Lobotomy and Pappy

Someone recently told me about a program on PBS concerning lobotomies. Apparently the PBS website crashed because so many folks logged on to check this out. The word lobotomy brings to my mind one of my neurosurgical mentors of the 1960s. His name was Raphael Eustace Semmes. He was a descendent of the admiral in the Confederate States of America Navy whose portrait hangs in the hotel bearing his name in Mobile, Alabama. There will be more on Dr. Semmes as this blog rolls onward.

To all out of earshot, Dr. Semmes was known as "Pappy". Pappy was a storehouse of practical knowledge, and he made sure that all who trained with him learned the practical side on neurosurgery. He relished simplicity in a complex specialty.

One of the simple things that I learned from him is what I call the Semmes lobotomy. It is a wonderful operation for very special types of pain. I rarely (maybe four times in twenty-five years) performed this operation, but it is so simple that I could do it again after twelve years of retirement. The "real" lobotomy as done by its proponents was a drastic severing of the frontal lobes. I saw one done in all my years. The lady was schizophrenic and did not speak for weeks after the operation.

Pappy's operation was done through two nickel sized holes near the hairline under simple Novacaine local anesthesia. A brain needle is passed downward a swung in a short arc back and forth. The skin is closed, and that is it. My introduction to this surgery was with a female patient of Pappy's who had suffered for years with constant vaginal pain. As his resident, I interviewed and examined this patient who sat in bed rocking back and forth while holding her lower abdomen. She had had many operations on her nerves, spinal cord and other areas to try to cure her pain. Nothing had helped.

We took her to surgery one morning, did the Semmes lobotomy, and she had lunch back in her room. I could hardly wait until the next morning to visit her and see how she was. Early the next day I went to her room and asked about how she was doing. She said everything was fine and was relaxing in her bed. Finally, I said "How is your pain"? She smiled at me and said, "Oh, its still there, but we don't worry about that anymore". That was that. I asked Pappy how he knew how much to do with the brain needle. He said that it was important to do less than you thought needed, because you can always go back and do more if it was not enough. You could not go back and fix what you had done if it was too much.

Some years later, I did my first Semmes lobotomy on a lady with cancer of the pancreas. She responded well, and I later asked her daughter if she had noted any difference in her mother. She told me that the only thing that she could see was that her mother's dresser was always in order, and now her cosmetics were in disarray all over it. Her pain was gone.

Sometimes simplicity is a good thing!