The Hardest Part

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Paralysis or the Piano, a Musical Prodigy Faces a Hard Decision
By Noah Evslin, Medical Researcher

Episode 418 ,"The Hardest Part" deals with a teenaged piano prodigy whose way of life is suddenly being threatened by a brain tumor.

PATRICK HOFFMAN, a fourteen-year-old piano prodigy comes into the practice with his legal guardian grandfather DENNIS. Patrick seeks treatment because of a recent bout of numbness in his hand, which is affecting his piano playing. He also has reoccurring headaches, two sure signs of a brain tumor. A worried Cooper orders a full neurological work-up including an MRI.

As the MRI machine scans Patrick, Cooper fills Amelia in about Patrick's musical background and upbringing. Amelia learns that Patrick is not only a prodigy; he's also an orphan, as both his parents died in car crash when he was five. Since then, his grandfather Dennis, a renowned conductor, has raised him.

Amelia half-listens, as she continues watching the screen. She mumbles a curse as she sees something bad. It's a pilocytic astrocytoma, a brain tumor that is growing in the part of the brain that controls hand function. If it isn't surgically removed, the tumor will first take away Patrick's ability to play the piano, then Patrick's life.

A stunned Dennis and a worried Patrick want to know their options. Amelia says chemotherapy doesn't work on this kind of tumor, and radiation will delay symptoms, but not cure them. Amelia suggests surgery, which she thinks can rid Patrick of the tumor. Unfortunately, because of the location of the pilocytic astrocytoma, the surgery will have the side effect of destroying motor control in Patrick's right hand.

For a concert pianist, this is the epitome of being stuck in-between a rock and a hard place. The choices are he can either play the piano for a short while before succumbing to the tumor, or remove the tumor at the expense of his piano playing.

Dennis and Patrick ask if there are any other options and Amelia says she can perform an awake craniotomy—a procedure that, true to its name, is done without putting the patient to sleep. Amelia likes this particular procedure because she'll be able to monitor Patrick's hand function in order to try and avoid damaging motor function as she carefully removes the tumor. The problem, however, is that this procedure is more risky than the other surgical procedure Amelia suggested, and there's also a chance it will cause paralysis in Patrick's right leg.

Despite the risks, the awake craniotomy option is more appealing to Patrick who would rather lose his ability to walk than his ability to play the piano. This doesn't sit well with Cooper. He wants Patrick to do the safer procedure. He also thinks at fourteen, Patrick doesn't understand the implications of this decision. Amelia disagrees. Who are they to even suggest doing a procedure that would take away his gift?

Cooper and Amelia aren't the only ones arguing over this. Dennis also wants his grandson to do the safer procedure. Despite Patrick wanting the craniotomy, they can't move forward without the grandfather's consent, as he has both legal and medical power of attorney over Patrick. When Dennis refuses to give his consent, Patrick announces he'd rather die than live without the piano.

Ultimately, after some convincing, Dennis allows Patrick to have the awake craniotomy, and there's a powerful moment where Patrick plays the piano as Amelia operates on his brain. To add to this moment, Patrick's grandfather enters and tells Patrick he loves him, something that Patrick has been longing to hear. In the middle of this sweet moment there's a crisis, however, and Patrick loses all feeling in his hand as Amelia struggles to stop and out-of-control bleed in his brain.

Ultimately, Amelia controls the brain hemorrhage and Patrick survives the procedure, but it's left unclear if he'll ever walk again.

Did Amelia make the right decision in encouraging Patrick to undergo this dangerous procedure that might cost him the use of one leg and could have cost him his life?

What would YOU do?