Neurosurgeon Nicholas Wetjen leans forward, elbows on his knees, and gently gives Ali Nowotny news no one wants to hear.
No matter how successful he is at removing her brain tumor Friday morning, Ali will lose some of her ability to retain new memories. There's a 10 percent to 15 percent chance her "memory deficit" could be profound.
"It's a lot," he says. "It's a lot to think about."
(Editor's note: This is the third in a series of stories on Rapid City teenager Ali Nowotny, who is being treated at Mayo Clinic in Rochester, Minn., for epileptic seizures caused by a brain tumor. On Thursday, Ali saw her pediatric neurologist and neurosurgeon for final appointments before surgery Friday. The Rapid City Journal is at Mayo with Ali, documenting her journey.)
Wetjen, a handsome young doctor with dark hair and glasses, explains that the Wada test Ali underwent Wednesday shows her brain's left hemisphere is doing most of her memory and language work. The tumor causing her epileptic seizures is also in her left hemisphere. There's no way to avoid damaging the tissue to some extent while removing the tumor.
While Wetjen talks, Ali and her father, Craig Nowotny, sit side by side in chairs. Family friend Carol Cooper sits by the door.
Ali's eyes redden, and a tear clings to a bottom lash as Wetjen describes the potential outcome. Craig sits forward on his seat, his face flushed. The memory loss has been touched on by other doctors throughout their stay at Mayo, but Wetjen's matter-of-fact pronouncement really drives it home.
Date: December 16th, 2008
Follow Ali Nowotny's journey as she travels to Minnesota to undergo brain surgery to remove a brain tumor.
Ali started her day in a more cheerful mood, being wheeled around the Mayo campus, following doctor's orders to stay off her feet after her Wada procedure Wednesday. She met with Dr. Elaine Wirrell, her pediatric neurologist, in the morning.
Wirrell's office is in the T. Denny Sanford Pediatric Center in the Mayo Building, a department designed with kids in mind. Children's drawings of skunks and raccoons have been transferred to tiles on the walls, and large animal footprints lead to the various exam rooms.
While waiting in Wirrell's office, Craig Nowotny, Ali and Cooper chat about homework and home. Craig Nowotny mentions that Ali's brother Dustin might not be able to make the trip to Rochester because of the weather. Dustin attends the University of South Dakota in Vermillion.
Ali mishears her dad, her eyes registering confusion and a little panic. He repeats himself, and Ali laughs. "I thought you meant we might not be able to do the surgery Friday because of snow. I'm doing the surgery. I'll walk there if I have to," she says.
Wirrell arrives shortly after and immediately notices Ali's mohawk. She also asks about the St. Thomas More cheer and dance team. Ali postponed her surgery until now to compete with her team in the state competition. The team took home a championship and several firsts. "So it was worth the wait," Wirrell says.
After a quick physical exam of Ali, Wirrell sits down to talk.
You have free articles remaining.
Removing the tumor will give Ali a 70 percent to 80 percent chance of becoming seizure-free. That's the long-term goal, Wirrell says. After the seizures stop, Wirrell will slowly wean Ali from her seizure medication.
Like Wetjen, Wirrell gently reminds Ali about the memory-loss potential. "You may notice a little more difficulty with verbal memory," she says.
Part of the reason Wirrell and Wetjen can be almost certain some memory loss will occur is because of the necessary operating process.
Wetjen will remove the tumor and some of the hippocampus, a portion of the brain affecting memory. It's the best bet for stopping the seizures permanently, he says.
If Wetjen only removes the tumor, he can't guarantee that the seizures will stop or that Ali won't suffer memory loss, anyway. Under that option, she might also need the surgery again some day.
"You can guide me how aggressive you want me to be," Wetjen says. "But it's a lot harder to go through that surgery again … psychologically. That's what we weigh and balance. It's a hard decision to make."
He also reminds Ali and Craig Nowotny that her seizures are likely causing damage to her memory already.
Ali nods. Earlier, she admitted to Wirrell that her academic life had suffered in the past two years. "I haven't been doing as well as my freshman and sophomore year," she said. "I think it's because I've been so stressed."
Wetjen tells Ali that things will be challenging after the surgery. She will have to work harder to remember things, work harder in school. But Wetjen said rehabilitation can begin immediately, and hopefully, the surgery will mean a seizure-free life for her.
"The trade-off isn't good. The whole situation sucks," Wetjen says.
For long minutes, Ali and her father are quiet. Then Craig Nowotny looks at his daughter. "What do you think?" he says. Then he looks at Wetjen. "We came here with the idea to get rid of the seizures permanently."
Ali nods, her decision obviously made.
"If I have to work harder at learning stuff, I'll work harder," she said, looking at Wetjen. "Do what you gotta do."
Contact Lynn Taylor Rick at 394-8414 or firstname.lastname@example.org