Duke surgeon removes Kennedy's tumor

After several days at Duke, the senator will get radiation and chemotherapy in Boston

DURHAM -- Dr. Allan Friedman, the neurosurgeon who spent three-and-a-half hours on Monday extracting a fast-growing tumor from the brain of Sen. Edward Kennedy, has a reputation among his peers as being high-strung inside the operating room.

Outside, away from the scalpels, clamps and whirring bone drills, the co-director of Duke University's Preston Robert Tisch Brain Tumor Center comes across as low-key and humble, his colleagues say.

As half a dozen media crews waited in tents and satellite trucks outside Duke Hospital for news on the Massachusetts senator, Duke, typically a trumpeter of its people and research, remained hushed about its famous patient and his doctor.

Shortly after 2 p.m., the family issued a statement from Friedman, describing the surgery as a success. During a procedure in which Kennedy was awake, Friedman sliced the malignant glioma, or fast-growing tumor, from Kennedy's left parietal lobe, which controls the ability to speak and understand language as well as sensation and movement to the right side of the body.

"Senator Kennedy was awake during the resection, and should therefore experience no permanent neurological effects from the surgery," Friedman reported in his statement.

Neurosurgeons familiar with such tumors say Kennedy was probably shown pictures of objects, such as footballs and other ordinary things, or asked to count throughout the surgery. The senator's inability to respond to such simple cues would indicate to the surgeon he was close to crucial brain tissue.

"People do amazingly well with awakeness surgery," said Stephen Tatter, co-director of the Gamma Knife Radiosurgery Center and a neurosurgeon at Wake Forest University School of Medicine. "There's no feeling in the brain itself."

During Kennedy's week of recuperation at Duke, doctors are likely to watch for complications from swelling that could cause motor-skill problems. Afterward, Kennedy, 76, will begin targeted radiation at Massachusetts General and chemotherapy treatment.

Why not Harvard?

It was not clear Monday why Kennedy chose to come to Duke instead of staying close to home at Massachusetts General and its physicians from Harvard University Medical School. But reports have indicated that Kennedy has always sought the best treatment for himself and his family, and Duke has a reputation for offering aggressive brain tumor treatments.

Duke's center, which dates to 1937, was one of the first brain tumor research and clinical programs in this country. It now has a staff of more than 250, and more than 2,000 patients from around the world are treated there.

"Duke has a lot of ongoing clinical trials for patients with brain tumors. Duke is known for having some novel therapies, said Dr. John Yu, co-director of the Comprehensive Brain Tumor Program at the department of neurosurgery at Cedars-Sinai Medical Center in New York.

Dr. Matt Ewend, chief of neurosurgery at UNC Hospitals, said it was a hopeful sign that Kennedy underwent surgery.

"If you're talking about a malignant glioma, surgery is never curative," Ewend said. "In general, I know that people are all doom and gloom about these particular tumors."

Surgery coupled with aggressive treatment can help extend a life, Ewend said, adding that a woman he saw in his clinic Monday morning had survived 13 years with a similar kind of tumor.

Skill, bedside manner

Friedman, a Chicago native, came to Duke to do research and training in neurosurgery after finishing medical school at the University of Illinois.

His career took him to London, Ontario, after that. By 1981, Friedman found his way back to Duke, where he developed into a surgeon known for his steady hands and precise cuts, and for a bedside manner and clinical care that sometimes elude top-notch surgeons.

"He just is your prototypical ultra-nice human being," said Dr. Henry Friedman, co-director of the Preston Robert Tisch Brain Tumor Center, good friend and no relation. "He just happens to have hands of gold wedded to top-notch medical management skills."

In a Faces of Hope exhibit displayed several years ago at the Duke brain tumor center, Allan Friedman offered a glimpse into why he chose to become a neurosurgeon.

"Malignant brain tumors ruin the lives of healthy, vibrant members of our society," Friedman said in the caption with the photo of him in his surgical scrubs and mask. "Advances in medicine and surgery fostered through dedicated research have given us the tools to provide these patients with additional useful time. Hope to me means: that with continued hard work and dedication malignant brain tumors will be curable in the future."

Neurosurgery, though, is not all that's on the brain of this neurosurgeon.

Friedman is a big fan of Duke basketball, both the men's and women's teams, and a runner who puts in three miles a day.

"He goes to all men's games and all women's games," Henry Friedman said.

The two Friedmans also have collaborated in developing a mentoring program for female athletes interested in going to medical school.

"Our goal is to even the playing field," Henry Friedman said.