Neurosurgery: Life with Half a Brain

During the week, Ernest Coe, 47, walks short distances down the corridors of Omaha Veterans Administration Hospital with the aid of a cane. Using his left hand, he works the automatic elevator. He can tell time and speak intelligibly in short phrases. At home on weekends, he gets out of his wheelchair to take his meals at the table and insists on helping his wife with the dishes. And, adds his wife, he whistles at pretty girls, as he always has.

For Coe, these are monumental accomplishments; for neurology and neurosurgery, they have important implications. Last December, surgeons removed the cancerous left hemisphere of Coe’s brain—the hemisphere on which he had relied all his life. Locked inside it were the major control centers for all the skills of speech, reading and writing, and everyday physical activities; for one half of the brain is almost invariably dominant. With virtually all right-handed people like Coe, as with many lefthanders, the dominant half is on the left. In almost eight months of his middle age, the right hemisphere of Coe’s brain has made a remarkable effort to take over.

Patient’s Decision. The radical operation to remove half a brain (hemispherectomy) dates from 1928, and it has proved useful mainly for treating young children with one-sided brain disease. Ernest Coe* is only the third right-handed adult known to have had a left hemispherectomy, and the first two did not survive long enough to recover full speech or control of their right hands.

A utility-company employee, Coe began to have seizures, with temporary impairment of speech, about two years ago. An operation in March 1965 was successful in that it resulted in the removal of most of a brain tumor. But it also disclosed that the trouble was a malignant glioblastoma. “Though my husband got along well then with medicine,” says Mrs. Coe, “the doctor told me the growth was extensive, and he probably wouldn’t live more than about 18 months.”

A severe seizure last November confronted the Goes with an agonizing decision: Should Coe have a hemispherectomy? “I never recommend this operation,” says Neurosurgeon Charles W. Burklund. “It can only be done on a select few patients. Then, because of the risk, the final decision must be theirs.” Says Mrs. Coe: “He didn’t want to be a burden and lie in a coma for months.” So they agreed that he should have the operation.

Color Test. The VA team went to work last Dec. 7. A sweeping cut through the scalp from behind the left ear to the crown, and then another to the forehead, exposed the skull. Next the surgeons sawed through the bone and lifted a big flap to expose the brain. Then, wielding an electric cautery, they spent one hour and 50 minutes cutting away the diseased hemisphere—from the neocortex, the control center for man’s most civilized mental processes, down to the ancient part of the brain, where reflexive and instinctual functions are mediated. The surgeons put nothing in the space; cerebrospinal fluid would soon fill it.

After Coe recovered from anesthesia, his first words were curses. Explains Neuropsychologist Aaron Smith: “Cuss words express feeling, not an idea. Communicating thoughts is more difficult.” Soon Coe was able to communicate rational thoughts in short phrases. Today he still speaks slowly and leaves many sentences unfinished, but he can make himself understood unless he gets too tired.

Although many neurologists had thought that color perception and singing ability were exclusive functions of the dominant hemisphere, Coe has scored 24 out of 25 in a color test, and can sing familiar anthems, hymns and Home on the Range. While he cannot write script, he prints left-handedly. He can pick out the right answers to simple arithmetical problems. In one-handed manual tasks, Coe is more adept than most men. Long bed confinement delayed his relearning to use his right arm, but he is now improving in this.

Presumably the right side of Coe’s brain made some, but only a slight, contribution to these functions before his operation. Now, Dr. Smith believes, Coe’s faculties are improving as the right hemisphere tries to take over, just as one lung or one kidney compensates for the loss of the other. What Dr. Smith finds most encouraging is that this process has gone so far in a patient so many years beyond childhood. While VA doctors concede that Coe’s considerable recovery may be a fluke, they believe that hemispherectomy deserves further investigation; because, for patients with spreading brain cancers, it is the only alternative to death.

*Not his real name, but a pseudonym supplied by the Omaha World-Herald, which first broke his story.