the technical view of a Pineal Gland Brain Tumor (a what gland?)

Here's what I know about this tumor.

I have a rare disease! Pineal gland tumors total less than 1 percent of all brain tumors. I always wanted to be special. Luckily for me, it's rare in a good way. I believe it to be more treatable than most brain tumors.

First thing I found out was that the word "tumor" itself comes from "tumescence"--to swell. Up till now, this has always been a desirable thing for men. We take pills to have it; now it's fuck all to get rid of it.

It's not enormous, but it's quite large. 3cm around. Ish. I've referred to it as the golf ball in my head.

This tumor is sitting on a little something called a pineal gland. (Pronounced either PIE-knee-ul or PIN-e-ul.) This gland creates melatonin, but no one really knows for sure what that stuff does. It might help with sleep cycles. It's not clear.

For me, the gland's purpose is to play host to mass of cells I clearly do not need. If I personified them, they'd be party crashers, drinking up my brain booze and clogging up my toilets. If I technofied the tumor, I imagine a possessed xerox machine. My cells are copying themselves endlessly. Either they think they are helping--they think other cells have died and they're honorably taking their places--or they are simply in open revolt.

Perhaps it's a misunderstanding. Mass mis-communication. I would like to talk to them if I could. But at this point, it just may make things worse.

So this tumor sits smack in the middle of my head. When the neurosurgeon first showed me an MRI image of it, I said, "Is it possible for it to be more in the middle of my brain?"
He pointed at a spot an half inch over. "Well, it could. . ." Then he laughed. "No," he said. "I guess not. Yeah. It's pretty much in the middle."

Such audacity! To insinuate yourself into a delicate space where you are clearly not wanted and where you do not belong. This tumor has earned my respect far more than my anger or fear.

The radiologist report said the tumor was "well-marginated," which made me recall all my old workshop manuscripts with corrections or "+" 's all across them. But the radiologist meant the tumor was very smooth and even. Such sense of order--perhaps it's British. This is not a wild prison break, each one breaking off in their own direction. No, these cells are a collective. They're Marxist cells. Perhaps this has been affecting my politics all along?

Really, and this is silly, but I feel proud of my organized cells. They are really like me-you should see my finances. I love tax time. Seriously. I have little folders I keep and when I finish packing them up I run my hand across their covers, lovingly. Everything in its right place, at least sometimes. I like this kinship between me and my tumor.

I talk about my tumor's smoothness on the phone to whichever random friend I haven't spoken to in years is calling me at that moment. "It's grown so evenly," I say. "You should see the pictures."

These cells have respect for uniformity. I believe in finding a personal philosophy and shaping your life according to that philosophy. If you see these cells, man, it's clear they have a vision and they are sticking to it. So many admirable qualities, these cells.

Of course they do complicate things. Remember that clogged toilet metaphor? It's actually quite appropriate. Next to this Pineal gland is the narrow tube that connects some ventricular sacs to my lovely and slightly curved spine. The sacs hold cerebrospinal fluid which--in the overly-literal and latin way of medical terms-- travels from my brain to my spine. It bathes my brain in a nice warm fluid, and provides some nutrients to my back. The tumor has clogged the tube.

It's basically a plumbing issue. The fluid builds up faster than it drips down, and my ventricles keep getting a little bigger and a little bigger to hold more fluid. So there's pressure. That's where the pain stirs when I bend over or strain, or, much more annoyingly, laugh too hard.

My horizontal MRI looks like I have two bananas in my brain. Those are two of my ventricular sacs. They should look more like grapes.

The doctors all think this has been growing for years. They think this because of the size of those bananas. Between them and the golf ball, my head is rather crowded. Stuff is pressing on every part of brain. If I were a pinball machine, we'd be breaking all the high scores.

"Well," one doctor said to me over the phone after looking at my MRI. "You don't sound incoherent." I am expected to be so. I should have double vision. I should be falling over, my limbs shaking involuntarily. The fact that I am not tells them that this has been happening slowly, a bit here, a bit there. My brain has been adapting for years. I'm a bit proud of that too. I am sick, but remarkably well.

So here's what's going to happen. First we have endoscopic surgery. Endoscopy, "to look inside"--once again, those damn literal medical terms--because, it's a mini camera. At this rate, they should just call it a look-insidey machine.

It's a tubular camera armed with a tiny light and, I imagine, a super tiny little knife. They will make two incisions in the front right of my head. (Why two, I failed to ask.) Then the tube goes in, and works it's way into the ventricular sacs. Once there, they will puncture a little hole in the sacs, so that the fluid will drip down, around the tumor, and eventually wend its way into my spine, where it belongs. Blood can complicate things--if I bleed too much, it will block the camera, and the surgeon will be working half blind. Sometimes they have to--for lack of a better term--pull out.

This puncture method beats the hell out of the old way they fixed this, which was to put a shunt--a long plastic tube that would run all the fucking way from my brain to my stomach. There is a small chance--10 to 15 percent, I am told--that this new drain will fail. It can swell up or scar over time. At that point they have to go ahead and make new holes and put a the shunt in anyway, just as a precaution. Brain surgery, small or large, will always linger on the horizon.

After the drain is created, the second order of business is to get a sample of this fucker. The tumor, I mean. There are 15 types of Pineal gland tumors. Most fall into two major categories, of course. Benign or malignant. Oddly, in my case, you want it to be mildly cancerous. Because the mild cancer is very receptive to radiation--like a 90 percent cure rate. So no open brain surgery.

But if it's benign, well, it has to come out. And that would mean a journey to the center of my skull. For that, I'd probably want to find the magic Pineal gland center of the world, if such a thing exists.

My first neurosurgeon felt very confident my tumor was the good cancer kind. My second felt equally assured that it was benign. I guess I'll call it a coin flip.