Major surgeries can be sources of nerves or even media hype, particularly when the patient is a prominent figure. But for Dr. Allan Friedman, himself a world-renowned neurosurgeon at the Duke University Medical Center, it is standard procedure.
On the morning of Friday, Aug. 15, Friedman's first patient was Robert Novak, a longtime syndicated conservative columnist.
Novak is just a recent addition to Friedman's 27-year-long list of prominent patients: He also operated on Sen. Edward Kennedy, D-Mass., June 2 and Reynolds Price, Trinity '55 and James B. Duke professor of English, in 1984.
After more than four hours of surgery, Friedman removed the 3-by-1.5-inch tumor. Friedman said surgery has not had any significant impact on Novak's physical or mental condition.
"He's pretty much the same," he said. "I encouraged him not to retire because I believe in physical and mental activity to recover.... He's written three columns since his surgery."
Indeed, Novak wrote in a post-operation column that ran Sept. 5 that it was at Friedman's urging that he had composed the piece.
"The irony of my going to Duke to save my life can only be appreciated by somebody who knows that I am a fanatic University of Maryland basketball fan with no use for the Duke Blue Devils and their student basketball fans, who certainly have not turned the other cheek toward me," he wrote, adding that he suspects it will be difficult to rail against the Duke team in the future.
Novak, who was diagnosed with a Grade IV tumor at Brigham and Women's Hospital in Boston, began experiencing problems with vision this summer, which he detailed in his column. Following the prognosis, the doctor who had removed Novak's cancer from his lung in 1994 recommended that Novak see Friedman. The remainder of Novak's treatment following the surgery will be coordinated by the Preston Robert Tisch Brain Tumor Center at DUMC and performed at the George Washington University Hospital in Washington.
Novak's case is not unique, Friedman said, as the majority of his patients make a pretty good recovery. He noted that within a week of Kennedy's operation, the senator went sailing.
Along with Dr. Henry Friedman-no relation-Friedman serves as co-deputy director of the Tisch Center, and Dr. Darell Bigner serves as the director. To be treated at the center, individuals that can be put on clinical trials are given the highest priority, as are North Carolina residents. In 2007, the Tisch Center admitted about 1,100 new adults and approximately 100 children. Individuals who can get the same level of care elsewhere are often referred to other doctors, but Henry Friedman pointed out that no patient is ever turned away without help.
Together, Allan Friedman, Henry Friedman and Bigner work to ensure optimal lab and clinical research as well as clinical care on what Henry Friedman called a "bedrock of hope."
It is this positive attitude, combined with the strengths in the clinic and the lab, that is one of the defining features of the Tisch Center, setting it apart from other institutions, Allan Friedman said.
"I can't say that every therapy is going to be a home run, but if you don't go out and work, you are never going to get [one]," he said.
Allan Friedman has a reputation for operating on patients for whom other doctors believed surgery was not a viable option. Operating on the brain is both difficult and dangerous-after opening "a window in the skull," a surgeon has to reach and remove the tumor without causing deficits to other brain regions.
"A malignant tumor is not like a cherry in a bowl of Jello," he said, noting that a tumor cannot be easily extracted from the brain. "So you are not going to cure [patients], but you can give them advantages before you start other modes of treatments like radiation and chemotherapy."
If patients are in good physical condition, Allan Friedman may choose to operate, hoping to increase their long-term survival or quality of life. Because of his confidence and skill, several famous individuals have left their hometowns-and their big-name hospitals-to have him remove their tumors.
"The Duke University Medical Center has been at the forefront of brain tumor research for many years and has earned an international reputation for excellence, most notably in neuro-oncology," Deneen Potter Hesser, director of research and patient services for the American Brain Tumor Association, wrote in an e-mail. "[Allan Friedman] was among the first recipients of an ABTA research fellowship... [and] serves as a member of the ABTA Scientific Advisory Council."
For one commentator, Kennedy's flight to Duke suggested that the Southern medical center was at the forefront of this kind of operation.
Dr. Lawrence Altman wrote in a New York Times article July 29 that the change of venue was a source of embarrassment for Harvard's Massachusetts General Hospital.
"Physicians in Boston told Sen. Kennedy they didn't think they could operate on him and that he had a bad prognosis," said Dr. Victor Dzau, chancellor for health affairs and president and chief executive officer for Duke University Health System. "When his family explored other teams outside of Boston... they found someone like [Allan] Friedman that has just such great skills [and] was willing to operate."
Friedman's extraordinary technical skills of locating and removing tumors, coupled with his skills for diagnosing and treating patients, distinguish him from other surgeons, Henry Friedman said. He added that some surgeons are excellent at performing surgeries but poor at treating patients.
Another major factor that separates the Tisch Center from other institutions is the rapport the top doctors have with one another. At other high caliber centers, people often do not get along at the leadership level, Henry Friedman said.
"Medicine is filled with people with huge egos," he added. "That means leadership doesn't always get along very well.... But Darell, Allan and I are incredibly close friends and we work together seamlessly without our egos getting in the way. We get along extraordinarily well and love each other very much."
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