Intensive care nurse Jessica Johnson rubs Ali Nowotny's arm and says: "We've got to do our wiggles now, Ali. Wiggle your fingers. Wiggle your toes."
Eyes closed, Ali slowly does as she's told.
"Can you squeeze my fingers?" Johnson asks.
(Editor's note: This is the fourth in a series of stories about Rapid City teenager Ali Nowotny, who is being treated at Mayo Clinic in Rochester, Minn., for epileptic seizures caused by a brain tumor. On Friday, doctors at Mayo Clinic's St. Marys Hospital removed Ali's tumor in a nearly day-long procedure. The Rapid City Journal was with Ali and her family throughout the day.)
Ali grasps Johnson's fingers with both hands.
"I know you're stronger than that; you're a dancer," Johnson says. Ali's hands constrict tighter.
Johnson moves closer to Ali's head, which is wrapped in white gauze. Despite undergoing a nearly six-hour brain surgery, Ali's face is pink and healthy looking.
"Do you know where you're at, Ali?"
After a long pause, Ali says, "Saint Marys."
"What month is it, Ali?"
"Ali, do you know what month it is?" Johnson asks again.
After another long pause, her eyes still closed, Ali says quietly, "December."
"Who is the president, Ali?" Johnson continues.
"Hey, Sleeping Beauty. Can you tell me who your president is?"
Again, no response.
Johnson looks up, undaunted.
The anesthesia from surgery makes Ali sluggish and tired, but Johnson is happy with what she sees. "You're moving really well," she tells Ali.
For the first two hours after surgery, Johnson puts Ali through physical, verbal and mental challenges every 15 minutes. After two hours, she does the exam every 30 minutes. Another nurse will take over at 7 p.m. and continue the routine every hour throughout the night. The exams tell the nurses whether Ali's brain is swelling, causing potential damage, Johnson said.
By 5:30 p.m. Friday, things seemed to be going well. Johnson assures everyone that when visitors stop Saturday morning, Ali will be sitting up eating breakfast. She's already on the road to recovery.
The first thing Ali wants to show people on the Friday morning before her brain surgery is the image on her cell phone.
Standing in the St. Marys Hospital lobby, she holds up the phone with a big smile. Her brother Dusty's image stares out from the screen. His mop of hair is gone, replaced by a shaved head not unlike his sister's. Another photo shows the back of his head. Like his sister, Dusty has shaved "Ali Tough" into his hair, only he spelled his "Ali Tuff."
Ali looks at the picture and grins. Just the day before, she admitted it was hard having her older brother away at college. "I miss him so much," she said.
Just then, a Mayo employee in a blue jacket arrives, calling out Ali's name. Or trying to, at least. The name Nowotny has left more than a few at Mayo fumbling for pronunciation. This guy is no different. Ali smiles, puts her phone away and follows him down the hall.
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Ali's entourage has grown as her days at Mayo continue. At 6 a.m. Friday, her followers include her dad, friend Carol Cooper, her grandma and two aunts. Within 30 minutes, two more aunts arrive. An impressive line of people follow Ali and her dad, Craig Nowotny. Most are wearing T-shirts that read, "Ali Tough: Your Family Has Your Back."
Once in an exam room, nurses run Ali through the usual series of questions: allergies, medications, sicknesses. Ali sits, ankles crossed, answering with a simple "Nope" or "Yes." In her hand, she holds a scapular, a cloth necklace worn by Catholics to indicate their commitment to their faith.
She has carried or worn the scapular since she arrived at Mayo. Her thumb and forefinger gently rub its cloth squares. The nurse assures Ali she can take it with her into surgery.
After the pre-operative exam is complete, a nurse walks Ali to the next room. It's time, she tells her, to leave for surgery. Only her father can follow from here, but only for another 30 minutes.
Ali begins her good-byes, starting with her grandma, Norma Nowotny of White Lake. Both begin to cry.
One by one, Ali hugs each person. "Love you Rosie. You're going to do great," says Ali's aunt, Bonnie Haines of Keystone, using Ali's middle name.
Ali and Cooper spend a long time in an embrace. Ali calls Cooper, her eighth-grade literature teacher, the "mother figure" in her life. The night before surgery, Ali and Cooper watched a movie together, although Cooper admits they talked through most of it.
Ali finishes with her hugs, tears streaming down her face. "Just pray for me," she says, before turning to follow the nurse.
For the next 10 or so hours, the family is relegated to the waiting room, relying on updates from nurses.
At first, talk focuses on the snow. Overnight, Rochester got several inches of snow, and more is arriving with every second. The hope is that Dusty will still be able to come after his last college exam, scheduled at 2 p.m. at the University of South Dakota in Vermillion.
Then, talk turns to Ali and her mom, Bette, who died of a rare cancer when Ali was 4. "She reminds me so much of her mom," Deb Olson, Bette's sister, says.
Another aunt says, "She acts like her mom a lot, … her mannerisms."
At 8:50 a.m., the family gets word that Ali has finally been moved into surgery.
Three hours later, a nurse calls to tell the family that Dr. Nicholas Wetjen has begun to remove the tumor.
Wetjen explained on Thursday that he would remove the tumor by cutting a C-shaped incision along Ali's hairline on the left side of her forehead. After removing part of her skull, he would work to reach the tumor. In order to do that, he would permanently remove a small part of her brain and push aside other brain tissue. He assured Ali that removing the tissue will cause no problems.
Wetjen told Ali that in addition to removing the tumor, he would also take out some of the hippocampus. The outcome of surgeries to end epileptic seizures tend to be better if the hippocampus portion is also removed. But it also means Ali will have some difficulty retaining new memories. How much difficulty is unknown. "It's very hard to predict. It's very variable," he said.
After the 11:50 a.m. phone call, the strain of the day begins to show in Craig Nowotny. He wanders in and out of the waiting room, stopping for long periods in the hallway. At several points, he rests against the wall, fingers squeezing the bridge between his eyes.
Earlier, Craig Nowotny admits that when Ali and he were in the pre-operative department together, she was doing better than he was. She assured her dad that everything would be OK.
The rest of the people in the waiting room handle the stress their own ways. Many have laptop computers, updating Web sites dedicated to Ali's surgery. Cooper fields a constant stream of cell phone text messages from family and friends. When she isn't returning messages, she wears a small ring rosary, slowly twirling the beads as she quietly prays.
About 3:30 p.m., nearly 9-1/2 hours after Ali and her family arrived at St. Marys Hospital, word comes that Ali is in recovery. For the first time in at least two years, she is tumor free.
Wetjen visits with the family, assuring them that the surgery went as expected. He removed the tumor and part of the hippocampus, which had been damaged by the tumor. It is too early to know how the surgery will affect Ali.
Craig Nowotny and his mother are the first to see Ali. Eventually, everyone files through the room. Ali opens her eyes for some, but not everybody. Ali's aunts laugh when she raises her arms high above her head, in a cheerleading arm raise, at a nurse's request.
Her father steps back into the room later, after everyone has had a turn. He does his best to wake his daughter, gently rubbing her forearm. Ali sleeps on, but he doesn't seem to mind. He stays for a long time, watching her sleep, before returning to the waiting room and his family.
With the worst over, it's time to think about tomorrow.
Contact Lynn Taylor Rick at 394-8414 or email@example.com
Date: December 16th, 2008
Follow Ali Nowotny's journey as she travels to Minnesota to undergo brain surgery to remove a brain tumor.