A Drive to Cincinnati

The response was immediate. This was unlikely to be a reaction to the P.P.I., her friend wrote. A nutritional deficiency was certainly possible. But the friend would be worried about a tumor too. When was her brother planning to go home? If he was going to stay in Chicago, one of their colleagues there might be willing to see him right away. He didn’t say it, but she felt that he was telling her she wasn’t overreacting — that her brother did need to be seen promptly. She was the vice chairwoman of the neurology department at the University of Cincinnati just five hours away by car. She reached out to another colleague, Daniel Woo, the neurologist who was admitting patients to the neurological service that night. She explained her brother’s symptoms, and he agreed that he ought to come in. Woo would make certain that he would get an M.R.I. once he was admitted.

They drove to Cincinnati the following day, and he had the M.R.I. His sister watched the images appear on the screen. There, just behind his ear, amid the gray swirls of his brain, was a bright white mass, about the size of a golf ball. It was a tumor, one of the largest she’d ever seen. The neurosurgeon went to tell the patient what they had found. This was probably an acoustic neuroma — a slow-growing tumor that is not cancerous. The tumor develops from the cells that protect and support the nerves controlling balance and hearing in the middle ear. For reasons that are not well understood, these cells start to grow out of control, but slowly. As the tumor gets larger, it disrupts the nerves and causes unilateral hearing loss, tinnitus (ringing in the ear) and difficulty with balance. It was also the tumor that had caused the nausea and vomiting that had torn up his esophagus. Woo explained that although it wasn’t cancerous, it had to be removed or it would continue to grow.

Because the tumor was so large and was close to so many important structures, it couldn’t be removed in a single operation. The first surgery, done three days later, lasted 12 hours. After the surgery, the first thing the patient noticed was that the metallic taste that had been his daily companion for months was gone. The nausea — also gone. But so was his hearing in that ear. And his balance was even worse. Along with most of the tumor, the surgeon had been forced to remove the nerves in charge of hearing and balance on the right side of his brain. The patient had to relearn how to understand where he was in the world using only half his previous equipment. The second surgery to remove the rest of the tumor took place six months later.

All this happened four years ago. Recovery was slow. And even now he still can’t bowl. His balance is better, but nowhere near as good as it was before the tumor. But his brain works in all the other ways he values. And these days he has a lot of other things to think about: He and his wife now have a daughter — just over a year old.

Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share, write her at [email protected].