A Winning Game Plan

Amanda Mallory will never forget the moment Kurtis Auguste, MD, appeared in the waiting room on the day of her son Elam’s brain surgery. She’d been told the operation to combat Elam’s crippling epilepsy would last until after 9 p.m. But it wasn’t even noon and the surgeon was standing in front of her.

Dr. Auguste asked the Mallorys to join him in a nearby conference room. “It was the longest walk of my life,” Amanda recalls.

Elam was stable, but Dr. Auguste shared alarming news: Elam’s heart had stopped twice during surgery. There was no choice but to call off the elective operation.

“Within an hour of waking up Elam said, ‘I feel better than I have in my entire life.’ It was a miracle.”  
—Amanda Mallory, Elam’s mother

At many hospitals, the story might have ended there. But, with Elam’s quality of life degraded by debilitating seizures, what followed instead was a quest by Dr. Auguste, director of pediatric epilepsy surgery at UCSF Benioff Children’s Hospitals, to ensure Elam could get the care he needed.

After two years of Elam experiencing seizures so severe he ended up in a wheelchair, the Mallorys sought treatment at our San Francisco campus.

“I knew immediately this would be different, that the doctors truly cared about us,” Amanda says.

But the empathy wasn’t the biggest game changer — that was the technology. The Mallorys learned that a stereo EEG, which their previous hospital didn’t offer, could determine where in Elam’s brain the seizures originated, making corrective surgery possible. “It was the first time I felt hope in years,” Amanda says.

They discovered the focal point was the occipital lobe, the brain’s visual processing center. Surgery could stop Elam’s seizures, but half of his visual field could be limited after surgery.

Elam had no doubt in his mind: He wanted the surgery. But that initial attempt ended soon after it began, when his heart stopped on the operating table.

“I didn’t want to go through it again, but Elam was adamant, even with the knowledge that his life was at risk,” Amanda says.

And Dr. Auguste was committed to seeing the surgery through. “We knew we had to face our fears and push the boundaries of our expertise,” he says.

He partnered with the cardiology department to come up with a game plan. A specialized breathing tube would be placed in Elam’s airway to electrically pace his heart if needed; an esophageal ultrasound probe would allow them to monitor his heart and air intake. A special kind of anesthesia would help stabilize his heart’s electrical activity. A cardiology team joined the neurosurgery team for the operation.

That day, when Dr. Auguste appeared in the waiting room, he brought the Mallorys back to the same conference room. “But this time it was a much different conversation,” Amanda says. The surgery had gone flawlessly.

“Within an hour of waking up Elam said, ‘I feel better than I have in my entire life.’ It was a miracle,” Amanda says. Elam, now 11, has been free of debilitating seizures ever since. And though he is adjusting to new limits of his peripheral vision, he can now run, draw, and even ride a bike, which was not possible before.

Dr. Auguste is thrilled to have helped Elam get back to being a regular kid. “I’m so thankful to be a surgeon at UCSF,” he says. “I can literally walk down the hall and say to a colleague, ‘I’ve got a really tough case and I can’t get this done without your help.’ It’s awesome to be part of this team.”