Jallo rarely talked about his cases with his wife, but he talked about Bobby’s because it ate at him. He’d brought Bobby’s case up many times at the pediatric neuro-oncology conference held Tuesday mornings at 7:30. The meeting was regularly attended by oncologists, radiologists, and other specialists, who reviewed the most difficult cases in detail.
The conference doctors offered no new answers as to why Bobby’s cyst had defied Jallo’s attempts to drain it. They agreed that it was one of the most difficult and puzzling cases they’d encountered. Only Dr. Ben Carson, a pediatric neurosurgeon in Jallo’s surgical group, recalled a similar case of a hard-to-eliminate cyst. His fellow experts assured Jallo he was doing the right things and agreed he had only one option—try again to drain the cyst and await the full impact of the radiation. If he couldn’t drain it with the minimally invasive approaches, they recommended that he take a more radical one.
Jallo met with Bobby and his parents on August 1 and told them the time had come to be more aggressive.
Bobby, now very close to blindness, listened to Jallo and said, “I only hope this will be the last operation.”
Jallo said, “It will be.”
Bobby’s fifth surgery began around 8 in the evening on August 3. This time, Jallo performed what he considered the procedure of last resort, a craniotomy that opened Bobby’s skull and exposed his brain. Potential complications included infection, stroke, and blindness.
Jallo made a cut in Bobby’s skull along the frontal area down to the midear and removed a chunk of his skull near his temple to gain a clear view of his brain. Using a retractor, he gently lifted the frontal lobe of Bobby’s brain up about two to three centimeters. If this maneuver went wrong, it could constrict a blood vessel and trigger a stroke. With the brain elevated, Jallo saw directly for the first time the spherical brown membrane that encapsulated the cyst. He knew it would be too risky to tie off the cyst and remove it because it pressed directly against the optic nerve.
With the operating microscope to guide him, Jallo moved the thin catheter into place to insert it into the cyst. It wouldn’t go in. When it didn’t, Jallo understood why the previous procedures had failed—the membrane that formed its outer shell was simply too tough.
Jallo cut an opening in the shell with surgical scissors, and a brownish fluid seeped out. Jallo slid the catheter through the opening into the cyst, and it began to drain into the small reservoir Jallo had inserted under Bobby’s scalp two surgeries before. As the cyst drained and deflated, Jallo could see it pull away from the optic nerve, creating enough space for the optic nerve to reexpand. Lifting the brain and inserting the catheter had taken about 50 minutes, and it had gone well. Jallo’s only regret was that he hadn’t taken this approach sooner.
When Bobby opened his eyes, he knew instantly that his vision was better—not as clear as after the first operation, but better. Much of the darkness had lifted.
When Bobby returned to school for his senior year in September, friends who hadn’t seen him all summer were shocked at his appearance. His face was bloated and puffy from steroids he’d been taking to reduce tissue swelling. The steroids also had caused him to gain weight. His complexion was pale, small patches of hair were missing, and his arms were scarred and discolored from IVs.
Bobby continued his academic load, taking Catholic ethics and morality, precalculus, anatomy, history, British literature, and band. His Spanish teacher knew he wanted to take Spanish IV, which would be very visual and require a lot of reading. She thought it might be hard for him to keep up in class, so she offered to let him do independent study for credit. Bobby jumped at the chance, and they began meeting twice a week.
A major help for Bobby was a portable closed-circuit television that magnified print, a machine Pallotti had acquired on loan from the Prince George’s County Department of Education. Bobby also had a stationary closed-circuit TV at home. At Pallotti, students helped him wheel a mobile unit from class to class.
The CCTV meant teachers no longer had to read tests to him; the unit at home allowed him to read his assignments. The one at school came equipped with a camera that Bobby aimed at the blackboard to make it readable. With the aid of both devices—and the school making accommodations to help him—Bobby earned straight A’s the first semester. He was elected senior-class treasurer.
Pallotti’s homecoming dance on Friday, October 5, was one of the school’s two big dances each year; the other was the junior prom. In September, every class nominated candidates for the homecoming court. Once the eight members of the court were named, the entire student body cast ballots for homecoming king and queen, who would be announced at the dance.
Bobby knew he had friends and enjoyed the help and support of many students, but he was surprised to learn he’d been nominated to the homecoming court, especially after missing so many weeks of school.
He wore his best suit and tie to the dance. The girls wore pretty dresses. The gymnasium was decorated with streamers and balloons, and a DJ played CDs.
The names of the king and queen were a secret tightly held by Patti Lutz. One of the nominees for queen, Kim Banocy, had been a friend of Bobby’s since sixth grade, and they’d both played in the band. The announcement of the king and queen would be made at 11:30 pm. Kim told herself and her friends that she didn’t care if she won, but she hoped Bobby would.
At 11:30, members of the royal court were escorted into the gym. Then the music stopped, and Lutz announced that Kim had been selected queen and paused for a moment. Then she announced that Bobby had been elected king. As principal Steve Edmonds placed crowns on Kim’s and Bobby’s heads and shook their hands, the crowd of more than 300 erupted into cheers.