I found out I had a pituitary tumor in December of 1978 and you know something, I was the very first patient of the young doctor who diagnosed it. He said I was lucky, because there was a doctor here who was one of the few who would actually operate in cases like mine. I went as soon as I could.

When I saw him, I almost didn't believe he was the doctor. He wasn't like any doctor I had met in Oklahoma. He had this long hair, and he wore a silk shirt that was unbuttoned halfway down his chest. And he wore all these gold chains, layered. I almost walked out. But then he started talking. Within thirty minutes I was convinced that he was the doctor for me.

What I liked was that he was straightforward. On that very first visit he said he would operate, but there was only a fifty-fifty chance that I would get out of the operating room alive. He also went down a long list of other things that could happen to me, including being blind or paralyzed.

The strange thing was, the more he talked about the details, the less worried I was. I could tell that he was very confident about what he could do. And the alternative-not having the operation-would have meant that I would have definitely died.

From that moment on I was never afraid. I don't know why, exactly, but there was something about his manner that made me feel like I was in the best hands and it was going to be all right.

The other thing that I like about Stanley is that he's very tough when it comes to protecting his patients. He does not want you to suffer any more pain than you have to. That feeling is in his soul, and he will go out of his way to make sure you don't have any more pain. When I went to the hospital for my operation, I noticed that almost everything on the top of my chart-my name, age, address-all the information was wrong. It sort of upset me. If they couldn't get that right, then how could I be sure they would take care of me right? I said, 'I'm going home.'

No sooner did I say that then Stanley comes marching down the hall as mad as a bat. He said to me, 'You pick a hospital. I'll send you there and we'll do the operation.' I picked another hospital and he did just what he said.

On other times, he has told the hospital that I don't have to come in the night before an operation. He says that he will not require his patients to spend the money staying overnight in a hospital bed when they can come the morning of the operation. I've also seen him tell nurses to get their pocketbooks and leave when he saw that my chart wasn't being kept carefully. He said, 'Your notes are what I depend on to tell me how she's doing. If you can't do that right, then get out.'

It may sound like he's harsh, but he's really only trying to get the best for me. I know that; and if that means that everyone in the hospital snaps to attention when he comes 'round, then that's okay with me.

Of course, the people who are on his team, who go into surgery with him, all know that he is the best and so are they. They work very closely and very smoothly. They also recognize that you are a person, not just an open brain lying there. I bumped into one of his nurses one day and she said hello to me. I didn't know who it was until she told me. But she remembered me, not my tumor or my brain, but me.

I've been a real challenge, like a special project for Stanley. He's told me that. He's said he's just not giving up on me. In that first operation they took out a tumor that was so big he needed both hands to hold it. I had radiation therapy, and I've needed to go back several times to have the damage that's been caused by the radiation repaired.

Every time, he is the same. He doesn't have someone else prep you; he does it. He shaves your head and he talks to you while he does it. After the operation, he comes in every morning that I'm in the hospital and wakes me up. We talk and he explains what is scheduled for me today. He tells me exactly what they are supposed to do, and he says that if they try to do anything else to me I should call him and he'll make them stop.

When I say that I have never been afraid, even when he was going into my brain, I mean it. I can joke with him about it. I call him the alien from hell that takes over people's brains.

He laughs. But the truth is, I wasn't always so confident that things would work out. I would have been very scared before I met him. But he taught me how to not be afraid. By watching him and listening to him, I learned how to be tough, how to take care of me. That's probably the most important thing I've gotten from him, and it was probably the thing I needed the most at the time."

Lavonna Saul, Patient
Lavonna Saul is the mother of Natalie Hartman who, in 1980, was born with cerebral palsy, hydrocephaly-fluid swelling her cranium-and spina bifida. As is typical with spina bifida, many of the nerves that would normally run down the spinal column were instead protruding from a hole in Natalie's back. The initial surgery, to repair the opening and reattach nerves, lasted twelve hours. Dozens of smaller operations followed.

When Natalie was born, they wouldn't even let me hold her because any jostling might have broken the sack that held all the nerves. She would have gotten an infection and probably died right away. But I was still in denial about how serious it all was.

The first time I met Dr. P. he told me I had a choice to make-operate or let her die. I thought, 'Who does this guy think he is telling me there's something this seriously wrong with my baby?' But as he talked, I started to accept it. Stanley is very calm, very factual. He gave me all the information, but he didn't try to influence my decision. That's the wav he is. He gives you all the information, then you have to be tough, strong like him.

When he came out of the operating room he said that it went very well. He had been able to reattach a lot of the nerves. But we weren't in the clear at all. In the next nine months he had to put seven different shunts into her brain to drain the fluid from the hydrocephal.

During that time when we were going through so many operations, Dr. P. let me call him at home whenever I had a question. When I didn't call for a while, he'd get in touch with me just to check on Natalie and see how she was doing. With Stanley, you are not a patient with a problem. You are a person struggling through something very difficult. He understands and he wants to help with your struggle.

Natalie's father and I got divorced pretty soon after she was born. Since then she's had twenty-seven operations, and every time we go back to Dr. Pelofsky. Natalie is now eighteen years old. She's got a certificate qualifying her to work as a medical assistant and a medical transcriptionist. Stanley has told her that she's got a job in his office when she's ready. In all this time I've learned a lot about Dr. Pelofsky. He's a pretty artsy guy. He's gone through a long-hair phase, a hippie look, GQ, and now he's dressing like Sean Connery. But what's inside of him has never changed. He is our Earth Angel. And even if Natalie never needs to have surgery again, were holding on to him. He's in our family now.

"As a whole, my patients have taught me that I must be a human being first, and then a doctor."

Doctor
Born in Brooklyn in 1941, Stanley Pelofskv, was a street kid who learned early how to fight. He attended Erasmus Hall High School, where he was steered toward a course in automotive repair. One of his most vivid school memories is of a guidance counselor who, upon hearing Pelofsky's dream of becoming a doctor replied, "Don't make me laugh."

Dr. Pelofskv's earliest professional role model was a disheveled allergist named Dr. Messer, whom he describes as "the lost Marx brother." As Pelofsky recalls, Dr. Messer provided him little relief for his chronic sinusitis, and he found many of the treatments uncomfortable. However, Dr. Messer was a warm, down-to-earth human being, in the Yiddish vernacular, a mensch. "He treated me like he cared, like I was a real person. He liked me, and I liked him. I never missed an appointment."

Stanley Pelofsky is a small, wiry man with dark hair and blue eves. He is so full of energy that he practically vibrates as he talks. He regularly performs operations that, in Dr. Messer's day, could only be imagined. However, along with the rewards of repairing potentially fatal aneurysms and removing deadly tumors comes a high level of risk associated with such heroic, last-chance surgeries.

As far as I'm concerned, my effectiveness really depends on my relationship with my patients. They are the ones who keep you on your toes. They teach you everything. The most important lesson, which you learn over and over, is to be ready for the new, the unexpected. That's what I love about my work. It really is exciting and challenging every day.

I can give you an extreme example of this from a long time ago. It was during Vietnam. I was a new general medical officer assigned to the First Marine Division in Da Nang. I wasn't even a neurosurgeon, really. Anyway, they bring in this soldier who had been fooling around with another Marine. They had accidentally set off this grenade launcher and the grenade had gone into his eye, lodged in the socket, but it hadn't exploded.

I was pretty nervous, but everyone told me there was no danger of this thing going off when I operated. My boss, the senior surgeon, tells me, 'Stan, you go ahead and get started with this. I'll join you. When I went in to see this fellow he was really calm. We Just talked about what was going to happen. I told him that I was going to take off his forehead in order to get at the grenade. I told him he would lose the eye.

I'll never forget what he told me. He said, 'Doc, you're number one. I'm here. I know I'm getting the best there is. I trust you.'

I realized then that I was this young man's doctor, his father, his friend, everything. And with this ease, this grace, he had just put it all in my hands. I also noticed that they were building a wall of sandbags around the operating room. Obviously they had lied to me about the fact that this thing could explode. But the important thing was that we both stay calm and be confident that it was going to work out okay. We couldn't give in to being afraid, because then we couldn't do what we had to do.

The operation was actually pretty straightforward. They brought in this special box for me to put the round in after I got it out, then they rushed it outside. It never did go off. When the Marine came out of the anesthesia I told him that there had been some frontal lobe damage and he had lost the eye. He said that he knew that, and that he thought the whole thing was a success.

We felt very close after going through that together. We wrote to each other for four or five years after that. He reinforced something that has staved with me ever since. In this specialty, where you are in there under extreme circumstances operating on someone's brain, often when it's life or death, you have to just believe in yourself, in your skills, and go do it.

I never lose sight of how amazing the brain is, and the risks I am taking. Just think about what it takes for the brain to produce a great artist, a Modigliani. Every time I operate I am aware that it is the essence of the person. But when there is a tumor of the brain or an aneurysm you have no choice; and the patients who come to me are giving me their ultimate trust. Because of that I am very truthful. I will not cheat them by holding back information.

But before we even get to that, I sit down and listen to what the patient is hoping will be the outcome. It's easy, really. I say, 'How can I help you?' Then I shut up. Ninety percent of the people will tell you within two minutes exactly what their expectations are.

With the other 10 percent, you need to make more effort. I use one technique that almost always works. I ask the person to tell me something that they have been trying to tell a doctor but haven't been able to. That's when you hear about bladder and bowel problems and sexual dysfunction. One older woman I operated on told me that what she wanted most was to recover the control of her bladder function. She had never discussed it with anyone. When that happened, she was completely happy with the surgery. She told me, privately, that the best thing was that she didn't have to wear a diaper anymore.

Even though there's a lot you can do, you have to remind your patients and their families that you are not God. You are not in complete control of what will happen.

''I remind myself of this all the time by remembering a younger woman I operated on in the mid 1970s. She had an aneurysm in the back of the brain about the size of a marble. The aneurysm was going to burst sometime soon, with the result being death or worse, her suffering incredible brain damage. That's why there was really no option but to operate. And she \vas a good candidate for a pretty successful outcome. The family met with me and they said, 'We trust in you and God to pull us through.'

Well, when I got into the surgery and reached the aneurysm, I could see the blood swirling around inside it. The aneurysm itself was tissue-paper thin, very fragile. As I exposed it, it just burst. I wasn't even close to it, but it ruptured and bled. She went into cardiac arrest and though we got her started again, she never recovered. She died.

Her family could see what happened on my face when I came out of surgery. That's one reason you always tell the truth. People know it, anyway. They accepted what happened because I had been honest with them and told them what was possible. But she had four children and a lovely husband, and every time I am doing an operation like that I remember her. I had connected with that family and it really affected me.

We learn a lot from our mistakes, especially if we are attached to our patients. And of course you get attached, if you are at all honest with people. You see them as human beings, not a procedure to be done. You listen to them, joke with them. You know them. They bake you apple pies and bring them by to surprise you. It's really quite wonderful.

But this can get you in trouble in ways that you'd never expect, though. It happened with one of those apple pie families. The patient was a woman who had a cervical disk problem that we repaired. She worked at the social security administration and she was very, very eager to get back to work. She called me a week or two before I said she could go and insisted It was okay. Then she showed up at the office with this apple pie and pleaded with me. I took the bribe. She went to work. Her office was in the Murrah Building and she died in the bombing.

Don't get the idea that my practice is all these difficult outcomes and problems. It's not at all. Even though a lot of patients are mine only when they have one operation, others are with me a long time and working with them is very rewarding.

There's this young woman Natalie, who came to me when she was very young. She has cerebral palsy. I must have operated on her a dozen times over the years. We even implanted nerves in her spinal cord. Her mother, Lavonna, raised her by herself. They battled everything together, but without help. I became their ally. In a few weeks she's going to graduate from computer school. I couldn't be happier if she was my own child.

As a whole, my patients have taught me that I must be a human being first, and then a doctor. I have to connect with them and make sure they see I recognize them as individuals. I think about my parents in Brooklyn, all the people I care about. My patients are no different. They are like family who trust me to take care of them.

When I talk to young doctors I tell them that they must look at themselves realistically. Are they arrogant? Are they stuck-up? Are they abrasive? Are they condescending? If they are, then they are useless. I say, 'Go get a personality. Or go get some psychotherapy. Do something to get over yourself.' This is my opinion. I'm not God. I could be wrong. But I don't think I am. People want a doctor who's a human being first.

Stanley Pelofsky, M.D., 58, neurosurgeon, Oklahoma City, Oklahoma
Pamela Deen, 46, homemaker, Norman, Oklahoma

Natalie Hartman, 18, student, Piedmont, Oklahoma