Charles George Drake

“My little thing,” he said. The hand was held outward, as if in benediction.

With a fluid motion borne of years making similar maneuvers in darkened rooms, the scrub nurse located and carefully placed a small dissector, a delicate, flat-edged spoon the width of the tip of a ballpoint pen, into Drake’s right hand. Guided by that hand, the dissector entered the valley, and then descended down along the beam of light, and into the depths.

“Mm, nice dissection, Howard,” he complimented the young American. “Huh, look at that leash of perforators,” he cautioned, pointing with his dissector towards several tiny, yet critically important, vessels feeding the woman’s brain. “Those little fellas are stuck to the back of the aneurysm, aren’t they? What are we going to do?”

“Yes sir, very stuck. I don’t know if we can get those freed up,” the resident said, now peering through the observer side oculars on the microscope, and probably relieved to be no longer personally putting the woman’s future at risk. It’s in the boss’s hands now, he may have been thinking.

“Well, maybe we can tease those little perforators away,” Drake said, his right hand making small turning and back-and-forth movements with the dissector, while the left hand held the tiny suction instrument steady.

“Uh-oh, look what I’ve done.” A small vein was torn and bleeding freely. “God’s teeth!” he muttered, handing the dissector back to the nurse, eyes fixed on the bleeding point while holding his suction steady. “Can you give me some of the stuff the boys like?”

The scrub nurse gave him a long, tweezer-like instrument with blunt tips, the tips holding a tiny wad of filmy material. It was oxycellulose, or as he liked to call it, “God’s gift to neurosurgery.”

With the wad applied to the bleeding point, the oozing of blood settled. As it stopped, the surgical suction tubes ran quiet. Only the dimmed, regular sound of the cardiac monitor, muffled on the far side of the surgical drapes, and the periodic heaving sound of the breathing machine, each breath punctuated by a final soft click, disturbed the dark silence.

“That’s better. Well, give me a clip, then.”

The nurse, watching the events unfold on a monitor straight ahead of her, discerned that a 7- millimeter aneurysm clip would probably be what he wanted. She set the clip, a tiny version of a clothespin, into a holding tool that looked like a long narrow sugar tongs. Drake began applying the clip onto the aneurysm. As he carefully eased the clip blades closed across the aneurysm’s neck, the aneurysm became strangled, and stopped throbbing. The blood no longer pulsed in and out of it. The aneurysm looked dead. There was a momentary pause. Everyone in the room exhaled.

Drake handed the now empty clip holding tool back to the nurse.

“Pig sticker?” he said.

She took a very long, very narrow needle and attached it to a fine hand-held clamp, allowing the needle to stick out half an inch beyond the teeth of the clamp. She passed the combination to him. Drake took the pig sticker, guiding it down the light beam, rotating it 90 degrees so that he could see the needle tip clearly, and then plunged it into the aneurysm sac. He then withdrew it. Drops of blood appeared at the hole the needle had left in the aneurysm wall. Using his left hand to place the tip of the suction over the hole, the blood drained out of the sac quickly. The aneurysm collapsed, like a balloon when the air is removed from it. It did not refill with blood: the clip was doing its job. A permanent cure. Using the little dissector again, Drake looked around the shrunken aneurysm sac, making sure all of the nearby arteries, large and small, were not pinched by the blades of the clip. None were. Handing the suction back to Howard, and the dissector back to the scrub nurse, he stepped away from the microscope. Kamala untied the back of his gown. “Thank ya,” he said. Then to his anesthesiologist: “Pirjo, are you happy?”

“Yes. Dr. Drake, very happy,” came her reply.

That was an easy case, he may have thought to himself. She will do well. Wish they were all like that. He picked up his pencil and paper, and walked over to the X-ray view boxes, to begin tracing the X-ray images of the aneurysm onto a piece of paper for his records.

~~~~~

When one hears the name Drake, one probably thinks of a hip-hop innovator and rapper. Or maybe one thinks of Sir Francis Drake, a daring explorer of the 16th century British Empire. This is the story of a different Drake, a remarkable individual named Charles Drake, a Canadian brain surgeon. By the 1970s, when Drake was in his fifties, his skills were renowned. He was the best in the world at treating brain aneurysms.

Drake’s most famous patient was the American jazz singer and actress, Ms. Della Reese. In 1979, during a taping for The Tonight Show Starring Johnny Carson, Ms. Reese suddenly collapsed. She’d had a brain hemorrhage. It was a rupture from an aneurysm, a weakened outpouching on one of her brain arteries. Surgeons in Los Angeles thought her surgery would be high risk. So they sent her to the best place for that surgery, worldwide – not somewhere else in the United States, not to Europe, but to London, Ontario, Canada. They sent her to the best aneurysm surgeon, Charles Drake. This is his story, and the story of the operation he developed and perfected.

An aneurysm is like a blood blister. Between 5 and 10 per cent of people have one. More women have them than men. Each year, about one in ten-thousand people have a rupture from one. A classic scenario is during stress, or during straining, for example during an orgasm, or soon after. Thirty per cent die. Many die almost instantly.

The doctor who led, and later inspired, the greatest advances in the care of brain aneurysms was a man of humble origins. For the most complex brain aneurysms, he rose to become the greatest surgeon that the world had ever seen, or may ever see again. Surgeons from around the world, even those having learned how to perform the operation he developed, continued to send their patients to him. Almost 2000 aneurysm victims came to him over three decades. They came from throughout North America, from Italy, from Scandinavia, from the subcontinent – one at the personal request of Indira Gandhi. They came to little-known London, Ontario. As Drake used to direct them, “you just go to Toronto...and turn left.”

Being a brain aneurysm surgeon can be an unforgiving, even nasty, career. Within the broader discipline of neurosurgery, aneurysm surgeons tend to work even longer hours, and their work entails the highest risk of causing lasting harm to another human being. It attracts strong-willed, self-centred and ambitious individuals. Some are narcissists, which can be a disruptive situation for colleagues. Despite his spectacular success, Drake remained personable and humble, never seeking the limelight. He always supported new ideas and new techniques, even near the end of his career, when a new aneurysm treatment was invented that ultimately led to the virtual disappearance of his remarkable operation, and of most open surgical aneurysm operations throughout the world. Just as remarkably, that new treatment was brought about by one of his favourite protégés, someone also part of this story, who Drake had helped train, and someone he inspired to change things for the better for aneurysm victims.

This is a story of leadership and team building. Drake recruited and helped lead a team that became the best in the world at what they did, not only with brain aneurysms, but with a whole host of diseases affecting the brain and its vital connections.

The story begins a little over 100 years ago in Canada’s motor city, Windsor, Ontario, across the river from Detroit, in 1920...