Bobby and his mother, Judy, go over his anatomy homework as the family relaxes in their living room. One of the family’s cats, Smokey, is next to Bobby; Misty relaxes on Bob’s lap. Matt keeps himself busy with his Game Boy.
Only when Ghannam moved his hand directly in front of Bobby’s face could he see the optometrist’s fingers.
Ghannam dilated Bobby’s eyes and looked into them with a slit-lamp microscope and a 90-diopter lens, but he detected no ocular pathology—no glaucoma, no impeded blood flow, nothing in the eye to account for vision loss. He hadn’t seen this before in his practice, but he recognized it as an almost textbook case. He asked Bobby to sit in his waiting room while he spoke with his father.
“I’m quite certain Bobby’s vision problem is neurological,” Ghannam told Bob. “It could be a mass or tumor of some kind. He needs to see a neurologist right away.”
Bob called Judy on his cell phone but could barely choke out any words.
Four days after Bobby’s visit to the optometrist, his pediatrician telephoned the Silko home with his MRI results. Judy answered. She called Bob, who drove home from work immediately. The two of them waited in the kitchen until Bobby got home from school. Bobby knew the news was bad the moment he walked in.
“What’s wrong, Mom?” he asked.
Judy and Bob wrapped their arms around their son and did the hardest thing they had ever done as parents. They told him he had a brain tumor.
Judy whispered, “We’ll all get through this together.”
When Dr. George Jallo examined Bobby’s MRI scan a couple of days later at Johns Hopkins, he saw a tumor bigger than a golf ball near the base of Bobby’s brain, compressing his optic nerve at the optic chiasm. The chiasm is where the optic nerves from the left and right eyes meet and cross before they traverse to the brain’s visual cortex, where vision is processed. The tumor was compromising blood flow to the optic nerve, shutting down Bobby’s peripheral vision because the neural fibers for peripheral vision are more sensitive than those for central vision.
The tumor also pressed against Bobby’s pituitary gland, the body’s master hormone gland, which is roughly the size and shape of a pea. This pressure interfered with the release of growth hormone and probably explained why Bobby wasn’t as tall as might be expected of the son of two tall parents. Jallo also noted that the tumor had begun to invade the brain’s third ventricle, a narrow cavity that provides a pathway for the circulation of cerebrospinal fluid.
Jallo suspected that Bobby had a craniopharyngioma, a tumor usually found in children. The tumor’s nascent cells likely had resided in Bobby’s brain since early development. Although the rare tumor is generally benign, Jallo knew that it could grow aggressively. He also knew that a tumor this big in so delicate an area would be hard to remove.
A graduate of George Washington University and the University of Virginia medical school, Jallo had come to Johns Hopkins in 2003 after training under the late pioneering pediatric neurosurgeon Fred Epstein at NYU and Beth Israel hospitals in New York City. Like his mentor, Jallo specialized in difficult tumors in and around the brain stem and spinal cord. Jallo had emigrated with his family to the United States from Lebanon in 1971. They had settled in New Jersey, where Jallo nearly failed the first, second, and third grades because he spoke only Aramaic, an ancient language known to few outside the Middle East. By fourth grade, Jallo spoke English well enough to succeed in school.
On the day after Christmas, Jallo—who had been recommended by Bobby’s pediatrician—met with Bobby and his family in his office. Judy’s parents, Margaret and Bob Bero, had driven from their home in Johnstown, Pennsylvania, to be there. Margaret, whom Bobby and his brother call Meme and everyone else calls Maggie, is a registered-nurse anesthetist; her husband is a retired high-school math teacher. They had researched Jallo’s qualifications to satisfy themselves that he was an outstanding doctor.