Neurosurgeon recounts a ‘a miracle of biology’
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The following excerpt from Off the Top of My Head: Stories from the Operating Room That Will Make You Laugh (Or Cry) by Dr. Barbara Lazio has been run with permission
Was This the Life You Wanted Saved?
“Show me two fingers,” I shouted, too close to his ear, as if trying to wake one of my kids for school. Beau’s surgery was a few days prior, and I hadn’t seen much response from him; he still leaned toward the coma side of the coma scale. Another hopeless case, I thought, humbled. Usually a soft talker, I summoned my inner megaphone and tried to kindle the dormant neurons in his brain to spark. “Show me two fingers!” Beau, still breathing through a plastic tube, locked eyes with me and ceremoniously raised both middle fingers. Fantastic!
A week earlier, I had met him in his hospital room. I say we met, although there were no introductions, handshakes, or pleased-to-meet-yous. He was unconscious. He had been emergently placed on a ventilator after being found in his room lethargic and vomiting. He had already been wrestled free from the grasp of certain death twice in the days before we met. He came in with chest pain, a STEMI, or a heart attack from the blockage of a major heart vessel. His cardiologist opened it up in the cath lab and he was feeling good. Two days later, he had a cardiac arrest, his heart beating in an erratic rhythm. He turned blue, dropped to the floor, and banged his head on the linoleum. This time, he was shocked back to life. Again, he felt better and was starting to walk. Blood thinners kept his blood pumping through his heart.
“Show me two fingers!” I shouted, crouched close to Beau’s ear, on the day we met. There was nothing but a weak movement of the toes. Was it real? The CT scan of his head showed an enormous collection of blood, a subdural hematoma. Now the blood thinners saving his heart had become the enemy of his brain. When his head hit the floor, a blood vessel on top of his brain tore. The blood thinners allowed it to leak over the next several hours until Beau was unconscious. It looked grim, and I told the cardiologist so. He hoped I would do surgery immediately. I called the patient’s only known contact, his brother, for consent, but there was no answer.
Sometimes, when these “oh-dark-thirty” crises develop, I will scour our studies and guidelines for the answer to the problem in front of me. I know the book answer, the guideline answer, but sometimes it is not the right answer for tonight’s patient. The studies would give this man a slim chance of functional survival with surgery and slimmer without. He was youngish, sixty. Was it my place to decide if today would be his last day? With no other family available, it was up to me to decide. So, I decided.
The surgery is one every neurosurgeon can do in their sleep, and our team moved quickly to drill open the skull, peel back the lining tissue, and irrigate the large, gelatinous, clotted mass of blood into the plastic suction bag attached to his head drape. I could almost hear his brain sigh, expanding into the space I gave it. It looks happier, I thought as I sutured up his dura, the protective membrane, and fastened his bone in place with titanium snowflake plates.
After I wrapped Beau’s head in a fluffy gauze bandage, we delivered him to the ICU and got him settled. I was finally able to reach his brother, Lenny, the next of kin, to update him. It was evident they were not very close.
“I am not sure he is going to make it this time,” I told him.
The surgery was technically a success, but Beau was in such poor condition before surgery, and his heart was weak. Lenny said he would come in to check on his brother.
In the days after he showed me his two middle fingers, Beau rallied a bit, alert enough to write some notes but not breathing well enough to come off the ventilator. One morning on rounds, I asked him how he was feeling. I waited as he painstakingly drew each letter on a whiteboard.
“I want to die.”
The words crushed me like a boulder. I did not have my crystal ball to see how this scene would play out when I decided, perhaps cavalierly, to operate on his brain. The cardiologist’s look had been pleading. His brother had not been reachable to consent. I had done the right thing. Was it not the right thing? Had I saved his life only to deliver him to this strange purgatory of tubes and needles?
He spent six weeks in the hospital from the time of his heart attack. He needed rehabilitation, but he was rejected from every area rehab and skilled nursing facility because of his insurance. So he lingered in the hospital.
I stopped by to check on Beau in his hospital room four weeks after surgery. His breathing tube had been removed, and he was talking and regaining use of his left hand, weak from brain compression. Someone had brought him his guitar, and he played me his best attempt at “Stairway to Heaven.” I hugged him through tears. He survived! He had no business surviving. His survival was a triumph, a miracle of biology.
When Lenny brought him to my office several weeks later, I reintroduced myself, this time not too loud. As is often the case with brain-injured patients, he had little recollection of his days in intensive care purgatory. The nurses and the physical therapists were memorable, but not the surgeon who was there on his darkest day and the many days after trying to spark the ear-to-two-finger connection. I could see that he was not necessarily thriving. He was living on his own. He could drive but was not well enough to work.
Beau’s survival was a win, but the weight of the crushing boulder was still on my shoulders. Was this the life he wanted saved? I told him about the day he had written me a note that said he wanted to die, and asked him if he was glad that I did the surgery. I had to know. He thought for a while. Like the day with the whiteboard, I waited patiently for the answer to this and the unspoken question of whether I did the right thing. He smiled sheepishly.
“Yeah. I’ve been meaning to thank you.”
Excerpted from Off the Top of My Head: Stories from the Operating Room That Will Make You Laugh (Or Cry) by Dr. Barbara Lazio run with permission of the publisher Sourcebooks, LLC, © Barbara Lazio, 2026. It will be available wherever books are sold on September 22.
About Dr. Barbra Lazio
For over two decades, Dr. Barbara Lazio has been a frontline neurosurgeon and writer. Now, as a respected medical school faculty member, she operates and teaches essential neurosurgery skills to budding neurosurgeons. In a world where gravity and seriousness rule, she strives to find tenderness and humor. Her work has been published in Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do, and Being a Woman Surgeon: Sixty Women Share Their Stories. Her essays have appeared on KevinMD, Doximity, and fiveminutelit. When she is not doing brain or spine surgery, she can be found exploring the mountains and beaches of the Pacific Northwest with her husband, two daughters, and dogs.
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