Malcolm Gladwell / The New Yorker
Early one recent morning, while the San Francisco fog was lifting from the surrounding hills, Charlie Wilson performed his two thousand nine hundred and eighty-seventh transsphenoidal resection of a pituitary tumor. The patient was a man in his sixties who had complained of impotence and obscured vision. Diagnostic imaging revealed a growth, eighteen millimetres in diameter, that had enveloped his pituitary gland and was compressing his optic nerve. He was anesthetized and covered in blue surgical drapes, and one of Wilson’s neurosurgery residents — a tall, slender woman in her final year of training — “opened” the case, making a small incision in his upper gum, directly underneath his nose. She then tunnelled back through his nasal passages until she reached the pituitary, creating a cavity several inches deep and about one and a half centimetres in diameter.
Wilson entered the operating room quickly, walking stiffly, bent slightly at the waist. He is sixty-nine–a small, wiry man with heavily muscled arms. His hair is cut very close to his scalp, so that, as residents over the years have joked, he might better empathize with the shaved heads of his patients. He is part Cherokee Indian and has high, broad cheekbones and large ears, which stick out at almost forty-five-degree angles. He was wearing Nike cross-trainers, and surgical scrubs marked with the logo of the medical center he has dominated for the past thirty years — Moffitt Hospital, at the University of California, San Francisco. When he was busiest, in the nineteen-eighties, he would routinely do seven or eight brain surgeries in a row, starting at dawn and ending at dusk, lining up patients in adjoining operating rooms and striding from one to the other like a conquering general. On this particular day, he would do five, of which the transsphenoidal was the first, but the rituals would be the same. Wilson believes that neurosurgery is best conducted in silence, with a scrub nurse who can anticipate his every step, and a resident who does not have to be told what to do, only shown. There was no music in the O.R. To guard against unanticipated disturbances, the door was locked. Pagers were set to “buzz,” not beep. The phone was put on “Do Not Disturb.”