Truly A Miracle
Neurosurgeon Uses Faith And Science To Combat Brain Tumor
The Sunday Beacon News
June 30, 2002
Story by Staff Writer Mike Norbut

truly a miracleIt sounded like an easy diagnosis to Lazo's primary care physician. He told her loved ones she had an advanced stage of Alzheimer's disease, but they weren't convinced. They pushed for a CT scan, and the results brought Dr. Ramsis Ghaly into their lives.

Today, however, his presence could cease as quickly as it developed.

It is 6:30 a.m. on Tuesday, May 14, and Ghaly, the medical director at the Center for Neuroscience at Rush-Copley Medical Center in Aurora, arrives in Lazo's room, exactly on time as he promised. In a few hours, he will cut open her skull and wage a war of minute proportions with colossal consequences. With millimeters dividing working brain tissue from a devastating tumor that has caused her headaches, her loss of balance, and her speech problems, Ghaly has to be precise. Lazo's life depends on it.

He's mindful of the possible outcomes. This is the same type of tumor that attacked former broadcaster and newspaper columnist Tim Weigel, who died last year. As soon as he saw the CT scan images, he knew the outlook was grim, and he didn't hide it from her family. If the orange-sized tumor didn't come out, she had one week to live. In similar cases, people who have the majority of the tumor removed can live about three months. And that's not even counting the possible complications, like loss of understanding and struggles with speech.

Brain cases often are initially misdiagnosed as ailments like dementia, sinusitis, migraine headaches, or stress. But the brain is a mysterious organ. You have to discover what's wrong with it, because it won't tell you. Not many neurosurgeons would operate, but Ghaly wanted to give it a try. Who am I to make a life-ending decision for someone, he asked.

truly a miracle Ghaly knows it is such a treacherous tumor that the night before, he visited an Orthodox Christian monk who shares his religion and Egyptian homeland. He asked the monk, who was staying with a family in the suburban area, to pray over Lazo's X-rays.

His faith is central to his practice. Ghaly is well-trained — he is board certified in neurosurgery, anesthesiology, and pain management — but he says his delicate touch comes from God. One wall of his office, located on the lower floor of the Rush-Copley Healthplex, is covered with his certificates, plaques and framed degrees — with a painting of Jesus Christ hanging in the center. The wall provides patients a glimpse into his soul, and it shows them their surgery will be a team effort.

"Miracles can happen to everyone," Ghaly says. "You do your part, and God does the rest."

At 7:30 a.m., Lazo is wheeled to the operating room. While she won't remember anything beyond having her head shaved — a task Ghaly performs himself — it begins the longest day of her family members' lives.

As they see her off, Lazo's family members hope this neurosurgeon can engineer the same type of miraculous outcome on which his stellar reputation is built. More realistically, however, they are just hoping Lazo survives, if only for a few extra months.

But Ghaly does not plan to lose a patient today.

• • •

It is 9:48 a.m. and a tiny amplifier projects the sound of Lazo's beating heart. She is lying with the bald left side of her head pointing toward the ceiling. Blue ink marks the circle that will be cut out of her skull. Metal pins hold the front and back of her head in place like a vice.

Lazo, already under anesthesia, is covered from the neck down in foam padding to protect and insulate her, as well as to keep her steady. The slightest flinch could have catastrophic consequences. Ghaly completes his silent meditation while he methodically washes his hands and forearms. He shakes the water off and steps back into the operating room, his hands, dripping, held out in front of him.

"Being in the brain of a patient: There can't be anything more sacred than this," Ghaly says. "This is a 62-year-old woman who did the best she could, and now I'm going to be in her brain."

This is the type of case Ghaly will later use as a model for what community hospitals can accomplish. He disagrees with the approach of hospitals to specialize in only a few specific areas, sending more serious cases to teaching hospitals in Chicago. Do everything, and do it all well, he says. Neurosurgery is his contribution.

The scalpel slides through Lazo's scalp for the first time at 10:15 a.m. He clamps the skin, suctions the blood and cauterizes as he cuts, trying to limit bleeding. Ghaly sews three rubber bands into the underside of the scalp, stretches them, and clamps them to one of the sheets hanging over the patient to keep the skin out of his way. Ghaly then uses a flat-edged tool to scrape muscle and excess blood from the skull.

A disturbing sound, similar to dragging a screwdriver on cement, pervades the room.

At 10:38 a.m., a drill starts to dig through Lazo's skull. Ghaly squirts water over the bone to douse the rising smoke and ground the tiny bits of skull that are spitting out from the hole. He makes five holes the size of a nickel in the skull, then takes a saw blade to cut between them. His finished product is a circle.

The surgeon knows from his X-rays the tumor lies directly underneath the bone, and he knows the kind of pressure it places on Lazo's brain. If it has any open space, it is going to take it. Ghaly pries the piece of bone from the rest of the skull, and spreads water mixed with antibiotics over the open area.

The first ultrasound, which is performed over the dura mater — the thin, skin-like layer that insulates and protects the brain from the skull — shows the tumor pressing against the surface. The high pressure in her brain makes this a delicate procedure.

He puts the ultrasound away. He knows the tumor will bulge through the opening once he cuts the meninges away. Ghaly is prepared, though. When he cuts the dura mater away, he tries to leave the portion that is harnessing the tumor until last. "Very ugly, very wild," he says.

It's 11:15 a.m. The brain and its invader are exposed.

Ghaly is a model of humility as he surveys the brain. He has dedicated his life to studying this organ, and he attends seminars on a regular basis to hone his skills, because he knows how much he has to learn.

While the peripheral parts of the brain are a light flesh color, there's a piece the width of an orange that looks discolored, like it has been bruised. That's the enemy — both hers and his. Its color comes from the many irregular blood vessels that are feeding it.

Ghaly takes a small piece of the tumor and puts it into a specimen jar to send to pathology. The results, which will be back in less than an hour, say the tumor is cancerous, but it is a primary, not secondary cancer. It did not start anywhere else in the body, so if Ghaly can vanquish this foe, Lazo may have a better chance at longevity.

Wearing a magnifier headset over his glasses, Ghaly looks similar to a jeweler carefully eyeing a gem. The magnifying lenses greatly enlarge what he sees, but also restrict his view to the width of two fingers.

He becomes quiet and intense as he peers over the tumor. Standing only about 5-foot-8, he uses a step stool to gain the proper view of his foe. He is always particular and demanding of his staff — he is quick to both correct and congratulate them — but at this moment, it is his battle.

Using suction and irrigation tools, as well as forceps, Ghaly gently works under the edges of the tumor. He drops cotton balls soaked in water and antibiotics into Lazo's skull to absorb the blood. Always cutting, cauterizing, rinsing, and suctioning, Ghaly already is deep inside Lazo's brain. He is slow and methodical, careful to avoid pieces of the brain and major vessels coursing through the tissue.

At 11:53 a.m., the bulk of the tumor is out, but he knows there's more to capture. Tumors do not grow in perfect shapes. This one has tentacles.

He still has about one-third of the tumor left to remove, but he already is deeper than many neurosurgeons dare to go. He trades in his magnifying glasses for a high-powered microscope to see exactly what to remove.

"Sometimes you have to proceed in the face of adversity," says Dr. William Gibbons, medical director of pathology who has just arrived to hand-deliver the news about the tumor's biopsy to Ghaly. "We all stand respectful here."

It is 1:55 p.m. — one of the brief moments during which Ghaly is not hunched over Lazo's open skull. Nurses, technicians, and manufacturer representatives, who help the doctor with the technology in the operating room, sit rubbing their arms or hunched under jackets. The guess among them is it's about 55 degrees. "The brain doesn't like hot temperatures," Ghaly explains.

He uses water to fill up a cavern the size of a fist inside Lazo's brain, the empty space the tumor once occupied. It's time for a second ultrasound reading, to see what remains after two hours of hunting. Ghaly likes what he sees. The disturbances the first reading showed are all but gone. But Ghaly knows his expedition isn't complete.

He now turns to the StealthStation Treon system, a global positioning device that allows the surgeon to see three-dimensional images of the brain. It works in many ways like a navigational system on a car, and it brings CT scan images to life.

Instead of knowing simply how long and wide the tumor is, Ghaly can also see how deep it extends into the brain. In this case, that information is critical.

Like a surveyor, Ghaly places the pointed end of a foot-long instrument at different spots in Lazo's brain. It transmits infrared signals to a type of satellite above the patient, which is connected to the Stealth machine. Every time he moves the instrument, he gets a different reading on the screen of where he is in relation to the CT scan images that were taken before the surgery began.

The machine shows Ghaly is deep in the brain, but the tumor has still extended some of its tentacles deeper. The meticulous process of tearing tumor cells, cauterizing, rinsing, and suctioning begins again.

"Our Father, Who art in heaven," Ghaly says.

Ghaly has been praying silently throughout the procedure, but his calls to God are vocalized at this point. If his instruments stray a few millimeters from their intended target, he could permanently damage his patient.

At 2:05 p.m., the anesthesiologist rubs his eyes, knowing he has hours to go.

Nurses have come and gone. Technicians have taken lunch breaks. But Ghaly doesn't even pause for a drink of water. Food is the furthest thing from his mind. Fasting during surgery is one of his methods of prayer, and he knows he needs every method in this case.

The meticulous process continues. Ghaly carefully uses a special set of forceps, which emits an electrical charge to help cauterize the broken blood vessels, to pluck away the tumor. He employs the suction tool to slurp up the pieces. Gradually, the water stays clear before it is suctioned. Cotton pads once took only seconds to become stained red with blood. Now, they're being removed as white as they were when they were placed in the crannies of her brain.

Ghaly has to make sure there is absolutely no bleeding before he can leave Lazo's brain. "We call it the unforgivable area," he says. "If anything hemorrhages here, the pressure is going to build."

It's 2:34 p.m. Ghaly decides his hunt is over, though he now has two hours of closing ahead of him. It starts with sewing the meninges back together, a tedious process of needlework and knot-tying.

Once the dura mater is sewn, he must attach it to the skull to make sure it doesn't collapse into the cavity left by the tumor. The brain will eventually shift back into that space.

Ghaly places the softball-size piece of bone over its hole, being careful to fit it correctly. Nasser Tavakoly, his surgical assistant, holds the piece down while Ghaly runs thread through tiny holes he drilled in the skull and ties tight knots over them. It's like they're a father-and-son team, wrapping a present together.

At 3:24 p.m., the skull is reattached. Ghaly will spend another half-hour attaching muscles, sewing skin and stapling the sutures together. He completes his work by carefully washing Lazo's hair.

It's 4:05 p.m. Ghaly takes more than three steps away from his patient for the first time in six hours. He goes to the phone, where he will spend 20 minutes dictating what he did during the procedure and how he thinks it went. He always does this immediately after the surgery, so his opinions and descriptions are not affected by the patient's outcome.

At this point, he still has no idea if Lazo will be the person everyone is praying she will be. He is just praying, too.

• • •

truly a miracle The words float through the fog into Lazo's brain. Still in the haze of the anesthesia she has been under for more than eight hours, she looks as if it would take her days, if not weeks, to respond to Ghaly's command.

But in the depths of her brain — the same brain Ghaly had just sifted through as he hunted the tumor that plagued her — the words make sense. Within seconds, the toes on both of her feet wiggle with energy.

Ghaly speaks another command in Spanish, Lazo's only language. This time, she responds by moving her right arm. One more command, and her tongue splits her closed lips. Ghaly smiles with satisfaction. As he exorcised the demons from Lazo's brain, he feared the damage the "nasty" tumor may have already created. Ghaly has been unsure how well Lazo will resemble the woman his family knew and loved.

There are hardships ahead for Lazo, but Ghaly knows these few actions are good signs.

"I cannot ask for more," Ghaly says, as he marches off to tell Lazo's family members about the war he waged in her skull.

It is 4:45 p.m. In less than four days from this moment, Lazo will go home with an excellent prognosis for recovery and an open-ended prediction for how much time she has left to live. Radiation and chemotherapy should take care of the few specks of tumor Ghaly's magical hands didn't capture.

"It's truly a miracle," says Lazo's son, an Aurora police officer.

"I was extremely radical," Ghaly tells the family. "I think if I had this, I would want somebody to do what I did to her." Regardless of how long he has known his patients or their families, the bond Ghaly forges with them is everlasting the instant he humbly accepts their cases.

"This is just the beginning," he says. "You marry them forever."

• • •

Eloisa Lazo stands in an exam room in Dr. Ramsis Ghaly's office, following his commands to touch her nose, twist her arms, and count to 20. She has no trouble completing those tasks, and prefers to focus on something a little more interesting to her.

"I can't believe (Ghaly's) not married," she says in Spanish to her son. "We have to get him married."

It is June 27, nearly six weeks to the day from when Ghaly removed Lazo's brain tumor. Her personality, not evident during the surgery and the first few weeks of recovery, has re-emerged.

She is a funny, vivacious woman with a sharp wit and a glowing smile. She speaks quickly and without hesitation, cracking jokes and speaking plainly, as if she has never been through a life-altering experience.

Ghaly puts his arm around his patient and shows her the X-rays, both before and after her surgery. There is still a spot in the left side of her brain, but Ghaly explains that is scar tissue and the empty space where the tumor once resided. The other commotion in her early X-rays is gone.

Lazo has about two weeks left of radiation treatment, and then she will begin chemotherapy. Ghaly is so impressed with her X-rays and how she's feeling that he says she doesn't have to come back for another appointment for three months.

truly a miracle
Lazo smiles and hugs her doctor. "She says when she can have you over, she'll cook for you," her son tells him.

Ghaly thanks mother and son, and walks down the hall to visit his next patient. This young man suffered a skull fracture in a motorcycle accident, one in which he was not wearing a helmet.

But today, this patient is all smiles, just like Lazo. Ghaly saved his life, too.

Contact Mike Norbut at (630) 844-5829 or