I can barely make out the sounds. They are very soft, muffled, and I just let them flow over me.  But the voices are interesting, friendly mostly. Somehow it is dark, too.  Therefore, opening my eyes, all I see at first was an unfamiliar ceiling; bright colors, fluorescent lights above and to the side. Moving my eyes downward, all I see are blankets, my arms half uncovered.
 

I start to look around. I am lying in a big room, enclosed on three sides by walls, like a bay. There is a very long happily patterned curtain in front of me, covering most of one-half of a huge sliding glass door, and the voices are coming from that front.
 

What time is it? I cannot tell; but somewhere on one wall, I finally can make out a clock face seemingly stuck at noon. Is the dial not moving? OK, let’s spend some time watching... it is moving, very reassuring. 
 
 
My head is bit elevated, my whole upper body seems to be propped up, quite comfortable in fact. Strange – last time my head, nor my body was elevated. My mind gets quiet for a while... 
OK, where am I? I do not recognize this place, but I start to recognize more sounds: rhythmic beeping high pitch behind me, and more than just voices through the curtain in front. What is behind that curtain? I am intrigued.

*****

“Last thing we need is to put your head in right over here” some soothing male voice asked me. I could not see his face. My answer was “you mean the one that looks its part of a French guillotine?” I remember many relaxed laughter; they wanted to do something with my head, MY HEAD mind you, but I felt relaxed. Finally, I was in this white plastic donut, lying on a table and looking up, and of course I see all these rotating little lights and other things, looking as always like a miniature set of a Stanley Kubrick’s movie. Then the machine started to make the by now familiar whizzing sounds of a slow-starting helicopter. A CT scanner – nobody told me that they would take another CT scan, except I should have remembered that they use CT scanners post-op. I started worrying about all the radiation this was adding, but then I remembered that I just had agreed to have six weeks of radiation therapy (3-6 MeV beams and a total of about 60 Gy), so what was just another CT-scan. Good time to fall asleep...

*****
 
I am on a bed, and lots of monitoring equipment hooked up. This is definitely the ICU. Voices through the curtain are muffled. Is it night or day? Must be post-op. 
 
 

*****

I was scheduled to undergo a resection of my second glioblastoma with Dr. Andrew Parsa on 2/17 at UCSF. My parents and my friends Jacob and Deb were there at the pre-operating room. 
 

Before the operation, we had discussed the issue of the urinary catheter with the doctors, because at Columbia I had gotten a urinary track infection. At UCSF they would also use the catheter during the operation, but would use a single antibiotic pill to prevent an infection.
 

The anesthesiologist (Dr. Caldwell), a very tall Scottish gentleman with a reassuring face soon joins us at my right bedside.
 

Suddenly, all heads turn to one side, so I see him, too. I feel sudden happiness swelling up. The by now familiar face of Andrew Parsa is entering the room. This is the second time I see him, and I greet him eagerly, asking him if he wants to be addressed as “Dr. Parsa, or as Andrew, or Andy”. “Whatever you prefer”, he replies with a playful smile. I feel reassured, relaxed. “Andy it is” I declare. We go over the procedure one more time. Then he smiles at me, excuses himself, and takes his leave. 
Soon comes the photo-op (“where is my Nikon DSLR? I ask my father, while Deb and Jacob are clicking away using their little camera phones).
 

Before we get on with operation, someone remembers that I have not signed any release forms for either the operation, or my agreement to join Dr. Parsa’s clinical trial. Soon, order is restored.


Then the by now familiar good-byes. Time flies. You really want to hold on to that moment, because you exactly and invariably know what is next:  the journey to the operating room for that second operation. That journey is another chance at life, this all-important “First Battle” to win “The War”, a very private war, which I must win at all costs. I know the rough outcome 90-95 % removal of the tumor, and something like 2-5% permanent damage. I trust Andy way too much not to.


On the way down, all I get to see are the underside of concerned and yet faces of my parents (and the stubble of my father’s unshaven and tired face), the ceiling lights, the occasional nurse or some other person in medical garbs, rushing out through some side entry, and of course as always the “transporters” – the ones that push these gurneys. Why do they always seem to rush? Why is it that the OR always seem to lie in the center of the floor in any hospital. Maybe a subtle signal about the importance of surgery?
 
 
Always that seemingly random and inevitable line, corner, or double-door where you are separated from your loved one’s, the last good-byes.
 

And then in an instance my mind forgets all that lies behind me, and I concentrate fully on the task ahead: I see the medical staff in the OR, they are prepared with my MRI images, which are displayed on large LCD’s around the room, stereotactic equipment. My memories fade. I know that Andy Parsa will take out a piece of my skull (as held in by tiny titanium screws, if it is the same piece of skull bone that Dr Jeff Bruce from Columbia removed), flip back the dura mater below, thus exposing my brain tissue . Then he will carefully place an electrode arrays to map an area of the brain to minimize damage to it, and find the best incision area. Then he will cut through my brain (including grey matter) to get to my tumor. This time he will save as much of the tumor tissue for the vaccine trial. 

*****


Thus, I found myself in the post-op ICU bays. I remember that the operation was to have started about 5:30pm on 2/17, so unless they delayed or there was a complication it must have ended somewhere before 9pm. I was not tired.

I want to call out. Nothing... That is not good. Where is my voice?
 

I try. Not much. I start to mumble. OK, I have a voice, at very low volume and pitch... I just concentrate. Don’t look at anything – just concentrate on my voice.
 

Slowly I can at least imagine sounds. The one’s from the outside of this mysterious curtain help. I press forward. Maybe I still have a breathing tube? I feel for it - nothing there. OK, now I start with monosyllabic sound, mostly imagining a sheep: “blaahh”. I go on for a while... Just a monologue of sounds, syllables, soon alphabets: German, French, English and Japanese.
 

Soon I find words. Words? Strange constructs I think. What do I remember? German words come back, my mother’s voice, her Japanese lullaby songs, childhood songs, more of them – slowly, unsteady.
 

Soon I am remembering the beautiful melodic intonation of Swiss German (actually the Zurich dialect). Suddenly the sounds invoke a picture of the Grand Vista of the Swiss Alps. It was on a train ride on the return from Interlaken to Zurich, after a conference on high-Tc superconductors in 1986 or so, with an impossibly clear blue sky, the central Swiss massive of the mountains of Canton Bern covered in blinding white.

 

I work myself into a steady stream of words. More and more, I go on. After a while, I get bored of German.
 

Let’s try some English. I go on, first tentatively, now with more confidence. I search around the wall for things to read, finding instruction sheets attached to them.  Reading them is hard. Intonation is hard.
 

Time is moving. So are my words. I start to talk more to myself, more words. I try to find more strength, and give voice more variation. I play around with my voice volume, trying to increase, then decrease, modulate it more. The grogginess starts to wear off.
 

However, I have questions: If this is post-op, where the hell is my breakfast? Where for that matter are the nurses? I start to feel around my body. EKG wires, blinking lights, IV, arterial line, beeping sounds – the reassuring monotony of it all... The catheter is still stuck in there.
 

As the clock moves on past one, slowly, the curtain is pulled back, just a bit and a smiling face appears a smile similar to the one like the cat in “Alice in Wonderland”. I smile at the smile, and ask: 
“Where am I, and what date is it?”
 

“You are at UCSF neurosurgery ICU, and it is February 18, 2010”, the smile tells me.
“Where is my breakfast? It is past lunch,” helpfully pointing my head towards the clock on the wall. I was hungry as usual.
 

“It is one-o’clock in the morning”; the smile responds (“Seriously? Barely out of surgery!”) I study the smile at the curtain, and as the smile steps into my room, it attaches itself to a nurse, and she steps forward to examine me. I do not recall much about her, but she is very nice. Soon she is at my bedside, and then as she is almost hovering over me, her feminine smells hit me. For the first time I am sure I am alive. She checks my vitals, and asks me to go back to sleep, and “smile” disappear behind the curtain.
 

I watch the curtain, as it swings back-and-forth as the air moves in and out of my room, back-and-forth, bak-and-forth… The “One-o’clock” somehow sticks to my mind, and I keep my eyes closed and soon I fall into some slumber. I try sleeping for a while, but curiosity at how it feels like to be a
live just swell over me, so soon I open my eyes, and soon sounds keep pouring out of my mouth. 
I become just a gushing geyser. I try to remember the US Constitution, instead I start to recite the end of Hemingway’s “The old man and the sea”. Most of what I remember in German is my mother’s novels. Then I seem to reach back further, and memories of decades past come back, and now time really flies with a vengeance, first I recite Voltaire’s great poems, but mostly a dozen or so poems of Arthur Rimbaud, one of the great French poets, who tragically died from cancer at a young age. His poems “Le Mal”, “Le Dormeur du Val”, and “Sensation” remain forever etched in my memories, and with it, the memories of the poems and their unspeakable beauty were even more uplifting. 
 

Trying to describe the melodic beauty of the French language to most German or English speakers is like trying to explain the melodic beauty of Mozart’s “Eine Kleine Nachtmusik” to someone who has grown up on a diet of Hip-Hop and Rap.

*****

 

Until I was 13, formal schooling was incredibly boring. I was more interested in reading non-stop, model airplanes, piano music, and classical music concerts.
 

At that moment, Winifried Bartenstein, an extraordinary French teacher entered into my life; someone who was for the first time able to motivate me to get engaged in school, but also the beauty of French literature. My Gymnasium was bi-lingual (meaning I would also earn a French baccalaureate, besides my German Abitur to enter a university in either country). He was in his mid fifties, a connoisseur of the French food, wines, literature, history, and culture in general, and a great teacher, with a striking precision his intonation of French language. I was too young to appreciate the depth of Bartenstein’s knowledge, as I still read his notes today in the many novels we read I class, like “le Rouge and le Noir”, “Les Miserables”, “Madame Bovary”, “L’Etranger”, ”La Peste”, etc. I went on to read everything I could.
 

He would use his humor to maximum effect, like when on school trip to the Provence, one of the girls, spurned by one the boys had threatened to commit suicide. (In America, counselors descend like vampires – in one of those disgusting American habits). One night, she found her way to a local lake, and as she was about to walk into the lake, he casually walked up to her, and commented: “would you like me to join you?” That broke her down, she laughing at the silliness of it all, changing her outlook on life forever.
 

Spring 1981 brought graduation, preparing for the ETH (Swiss Federal Institute of Technology) entrance exam, and tragedy, when his wife of 20+ years left him for a younger man. She was his opposite: superficial, gossipy, and pseudo-everything. He was quite embarrassed about her, though his real tragedy was he let her control him.
 

After she left, he could have just moved on with his life; instead, he started to get depressed and soon all he did was to imagine money, housing, and retirement problems, mumbling to himself, being at home most of the time. His colleagues treated him like a pariah, and students only whispered about him. 
One day, he did the predictable – he tried suicide. Oh the irony of it all!!!


The authorities immediately confined him to a mental hospital, and for a time I thought he really had gone insane, believing that other patients were to steal his underwear and the nurses were out to kill him (that was just a few years after “One Flew Over the Cuckoo's Nest” was released).  I could have never just left him in these terrible surroundings. Therefore, with my parents’ encouragement, during the summer of 1981, every sunny afternoon I would go to the mental ward, to wheel him around for hours through the green parks that circle Cologne. His face was usually ash fallen, in fear, glancing around, sometimes we would rest, his frame shrunk in a bit, and the sun on his face. I would ask him questions, sometimes he would answer, but mostly he was quiet.


A few years later, during a warm summer day, my mother and I visited him again – where his children confined him to a tiny room under the roof of one of these huge pre-century buildings, with fifteen-foot ceilings, and central wooden staircases  – and his children taking up residence on most of two floors below (incl. the one that was his former home). Dirty clothes, used dishes all over, and where it not for the open sunny window, despair would just dominate the place. There he was, unshaven, shrunk, and his eyes deep-set, with a hint of urine hanging around.


This was all that remained of that giant of a teacher, literally sitting on and surrounded only by the remnants of his former impressive library of thousands of his books – where was the rest of his enormous library? Given away I am sure. I remember his embarrassment at us seeing him in this condition, then a bit of small talk, especially with my mother.


To my utter amazement, he remembered my questions from our trips in the park, and he profoundly thanked me for the daily trips. His description of the little details of the wards, and our trip confirmed made it certain that he in fact did remember.
 

I deeply regret missing to talk to him that day longer, because he committed suicide a short time later. I wanted to ask him so many questions, about his childhood growing up on the border with France, right next to a concentration camp during the war. He told the story how he once got too close to look, and was caught by the Nazi guards, and getting scared to death, especially because his parents were known liberals, and then in 1981 not having the strength to move on with his life…
 


Besides the tremendous influence on my appreciation of language, he had a far deeper influence on my life: he validated my identity, really telling me enthusiastically how much he appreciate that my mother was Japanese. Racism and school bullying (also by teachers)in Germany  against Orientals in the 1960’s to mid 1970’s was the norm.

*****


I just talk my time away, my voice gaining ground, and I am gaining confidence in French, remembering my great teacher. I cannot get it right, but at least I try. The clock seems to barely move, so I dig in, and talk more, gaining confidence. Last time I saw him, I talked to him in French, and his voice was still in me, with passion, broken somewhat, but it was still there.
 

The smiling nurse comes in again. She seems to study me, this time again with a smile, but looking a bit concerned.

“Please be quiet, you are disturbing the other patients.”



“Is my voice so loud?” 

 
“Yes, others are trying to rest and sleep.”


I am proud of myself, but I want to be considerate too, so I smile and tell her that I will try. 
 
 
If she just knew whom in my life, she was talking about… Maybe I should tell her. I quiet down, but not only do I continue to recite French poetry (as Mr. Winifried Bartenstein’s voice remains forever etched in my mind).
 

“Please bring me something to drink.” I ask of her – I am incredibly thirsty. Afterwards, she removes a bag filled with my urine from below my bed, nods approvingly, and then tugs me in bellow my blankets. 

I continue with my recital of my language skills, and finally time moves, rhythmically, faster, and my
words and sentences are getting more surefooted.
 
 
In between, I find time to sleep. Suddenly, there is the smile again, and the smile steps forward into the room: “Please sleep”, more desperate, yet less of a request more of a command. I look at her. I nod.
She asks the standard question about pain: if I have any.
“None, I almost never have pain”. She is satisfied. 

 
Soon, I fall into a quiet netherworld between sleep and wakefulness. 


 
The clock has moved to almost two-thirty as I awake. Commotion outside, and my curtain is halfway open. I see another patient in the berth opposite to mine, unshaven, maybe mid-fifty, still on his transport gurney. He must have just arrived, or maybe he is about to leave? I decide it was the former. I study him closely. He looks barely alive, his eyes empty.

 
“Do I look like this?” No, I decide! 

 
For the first time I feel around my head, my left side feels normal – the right is shaven (whoever did this clearly has a great sense of style – I already like it), and there is a narrow bandage running down the right side of my head. No pain whatsoever.

 
I press the call bottom. The smile appears.
   

“What is going on outside?” 

 
“New patient, sorry need to leave”, and then the smile joins the commotion.

 
Thinking of having a punk haircut, I go into a faster rhythm, talking for a while in English mostly, suddenly remembering Robert Frost “Meeting and Passing”. 

 
Both joy and gratitude to be alive fill me.

 
The smile comes again after a while.

 
“The other patients are complaining about your noise level“ she pleads this time.

 
“Can you please close my door”

 
“I cannot do this.” 

 
Of course I know, she must keep the door open, to observe me.
 
 
“I have never been so happy and grateful to be alive. This was my second glioblastoma resection in five months.” I tell her. “Please understand”. 
 
 
The smile comes over, hugs me carefully. I ask for her name, but forget it. What is more important the human connection of that moment.

 
She whispers: “Please just keep it down”


“Thank you for your kindness and understanding” I say.

 
This time she smiles broadly. Maybe she will remember me, I wonder. Sometime today, she will have a new patient to care for. I look at her as she leaves – the sliding door almost closes. 
I continue with my monologue. I try anything, songs. I try the Beatles. “Yesterday” jumps to mind. Damned, I dismiss it in a millisecond. I am livening in and for the future, not yesterday, I decide. 

 
Slowly as the waking hours of February eighteenth creep up to, I continue my monologue. 

 
After a while, I ask for breakfast. Nope, but I do get a cup of applesauce. I ask for more. I get a second, a third cup. Soon I clean out the station’s refrigerator. I should have told my parents to leave a lot of food for me. 

 
Finally, dawn rises, I ask the smile to open the curtain, so I could see the dawn. 
 
 
“There is only a wall where you are looking at.“

 
“No window close by?” 

 
“Nope” I was totally off.
 
 
Soon I ask about doctor rounds. “Dr Parsa will be here shortly” the smile tells me. I continue my monologue, while I also intently listening to the beeps behind me, as well as the cacophonies of voices, machinery, and that of a waking hospital. Time passes, but for an instance, everything seems to be quiet. I hear steps right outside my bay, and as the curtain pulled back, Andy Parsa steps into my bay. 

“Look at you!” he exclaims with excitement, his hand pointing my way, his face lightening up, with a broadening mischievous smile, his eyes sparkling with utter delight. He steps forward.
 
 
“Thank you Andy. How did the operation go?”
 
 
He goes on to explain that there was a section of the tumor (~3-5% of the tumor) he had to leave in, because taking it out would seriously risk to permanently damage my brain.

“You still want to participate in the clinical trial?”
 
“Of course, and also whatever else it takes to get there.”


His smile broadens even more. We exchange only a few more sentences, and just like that, he is gone…