Egan was a friend of Muizelaar’s, and, like Terri Bradley, he had exhausted the standard therapies for the disease. The tumor had spread to his brain stem and was shortly expected to kill him. Muizelaar cut out as much of the tumor as possible. But before he replaced the “bone flap”—the section of skull that is removed to allow access to the brain—he soaked it for an hour in a solution teeming with Enterobacter aerogenes, a common fecal bacterium. Then he reattached it to Egan’s skull, using tiny metal plates and screws. . . as the consent form crafted by the surgeons, and signed by Egan and his wife, made clear, the procedure had never been tried before, even on a laboratory animal. Nor had it been approved by the Food and Drug Administration. The surgeons had no data to suggest what might constitute a therapeutic dose of Enterobacter, or a safe delivery method. The procedure was heretical in principle: deliberately exposing a patient to bacteria in the operating room violated a basic tenet of modern surgery, the concept known as “maintaining a sterile field,” which, along with prophylactic antibiotics, is credited with sharply reducing complications and mortality rates. “The ensuing infection,” the form cautioned, “may be totally ineffective in treatment of the tumor” and could cause “vegetative state, coma or death.”It makes some kind of medical sense. Healthy, well organized tissue is pretty good at resisting bacterial infections, while disorganized, and often metabolically abnormal cancer tissue might be lacking in the ability to resist common infections.
For four weeks, Egan lay in intensive care, most of the time in a coma. Then, on the afternoon of November 10th, Muizelaar learned that a scan of Egan’s brain had failed to pick up the distinctive signature of glioblastoma. The pattern on the scan suggested that the tumor had been replaced by an abscess—an infection—precisely as the surgeons had intended. “A brain abscess can be treated, a glioblastoma cannot,” Muizelaar told me. “I was excited, although I knew that clinically the patient was not better.”
. . . for decades talk has circulated in the field about glioblastoma patients who, despite hospitals’ efforts to keep the O.R. free of germs, acquired a “wound infection” during surgery to remove their tumors. These patients, it was said, often lived far longer than expected. A 1999 article in Neurosurgery described four such cases: brain-tumor patients who developed postoperative infections and survived for years, cancer-free.Unfortunately, it didn't work out in the end. The patients all died after various lengths of time, and the doctors got in trouble for violating all the rules.
Three of the patients were infected with Enterobacter, the fecal bacterium, and although the cases were anecdotal, and the alleged connection between the bacterium and survival was unproven, the notion became operating-room lore. One neurosurgeon, currently in private practice, told me that his former boss would joke during operations, “If I ever get a GBM, put your finger in your keister and put it in the wound.”
But patients with no hope need to be free to allow doctors to try new therapies that offer some slight chance of success, and some way needs to be found to prevent their heirs for suing the doctors and hospitals after the fact, if, as will likely happen in most cases, the results are less than sterling.
