Articles about Dr. Ghaly

Ten years after losing his small son to a brain tumor, Jim Boland calls upon HIS UNDYING FAITH as he finds himself facing his own lethal brain cancer

November 26, 2006
Sunday Beacon News

Story by Angela Fornelli
Staff writer

Jim Boland's eyes are closed, his head leaned back on the pillow. "The body of Christ," the woman said, lifting a wafer of bread in front of him.

Slowly, Jim opened his lips, just wide enough for the bread. He didn't have the strength to say "Amen" before taking his communion. Soon, he will only be able to swallow the tiniest of pieces, and the remainder will be given to Debbie, his wife of almost 27 years.

Debbie Boland tends to her husband Jim in their home in Batavia. Jim lost his long, spirited battle with cancer in October, two weeks before his 49th birthday.
(Craign Watson/Staff photographer)

Family members gather in the neurosurgical office of Dr. Ramsis Ghaly, where he explains the details of their father Jim Boland's relentless brain tumor.

But he would keep receiving it, every morning, just as he has for the past year and a half. It is what has kept him alive. It is his strength, his hope, his everything.

Jim and Debbie know what is to come. They've been through this before, with their 6-year-old son Mitch. The boy, too, was in a hospital bed in that same family room for months as an aggressive tumor slowly took over his brain. He, too, fought every morning to tell Debbie he loved her -- even if it was just with his eyes. He, too, pledged to stay alive.

As Jim's time drew nearer to the end, those memories of Mitch from more than a decade ago began repeating in Debbie's mind. She remembered that night she told her little boy he no longer had to hang on for her, and that God would take care of him in heaven.

Debbie remembered cradling her son for five hours after he drew his last breath -- until Jim told her it would be OK, that it was time for Mitch to be taken away.

This time, Debbie was afraid, Jim would be the one to be taken away, and he wouldn't be there to tell her it would be OK.

'Borrowed Little Angel'
In the year and a half since Jim was diagnosed, the sadness of Mitch's death has felt all too present for this Batavia couple, who had five surviving children. But they also knew Mitch was with them as their angel. They took it as a sign, on the day Jim was diagnosed, when they saw a statue of dolphins in the hospital courtyard: Mitch swam with dolphins shortly before he died, and the family adopted the animal as a symbol for the boy.

From then on, Jim and Debbie knew their "Borrowed Little Angel" -- as was inscribed on Mitch's gravestone -- would continue to be their angel in death. Jim and Debbie believe Mitch led them to Dr. Ramsis Ghaly, an Aurora brain surgeon known for his deep faith in God and his belief in doing everything possible to preserve life. Twice, during Jim's battle with his cancer, Ghaly performed radical procedures that many surgeons wouldn't do: Jim had the most cancerous, most aggressive form of tumors, and they were already showing signs of spreading. By the books, operating would only extend Jim's life for a couple months, at most.

"These two beautiful people always had faith," Ghaly said of the Bolands. "They'd say, 'We're not going to give up.'"

Little more than a year after his first surgery in January of 2005, the cancer spread to the other side of his brain. Those tumors were then removed, and Jim survived for nearly another seven months. In his medical reports, Ghaly repeatedly called it "miraculous." He knew it was not his masterful surgery skills keeping Jim alive; it was Jim's faith.

Messages of support
Jim and Debbie came home after Jim's first surgery to find 43 messages from friends and family on their answering machine. "People from everywhere are just praying, and that's what he needs," Debbie later said.

In the year following that surgery, Jim grew even closer to the God he'd been faithful to his whole life. Every morning, when he woke up, he'd make a sign of the cross over a photo of Jesus, Mary and Joseph that hung in his bedroom. On his way down the stairs, he'd kiss the painting of Mitch that hung in the hallway.

He and Debbie went to 8 a.m. Mass every day. They went to a healing Mass every Tuesday night at Holy Cross Church in Batavia, and said the rosary with a group every Wednesday night.

Much of the time, Jim would focus his prayers not on himself, but on others. "He used to come pray for my son who had cancer," said Mike Riordan of Batavia, a friend from Annunciation Church. "That's the kind of guy he is."

On many days that year, Jim was able to make it to his job as a carpenter -- a vocation that 15 years prior allowed him to build his home in Batavia. He traveled as much as possible with the kids and Debbie, who works for U.S. Airways. Often, Debbie was able to get off work to take care of her husband.

That summer, more than 600 people showed up to a benefit held in Jim's honor.

Health, then new tumors
Every few months, Ghaly checked the progress of Jim's tumors. With each MRI, to Ghaly's surprise, Jim's brain was clear. At least for the first 14 months. But on Ash Wednesday of the next year, Jim found out two massive cancerous tumors now covered the majority of the right side of his brain, and another was growing on the left.

This time, Ghaly told the Bolands not to "waste a lot of time searching for the impossible." Jim could refrain from surgery and live another week or two in peace, or get the procedure -- at the risk of coming out without the ability to read, talk, write -- but live for about a month.

After they learned the news, Jim and Debbie left Ghaly's office to go to Mass at Annunciation in Aurora -- the church they've attended since they moved to the area about 12 years ago. Afterward, they got second and third doctors' opinions, and returned to the hospital in the afternoon.

Jim would have the surgery.

"He made it clear," Ghaly said. "He said, 'Dr. Ghaly, I want to live -- if even for two more weeks -- I want to be with my kids.'"

That night, in the hospital room, Jim and Debbie looked out the window as the sun set on the lake. "God, I'm not ready yet," Jim prayed, the ashes in the shape of a cross still on his forehead from the morning's Holy Day Mass. "Give me another year here."

He turned to his wife and told her he has always loved her and how he looked forward to renewing their vows later that month. "It's you and me forever, and I'll always take care of you," he told her. "Don't ever be mad at God."

Through all of this, Jim and Debbie have never asked, "Why me?" They've never blamed God. "We say so many prayers, and you just feel like they're going to be answered," Debbie said that evening.

By the time Jim was taken for his MRI that Ash Wednesday, the children had arrived at the hospital from Annunciation School. They, too, had ashes on their foreheads. "We can pray for Dad now," said Ryan, 7, as he climbed onto the now-empty hospital bed. Debbie joined him, cradling the child in her arms.

"I'll say the Our Father, you say the Hail Mary," 9-year-old Thomas told his brother.

And so they prayed, the two boys, their mother, and their three sisters. "God bless Daddy," Ryan said when all the prayers were completed.

Renewing their vows
Jim survived the surgery and, two weeks later, the Bolands -- high school sweethearts -- renewed their vows. The couple had grown closer than ever throughout the last year. They knew there wouldn't be much time left, but they tried not to think about it. "It hurts too badly to think about it," Debbie said. "I can't imagine my life without him."

That summer, Jim's memory slowly began to fade. He wasn't able to concentrate, couldn't always get words out. Sometimes he'd stand in front of the mirror and brush his hair over and over. Sometimes he would leave the stove on or the water running when he got out of the shower.

Tumors had now spread to all corners of Jim's brain. But Debbie made sure her husband stayed active. A couple of times, he tried to play catch in the backyard with Ryan and Thomas. "He couldn't get up off his knees," Debbie said. "But he tried; he tried."


As summer drew to a close, Jim talked a lot about heaven.

"He said, 'It's going to be beautiful,'" Debbie remembers. "'I'm going to see Mitch, and I'll give him a big hug and tell him how much his mom loves him.'"

Debbie could sense Jim knew his time was coming. One morning after church in mid-August, while the couple was at the Waffle House in Batavia, she asked Jim if he felt his condition was worsening.

Jim told her, "Just like summer is going to end soon, this is going to end."

Soon after, they visited Ghaly, and together, they decided it was time to bring hospice care into their home. The hospital bed was placed in the center of the family room, where Mitch's once stood. Lying there, his vision failing him, Jim would face the spiritual candles, statues of dolphins and family photos that decorated the fireplace.

On the first Wednesday evening after he came home, Jim was motionless as 30 people from his rosary group gathered in his home. Tim McLean kneeled next to his dying friend and told him how inspiring he has been to everyone, and how powerful an example he set when he came to Mass last Sunday.

With a strong gasp for breath in between each word, Jim replied, "I'm thankful that I can be here."

Debbie sat next to her husband, holding the rosary made from the roses that had been at Mitch's funeral. Quietly, she said the prayers as she twisted the beads between her finger and thumb. Jim remained still, holding the crucifix in his palm, his eyes watching the beads dangling from his hand.
'Lord hear our prayer'
The prayers for Jim continued.

Annunciation Church's annual Luminary Mass, held in honor of all those who've been "a light in our lives," was dedicated to the Bolands. Although Jim was unable to make it to the Mass, hundreds of people gathered around a large, illuminated crucifix that stood between two tall trees in the church's cemetery on a chilly early-October evening. In front of that crucifix was an altar adorned with two candles -- one with Jim's name on it, one with Debbie's.

"We offer this to the Boland family, who have been lights in our lives because of their faith despite their heavy cross," the priest said. "We pray to the Lord."

"Lord, hear our prayer."
Wearing his ring
Eventually, Jim was only able to speak a few words a day: They were always "I love you." On the day before he died, Jim could only squeeze Debbie's hand three times to signify those words.

After he took communion the following morning, Debbie told him it was OK to let go, that she knew he fought hard and she didn't want him to suffer. A few hours later, Jim took his last breaths, just two weeks before his 49th birthday.

Just like with Mitch, Debbie stayed in the bed next to him for five hours before even calling anyone. "I put my arm around his head and just looked at him and looked at him and looked at him," Debbie said.

When it was time to go, Debbie removed her husband's wedding ring and put it on her finger. She planned to wear it forever, just as she still often wears the ring Mitch found for her on the beach of Lake Michigan a couple weeks before he died.
'He wasn't angry'

Annunciation Church was packed to capacity at Jim's funeral Mass. The Rev. Mario Pedi told the story of how, at one of the last masses Jim was able to attend, he knelt and touched the statue of Jesus that sat on the altar. "He knew Jesus suffered more for him and you and me than anyone else," he said. "We need more people like Jim, and we can be, because we heard his words."

Later, at the cemetery, the sun shone brightly despite the weather reports of rain on that mid-October afternoon. "I think all of us know people that help us see God, and Jim is one of those people that helped me see God," said the Rev. Tom Paul, who Jim and Debbie have known since high school. "He wasn't angry even though he suffered and was hurt, but Jim just gave. He gave deeply and sincerely ... He is now our saint."

Debbie wiped the dirt away from Mitch's gravestone, and swiped her hand across the words, "Our Borrowed Little Angel."

"You've got company now," she told her boy as Jim's casket was lowered into the ground.

Wake-up call
Brain surgery gives Joliet woman hope

By Denise M. Baran-Unland
Special to the Herald News

Dulcy Hawksworth, 32, of Joliet, has a passion for community service that is reflected in her numerous outreach activities.

She participates in political campaigns, events that raise awareness for domestic violence and, recently, marketing an Ohio self-esteem and leadership day camp for children ages 9-13.

But Hawksworth's tendency to overschedule and micromanage every minute of her day, including her regular job as an account manager for Storandt Pann Margolis in La Grange, a health care marketing and communications firm, left her unable to pay attention to the subtler, more meaningful aspects of life, until she received the unexpected news that a brain tumor—a meningioma—was causing her severe chronic headaches and that she required immediate surgery.

"I used to think that I'd pay attention to God and schedule him in my life someday when I had the time," Hawksworth said. "The tumor was God's way of saying to me, 'Thou shalt sit.'"

Wake-up call
Benign and slow-growing most of the time, meningiomas can still be life-threatening because as they grow, the tumors can compress brain tissue. Meningiomas account for 27 percent of all primary brain tumors. They develop from the meninges, the protective linings of the brain and spinal cord. They may cause seizures as well as changes in vision and mental functioning.

This proves the point doctors have been making for years: Medical attention is necessary if someone experiences a headache for the first time or experiences a change in existing headaches, said Dr. Ramsis F. Ghaly, neurosurgeon at Rush-Copley Hospital in Aurora, who removed Hawksworth's tumor.

Ghaly said that meningiomas are most common in women aged 40 to 60, with some research also suggesting that women of childbearing age are particularly susceptible to meningiomas than older women or men are. This is due to the influence of the hormones estrogen and progesterone.

At first, Hawksworth was unconcerned about her headaches. She had her first migraine in college. Preceding the headache was an "aura," which migraine sufferers often describe as scintillating light flashes heralding the onset of a migraine. Lying down in a dark room for several hours cured the headache that time.

But as years passed, Hawksworth's migraine headaches accelerated both in intensity and frequency, requiring more medication—as well as an alarming amount of more potent medication—to control them. Desperate for pain relief, Hawksworth also experimented with a variety of natural remedies, including medication, yoga and massage therapy.

Ready for surgery
By May, with severe head pain a constant presence, Hawksworth's primary care physician ordered a CT scan of her brain, which revealed the orange-sized meningioma. Nevertheless, Hawksworth applied her bold and forthright approach to life situations to the meningioma. She interviewed two other neurosurgeons before deciding she wanted Ghaly to remove the tumor.

"I liked his patient care philosophy," Hawksworth said. "I was not just another craniotomy and I knew that the person cutting my head open had a really good plan for my health afterwards and that was comforting."

Hawksworth took a tour of a Rush-Copley operating room. She composed a comprehensive list of questions for both Ghaly and hospital staff about the tumor and the care she required and considered the responses. She wrote a prayer and sent it Ghaly, who read it before beginning surgery, since she would be unable to do so. She even prepared a list of complicated words so she could test her own memory following surgery.

Hawksworth also named her tumor "Snarky the Brain Tumor" and explained to it the necessity of her and it going their separate ways. To pass the time until the scheduled surgery date, Hawksworth even alphabetized her CD collection. Finally, there was nothing else Hawksworth could do but wait and pray.

Tricky operation
While Ghaly's intention was to remove the entire tumor, he was concerned about the tumor's location deep within the middle of her brain, a particularly inaccessible spot. The veins and arteries that control Hawksworth's legs were also in that area and could be damaged during surgery. Additional risks of surgery for Hawksworth included infection, hemorrhage, paralysis, reduction of or loss of smell, vision and speech or even death.

Also of concern to Ghaly was that the meningioma itself showed evidence of recent, rapid growth. Its center had begun to die, proof that the tumor had grown so rapidly that it starved itself of its blood supply, while also releasing toxic chemicals that caused the frontal lobes of Hawksworth's brain to swell.

Yet, during Hawksworth's seven-hour surgery June 12, Ghaly not only removed the entire tumor, he also removed about a two-inch area inside Hawksworth's brain that surrounded the meningioma, just in case the meningioma had infiltrated the brain. The biopsy showed that Hawksworth's meningioma was benign and very slow-growing.

Still, Hawksworth will need regular check-ups with a neuro-oncologist to be certain the tumor remains at bay and MRIs every three months during the first year, every six months during the second year and annually after that. If the tumor shows signs of regrowth, Hawksworth may need radiation treatment at that point. Ghaly also recommended Hawksworth consult a neurologist for her migraine headaches, which may still occur.

Recovering at an astonishing rate, Hawksworth spent only one night in the intensive care unit following her surgery, was moved to a regular room the following day, passed her own memory test and was discharged 24 hours later.

At home, a marvelous support system surrounded Hawksworth that sped her toward full recovery. That system included her family, friends, daily visits from a home health nurse and twice-daily telephone calls from Ghaly himself. Hawksworth returned to work at the end of July. Her most recent MRI showed no tumor, Ghaly said.

Overall undaunted by her frightening experience, a stronger Hawksworth has a clearer vision for community service and a stronger drive to begin her own firm that specializes in non-profit consulting and event marketing. She hopes to bring the Ohio self-esteem camp to the Chicago area next year.

"I'll continue to get involved in causes that I feel are worthy and helpful to society. They just kind of find me, like some divine entity puts them there," Hawksworth said. "I have found that it enriches my own life to share my experience and mentor others. It's a way to put my mark on the future and provide opportunity for people. I am driven by hope. I have consistently found that with hope things can always get better."


Pushing to the edge

The Sunday Beacon News
By Marie-Anne Hogarth

Last year, as a national debate raged over the fate of Terry Schiavo, the Florida woman who has existed in a vegetative coma for more than 13 years, a Fox Valley family faced a similar dilemma: To save their loved one's life irrespective of condition, or watch him die within a matter of hours or days.

They were lucky to have had the choice.

In the early morning hours of Palm Sunday a year ago, as he slept peacefully next to his wife in the bedroom of the log home he built with his own sweat and determination, Dennis Ryan's brain began to die.

Unbeknownst to him, three days earlier the 55-year-old swim coach from North Central College had torn a major artery in his neck as he strained to start an old piece of machinery.

But as he lay sleeping that Sunday morning, this injury to the carotid artery finally stopped the flow of blood and oxygen to the brain enough to cause a massive stroke. It would destroy almost half of Ryan's brain and leave him heading toward certain death.

But Dennis Ryan caught a break. From his home in Lee County, he was taken to Rush-Copley Medical Center in Aurora, one of a diminishing number of community hospitals in an era of skyrocketing malpractice rates where a neurosurgeon still operates on brains.

And Dr. Ramsis Ghaly believes in aggressive intervention, even when hope is slim.

He suggested a surgery rarely attempted so late in the game for a patient with so massive a stroke. In the tree of arteries and vessels that feeds to the brain, Ryan's stroke amputated a major branch, destroying almost 90 percent of the right hemisphere, compared to 5 percent in an average stroke.

Within 24 hours of the stroke, the brain had started swelling uncontrollably, the natural reaction of billions of cells and nerve fibers dying together. The brain became like an animal unable to escape the cage of Ryan's skull. Inside the cavity, the pressure increased. Cells collided, releasing toxic substances, further angering the swelling brain.

Two days after the stroke, Ghaly wanted to open the skull to give the brain more room.

It was not the most radical solution. A handful of physicians might have removed parts of the dying brain, but that would have hurt chances of eventual healing. Other doctors might have done nothing because the prognosis for intervention was so poor.

After years of under-utilizing this surgery, doctors are turning to it again for patients with massive strokes accompanied by swelling, says Dr. Jeffrey Frank, a stroke specialist with the University of Chicago. And preliminary findings from a study he's directing for the National Institute of Health, indicate the procedure might modestly increase chances of survival.

Still, there is the risk patients can fall into a lifelong coma.

Ghaly believed it was a chance worth taking.

"I have learned over the years that you cannot predict, only do your best," the surgeon told Ryan's family. "And if God has meant for him to go, we can always withdraw support measures later."

During those hours, as Ryan's brain boiled and doctors used drugs to keep him from death, the family debated what course would be best.

His daughter, Amy Ryan, flown in from her home in the Czech Republic, feared the worst. Ryan's sisters, including one who said God cured her cancer, wanted to give their brother every chance. Meanwhile, Ryan's wife, Venna ("Vee") Raye considered something her husband once said: He didn't want to live unless he could walk in the fields with his dogs.

"What do I do if he ends up paralyzed?" she worried. "Is he going to hate me, be mad at me?"

As morning broke on the third day, Vee Ryan made the final decision — opting for surgery.

'Angry brain'
As dozens of relatives, student swimmers and coaches gathered in a waiting room, Ghaly went into battle against his patient's dying brain. Assisting in the operation was Dr. Jaweed Sayeed, a personal friend who Ryan was teaching to swim.

During the five-hour ordeal, they removed almost half of the coach's skull and placed it for preservation into a pouch in the fat of his abdomen. This is the same surgery that would be used six months later to save the life of entertainer Roy Horn after he was mauled by a white tiger in Las Vegas.

Outside, Ryan's supporters talked and prayed.

"It was so weird," recalls Stephanie Fameree, a North Central junior and one of Ryan's athletes. "It felt like we were at a funeral or a memorial service."

In the first hours after the surgery, all seemed in vain as doctors watched the pressure inside Ryan's head climb — a sign the operation had failed. When Ryan's pupils no longer reacted to light, the only reason to keep pushing was because the heart and lungs had not stopped.

Alarmed, the doctors performed a CAT scan and talked briefly with the family. Without taking time to alert the O.R. staff or even scrub in the normal fashion, they pushed the patient back into surgery, fully aware that lost time means lost brain power.

They removed more skull to make room for the swelling brain. But each time they suctioned out blood from the hemorrhaging brain and fed Ryan fresh frozen plasma, more blood ran out.

"I remember Dr. Sayeed came out into the waiting room and he was crying," says Vee Ryan. "He sat on the window ledge and said, 'I held the coach's brain in my hands and it was bleeding so much it wouldn't stop. I don't think he is going to make it.' "

When Ghaly could do no more, he induced a deep coma with barbiturates, cooling fluids and blankets to bring down Ryan's temperature to 33 degrees Celsius, the point at which the body loses consciousness.

Then the doctors called off their efforts.

'Like an infant'
Inside the Copley Intensive Care Unit, a team of nurses and therapists pushed past the limits of the health-care system, into the deep recesses of the human brain and to the edges of the human spirit.

Often it would have been easier to call it quits.

For five days they pushed fresh blood plasma into him. Ryan required sometimes as many as two nurses devoted exclusively to his care. He was hooked up to so many heart monitors, IVs and feeding tubes that it took three people at once to move him.

Managing the coma was a constant juggling act. Too much of one drug could help the brain but hurt the heart; too much of another could help the heart but hurt the brain.

"We were watching him on the ventilator, doing the breathing for him. We were drawing labs every hour, titrating different therapies," recalls Robyn Hansen, an intensive care nurse. "He required more care than an infant."

Vee Ryan stayed at her husband's bedside throughout the long days, ignoring her own body's need for food and sleep.

Ghaly knew how vital her role was. Even in this most dedicated of environments there could never be enough eyes watching over this neediest of patients. For a patient this vulnerable, the slightest mistake could mean disastrous consequences.

Over and over, Vee Ryan touched her husband, kissed him, spoke to him. She recounted their dating days, their first camping trip and how they ate potato pancakes and thick-slab bacon on Sundays. Sometimes she played her husband's recorded message on his cellular phone, hoping the sound of his own voice would awaken him.

Often, as the weeks went by, nurse Hansen sat by her side, playing "spirit fingers" over the patient in a giddy attempt at bringing the coach out of his coma and his wife out of the doldrums. Vee Ryan told the nurse how she missed her husband, who used to call her Honey Bunny.

"One of these days, you will hear him say Honey Bunny," Hansen told her.

Hunting for consciousness
Then Vee Ryan got the discouraging news that two EEG tests showed low amounts of activity inside the coach's brain.

She can't remember the doctor's exact words — just that he shook his head a lot.

But she refused to believe her husband would not wake up. She had read that EEG tests are not always conclusive since sweat can disturb sensors. She trusted that somewhere inside her husband's swollen bandaged head there existed some consciousness.

That hope, as tenuous as it was, became significant at crossroads in Ryan's care.

When the drugs that had been used to induce the coma wore off and he did not awaken, for instance, the family did not lose hope. They could have removed the breathing tube then, allowing the coach to die peacefully.

It was appropriate then to question the worth of keeping Ryan alive since he probably wouldn't ever have a quality of life that he would have wanted.

But Vee Ryan never considered letting her husband go. Encouraged by Ghaly, she chose the aggressive option — for doctors to cut a hole in her husband's trachea so the breathing tube, which would eventually cause permanent damage to the tissue and vocal chords, could be removed.

"As a physician and as a Christian, I strongly believe that life should be preserved ...," Ghaly says. "In the end, God's will will dominate."

"I don't force my opinion," he adds. "I give people options."

Meanwhile, therapists who regularly moved Ryan to prevent pneumonia, skin deterioration and muscle atrophy, were teaching the family to stir Ryan with smell, tastes and sound.

In coma stimulation therapy, the patient's responses are measured on a scale called Rancho Los Amigos. How quickly patients move along this scale, says speech pathologist Elizabeth Miller, is one way of predicting if patients will emerge soon from the coma or remain in a "persistent vegetative condition" like Terry Schiavo.

But it is a gray area at what point a person transitions from one state to the other. Some say it can take several months; others talk in years.

At the therapists' direction, Ryan's sister, Kathleen Dunagan, a pediatric nurse from Florida whose work includes rescuing the life of fetuses after attempted abortions, reminisced with Vee about things that would be most significant to Dennis Ryan — like ginger ale or Necco wafers he enjoyed as a child.

They put these objects up to the patient's nose and lips — sometimes defying nurses' orders by placing them in his mouth where they risked entangling in his ventilator. They watched for changes in heart rate and oxygen saturation, twitches in his lips or fluttering of the eyes.

These physiological reactions were meaningful, says Miller, but the therapists wished they were more consistent.

"He was a young guy. He had a lot going in his favor," recalls Miller. "We all wished that he was moving more quickly through the stages."

Vee Ryan wept when she saw her husband's eye roll under its lid after smelling her favorite perfume. "I was very excited," she says. "It gave me hope that he responded to the things that were the most basic or closest to him."

Ghaly considered an even deeper meaning.

He believes in a kind of silent communication between loved ones that sometimes allows them to perceive changes in patients before medical professionals. These inconsistent reactions are like a spiritual vision — hard to quantify but nonetheless important.

"The coma," says Ghaly, "is a beautiful mystery."

After a month, Ryan was transferred to a facility for patients on ventilators. But his wife was concerned, because no single nurse would be exclusively devoted to her husband's care.

But here, the patient began showing signs of wakefulness.

When Dunagan came to say goodbye to her brother — she was returning to Florida to care for her husband who had cancer — she saw Ryan open his eyes.

When Dunagan told him he'd suffered a stroke and fallen into a coma, she felt he understood. Tears streamed from his eyes as she explained she was going home. And then her brother closed his eyes again.

Doctors say open eyes during a coma are common and don't necessarily mean a person is awakening. Still, over the following weeks, Ryan showed more signs of awareness. His eyes tracked movement across a room and he demonstrated purposeful movement on the right side.

His wife, noticing now that Ryan puckered up his lips to drink or receive a kiss, grew more hopeful.

Then, two weeks later, on the first evening Vee Ryan returned to work at Home Depot, she got a telephone call.

Her husband had been rushed to the hospital.

Turning Point
To hear Vee and her mother Pat Hoffmann tell it, the coach lay covered in blood on a gurney in the emergency room at Hinsdale Hospital, his eyes open and struck with fear.

As it turned out, the bleeding, likely caused by an irritation to his stomach lining, was not so terrible to require immediate surgery. Still, Ryan was suffering from dehydration, severe anemia, pneumonia and a staph infection called MARSA, common in people with long hospitalizations.

"These are expected complications of longtime coma patients," says Ghaly. "But they are also how people die."

The danger for Ryan had been averted, but the fear had been instilled in his wife, who continued to worry that after coming so far she would lose her spouse again.

As frightening as that trip was, it proved a turning point, for it was during his two-week stay in Hinsdale's ICU that Ryan truly awakened. He spontaneously moved his arms; his eyes remained open for long periods of time; and he tried lifting his head instead of letting it flop over like a rag doll.

Once, while Ryan watched television, his wife saw him mouth the words she thought she would never hear again: "Honey Bunny."

And then, when North Central College Minister Lynn Pries and Ryan's son Steve stopped by, the coach stuck out his hand so they could shake it.

Another time, while a speech therapist was teaching Ryan to speak using a plastic valve placed over the breathing tube in his throat, she pointed to Vee and asked her patient his wife's name.

"Fred," he answered, panicking his beloved.

"I was so worried he had amnesia, or maybe his brain wasn't functioning, or he knew it was me and couldn't verbalize," Vee Ryan recalls. "I freaked out."

Then the coach looked in his wife's eyes and said, "Pizza Hut," an old nickname from their dating days when they used to eat regularly at the restaurant.

"That's when I knew he was back," she says.


The Journey

By Marie-Anne Hogarth

Dennis Ryan emerged from his coma, a dazed hero returned from battle.

When nurse Robyn Hansen picked up the phone in the Rush-Copley Medical Center ICU, she was surprised to hear the voice of the North Central College swim coach who had spent six weeks in the coma after suffering a massive stroke.

"Hello, Robyn," he said. "This is Dennis."

"We cried," she said of the nurses. "Usually when people are that bad, they pass away or they go to somewhere where they never wake up."

Together with the doctors, nurses and therapists, Dennis' wife Vee Ryan and the rest of their family had helped battle the assault inside Dennis' brain, when his own body turned against him, when his skull held his swelling brain in a siege until it almost suffocated.

They had averted death, but for what kind of life?

Most of Dennis' right brain was decimated. He was like a victor with his homeland destroyed.

Would he be able to coach swimming again? Live in the log home he had built with his own hands? Would he need a wheelchair or a walker, or somebody to look after him?

Would he have the same personality? Be the same man?

Damaged brain
With half of Dennis' right brain so damaged, most of his left side was paralyzed.

The stroke impacted the ability to feel fine sensation and sense of spatial orientation. Dennis would forget where he had placed his arms and legs. He couldn't say if he had been poked with one or two fingers.

The coach could see out of his left eye, but his brain no longer told him to look at the left visual field. He ignored the left side of pages, didn't notice people on the left side of the room, forgot to turn his head in that direction.

Other functions — memory, reasoning and intelligence — were less damaged. They existed in duplicate form in the salvaged half of Dennis' brain, which also enabled him to control the right side of his body.

It was with this left brain hemisphere that the coach could still think, remember, feel emotions.

It was these surviving portions of the brain that could eventually take over the jobs of the parts that died.

It was in here where hope still existed.

Fighting fatigue
Vee Ryan took the helm of her husband's ship. But even as the couple began their journey, pain, fatigue and fear often threw them off course.

Sometimes it seemed a powerful undertow threatened to pull Dennis into lethargy. With one of his major arteries blocked, less oxygen reached the brain. It was as if he were a four-cylinder car operating on three cylinders. He needed to work harder to do the simplest things — chewing, speaking without sounding mechanical, holding up his weakened neck.

But Vee couldn't communicate that urgency to him.

The system demanded Dennis show progress before he could have more therapy. Rehab programs reserve their limited space for those who will most likely succeed. But often the coach stagnated — wanting to do nothing but lie in his bed and be cared for.

Vee needed to convince the professionals her husband could do more if only they pushed him harder.

Stormy seas
After two months of lobbying to have Dennis transferred from the DuPage Convalescent Center in Wheaton to Marianjoy Rehabilitation Hospital, Vee succeeded. There, she knew, her husband would receive more aggressive therapy.

Dr. Richard Krieger, in charge of Dennis' care at both facilities, agreed the change in environment might spur the coach. But two weeks later, Krieger discharged Dennis from Marianjoy because he felt the patient wasn't motivated.

"We tried. The family tried," said Krieger. "They used guilt, fear and love. They tried all of those things. But you can't make somebody do something."

Vee, exhausted from marathon days divided between work and hospital, became enraged upon hearing this news, insisting doctors were giving up on her husband.

"If he doesn't walk, I'd love to know it wasn't because of the insurance or money or because a doctor wrote him off," she said. "I can't think I'm so out of touch that I imagine Dennis improved."

But Krieger argued the decision was not about money. "If the Saudi king came here, ethically we would not take his money if he did not show improvement," the doctor said. "Dennis lost half his brain. Families forget that."

His intention, he added, was not to give up on the patient. "My last words to Dennis were that I hoped he would prove me wrong."

Finding motivation
Dennis' apathy remained a mystery.

The area damaged in his brain — the frontal lobe — prompts a person to initiate action. And many times the chemical imbalance after a brain injury causes depression.

But doctors don't know why some patients work through pain, fatigue and fear while others don't.

Dr. Ramsis Ghaly, the neurosurgeon who had operated on Dennis after his stroke, says the brain does not heal on the same clock as the health-care system. For that reason, patients often slip through the cracks navigating its maze. That's why he believes families become more important than hospital charts in passing on details about patient care — doubly true for those with massive brain injuries.

But Krieger lived in the more tedious world of rehabilitation, which sets standards so patients aren't warehoused endlessly. Dennis was an exceptional patient. But then again, he had already received more therapy than most.

Krieger recommended a nursing home or convalescent center. And while Vee insisted that would be short-changing Dennis, she wasn't ready to provide the 24-hour-nursing care he needed at home.

Streams of people visited, but only a few could be relied upon to help out.

It was the way of a death-obsessed society, said Krieger. People were often more willing to attend a funeral than do the hard work of rehabilitating a person.

Facing fear
The Ryans found safe harbor at Rush Copley Medical Center, where Dennis returned for another surgery. Ghaly would replace the skull piece he had removed from Dennis' head during the efforts to save the coach's life after the stroke.

The weary travelers had come a long way, Ghaly told them. Many never made it this far.

Still, the Ryans were terrified.

On the night before the surgery, two dozen people from the First Presbyterian Church in Rochelle packed into Dennis' room. Vee held tightly to her husband's fingers and wept while the visitors prayed for his recovery.

"You are the greatest of physicians, healer of all," one man called to God. "We pray that you will guide the hand of the doctor in surgery, that it be a successful operation."

As emotions in the room surged, Dennis told his supporters how he heard God's voice when he was in the coma.

"I will heal you," the voice had said. "But you and your wife must spread my word to the young people."

Working through pain
Physical therapist Rious Manabat is a young athletic man with a smile that sets his patients at ease from the start.

But to Dennis, therapists were inflictors of pain. And pain had become Dennis' companion. His damaged brain no longer released the chemical necessary to keep his muscles from becoming stiff and spastic, so they hurt whenever moved or touched. Meanwhile Dennis' weakened joints barely supported his paralyzed limbs. His left arm and leg weighed so heavily that the arm eventually dislocated from its socket.

Drugs might have masked the pain and lulled him to sleep. But Dr. Dennis Keanne, the medical director of Copley's rehabilitation program, felt the patient would never get better if he slept through therapy.

The suffering made it hard for Dennis to recognize his therapist for the kind man he was.

"Please give me a break. Let me off easy," Dennis shouted, "I don't want to swear at you ..."

Fighting fatigue
Fatigue was like a whirlpool that swallows the sea and spits it up again.

When it wore on Dennis, even his wife couldn't skirt her husband's dark moods.

"You don't love me anymore," Dennis said one morning when Vee refused to let him take a nap before therapy at Copley. "You've given up on me because . . . you're going to leave me."

It wasn't true, but Vee was sucked in.

"I stood by you through not being able to have a baby, you going on vacation without me because you were with your kids," she reminded him. "So you think I will leave you now? I would never leave you."

Keanne had said Dennis' stroke meant he lacked even the awareness that he needed to improve. That made Vee's journey all the lonelier.

"I love you more than anything in the world, but I can't motivate you," she told her husband.

"You motivate me each time you see me," he replied. "Now I need a nap."

Under greater pressure
Through it all, Vee struggled to manage the couple's finances.

One morning, working to pay off a mountain of medical bills, Vee and her mother, Pat Hoffmann, worked the hospital phone lines, promising creditors minimum payments.

One call brought Vee to tears.

"It's OK," said Pat, watching her daughter collapse in a chair.

"It's not OK," said Vee, sobbing on her mother's shoulder.

The insurance company had approved as much as $1 million a year — an amount the Ryans had exhausted by December — and up to $5 million lifetime coverage.

But it wasn't enough.

Dennis' Social Security and disability payment totaled only a third of what he earned teaching at North Central College and running swim classes in the summers. Medical costs aside, the Ryans still owed $1,500 each month after they paid back their monthly construction loan and daily living costs.

Watching his wife cry, Dennis said, "Everything is going to be OK, Vee."

Carefully balancing herself so as not to unsettle the mattress where her husband lay, Vee climbed into bed next to him.

Dennis turned away.

Pushing for healing
The staff at Copley propelled the coach with small victories.

In speech therapy with Joan Blasingame, Dennis typed and sent an e-mail to Ghaly, a significant achievement since Dennis often ignored his entire left visual field.

In occupational therapy, Sherrie Giles told Dennis of their shared faith in God to encourage him to relearn activities like brushing his teeth.

And Manabat joked through the painful physical therapy session, so that Dennis called him "the best guy here."

Still, no one could unleash the motivation that would push Dennis forward.

Vee waged her own campaign.

She barbecued Dennis' favorite pork chops, tailgate-style on a grill in the back of her truck in the hospital parking lot. She drove an hour each way to Paw Paw to bring the coach's favorite dog to therapy.

And she prodded her husband to remember details about their past — that they liked to eat burgers by the river when they dated, that he nicknamed her Betty Boop, that it rained on their wedding day.

"Why did it rain," Vee asked.

"I don't know," Dennis answered.

"What time of year was it?" she hinted.

"December," he answered. "It was the 19th of December."

Dealing with depression
When Dennis wasn't motivated, Vee spiraled into her own darkness.

Maybe Dennis was apathetic because he knew his 33-year career as a coach was finished, she thought. Or maybe he'd be doing better if he hadn't been shuttled between hospitals and care centers.

Had she failed him?

As depression set in, Vee resurrected old doubts that she wasn't smart enough for Dennis' academic world.

"You do such a great job," Dennis comforted her.

"I don't," she told him.

"Yes, you do," he answered. You do such a great job taking care of me. Now cut my sandwich in quarters."

Helping him with these everyday tasks made her feel better — but she knew she shouldn't.

"Dr. Ghaly isn't going to be happy about me feeding you," she said. "That's why he doesn't want me around so much."

She blamed Dennis, too, for using his newfound faith as an escape.

"Dennis, what would make you good?" she asked.

"God would make me good," he answered.

"I'm asking you to try harder," said Vee.

Celebrating progress
When Dennis pulled himself to a standing position using the parallel bars one morning, it was as if they had touched the shore.

"Oh my God," said Vee. "I can't believe it."

"Rious pulled me up," said Dennis.

"No, it was you," said Vee. "You basically did it."

While the therapists were excited, they also were cautious. Dennis had never tried pulling himself up from between the parallel bars, only from either side. It was easier this way, they pointed out.

Vee knew Dennis wasn't taking steps on his own. One therapist supported Dennis from behind while another moved the coach's legs.

Still, she saw a glimmer of excitement in her husband that day and her imagination ran away.

If Dennis could stand in a pool, he could go to water therapy. And if anything, water therapy would flip the switch inside the swim coach's brain.

Fearing the future
When Dennis' discharge day arrived three weeks after he began the Copley program, Vee was disappointed.

Dr. Keanne didn't believe the coach's rate of progress was sufficient enough to warrant staying in the inpatient program. He said Dennis would benefit as much from receiving 15 hours of therapy a week by coming to the hospital during the day. Now that he could move to and from his wheelchair with the help of one person, he could travel by car. There also was home-based therapy.

Keanne said these options would be a good bridge into a self-sufficient life at home.

But despite meetings to prepare her for this day, Vee wasn't ready.

She would miss the attention Dennis received at the hospital. She hadn't finished making all of the necessary arrangements for his care at home. Her co-workers from Home Depot had built a ramp to their house, but she hadn't figured out who would care for her husband when she was at work.

Nurse case manager Jayne Wallers had written a letter to the Department of Rehabilitation Services, which could provide minimum-wage home-health workers who could visit the Ryans' home when Vee was working. But there were financial parameters. And it would be considered double-dipping to go to therapy at Copley and also have somebody come to the home.

Most of Dennis' relatives lived far away. And Vee's sister nearby was caring for her husband who suffered from kidney failure. Vee didn't call upon a church or community group to step in with volunteers. It wasn't realistic, said Vee's mother, to ask Dennis' swimmers to come out to the country and care for a sick man. And Vee wasn't prepared to move closer to the hospital and her work.

Selling their dream home — despite its $3,000-a-month construction loan — would destroy about any hope her husband might have left, Vee said.

At least temporarily, the Ryans decided, Dennis would go to Alden of Waterford, a nursing home.

Looking for meaning
Their journey never-ending, Vee kept hope alive with the smallest of signs. The white underbelly of a hawk flying over the pond outside Alden was enough to lift her spirits.

"Dennis, today is going to be a good day," Vee told her husband one morning. "Remember, this day is Oct. 19. You were born May 19. We were married Dec. 19. This is going to be another great 19th."

That day Dennis "walked" again, as he had at Copley before, with the help of physical therapists. Over the days that followed, the Ryans counted each step — as many as 85 in one session.

Vee hoped these victories meant Dennis was moving toward self-sufficiency. In the meantime, she enjoyed sitting outside with him at the pond while he practiced bird-calls."

"Hey guys," Dennis called out to the geese and mallards. "Go for a fly. Fly the coop."

Long way to go
Dennis' long-awaited homecoming finally arrived after three weeks at Alden — six months after the stroke.

Vee and her parents would take turns caring for Dennis, conserving precious insurance dollars.

As the Jeep pulled onto the farm road leading to his log home, Dennis was welcomed by a small group of relatives who had just finished sweeping up dead flies, the remains of a summer when chores mattered little.

"We'll have to have a barbecue to make you fat again," his nephew, Kenny Rygh, told him.

Pushing his son-in-law up the ramp, Don Hoffmann reminded the coach to look to his left. Precariously attached to the front-porch railing was a "welcome home" banner and a single helium-filled balloon, blowing with each gust of October wind.

"That's nice," said Dennis, his voice catching.

Inside the house, Vee stood close to her husband for a long time. She lifted up their cat and dangled it above his face so that he could touch its warm fur.

"My Pepper," Dennis stroked the cat, his pained words mixing with his tears as he talked. "Meow."

Feeling his wife's fingertips running through his hair, Dennis looked up at her red and weepy face.

"It's good to come home," he said. "But it's hard at the same time."

A matter of perspective
Much would happen in the months that followed.

Dennis was hospitalized again for common but potentially fatal complications: a blood clot in his leg, severe dehydration and other difficulties. He struggled with depression, also frequent in stroke patients.

Vee often grew discouraged, blaming her husband's setback on the diminished therapy hours at Copley. Dennis never gained enough strength to pull himself up on the parallel bars. Disappointed therapists said their work wasn't reinforced with exercises at home.

As the year anniversary of Dennis' stroke passed this week, he has made strides in reading, short-term memory and motivation. He is starting to move his paralyzed left leg consistently. Images of Dennis' brain also show blood flow returning to the damaged areas, a sign the neurosurgeon interprets as the beginning of long-term healing. And Dr. Ghaly talks of other options for the future — vocational therapy and hope in new technologies.

Dennis once said he did not want to live if he couldn't walk in the fields with his dogs. He still can't.

But in a therapy program closer to home he has a new goal: taking steps inside his house. He goes out to dinner with his wife, hosts a Bible study for those who prayed at the hospital when he was sick, and he saw friends married in his home a few days ago. Twice he has conquered a new enemy — fear of being trapped in his wheelchair and falling into water — to watch his swimmers compete.

At an invitational meet in December at Wheaton College, he hid in an office until Vee convinced him to come onto the pool deck.

As he was wheeled out, glimpses of the old Dennis Ryan shone through. He waved to the crowd and tearfully accepted a standing ovation from his team. A stopwatch in one hand, he kept track of split times for the swimmers, a habit so significant to him even the stroke could not steal it.

And when he wasn't looking, a favorite swimmer, Molly Foote, whispered in his ear.

"You are my motivation ...," she said. "Work hard for me."

"I will," he replied. "And you work hard for me."


Truly a miracle
Neurosurgeon uses faith and science to combat brain tumor

The Sunday Beacon News
June 30, 2002
Story by Staff Writer Mike Norbut

It sounded like an easy diagnosis to Lazo's primary care physician. He told her loved ones she had an advanced stage of Alzheimer's disease, but they weren't convinced. They pushed for a CT scan, and the results brought Dr. Ramsis Ghaly into their lives.

Today, however, his presence could cease as quickly as it developed.

It is 6:30 a.m. on Tuesday, May 14, and Ghaly, the medical director at the Center for Neuroscience at Rush-Copley Medical Center in Aurora, arrives in Lazo's room, exactly on time as he promised. In a few hours, he will cut open her skull and wage a war of minute proportions with colossal consequences. With millimeters dividing working brain tissue from a devastating tumor that has caused her headaches, her loss of balance, and her speech problems, Ghaly has to be precise. Lazo's life depends on it.

He's mindful of the possible outcomes. This is the same type of tumor that attacked former broadcaster and newspaper columnist Tim Weigel, who died last year. As soon as he saw the CT scan images, he knew the outlook was grim, and he didn't hide it from her family. If the orange-sized tumor didn't come out, she had one week to live. In similar cases, people who have the majority of the tumor removed can live about three months. And that's not even counting the possible complications, like loss of understanding and struggles with speech.

Brain cases often are initially misdiagnosed as ailments like dementia, sinusitis, migraine headaches, or stress. But the brain is a mysterious organ. You have to discover what's wrong with it, because it won't tell you. Not many neurosurgeons would operate, but Ghaly wanted to give it a try. Who am I to make a life-ending decision for someone, he asked.

Ghaly knows it is such a treacherous tumor that the night before, he visited an Orthodox Christian monk who shares his religion and Egyptian homeland. He asked the monk, who was staying with a family in the suburban area, to pray over Lazo's X-rays.

  His faith is central to his practice. Ghaly is well-trained — he is board certified in neurosurgery, anesthesiology, and pain management — but he says his delicate touch comes from God. One wall of his office, located on the lower floor of the Rush-Copley Healthplex, is covered with his certificates, plaques and framed degrees — with a painting of Jesus Christ hanging in the center. The wall provides patients a glimpse into his soul, and it shows them their surgery will be a team effort.

"Miracles can happen to everyone," Ghaly says. "You do your part, and God does the rest."

At 7:30 a.m., Lazo is wheeled to the operating room. While she won't remember anything beyond having her head shaved — a task Ghaly performs himself — it begins the longest day of her family members' lives.

As they see her off, Lazo's family members hope this neurosurgeon can engineer the same type of miraculous outcome on which his stellar reputation is built. More realistically, however, they are just hoping Lazo survives, if only for a few extra months.

But Ghaly does not plan to lose a patient today.

  • • •

 It is 9:48 a.m. and a tiny amplifier projects the sound of Lazo's beating heart. She is lying with the bald left side of her head pointing toward the ceiling. Blue ink marks the circle that will be cut out of her skull. Metal pins hold the front and back of her head in place like a vice.

Lazo, already under anesthesia, is covered from the neck down in foam padding to protect and insulate her, as well as to keep her steady. The slightest flinch could have catastrophic consequences. Ghaly completes his silent meditation while he methodically washes his hands and forearms. He shakes the water off and steps back into the operating room, his hands, dripping, held out in front of him.

"Being in the brain of a patient: There can't be anything more sacred than this," Ghaly says. "This is a 62-year-old woman who did the best she could, and now I'm going to be in her brain."

This is the type of case Ghaly will later use as a model for what community hospitals can accomplish. He disagrees with the approach of hospitals to specialize in only a few specific areas, sending more serious cases to teaching hospitals in Chicago. Do everything, and do it all well, he says. Neurosurgery is his contribution.

The scalpel slides through Lazo's scalp for the first time at 10:15 a.m. He clamps the skin, suctions the blood and cauterizes as he cuts, trying to limit bleeding. Ghaly sews three rubber bands into the underside of the scalp, stretches them, and clamps them to one of the sheets hanging over the patient to keep the skin out of his way. Ghaly then uses a flat-edged tool to scrape muscle and excess blood from the skull.

A disturbing sound, similar to dragging a screwdriver on cement, pervades the room.

At 10:38 a.m., a drill starts to dig through Lazo's skull. Ghaly squirts water over the bone to douse the rising smoke and ground the tiny bits of skull that are spitting out from the hole. He makes five holes the size of a nickel in the skull, then takes a saw blade to cut between them. His finished product is a circle.

The surgeon knows from his X-rays the tumor lies directly underneath the bone, and he knows the kind of pressure it places on Lazo's brain. If it has any open space, it is going to take it. Ghaly pries the piece of bone from the rest of the skull, and spreads water mixed with antibiotics over the open area.

The first ultrasound, which is performed over the dura mater — the thin, skin-like layer that insulates and protects the brain from the skull — shows the tumor pressing against the surface. The high pressure in her brain makes this a delicate procedure.

He puts the ultrasound away. He knows the tumor will bulge through the opening once he cuts the meninges away. Ghaly is prepared, though. When he cuts the dura mater away, he tries to leave the portion that is harnessing the tumor until last. "Very ugly, very wild," he says.

It's 11:15 a.m. The brain and its invader are exposed.

Ghaly is a model of humility as he surveys the brain. He has dedicated his life to studying this organ, and he attends seminars on a regular basis to hone his skills, because he knows how much he has to learn.

While the peripheral parts of the brain are a light flesh color, there's a piece the width of an orange that looks discolored, like it has been bruised. That's the enemy — both hers and his. Its color comes from the many irregular blood vessels that are feeding it.

Ghaly takes a small piece of the tumor and puts it into a specimen jar to send to pathology. The results, which will be back in less than an hour, say the tumor is cancerous, but it is a primary, not secondary cancer. It did not start anywhere else in the body, so if Ghaly can vanquish this foe, Lazo may have a better chance at longevity.

Wearing a magnifier headset over his glasses, Ghaly looks similar to a jeweler carefully eyeing a gem. The magnifying lenses greatly enlarge what he sees, but also restrict his view to the width of two fingers.

He becomes quiet and intense as he peers over the tumor. Standing only about 5-foot-8, he uses a step stool to gain the proper view of his foe. He is always particular and demanding of his staff — he is quick to both correct and congratulate them — but at this moment, it is his battle.

Using suction and irrigation tools, as well as forceps, Ghaly gently works under the edges of the tumor. He drops cotton balls soaked in water and antibiotics into Lazo's skull to absorb the blood. Always cutting, cauterizing, rinsing, and suctioning, Ghaly already is deep inside Lazo's brain. He is slow and methodical, careful to avoid pieces of the brain and major vessels coursing through the tissue.

At 11:53 a.m., the bulk of the tumor is out, but he knows there's more to capture. Tumors do not grow in perfect shapes. This one has tentacles.

He still has about one-third of the tumor left to remove, but he already is deeper than many neurosurgeons dare to go. He trades in his magnifying glasses for a high-powered microscope to see exactly what to remove.

"Sometimes you have to proceed in the face of adversity," says Dr. William Gibbons, medical director of pathology who has just arrived to hand-deliver the news about the tumor's biopsy to Ghaly. "We all stand respectful here."

It is 1:55 p.m. — one of the brief moments during which Ghaly is not hunched over Lazo's open skull. Nurses, technicians, and manufacturer representatives, who help the doctor with the technology in the operating room, sit rubbing their arms or hunched under jackets. The guess among them is it's about 55 degrees. "The brain doesn't like hot temperatures," Ghaly explains.

He uses water to fill up a cavern the size of a fist inside Lazo's brain, the empty space the tumor once occupied. It's time for a second ultrasound reading, to see what remains after two hours of hunting. Ghaly likes what he sees. The disturbances the first reading showed are all but gone. But Ghaly knows his expedition isn't complete.

He now turns to the StealthStation Treon system, a global positioning device that allows the surgeon to see three-dimensional images of the brain. It works in many ways like a navigational system on a car, and it brings CT scan images to life.

Instead of knowing simply how long and wide the tumor is, Ghaly can also see how deep it extends into the brain. In this case, that information is critical.

Like a surveyor, Ghaly places the pointed end of a foot-long instrument at different spots in Lazo's brain. It transmits infrared signals to a type of satellite above the patient, which is connected to the Stealth machine. Every time he moves the instrument, he gets a different reading on the screen of where he is in relation to the CT scan images that were taken before the surgery began.

The machine shows Ghaly is deep in the brain, but the tumor has still extended some of its tentacles deeper. The meticulous process of tearing tumor cells, cauterizing, rinsing, and suctioning begins again.

"Our Father, Who art in heaven," Ghaly says.

Ghaly has been praying silently throughout the procedure, but his calls to God are vocalized at this point. If his instruments stray a few millimeters from their intended target, he could permanently damage his patient.

At 2:05 p.m., the anesthesiologist rubs his eyes, knowing he has hours to go.

Nurses have come and gone. Technicians have taken lunch breaks. But Ghaly doesn't even pause for a drink of water. Food is the furthest thing from his mind. Fasting during surgery is one of his methods of prayer, and he knows he needs every method in this case.

The meticulous process continues. Ghaly carefully uses a special set of forceps, which emits an electrical charge to help cauterize the broken blood vessels, to pluck away the tumor. He employs the suction tool to slurp up the pieces. Gradually, the water stays clear before it is suctioned. Cotton pads once took only seconds to become stained red with blood. Now, they're being removed as white as they were when they were placed in the crannies of her brain.

Ghaly has to make sure there is absolutely no bleeding before he can leave Lazo's brain. "We call it the unforgivable area," he says. "If anything hemorrhages here, the pressure is going to build."

It's 2:34 p.m. Ghaly decides his hunt is over, though he now has two hours of closing ahead of him. It starts with sewing the meninges back together, a tedious process of needlework and knot-tying.

Once the dura mater is sewn, he must attach it to the skull to make sure it doesn't collapse into the cavity left by the tumor. The brain will eventually shift back into that space.

Ghaly places the softball-size piece of bone over its hole, being careful to fit it correctly. Nasser Tavakoly, his surgical assistant, holds the piece down while Ghaly runs thread through tiny holes he drilled in the skull and ties tight knots over them. It's like they're a father-and-son team, wrapping a present together.

At 3:24 p.m., the skull is reattached. Ghaly will spend another half-hour attaching muscles, sewing skin and stapling the sutures together. He completes his work by carefully washing Lazo's hair.

It's 4:05 p.m. Ghaly takes more than three steps away from his patient for the first time in six hours. He goes to the phone, where he will spend 20 minutes dictating what he did during the procedure and how he thinks it went. He always does this immediately after the surgery, so his opinions and descriptions are not affected by the patient's outcome.

At this point, he still has no idea if Lazo will be the person everyone is praying she will be. He is just praying, too.

  • • •

The words float through the fog into Lazo's brain. Still in the haze of the anesthesia she has been under for more than eight hours, she looks as if it would take her days, if not weeks, to respond to Ghaly's command.

But in the depths of her brain — the same brain Ghaly had just sifted through as he hunted the tumor that plagued her — the words make sense. Within seconds, the toes on both of her feet wiggle with energy.

Ghaly speaks another command in Spanish, Lazo's only language. This time, she responds by moving her right arm. One more command, and her tongue splits her closed lips. Ghaly smiles with satisfaction. As he exorcised the demons from Lazo's brain, he feared the damage the "nasty" tumor may have already created. Ghaly has been unsure how well Lazo will resemble the woman his family knew and loved.

There are hardships ahead for Lazo, but Ghaly knows these few actions are good signs.

"I cannot ask for more," Ghaly says, as he marches off to tell Lazo's family members about the war he waged in her skull.

It is 4:45 p.m. In less than four days from this moment, Lazo will go home with an excellent prognosis for recovery and an open-ended prediction for how much time she has left to live. Radiation and chemotherapy should take care of the few specks of tumor Ghaly's magical hands didn't capture.

"It's truly a miracle," says Lazo's son, an Aurora police officer.

"I was extremely radical," Ghaly tells the family. "I think if I had this, I would want somebody to do what I did to her." Regardless of how long he has known his patients or their families, the bond Ghaly forges with them is everlasting the instant he humbly accepts their cases.

"This is just the beginning," he says. "You marry them forever."

  • • •

Eloisa Lazo stands in an exam room in Dr. Ramsis Ghaly's office, following his commands to touch her nose, twist her arms, and count to 20. She has no trouble completing those tasks, and prefers to focus on something a little more interesting to her.

"I can't believe (Ghaly's) not married," she says in Spanish to her son. "We have to get him married."

It is June 27, nearly six weeks to the day from when Ghaly removed Lazo's brain tumor. Her personality, not evident during the surgery and the first few weeks of recovery, has re-emerged.

She is a funny, vivacious woman with a sharp wit and a glowing smile. She speaks quickly and without hesitation, cracking jokes and speaking plainly, as if she has never been through a life-altering experience.

Ghaly puts his arm around his patient and shows her the X-rays, both before and after her surgery. There is still a spot in the left side of her brain, but Ghaly explains that is scar tissue and the empty space where the tumor once resided. The other commotion in her early X-rays is gone.

Lazo has about two weeks left of radiation treatment, and then she will begin chemotherapy. Ghaly is so impressed with her X-rays and how she's feeling that he says she doesn't have to come back for another appointment for three months.

Lazo smiles and hugs her doctor. "She says when she can have you over, she'll cook for you," her son tells him.

Ghaly thanks mother and son, and walks down the hall to visit his next patient. This young man suffered a skull fracture in a motorcycle accident, one in which he was not wearing a helmet.

But today, this patient is all smiles, just like Lazo. Ghaly saved his life, too.

  Contact Mike Norbut at (630) 844-5829 or


Mind, body and spirit
Through faith and medicine, Rush-Copley neurosurgeon reaches out to restore patients to their former selves
------------------------------------------------------------------------ — 
© 2002 Digital Chicago & Hollinger International Inc.

By Donna DeFalco

When Jorge Salas took his first steps, he was surrounded by family and friends, who cried with joy. His neurosurgeon, Dr. Ramsis Ghaly, who visited Salas every day in the hospital during his recovery from brain surgery, was there to witness that pivotal event in the 54-year-old Aurora man's life.

 Salas had suffered a hemorrhagic stroke March 8 and was in the intensive care unit for two weeks. The family didn't think he'd survive. Ghaly opened a hole in Salas' brain to relieve the pressure. Nineteen days later, his test results looked much better. Though Salas' left side is impaired, he responded well to physical therapy and, eventually, took his celebrated first steps.

Salas' sister, Martha Aranda of Aurora, said that Ghaly saved her brother's life. When the soft-spoken neurosurgeon refused to take credit, she insisted, "That's what you did, doctor." Aranda and Salas' father had died just over a year ago from the same type of stroke.

 "They all told us that my father had a stroke because of high blood pressure," Aranda said.  Her brother, who suffered a small stroke in 1999, had the classic warning signs including high cholesterol, high blood pressure and diabetes. But when the scare subsided after his first stroke, his sister said that Salas didn't take care of himself and refused to modify his lifestyle, which resulted in a second, more severe episode. The reason Aranda was pleased that her brother was at Rush-Copley Medical Center in Aurora is that it's close to home. She also appreciates Ghaly's patient- and family-centered philosophy of care. "We can ask questions. We feel we are involved in his treatment," Aranda said. "He tells you straightforward and he's very calm."

 Specialties close to home
Ghaly, who is board-certified in three specialties — neurosurgery, anesthesiology and pain management — is the medical director of the Rush-Copley Neuroscience Center, which was launched in late 2001. The center specializes in the diagnosis and treatment of brain injuries, tumors, aneurysms, hemorrhages and management of stroke and spine injuries, microscopic diskectomy and endoscopic carpal tunnel release surgery. Ghaly, 43, has been promoting the concept of a community neuroscience center for years. "You have to have service to your patients close to home," he said.

Also chairman of the American Stroke Association for four counties — Will, Kane, Kendall and DuPage — Ghaly has developed a "how-to" packet for physicians to give them guidelines for treating stroke or brain injury patients. "Diabetes and blood pressure have to be controlled to prevent a stroke," he said. And as the Salas family found, family history can be a factor in the probability of having a stroke.

Leslie Barna, a registered nurse and case manager for Ghaly, followed the physician from Silver Cross Hospital in Joliet, where she had worked for 20 years. It was Ghaly's philosophy of patient care that brought her to Rush-Copley. "His ability to look at a patient as a whole was the most incredible thing," she said.

His dedication to working with the families of patients also impressed her. "People ask me, 'Why do you want to involve the families from day zero? Why do you want to share the plan?' " Ghaly said. "The family becomes an active member of the treatment plan. It's patient-empowered care. I embrace that."

Family involvement proved to be a critical factor in Salas' recovery, with his extended family from Aurora and Mexico providing round-the-clock support while he was in the hospital. Ghaly also credits the Salas family's strong faith with his patient's recovery. "The reason he is doing better is because of their faith," Ghaly said. "From the ICU, they have brought religious pictures. They feel this is the normal expectation." In Salas' hospital room, there was a large picture of Our Lady of Guadalupe, a statue of the Infant of Prague and several statues of Mary adorned with rosary beads. "He's a miracle," Sandra Munoz said of her father. "We're really happy with Dr. Ghaly. A lot of people don't share the same religious beliefs. He feels the same way we do."

One step at a time
Family support was important to Sharon Matheson, a 62-year-old grandmother from Washington state, who was baby-sitting her grandchildren in Naperville. One morning, her husband, Don, couldn't wake her up. The formerly active woman, who had walked between four and five miles a day, had a brain aneurysm and spent 30 days in the intensive care unit at Rush-Copley.  Maintaining an active lifestyle was beneficial to Matheson when she began physical therapy. "She's a great success story for us," said Jayne Wallers, nurse case manager for physical therapy. At the time of her discharge, Matheson hadn't completely regained her strength and exhibited some memory loss, but Wallers said that time and a lot of support will help the healing process. "We never promise perfection. We're going to work as hard as we can to get you home and as functional as possible," she said. The hospital staff gave the Mathesons a sendoff with cake, punch and an "I love Rush-Copley" sweatshirt that was signed by all the personnel throughout the hospital, who were responsible for her care. "I think it's astonishing that she's made the progress she's had," Don Matheson said. "The staff is supportive and compassionate. People have gone out of their way to befriend her even after she's gone out of their unit."

Faith is key element
In Ghaly's office, there is a large, framed picture of Jesus and another of Jesus' mother Mary. The doctor is a member of St. Mark Coptic Orthodox Church in Burr Ridge and attends services every Sunday. As one of eight children growing up in Egypt, his family endured persecution because of their religious beliefs. "We learn we have to do things 100 times more to be acceptable to the society. You read and study hard," he said.

Ghaly attended Ain Shams University medical school in Cairo, Egypt, graduating with honors in 1981. While completing his internship at the university hospital, he saw stroke patients who were dying and nothing was being done for them. "I wish the time would come that I would be the surgeon to help them and to diagnose and try to help these people," he said. Instead of staying for one month, he stayed for six. The professor of the department advised Ghaly to leave the country because there was no future for him in Egypt.

After his internship, Ghaly said he was sent to a remote village that had no electricity or running water. "I didn't do anything wrong and (it) was just because I was Christian," he said.

Ghaly decided to come to the United States and arrived at Cook County Hospital in Chicago. Because he was reticent in talking about his accomplishments to the people in charge of the large hospital, they weren't initially impressed with the young man. "I told Cook County, let me work for free, watch me, observe. I am really interested in medicine. Sure enough, I stayed three months for free. Within three months, they hired me."

 The love of knowledge that was instilled in him by his parents — his father was a teacher of the arts and his mother was self-taught — he passed all three of his board exams for the three specialties on the first try.

He's currently writing a book titled "Christianity and the Brain" that will attempt to explain the connection between mind, body and spirit. "The brain is the hidden treasure. You're not only working in the physical, but the spiritual," he said.

Putting the pieces together
Ghaly begins his hospital rounds at 6:30 a.m. The reason he chooses that time of day is so he can talk with nurses in the transition period between the day and night shifts. "I give them the plan for the whole day," he said. "Everyone knows exactly what they should do."

After visiting his patients, depending on the day of the week, he will have a meeting with staff members from throughout the hospital involved in his patients' care. He might teach a class to the residents or see patients in his office. On Tuesdays and Thursdays, he performs surgeries that can range from removing a brain tumor to correcting carpal tunnel syndrome toback surgery.

Patricia Alsvig of Plano had just turned 40 years old when she learned she would need surgery. Fourteen days later, she had a malignant tumor removed that was the size of a grapefruit.

On the morning of the surgery, scheduled to last about six hours, Alsvig was carefully positioned on an operating table to ensure that there was no added pressure on the brain or spinal cord while she was immobilized under anesthesia. Any little movement could cause nerve damage. The tumor at the back of her neck was near the area of the brain that controls eyesight, speech, the ability to read, the ability to understand the spoken word and balance. Ghaly had to carefully and completely remove the large tumor without damaging the nerves.

Ghaly used new technology called image-guided surgery that allows the physician to navigate through the brain using real-time imagery that provided a three-dimensional image of the tumor and the brain. Incorporated into the eyepiece is information transmitted from the camera and the computer. In addition to the nurses, doctor's assistant and anesthesiologist, representatives from the company that makes the equipment were on hand to answer any questions or troubleshoot any problems.

A neurophysiology monitoring system recorded the response of nerves in Alsvig's arms, legs and ears. As long as a response was received from the nerves, that meant sensation was intact and the surgery was proceeding well, even though the patient was under anesthesia.

Whenever he reached a critical part of the surgery, Ghaly asked one of the nurses to call the family to let them know the patient's progress. After the surgery was finished and Alsvig was in the recovery room, Ghaly woke her up and called in the eight family members who were anxiously waiting.

His patient, who was referred to the surgeon by another doctor, is grateful for her care. "I can't say enough about Dr. Ghaly; his personal touch for everything. He came in and he had so much hope. When I was looking at it, I wasn't very hopeful at that time. He had a very positive attitude and spirit," she said.

The mother of a 4-year-old and 12-year-old has resumed her previously active lifestyle. "It's kind of a miracle for me," she said. She is going through radiation treatment to make sure all the cancer is gone and will continue to see her neurosurgeon every six weeks. "As far as doing everyday things with my family, I'm back to normal," she said.

Her biggest fear prior to the surgery was that her children would grow up without their mother. "I feel I had the best neurosurgeon in the country with the way he treated me and my family," she said. "He has an aura about him to make you feel like God is with you and you're going to survive and everything is going to be the best."


Chicago Tribune
Date: Sunday, June 10, 2001
Edition: Chicagoland Final
Section: Health & Family Page: 1 Zone: C
Source: By Mary Daniels, Tribune staff reporter.

A miracle worker
A top-notch neurosurgeon transplants big-city medicine to a community hospital

Kicked in the head by a horse one night last February, half her skull turned to dust and gravel, her brain swelling from its smashed shell, Sue Ann Curtis is alive today because her neurosurgeon, Dr. Ramsis F. Ghaly, was where one would not expect him to be.

Ghaly was available to Curtis almost immediately, in the small window of time in which surgery can be done to avoid permanent brain damage. Her brain surgery was not done at a major university hospital but at Joliet’s Silver Cross Hospital, a small community hospital a few miles down the road from her Lockport horse farm.

Curtis, who has a doctorate in cultural anthropology, is in rehabilitation–and thinking about riding her horses again–because of Ghaly’s singular ambition. He would like to reverse the tide of medicine today: Rather than send all the complicated cases to downtown hospitals or university medical centers, higher quality, more sophisticated medicine should be offered closer to home. On the night Curtis was injured, I was the anguished friend at the scene who called paramedics. Desperate, I called a retired physician friend for input while the ER team hovered over Curtis, whom they said was dying.

"If it’s a head injury, Dr. Ghaly is the best neurosurgeon there is," said the retired doctor, who once worked at Silver Cross. I raced back to the emergency-room desk and asked for "Dr. Ghaly" to be called.

"Oh, Dr. Ghaly! He’s the best neurosurgeon there is," said the attendant, lifting the phone.

Moments after the call, the ER team burst from the cubicle and began running down the corridor with Curtis on a gurney. "Where are you taking her?" I shouted after them.

"You’re very lucky" an ER doctor said over his shoulder. "Dr. Ghaly is going to operate, and he’s the best neurosurgeon there is. He’s going to try to save her life."

I interlaced the mantra of recommendation I had just heard from three people with prayers for 6 1/2 hours until I learned that Ghaly had indeed saved my friend’s life.

The 43-year-old Egyptian-born physician’s career is filled with similar stories of last-minute saves from strokes, aneurysms, tumors and other assaults on the brain. He also is known for resolving mystery maladies, some of which had been misdiagnosed for as long as 20 years, including nerve tumors, trigeminal neuralgia (tic doloreux), spinal infections and more.

One would expect a physician with his credentials to be found in an exclusive private practice where the waiting list is six months long.

He is board certified in three disciplines–neurosurgery, anesthesiology and pain management–the only physician in the United States so qualified, said Dr. Fady Charbel, acting head of the residency program at the University of Illinois Hospital, where Ghaly did his residency in neurosurgery.

Ghaly joined the Chicago Institute for Neurosurgery and Neuroresearch (CINN) in 1995 after completing a residency in neurological surgery with special training in complex cranial and spinal surgery. He received a medical degree from Ain Shams University School of Medicine in Cairo. In 1991, he completed a residency in anesthesiology and critical care and pain management at Cook County Hospital, where he also completed fellowships in neurophysiology and neurotrauma. He also is an assistant professor of neurological surgery and anesthesiology at Rush Medical College in Chicago.

He arrived at Silver Cross six years ago, a year after the hospital established a relationship with CINN.

"Silver Cross Hospital was CINN’s first satellite," said Leslie Barna, a case manager at Silver Cross who works closely with Ghaly. They (the institute) were based at Columbus Hospital. It was their interest to provide care outside of the city in outlying areas."

During his training, Ghaly said he felt "really challenged" by what he found. "I went to medical school and saw how easily people die or are misdiagnosed," he said. He wanted to do something about that, a drive that has been with him since he was very young.

As one of eight children, "I saw my parents and my grandparents suffer from no-good care or average care. I became very sensitive to suffering. This is a gift; it’s the way I look at it," he said. "I put myself in the patient’s place."

Deeply spiritual, a member of the Coptic Christian Orthodox Church, Ghaly’s personal role model is the biblical Good Samaritan, who he said, was a foreigner, like himself.

Kathleen Prunty, director of patient support services at Rehabilitation Institute of Chicago, cites Ghaly’s spiritual charisma as an inspiration both to co-workers and patients.

"He’s in a category of one," she said. "You’re not going to find many people who will abandon everything to focus with sacred devotion on the patient.

"He’s a healer to the community," added Prunty, who met Ghaly at Silver Cross when she worked there in patient support. "He could go the way of the rest [and become] the big downtown personality, but he believes these are beautiful people in this kind of sleepy community, and they deserve the best."

Of all Ghaly’s recent cases, Robert Wals of Romeoville perhaps best personifies the advances the doctor and the CINN satellite program have made at Silver Cross.

In March 1998, Wals was acting abnormally, said his wife, Virginia, and the family doctor found a brain tumor through magnetic resonance imaging. At that time, Wals said, Silver Cross did not have the proper facilities to care for him, so he was referred to Columbus Hospital in Chicago, where Ghaly removed two tumors, one the size of a lemon, one the size of an orange, from his brain.

"In and out, no problems, operated on Monday, home Saturday," Wals said.

‘Let him die’

In October 1999, problems returned and Wals went to a downtown hospital, where bleeding from another tumor in his brain was discovered. His family was told there was nothing to be done for him.

"Take him home and let him die," they were told. Wals was transferred to Silver Cross, where he lingered in a coma until early January 2000, when he startled the night nurse by talking to her. "I came back to life," Wals said.

"This time there was a lot more equipment at Silver Cross to do this type of surgery than before," he added. The family contacted Ghaly, who operated again, this time in Joliet.

"Not once but twice he saved my husband’s life," said Virginia Wals.

Now her husband is doing a lot of things he did before, hanging blinds and playing with grandchildren Ashley and Jake.

"They pushed me out the window downtown, and I came back to Joliet, they take care of me and here I am, living yet," said a grateful Wals.

Changing the mentality.
"I’m bringing a high medical-center expertise to a small community," Ghaly said. "It’s the best for the community, but I was really challenged when I came," challenges that he said should not be underestimated in today’s cost-conscious climate.

"But I decided this is where my heart is. This is where my patients want me. I think it is time to make the community hospital an excellent facility, ready to give good care, to have good people on staff, and reward them," he said. "It cannot be treated differently than a university hospital."

"The mentality in the community hospital has to change. No in-between treatment. I’m a hospital or I’m not a hospital, "I'm a walk-in clinic.

"Just go one hour from the city of Chicago, and the quality of health care diminishes," he said.

The reasons why are complex, with serious deficiencies in equipment among them. Ghaly would like to see the government give more support to community hospitals to improve care. Proper equipment is essential and expensive, even an average-quality MRI machine can cost $1 million.

But most important to Ghaly are human resources. "Nothing replaces the eye and hand of the physician," he said. Yet, often, today, there are "not always a lot of physicians available in the hospital," he said.

And ironically, when there are, it can be a problem.

The big picture.
"The fragmentation of medicine is an extreme disadvantage today," Ghaly said. "Everyone is subspecialized. Physicians look at each part, and who is looking at the overall picture? The patient as a total is forgotten."

For him, it is foremost.

Dr. Thomas Hurley, Ghaly’s partner in neurosurgery at Silver Cross since the end of 1996 and a CINN member, said, "I’ve always been impressed how he looks at the patient globally. He is excellent at being the complete physician."

Ghaly found that one way to decrease fragmentation of medicine within the hospital is the multidisciplinary meeting he has held every Wednesday for the last five years for all medical-care providers.

"We all sit around and talk about the patient. We all interact and try to solve problems in the care of the patient," said Barna, who has been employed at Silver Cross for 20 years.

"It is a wonderful service that we can provide a high level of neurosurgery in a community hospital and maintain the level of personal care at the same time, as in the case of Mr. Wals," she added.

But creating this best of both worlds for the patient can be what Ghaly calls "a sword with two sharp edges."

Up close and personal
"You demand a highly skillful type of work in a place that might not have everything they have in a university hospital," he said. "What I did to compensate for that, instead of doing my surgery and going home, I made myself available 24 hours a day."

Unlike most surgeons who operate, then hand over the patient to other doctors, Ghaly stays with them through their recovery and even beyond. He calls on them at home to see how they are doing, gets to know the family.

This is his prescription for what he thinks is another great disadvantage in today’s medicine: "the ongoing practice of limited time doctors spend with patients. It takes more than 15 minutes to see a patient," he said. Pain is hard to describe; that takes time."

Chicago lawyer Annie Lopez, a patient who suffered with a tumor in her leg for many years while being treated for lower-back pain, expressed gratitude that Ghaly took the time to listen carefully to her complaints in order to solve her problem.

Even if a patient at the point of death can’t be cared for near home, by increasing standards in the community hospital, it will decrease complications in the interim period. That is the period during which everyone is asking, ‘what should we do next? Should we transfer the patient?’ when there is a difficult problem due to a lack of knowledge or equipment," Ghaly said.

In either case, "the community has the right to say, this is our hospital, we want it to be the best," he added. The way to give a community this kind of self-esteem, he believes, is to educate it "so its members don’t die in the system."

Leading by example
Ghaly regularly gives free lectures to the public on health issues, even goes to local factories to talk about how to prevent or treat carpal-tunnel syndrome "so people can be their own health advocates." (He will present a symposium on strokes at Silver Cross on June 16.)

Ghaly’s strongest impact, however, is the example he sets. "Ghaly is a model for us all," said Dr. Walter J. Levy, in private practice in Ithaca, N.Y., who has worked with Ghaly on papers and presentations.

Ghaly’s colleague Hurley thinks the public isn’t getting the quality of doctors they got years ago. "There is no incentive. Ramsis and I are working harder and making less, with government and insurance companies cutting back. It is becoming a hard field, as far as being rewarded for what you do. "If you don’t love medicine, find something else," Hurley said. "I think our society in general has been blinded quite a bit to the fact good health care, or life itself, doesn’t come cheap."

Ghaly, who has had to accept "a lot of financial compromise" to practice as he does, would like to see the idea of medicine as a business career disappear. "I am sure I am not unique," he said. Other physicians like him exist, and "as a society we need to encourage and motivate them to go the extra mile."

"I would like to see this model reach other communities, to help the patient in extreme need," Ghaly added. "These are hard-working people here. I feel they do their best for the community, therefore they deserve the best medicine there is. I was sent on this mission because of Sue Ann and other people like her."

Go to the article which appeared in The Herald News.

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