Blanche Cascio's brain tumor was slightly smaller than a Ping-Pong ball. It grew undetected for perhaps 20 years, just behind Blanche's cerebellum, partially wrapped around her brain stem. Parts of it were soft and pulpy, other parts were leathery like beef jerky. A gossamer- thin cranial nerve, controlling facial movement, stretched around the outside of the tumor. The nerve was embedded in the whitish, vascular tumor like barbed wire in the bark of a tree.
The tumor somehow choked off an auditory nerve about 10 years ago, making Blanche deaf in the left ear. It also caused her intermittent facial pain. Until last fall, the 60-year-old Vienna, Va., housewife, mother of three and part-time teller at a credit union had no idea what caused the hearing loss or the facial pain.
In October, when Blanche and her husband Morris, a retired CIA employe, went out to Los Angeles to celebrate their wedding anniversary, the tumor announced itself with a vengeance. Knife-like stabs of facial pain crippled Blanche. The growing tumor was chafing against a facial nerve. Blanche could not walk, sleep or touch her face. On the day of their 40th anniversary, Morris drove his wife to the UCLA Medical Center.
Doctors there ordered a CAT-scan, a computer-enhanced X-ray picture of Blanche's brain. The tumor was spotted; immediate surgery was advised. Disbelieving and frightened, the Cascios asked for the name of someone back in Washington who could remove the growth in Blanche's head. They were referred to a young doctor at Georgetown University Hospital named Teodoro Forcht Dagi, who, they were told, was first-rate.
Teo Dagi belongs to an exclusive club whose members consummate man's timeless fascination with the brain. As one of 3,000 neurosurgeons in the United States, Dagi actually touches--with surgically gloved hands--the living stuff that somehow makes us human. There are 60 neurosurgeons in the Washington area and Dagi, at 33, is the youngest.
The members of Dagi's club, admission to which requires more years of surgical training than any medical specialty, operate on the least understood, most unforgiving organ in the human body. Brain cells, unlike muscle or kidney cells, do not regenerate. Surgical errors on the brain often can never be corrected. A mistake--a scalpel misplaced by a fraction of a millimeter--can disfigure, paralyze or kill. Unlike any other kind of surgery, brain surgery can horribly alter the way a patient thinks.
These risks, combined with the mysterious functions of the brain, give brain surgeons a status both ethereal and intimidating. If heart surgeons, with their fancy transplants, bypasses and million-dollar incomes, are the glamour boys of medicine, brain surgeons may well be the high priests.
Recent advances in diagnostic and surgical techniques-- particularly the CAT-scan, which precisely locates growths like Blanche Cascio's tumor, and widespread use of surgical microscopes--have sharply decreased the percentage of patients who die on the operating table and make brain surgery far less depressing work. The old hospital joke--"This patient has lived long enough, turn him over to the neurosurgeons"--is told far less often. The operative death rate, for example, with brain aneurysms (bubble-like deformations in blood vessels) was nearly 30 percent in the early 1960s; now it's between two and five percent.
Young neurosurgeons like Dagi, who've never known surgery without the aid of the CAT-scan and the surgical microscope, are trained to routinely save cranial nerves and brain tissue that the best brain surgeons of past generations could salvage only when they got lucky.
In the rarified world of neurosurgery, Teo Dagi is 15 or so years from his professional peak and even further from a national reputation. But right now, according to Dr. Hugo V. Rizzoli, head of neurosurgery at George Washington University and the biggest name in Washington brain surgery, Dagi is "just the kind of young guy we like to have."
Dagi has had perhaps the best neurosurgical training available in the world. He earned his MD at Johns Hopkins University at the age of 22 (he received a BA in Renaissance studies from Columbia at 18; graduated from the Bronx High School of Science at 15). Dagi took eight and a half years to complete the normal six-year neurosurgical training at the renowned Massachusetts General Hospital in Boston. It took him longer than normal because he squeezed in three years of laboratory brain research. He spent one year as chief resident at the Maudsley neurosurgical unit in London, one of England's best neurosurgical centers, where he qualified to submit a doctoral thesis in neurophysiology, which he is now writing. Dagi has just completed his first year at Georgetown as an attending neurosurgeon and assistant professor of neurosurgery.
Besides his interest in the brain, Dagi has an astounding array of what he calls "hobbies." He speaks 10 languages, studied classical piano at the Juilliard School of Music, is an accomplished photographer and an expert in the restoration and illumination of ancient Hebrew documents. He has master's degrees in public health from Johns Hopkins and in medical ethics from Harvard. He is an adjunct professor at Georgetown Law Center where he teaches Talmudic law. He is a senior research fellow at Georgetown's Kennedy Institute for Bioethics. An inveterate fiddler with gadgets and hardware, Dagi during his residency rebuilt the engine and restored a 1952 Jaguar XK 120. When a surgical microscope breaks down in the operating room, he fixes it. Not surprisingly, he sleeps five hours a night.
Despite more than 10 years of medical training and hundreds of brain operations, Dagi is still a neophyte. None of his patients have died, that is, in front of him on the operating table. (Many have died later of head wounds and untreatable brain disease. Half of all brain tumors, for instance, are cancerous and incurable.) Dagi says he has not yet made the kind of lethal or crippling surgical goof that brain surgeons cannot help but make over the course of a 30-year career. He claims to be lucky.
Georgetown Hospital pays him a $70,000-a-year straight salary for his services, which include teaching, making hospital rounds, seeing patients and operating about three times a week. In private practice, Dagi could probably make $100,000 a year or more, but he would not get as many surgical referrals, and surgery is what he lives for.
"I like to operate. There is nothing else I'd rather do. If somebody wouldn't pay me to do neurosurgery, I'd find something to support myself, and I'd still be a neurosurgeon. When I finish an operation (his longest, so far, has been 28 straight hours) I am so wide awake I want to do another one. The greatest thrill I can have is to do an operation and do it well and to know--for one moment in time--that everything I wanted to accomplish, I accomplished."
To become good and stay good, a brain surgeon needs practice. When a neurosurgeon friend from UCLA called Dagi in October and told him about Blanche Cascio's tumor, Dagi quickly found time to operate.
For a small woman with a relatively small skull, Blanche Cascio had a huge tumor. After looking at a CAT-scan picture of it, Dagi decided it would take two operations to take it out. He hoped that after the first operation, in which he planned to gut the inside of the tumor capsule, the rhythmic pulsations of the brain would push the remaining pieces of tumor out away from the delicate brain stem. Irritating the brain stem can cause uncontrollably high blood pressure and hazardous slowing of the heart beat.
So Blanche--her head shaved, her body held in a sitting position on a folding operating table, her breathing controlled by a device called a ventilator, her life in the hands of Dagi and four other strangers in blue-green scrub suits-- went into surgery twice for a total of 26 hours.
The tumor was located about four inches from the top of Blanche's head, about two inches from the skin on the back of her head. To get to it, Dagi drilled several holes in the back of Blanche's head, just to the left of the skull's midline, at about the level of the ears. He drilled the holes with a craniotome, an air-powered drill that looks like a ray-gun, sounds like a squealing hog and is designed to stop drilling when it has cut through bone and senses the soft tissue covering the brain. With a plier-like instrument, which he used in a strenuous sort of connect-the-dots exercise, Dagi cut between the holes to form an opening about the size of a silver dollar.
Throughout the operation, blending with the muted beeping of a pulse monitor, baroque and chamber music played softly from a small tape recorder on a table near Blanche's feet. Nurses and a resident in the operating room periodically changed the tapes, picking from a selection that Dagi brought in. A devoted student of opera and choral music, with a special interest in Mozart and Beethoven, Dagi listens to no music during surgery (or outside surgery, if he can possibly help it) composed after 1900.
Once inside Blanche's skull, he cut through a tough membrane surrounding the brain and tried to move aside Blanche's cerebellum, twin tangerine-sized structures at the bottom rear of the brain that, among other things, process information from the arms and legs and coordinate fine movement. Blanche's tumor was so large that it sharply limited the working area inside her skull, forcing Dagi to cut off a third of the cerebellum. Brain surgeons, through trial and error, have learned that they can cut away about a third of the cerebellum with no apparent "deficit." They don't know exactly why.
With the cerebellum out of the way, Dagi spotted the tumor. Using a 40-power operating microscope, he identified cranial nerves wrapped around the tumor and began the painstaking process of gutting it. A microscopic slip could sever Blanche's seventh cranial nerve, permanately paralyzing her face. A slightly larger slip, at the point where the tumor touched the front of the brain stem, could split open the basilar artery that supplies blood to the back of the brain and would probably kill Blanche.
For 13 hours during the first operation, Morris Cascio, his three children and his daughter-in-law, sat outside the operating room in a waiting area, terrified that Blanche would die or be paralyzed. They went through the same misery 10 days later during the second operation when Dagi went back inside Blanche's head to peel the skin of the tumor off the brain stem. To save Blanche's facial movement, he dissected the tumor from the stretched and frayed seventh cranial nerve, a tedious process akin to removing a spider web from a wet grape while leaving the web intact.
It worked. Most of the nerve survived. Although Blanche awoke from the second operation with the left side of her face paralyzed, much facial movement has since returned. Her pain is gone. Her face still droops on the left side, but she says it seems to be getting better each week. Her prognosis after the two operations that each cost $2,500 (plus $31,000 for a month in Georgetown Hospital) is for a complete recovery. It will take a year to find out if full facial function will return. Chances are remote that the tumor, which was not cancerous, will grow back.
Dagi emerged exultant from the operating room to tell the waiting Cascio family that he'd removed the tumor and saved most of the facial nerve. According to Morris Cascio, "Dagi was just beaming. He was so proud of himself."
Over the next 10 years, odd as it may sound, there may not be enough tumors to go around for all the neurosurgeons trained to remove them. For example, in this country in 1980 there were 5,000 reported acoustic neuronomas, the kind of tumor Blanche had. Based on the number of doctors now training in neurosurgery, by 1990 there will be 5,100 neurosurgeons in the United States. That means (assuming the number of these tumors remains constant) that in eight years there will be slightly less than one acoustic neuronoma annually for each of the nation's neurosurgeons.
Like many medical specialists, brain surgeons are threatened by their own overpopulation. The 5,100 neurosurgeons expected in 1990 will be about twice as many as are needed, according to a recent federally funded study by the Graduate Medical Education National Advisory Committee. If the study is to be believed (many teaching neurosurgeons reject it), the Washington area, with about 3.1 million people and 60 neurosurgeons, already has about twice as many as necessary. The study estimated that one neurosurgeon could handle the needs of 97,556 people.
The need for brain surgery has never been all that great. According to federal figures, of the 25.5 million surgical procedures performed in 1980, only .3 percent--or 89,000--involved the brain. Many neurosurgeons are beginning to worry that there may not be enough patients to go around in the future, according to Dr. Alvin Tarlov, a University of Chicago professor of medicine who chaired the federal study of medical specialties.
But for the 89,000 or so people who do need brain surgery every year, a neurosurgeon is their only guardian against stroke, paralysis, uncontrollable seizures, diminished ability to think, intolerable pain or death. These patients and their families often look at a brain surgeon with jumbled feelings of fear, reverence and wonder, hanging on his every word, attuned to his most insignificant gestures, desperate for the help of someone who offers a cure for an intra-cranial evil that has rendered them helpless.
In his book, The Healer's Art, Eric J. Cassell writes about brain-surgeon worship: "It is interesting that perhaps the seemingly most omnipotent of all physicians are the neurosurgeons, and theirs is the specialty in which nature's odds are most against them. In terms of curing, they are the least effective. Does any diagnosis strike such terror as a brain tumor? The brain surgeon's incredible feeling of omnipotence helps protect us from our fear."
Richard Price, a retired civil servant from Montgomery County on whom Dagi performed an arterial bypass graft that increased the flow of blood to his brain, preventing an almost certain paralyzing stroke, says of his brain surgeon: "As far as I'm concerned, Dagi can walk on water. If I were a millionaire, I'd give him a third of everything I had."
Just before he was put under anesthesia in an operating room last Nov. 16, Price remembers: "I grabbed my arms around Dagi. I told him I have complete faith in him. I said, 'No matter how it goes, I love you.'"
Teo Dagi, a slightly
stout man whose hair has gone prematurely gray at the temples, says he was touched by Price's offering of faith. Yet Dagi finds nothing extraordinary in being deified by his patients or in poking stainless steel gadgets in their brains. It is a role he has sought out and prepared for since childhood.
Dagi, an only child, grew up in a privileged world of books and learning, of medicine and classical music, of impassioned ideological arguments carried on in a half-dozen languages and of loving encouragement to learn. But never, he says, was he permitted to take his privileges for granted.
His parents, Dagi says, took nothing for granted. They were survivors of Nazism, Lithuanian Jews whose entire families, save one uncle, were killed in the Holocaust. Dagi's father, a Hebrew scholar and teacher, met his mother, a pediatrician, in Milan, Italy, shortly after World War II. Dagi was born there in 1948, and one year later his family moved to Forest Hills, N.Y. As a child, his home was alive with the comings and goings of his mother's patients and with the frequent visits of other Jewish families who'd survived the war and fled Europe. The children of these families, according to one of Dagi's friends who grew up in the same world, were expected to be doctors or earn PhDs. Says the friend, "Our parents looked upon us as living proof that Hitler lost."
With his father, Dagi spoke Hebrew, with his mother, Italian. The family spoke German at the dinner table, and Dagi picked up English in the streets. His English, perhaps an indication of those streets, is formal, his accent almost British (he pronounces "castle" as "cawstle" and "been" as "bean"). Dagi's other languages are French, Yiddish, Arabic, Spanish, Latn and Aramaic. The first book Dagi remembers buying, he thinks at the age of 4 or 5, was Thomas Babington Macaulay's "Lays of Ancient Rome," about the legend of Horatius defending Rome. Dagi was interested in the subject, he recalls, because there'd been a lot of talk about it around the house.
Dagi cannot remember a time when he didn't want to be a doctor. He heard Biblical accounts of Moses' speech impairment and tried to figure out, in a medical way, what the problem might have been.
At the age of 12 and 13, with his friend Alan Tuchman (now Dr. Tuchman, director of neurology at Lincoln Hospital in New York and assistant professor of neurology at New York Medical College), Dagi read books that he considered "exciting stuff." These were, Tuchman recalls, "heavy classics. Anything written after the 15th or 16th century was not done. We got into it." They poured through books such as Homer's "Iliad," Dante's "Divine Comedy," Boccaccio's "Decameron." Tuchman read in English, Dagi, if possible, in the original language.
"I had this feeling," Dagi says, "that Western civilization had come from somewhere, that great things had been written and I wanted to find out. I'm curious."
Dagi was curious, as well, about the brain. He returned again and again as a child to the B volume of his parents' encyclopedia. He was fascinated, in high school and college, by how the flesh of the brain could be the vehicle of the incorporeal mind. He wondered about how the mind managed to translate an event or thought from one language to another, about the evolution of language and syntax.
His fondness for languages has shaped Dagi's adult personality and his sense of humor. He abhors clumsy speech. Asked an imprecisely worded question, Dagi rephrases it first, with pedantic exactitude, then answers. Dagi's humor amounts to playing with language--punning. The puns are often obscure, often cannot be understood without knowledge of two or more languages and are often quite bad. Perhaps 50 times a day, he makes up a pun, tells it, grins impishly, waits for someone to groan and then usually tells another one.
According to his close friend Terry Pinkard, an assistant professor of philosophy at Georgetown, lunch with Dagi often amounts to a series of bad puns, punctuated by the increasingly pained responses of his listeners.
"That's what happens when you meet a really funny guy," Dagi explains, "he groans on you."
Dagi's interest in medicine, the brain and in thinking all came together in medical school when he had his first chance to dissect a human brain. "I found it to be beautiful," he recalls. "It is aesthetically pleasing." Brain surgery and treating sick people, he says, not only engages his mind and enables him to use his hands but also allows him to "justify my existence. What counted with my parents is, yes, you know things, but you can't just sit somehwere and read books. You have to contribute."
That contribution, which keeps him plugged into a beeper 24 hours a day and has him working 12-to 14-hour days six or seven days a week, leaves Dagi little time for a personal life. An observant Jew, who tries to eat kosher and struggles (mostly without success) to avoid working Saturdays, he would like to marry a Jewish woman and raise a family. He is looking for a professional woman whose career commitments would help her understand the incessant demands of his career. So far, it hasn't worked out.
"I was going with someone in Boston I really liked, but she couldn't stand the beeper," says Dagi. "She wanted me to turn it off sometimes so we could have time alone together. She couldn't understand that I've made a commitment to my patients. I stopped going out with her."
When Dagi opensup a skull, all that is left between his hands and the brain is the dura--a translucent membrane that encapsulates the brain, protecting it from the infectious outside world. Each time before he slices through the dura, Dagi says he feels a certain reverence for the brain, as though he were about to walk on hallowed ground.
The object of his reverence, in the average person, is three and a half pounds of pinkish white tissue, laced with blood vessels, textured like lumpy Jello and wrinkled like the meat of a walnut. It is 85 percent water, the rest mostly fat. It cannot feel pain, heat or touch and has no way of protecting itself from disease. It is, scientists agree, the most complex hunk of protoplasm in the cosmos.
The brain is made up of about 10 billion neurons, microscopic nerve cells shaped like an elongated oak tree. The connections between these billions of neurons are called synapses, vaguely understood gaps bridged by intricate electro-chemical transmissions. The brain, with an estimated 100 trillion connections, is capable of storing up to 100 billion individual units of information.
After Dagi drills into the skull, cuts away the dura and confronts the brain proper, what exactly does he have at hand? Is he about to stick his fingers into someone's mind? Where's the part that believes in God, craves cheeseburgers or hates the New York Yankees?
Brain surgery raises all the mind-brain, body-soul questions that have teased philosophers and theologians since the ancient Egyptians first guessed that thinking came from the head. These questions come down to one central dilemma: If the mind is something other than a word we've invented to describe electro-chemical complexity, then what and where is it? Could Dagi stab it with a scalpel?
The neuroscientists under whom Dagi studied cannot answer these questions.
"No one has the faintest idea what is necessary for there to be a thought," says Dr. William Sweet, Dagi's mentor and senior neurosurgeon at Massachusetts General Hospital in Boston, and a world-renowned brain scientist. "No one has been able to put down a meaningful relationship between physical phenomena and what it is to compose a thought."
So, when Dagi opens up the skull and confronts the brain, he does so with an immeasurable ignorance of what he's confronting. Like everybody else in his business, he goes in as a sort of glorified fix-it man in the central office of a great corporation whose business he cannot comprehend. He knows, however, that the corporate headquarters (as Dagi might punningly call them) cannot survive without certain maintenance and emergency repairs.
In the headquarters, these services include ensuring an abundant flow of blood (the brain uses about one-fourth of the body's oxygen). This plumbing repair sometimes requires patching of arteries that seem ready to burst, unclogging blood vessels choked off by plaque and bypassing diseased arteries. Fix-it service also requires, on occasion, removal of tumors, malformed arteries and veins, as well as certain brain tissue undergoing uncontrollable electrical firestorms that cause fits and seizures. Finally, as the shooting of White House press secretary James Brady so horribly demonstrated, there is damage control: Cleaning out shards of bone and bits of debris, controlling swelling and hoping for the best when a foreign object smashes into the guts of the corporation.
Part of many neurosurgeons' work used to include lobotomies--severing the connections of the brain's frontal lobes in an effort to stop behavior that was considered depraved, depressed or destructive. Between 1936 and the late 1950s some 40,000 to 50,000 lobotomies were performed in this country. Washington was the capital for this experimental surgery, and the late Dr. Walter Jackson Freeman, a neurologist and psychiatrist at George Washington University and St. Elizabeths Hospital, was the operation's chief prophet, promoter and practitioner. He personally performed or directed 4,000 of them.
Lobotomies fell out of favor when mental institutions began using tranquilizers to control patients. It became apparent that the operation literally de- humanized patients, destroying an area of the brain associated with rational thought, imagination and will. Now only about 200 to 500 lobotomies are performed annually, almost none of them on involuntarily detained mental patients. Because the workings of the brain are so poorly understood, so-called "psychosurgery" of any sort is out of favor among neurosurgeons.
>In their capacity as fix-it men (there are fewer than30 women neurosurgeons), experienced brain surgeons don't worry about brain-mind questions. For many, such questions are stale, irrelevant to fixing brains and too darn tricky to answer.
"We don't get involved in all the stuff," says Dr. Alfred J. Luessenhop, chief of neurosurgery at Georgetown and Dagi's boss. "We (neurosurgeons) just sit back and let other people armchair those questions."
What may keep Dagi from slipping into a fix-it-man view of his work are patients whose illnesses cannot be treated by tending to the plumbing. Susan Anderson, 39, a psychiatrist who lives in a rural suburb of Washington, is such a patient.
Anderson, Dagi says, "comes as close to a clinical example in the brain-mind problem as anybody will ever get. As a psychiatrist, she is an ideal inside observer of her own brain."
Anderson (her real name will not be used in the story) tumbled off a 25-foot embankment in her car late last summer. The seatbelt she was wearing saved her life, but she suffered a concussion that nearly killed her. Her injury was "non-operable," which means that opening up her skull could not help. Dagi has had no choice but to take a passive role with Anderson, easing her pain with drugs and trying to help the psychiatrist understand the workings of her brain as it slowly recovers from a concussion that almost sent her into a coma.
The accident apparently damaged cranial nerves coming out of Anderson's brain stem, causing "crosstalk" or signal leakage between eye and facial nerves and giving her flashes of paralyzing pain. She feels, at times, as though a knife is slicing through her right eyeball. More mysteriously, however, the concussion has profoundly altered some functions of her mind.
Anderson, a slim, athletic woman who before her accident used to run five to seven miles a day, can now sit contentedly for an entire afternoon without being aware of the passage of time. When she rides in a car (since the accident she has not driven), she has no idea if cars on the highway are coming toward her or going away. An accomplished artist before the accident, her drawings now are wooden and cartoon-like. She is constantly aware of being an observer of her own body. She hasn't felt angry since the accident.
For nearly three months after the accident, she looked, her friends told her, as though she was on hallucinogenic drugs. She didn't understand humor, but when her friends laughed, she laughed. Often, in the middle of this copycat laughter, she'd break out in tears, crying only out of her left eye. The right eye has not shed a tear since the accident.
These symptoms, although they sound strange, can be traced to specific areas of the brain. Dagi guesses they are related to thousands of microscopic hemorrhages or lesions in Anderson's non-dominant parietal and temporal lobes. These lobes are believed to control, among other things, perceptions of space and time, the ability to understand, imitate and express emotion and the sense of being within one's body.
Anderson, however, says even stranger things went on inside her mind, things that Dagi can't trace to any specific part of the brain. The psychiatrist reports:
"When I was able to go walking in tha neure woods (about a month after the accident), I saw mushrooms growing on the side of trees, they looked like clams and therefore I believed them to be clams. I know clams don't grow on trees. It was absurd. When I saw this, I really got upset. Deep in my heart I was convinced that it was a clam tree.
"On those walks in the woods I also had problems with acorns. Intellectually, I'd know those things on the ground were acorns, but emotionally I thought they were olives, that I was in an olive grove.
"It was about that time that I started hearing a voice. It was a monotone voice, a man's voice. When I was in the woods, it was very soothing and unjudgmental. It said: 'If you want the acorns to be olives, they can be olives. If you want them to be acorns, they can be acorns.' The voice was coming from inside my head. I thought of a name to call it. I decided that it was very busy, going over every event since the accident. So I called it the 'busy talker.'
"He (the busy talker) defined the absurd to me. I was having trouble with the acorns and the olives, the clam trees, but as long as he was talking it was safe to go out in the woods."
Anderson says she listened to the "busy talker" for nearly two weeks before mustering the courage to tell Dagi about it. She says she'd grown to trust Dagi because he'd always assured her that her thinking, no matter how bizarre, was normal for someone with a serious brain injury. But she was afraid that he wouldn't be so accepting of a "busy talker"--the sort of thing that she as a psychiatrist knew could be seen as an indication of schizophrenia. She was afraid she'd be classified as crazy.
Dagi admits he was taken aback by the "busy talker." He says he started considering, for the first time, the possibility that Anderson may have a psychiatric disorder--a problem caused not by brain lesions but by far more ephemeral and less understood disorders of the mind.
"But I know enough psychiatry to tell when someone is crazy," says Dagi. "She is not crazy. She has no language disorders, no loss of ego boundaries (Anderson doesn't think she is Napoleon or that Napolean is the busy talker). You can have a distortion of perception without being crazy so long as you continue to realize that your perception is distorted."
For all of Anderson's "non- localized" symptoms, Dagi has no sound explanations: "I really don't know what is happening."
In the meantime, Anderson is recovering. The "busy talker" went silent more than three months ago. The voice disappeared about the same time she regained her ability to know when someone was telling her a joke. It has not returned. Dagi doesn't know why it came or why it left.
Anderson has also resolved the acorn-olive problem by taking some acorns home in a bucket and looking at them. The clam trees have disappeared. But the psychiatrist still has trouble with depth perception and telling time, and she finds it difficult to read. Dagi thinks these functions, too, will probably return, at least to some extent. He says, however, there is very little that he can do to help.
A brain surgeon's best work --when the plumbing and the wiring isn't obviously broken-- often amounts to wondering at the vastness of his ignorance, holding his patient's hand and hoping that the brain will fix itself.