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1 Boston, 1927 AT 9:30 in the morning on August 6, 1927, an orderly wheeled sixtyseven -year-old Leonard Wood into the neurosurgical operating room at Boston’s Peter Bent Brigham Hospital. The general’s brain tumor, operated twice in the previous twenty-two years, had recurred and rendered him paralyzed on the left side and nearly blind. Wood had been a physician , an Indian fighter, a Rough Rider, chief of staff of the army, governor of Cuba and the Philippines, and very nearly president of the United States. This day he was a patient with his life in another man’s hands. That man was Harvey Cushing, the legendary chairman of the Brigham’s surgery service. Wood’s tumor was large, bloody, and in a singularly dangerous part of the brain; the chief warned his team they were in for a “desperate procedure.”1 Cushing had been in the midst of a European tour, celebrating his extraordinary scientific and surgical achievements, when Dr. Alexander Lambert of New York urgently wired that the general had just returned from the Philippines in shocking condition and needed immediate surgery.2 Cushing was taken aback at Wood’s deterioration and awed by his courage. He found the general “bloated in body and face . . . crumpled up on a couch with face distorted, eyes almost closed, a grotesque, pitiful figure, yet talking as though there were nothing particular the matter with him at all.”3 Wood had to be led about, dressed, and all but fed by his Chinese nurse but still insisted that Cushing operate immediately so he could get back to eradicating leprosy in the Philippines. The next morning Cushing took Wood and his wife up to Boston and checked his old friend into the hospital. That night Wood ate a light dinner and shampooed before retiring. The next morning, the general was awakened early so Cushing’s barber could shave his head, already scored with deep horseshoe-shaped scars from the previous procedures. The general’s bare scalp was washed 1 again and wrapped in a towel before he was brought into the operating room and transferred to a white enamel table. Cushing’s team, composed of an anesthetist, surgical nurses, assistant surgeons, and an assortment of residents, congregated around the table like white-robed priests, heads covered and faces masked. Stiff pillows and hard sand bags would hold the general still in the hours ahead. His head was wrapped in antiseptic soaked cheese cloth held in place by a black rubber band that doubled as a tourniquet. A blood pressure cuff—Cushing’s innovation—was placed on Wood’s arm, and, at 8:00 a.m., his scalp was injected with novocaine and adrenaline . Wood’s first two operations had been done under ether, but Cushing decided late in his career that operating on awake patients forced the surgeon to be more delicate and was safer. While the local anesthetic was injected, the general talked and joked with the surgical team.4 Cushing cut through the cheesecloth along the old scar and peeled the skin off the skull with little trouble. Up to that point, the tourniquet and the adrenaline had done their job, but in the next few minutes things got difficult. He drilled a series of “keyholes,” sawed around the edges of the old opening, and loosened the bone from the fibrous dural membrane that separated the brain from the skull. The tumor originated from that membrane and there were innumerable tenacious, bloody attachments between the skull, the dura, the tumor, and the brain. As he pried off the bone, Cushing faced his first serious hemorrhage. Hundreds of arteries erupted in life-threatening jets. Mechanical suckers hissed and gurgled as Cushing’s assistants tried to clear the field so he could see to operate. Blood poured out of the head, soaked the sheets, and pooled on the floor. Cushing spent the next four hours in “constant combat” trying to control the hemorrhage while Wood calmly chatted with the operating team. For hours the general tried to lie perfectly still, apologizing when he became restless and moved about. Then Wood’s blood pressure dropped, came back, and dropped again. By 1:00 in the afternoon, Cushing was exhausted and wanted to abandon the procedure even though he had only opened the skull and had not yet started to remove the tumor. Wood, still awake and unwilling to have his wife sit through a second operation, insisted that...

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