A Physician’s Clinical Diary-Episode 47: A Lonely Flower in the Crevices of the Mind(2)
120 Days Fighting the Solitary Fibrous Tumour of the Dura
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[Progression: The Silent War]
The Language of Cells
Surgery often feels like victory.
But true judgment belongs to pathology.
Three days after the brain tumor surgery for Dural Solitary Fibrous
Tumour (SFT), Minseo regained consciousness in the intensive care unit. Her
pupils responded symmetrically. Her motor strength was intact. Neurological
examination revealed no new deficits.
Technically, the operation had been a success.
Emotionally, however, the war had only begun.
When I entered her recovery room, she looked at me with eyes that carried
a fragile blend of relief and terror.
“Is it gone?” she asked.
“The tumor has been completely removed,” I said gently. “Now we must
confirm exactly what kind of tumor it was.”
Her husband leaned forward anxiously.
“You already know it’s that… SFT thing, right?”
“In medicine,” I replied carefully, “radiology suggests. Pathology
confirms.”
📚 Medical Insight
The Cold Courtroom
The pathology laboratory was quiet—eerily detached from human suffering.
Slices of Minseo’s tumor were fixed in formalin, embedded in paraffin, and
stained with hematoxylin and eosin. Under the microscope, the tumor cells
formed a pattern pathologists call a “patternless pattern”, interwoven
with branching vascular channels known as staghorn vessels.
Later that afternoon, I met Dr. Han, our senior neuropathologist.
He adjusted his glasses and rotated the microscope lens.
“Classic SFT morphology,” he said calmly.
He continued,
“CD34 strongly positive. STAT6 nuclear staining is positive. Mitotic count
low. This is WHO Grade I–II spectrum.”
I exhaled slowly.
A low mitotic count meant slower tumor proliferation. A favorable prognostic
indicator.
But SFT carries an unpredictable biological personality.
Some remain dormant for decades.
Others return without warning.
Delivering the Verdict
Breaking medical news to families requires a delicate choreography between
truth and hope.
Minseo sat upright in her hospital bed, clutching a blanket as if it were
an anchor.
Her daughters were not present. She had chosen to hear the results first.
“The diagnosis is confirmed,” I began.
“You have a Dural Solitary Fibrous Tumour (SFT). It is rare but
treatable. The tumor has been completely removed. The cellular activity suggests
a lower-grade tumor.”
Her shoulders relaxed slightly.
“But…” she whispered.
She understood instinctively.
“But SFT is known for recurrence,” I said honestly. “Sometimes even years
later. In rare cases, it can metastasize to lungs or bones.”
Her husband inhaled sharply.
“So the nightmare isn’t over?”
“It becomes a long-term surveillance journey,” I answered.
📚 Medical Insight
Minseo remained silent for several seconds.
Then she spoke softly.
“So… I will live with a shadow?”
“Yes,” I replied.
“But shadows exist only when there is light.”
Rehabilitation of the Mind and Brain
Postoperative recovery from brain tumor surgery is not solely
neurological. It is a psychological reconstruction.
Minseo developed transient cognitive fatigue, a common postoperative
phenomenon due to cortical compression recovery and cerebral edema resolution.
During her rehabilitation sessions, she struggled with memory recall
exercises.
“I used to catalog thousands of books,” she sighed. “Now I forget simple
words.”
I reassured her,
“The brain heals gradually. Neuroplasticity allows surrounding neural
networks to compensate.”
📚 Medical Insight
Neuroplasticity refers to the brain’s ability to reorganize neural
pathways after injury or compression. Cognitive rehabilitation plays a crucial
role following the removal of intracranial tumors such as Dural SFT.
One afternoon, I overheard her speaking to the rehabilitation therapist.
“I’m scared I won’t be the same mother anymore.”
Her voice cracked.
The therapist responded gently,
“Children don’t need perfect mothers. They need present ones.”
I wrote that sentence in my clinical journal that evening.
The Family’s Invisible Trauma
Medical textbooks rarely mention the suffering of caregivers.
Minseo’s husband, Jisoo, visited daily. He asked detailed medical
questions—often repeating them as though repetition could build certainty.
One evening, he stopped me in the hallway.
“Doctor… can stress cause tumors?”
“No,” I answered gently. “There is no proven causal relationship between
emotional stress and Dural Solitary Fibrous Tumour formation.”
He nodded slowly.
“I kept telling her to rest more. I thought it was my fault.”
Guilt is a silent epidemic among caregivers.
I placed my hand on his shoulder.
“You did exactly what loving husbands do. You stayed.”
He lowered his head.
The Children’s Questions
Two weeks later, Minseo’s daughters visited the hospital.
The younger one clutched a stuffed rabbit. The older one tried to act
brave but avoided eye contact with the surgical scar hidden beneath her
mother’s hairline.
“Did the doctor remove the monster from your brain?” the younger daughter
asked.
Minseo smiled gently.
“Yes. But the doctor says we must keep watching to make sure it doesn’t
grow back.”
The older daughter turned to me.
“Will Mom die?”
Children ask questions adults fear to articulate.
“I am doing everything possible to help your mother live a long life,” I answered
carefully.
She nodded, absorbing the answer with premature maturity.
The Follow-Up Scan
One month after surgery, Minseo underwent her first postoperative MRI.
Radiology is a peculiar emotional landscape for neurosurgeons. Each pixel
can resurrect nightmares.
The scan appeared on my screen.
No residual tumor.
No postoperative hemorrhage.
Minimal edema.
I felt the familiar surge of restrained relief.
When I showed her the images, she stared silently.
“That empty space…” she said.
“Yes,” I replied.
“That is where the tumor once lived.”
She touched her temple thoughtfully.
“It feels strange… knowing something tried to grow inside me without
permission.”
📚 Medical Insight
Complete resection of Dural SFT is the most significant predictor
of long-term survival. However, lifelong imaging surveillance remains mandatory
due to unpredictable recurrence potential.
The Return of Ordinary Moments
Recovery rarely announces itself dramatically.
It arrives disguised as small victories.
Minseo returned home after six weeks.
She sent me an email later that night.
“Doctor, today I cooked dinner for my family for the first time since
surgery. The smell of garlic and sesame oil felt like breathing again.”
I reread the message multiple times.
Medical success is rarely measured in survival curves alone.
Sometimes it is measured in cooking oil and family laughter.
The Doctor’s Private Doubt
Physicians are trained to project confidence.
But uncertainty follows us like a second shadow.
Late one night, I reviewed Minseo’s pathology slides again. SFT tumors
possess unpredictable molecular behavior despite benign histology.
“What if it returns?” I wondered silently.
Medicine is built upon probability, not certainty.
I closed her file carefully.
Then I wrote in my journal:
“Hope is not the absence of risk. Hope is the courage to coexist with it.”
The Sixty-Day Mark
By postoperative day sixty, Minseo resumed part-time work at the library.
She visited my clinic wearing professional attire rather than patient
clothing.
“You look different,” I told her.
“I feel different,” she replied. “Not healthier. Just… more awake.”
She paused thoughtfully.
“Before the tumor, I lived automatically. Now every morning feels
borrowed.”
📚 Medical Insight
Patients surviving rare brain tumors such as Dural Solitary Fibrous
Tumour frequently experience post-traumatic growth, a psychological
transformation characterized by increased appreciation of life and
interpersonal relationships.
The Hidden Contract Between Doctor and Patient
During her routine neurological examination, she suddenly asked,
“Doctor… do you ever get tired of fighting death?”
I considered the question carefully.
“Yes,” I answered honestly.
“Then why continue?”
“Because sometimes we win,” I said quietly.
She smiled.
“Then I guess I am your evidence.”
Approaching the 120-Day Horizon
By day ninety, Minseo demonstrated complete neurological recovery. Her
cognitive testing scores normalized. Her visual disturbances had disappeared
entirely.
The upcoming 120-day follow-up MRI carried symbolic weight. In
neurosurgical oncology, early postoperative stability significantly predicts
long-term outcomes.
The day before the scan, she messaged me again:
“Tomorrow feels like judgment day.”
I responded:
“Tomorrow is simply another chapter.”
To be continued!
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