you sit in a room and talk to him,  his calming presence and total command of what he is doing make you feel as if you are in the presence of such a beam. He also pulls no punches. When I met with him Wednesday at the completion of my first week of treatments, for example, he gently reminded me that there is no such thing as “curing” a glioblastoma tumor and being declared “cancer free.”  That’s never happened with GBM, despite the way some patients might have interpreted their own cases. Rather, the goal of my treatment is to manage my cancer so I can enjoy life for as long as is possible — possibly for many years. I get the distinction.

Now back to BrainLab, which is where I walked again today right after my meeting with Dr. R. For the machine to physically accomplish all of Dr. Ramakrishna’s intricate orders requires some maneuvers that owe more to The Matrix than to James Bond. Wearing my street clothes, I lie flat on my back on a steel slab while the cheerful radiation therapists lock my head into position with a plastic mask that has been molded to fit me perfectly. Then the steel slab slides onto a 360-degree turntable, which lifts me up so that my face is positioned just under the main eye of the yellow-and-white Novalis machine. It’s a giant machine, but it can pivot, twist and turn in any direction in order to get the radiation-beam angles just right. I just lie there quietly as the nice therapists lock me up, line me up, chat me up and finally ask me what kind of music I’d like to listen to during the session. I always say whatever is playing is fine (mostly light rock and oldies). Then comes the only really scary part, when the therapists say “Okay, we’re ready to go. See you later!” Then they head for the cover of the control room, pulling a six-inch thick solid steel door closed behind them. The machinery whirs to life and my little Matrix turntable starts spinning me around in this or that direction while the Novalis spins over, under and around me like a massive potato-masher-shaped break dancer. I just close my eyes, because all the music and movement makes me a little dizzy. (I’m such an old man.) When the radiation beams are actually administered, all I see are green flashes lighting up the outside of my eyelids. It’s sort of like sleeping in a tent during a bad lightning storm.

But hey, it’s all over in less than 15 minutes. And it’s sure alot better than what I’m told was the old technology, which was more akin to having your head shoved like a Pop Tart into a giant toaster oven that heats up everything in hopes of killing something. One of my techs told me it might take an hour just to get your hearing back after just one session of that stuff.

Instead, after my date with the BrainLab is over, I just say goodbye to the therapists, walk back across those polished floors and out the front door of the M.D. Anderson Cancer Center. Then I hop on my bicycle and ride home.

PROGRAMMING NOTE: Anyone who wants to watch a 4-minute video of the Novalis machine in action can click this link: The surgical procedure described in the video is not the same thing as my radiation treatment, but the machine, the technology and its movements are pretty much the same and will give you a good idea of how it works.


9 Responses

Subscribe to comments with RSS.

  1. Lois Grebowski said, on August 27, 2009 at 9:42 am

    Thanks so much for sharing the procedure…

  2. Chloe said, on August 27, 2009 at 11:59 am

    Hi Sean, Did you ever see the movie ‘The Doctor’ with William Hurt. I thought of it, when you just described entering the hospital for your treatment. It was one of my favorite movies back in ’91 (maybe partly because I love William Hurt), but it was such a beautiful portrayal of what people go through when they get diagnosed with cancer, and how a life-altering health crisis can change your perspective on life. He and Elizabeth Perkins have a dance scene in the desert (the background music was Strange Angels by Laurie Anderson, which I think I’ll download on itunes, now that I remembered it), that I’ll never forget. The director was the same one that directed ‘Children of a lesser God’, Randa Haines.

    Here’s a cute scene from the movie:
    Keep up the good work Sean!

  3. Colorado Bob said, on August 27, 2009 at 12:21 pm

  4. Jamie said, on August 27, 2009 at 12:56 pm

    Your description conveyed the absolute serenity a doctor can give a patient by simply knowing his field completely. However, there are those reading who probably objected to you covering up Ursula. A flashable lab coat might have been more distracting to the worker drones.

  5. harborwoman said, on August 27, 2009 at 2:14 pm

    I quietly read what you’re writing every day. Lard. Your writing is so well done, and your ability to share this journey with us is amazing. Just want you to know I’m out here…even though I don’t say much….

  6. Walter Julian said, on August 27, 2009 at 3:37 pm

    Thanks for your blog. I was directed to it by our mutual friend John Huff, who thought I might be interested in what you have to say because I have Stage IV melanoma, which most recently invaded my lungs in its determined quest to extinguish my light from the universe. I am wishing good things for you.

  7. Tonyb said, on August 27, 2009 at 6:20 pm

    Hey Sean
    Uplifting piece! I love how after your treatment; you just jump on your bike and ride home.

  8. Maxtrue said, on August 27, 2009 at 11:20 pm

    Well, jump on your bike means you’re not THAT old Lard. And fortunately young enough to ride the cusp of invention.

    Yes, in THIS moment in history your head sits between the Microwave and the Gliazapper 2040, but the obstacles yield a bit more every day.

    Your entry evoked memories. It is a factual and physical interface between the sci fi of my youth and the very real and emergent power of the human mind. Indeed, “a beam of pure intelligence”. In a divinely blasphemous way, this heroic story was always about the struggle between life and death. With every individual victory, no matter how fleeting, we poke another hole in the dam. Keep riding the wave of human achievement LL, with Dr. Ramakrishna as your guide. If you’re feeling superstitious, keep a Blue Buddha by your side. For now, Gliazapper 2009 is damn impressive.

  9. paul lester said, on August 28, 2009 at 12:09 am

    Shaq doesn’t have anything on Dr. Ramakrishna. Guy is amazing. Excellent post!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: