Actually, It Is Brain Surgery

I am now scheduled to have surgery in one week.  Is it possible for such a thing to be a pleasant surprise?  I have been living for almost two years under the impression that I would never be a candidate for further surgery because of the diffuse nature of my cancer.  So I am truly glad that this is not the case but after purging even the possibility of more surgery from my consciousness for so long, I'm once again trying to adjust to a new reality. 
I apologize if this picture of my healing scalp after my first surgery is disturbing - Steph didn't take it to document the gore but rather for the simple reason that because it was in the back of my head, I couldn't see it for myself.  I just kept running my fingers over the Frankensteinesque staples jutting out of my head and I was wondering what was going on up there.  I have found that for me, it is better to confront everything about my situation honestly and directly.  
I have been rereading David Servan-Schreiber's book about dealing with the reccurrance of his brain cancer Not The Last Goodbye, and I was stunned to read (I guess I just forgot this detail) that he never looked at an MRI image of his cancer.  He writes,"I wasn't being superstitious, but I believe in the effect images can have on both the body and mind.  I'm convinced that we shouldn't look at things that frighten us too much; fear, as we all know, blurs our judgement."  I believe we are all unique in how we respond to these events.  What is absolutely necessary for one person might be completely wrong for some one else.  I feel more comfortable seeing these things rather than wondering about them.  Perhaps it's because I am a visual person or maybe it is because my imagination will conjure an image whether I see one or not.  Fundamentally, I don't think that fear can be avoided when facing something like this.  I have a dog-eared copy of Frank Herbert's wonderful novel Dune on the shelf.  The spine is sun-faded.  The cover came off at one point and I taped it back on.  I first read it when I was thirteen and marked a paragraph in yellow highlighter that resonated with me at the time and still does.  It is from the mind of the protagonist Paul,"I must not fear.  Fear is the mind-killer.  Fear is the little-death that brings total obliteration.  I will face my fear.  I will permit to pass over me and through me....Where the fear has gone there will be nothing.  Only I will remain."  I cannot possibly banish frightening images or negative thoughts from my mind.  They come and they go.  The best I can do is ride them out and remain my true self.
The surgeon said he plans to follow the scar from the original incision and perhaps go a bit further.  He will remove a section of skull several inches in diameter and enter the brain between the parietal and occipital lobes.  For everyone scoring at home, the parietal lobe is where sensory information is processed and integrated and the occipital lobe is the home of sight.  The plan is to "debulk" the largest mass which appeared to have grown on my last MRI.  Taking any amount of this tumor out should help lower the inter cranial pressure and potentially ease the seizures and headaches.  Having a larger sample of the tumor tissue might make me eligible for newer clinical trials many of which involve attempting to tailor a more precise treatment to the genetic make-up of the specific cancer growing in my brain.  There are no guarantees of this but right now, there is zero possibility that I could pursue any of these treatments since the amount of cells taken during my first surgery is simply too small.
Of course, there are risks associated with further surgery.  The goal of my surgery will be quite different from that of most brain cancer patients undergoing surgery.  Typically, a neurosurgeon would try to safely remove the maximum amount of visible tumor.  It has been shown that if most of the visible tumor (somewhere between 94 and 98 percent) is removed, this has the greatest effect of any treatment in improving a patient's chance at long term survival.  This won't be the goal for me - the malignant cells are too dispersed, too intermingled with healthy brain tissue in both hemispheres of my brain to even attempt something like that.
I asked the surgeon what he viewed the worst case scenario for potential deficits from the procedure.  Since the affected area is near the occipital lobe, there is a danger that my eyesight could be damaged.  Specifically, he mentioned more limited peripheral vision in my right eye.  He assured me he didn't think that was likely but that's what the risk is.  The whole procedure is scheduled to take four hours and my recovery is expected to be similar to my first surgery.
Steph and I have been mulling this over for a few days now.  I feel certain that this is my best option and worth pursuing but that doesn't mean that it is a simple and stress-free decision.  The unfortunate fact is, all the potential treatments carry risks and involve tradeoffs.  I see surgery as having the greatest potential upside.  I feel confident in the neurosurgeon and it helps that he preformed my earlier surgery.  Still, I appreciate that this will be a very different procedure - longer, riskier, and more complex than what I had before.
I deeply appreciate all of your prayers, positive thoughts, and messages.  I'm in for another long week but I'm feeling hopeful and positive in spite of it all.