Issue link: https://viewer.e-digitaledition.com/i/1029344
good reason for optimism about positive outcomes for these children. Recent advances in the genetics under- pinnings of various tumors have allowed doctors to better tailor radiation and chemotherapy treatments, both the medica- tions used and the duration, ultimately improving the survival odds for patients. " We used to infer the biolog y from the shape — how tumors looked under a microscope — whereas now we can infer more about the tumor from the genetics," Dr. Gra nt says. "A medu l lobla stoma , for exa mple, m ig ht behave ben ig n ly o r m a l i g n a n t l y d e p e n d i n g o n i t s genetic ma keup." PL ASTICIT Y T he pl a s t icit y of c h i ld r en's br a i n s is¦a nother factor that Dr. Gra nt wa nts to empha si ze. For exa mple, it 's pos- sible for¦ a baby to have a major stroke i n ¦ t h e ¦ l e f t m i d d l e c e r e br a l a r t e r y a n d p a r e n t s m a y n o t e v e n n o t i c e sig ns that¦ the stroke took place. The resu lt m ig ht be a couple of episodes o f ¦ a p n e a ¦ or ¦ o t h e r m i l d e f fe c t s , or m ay b e¦ a¦ l it t le del ay i n m i le s t one s , but t he ch i ld of ten is a sy mptomatic in 10 years' time. The same stroke would leave a n¦ adu lt w ith a¦ hemipleg ia a nd increase his or her risk of death because of swelling. " Even w it h somet hing a s major a s a¦ hemispherectomy in, say, a 5 -yea r- o l d s u f f e r i n g f r o m s e i z u r e s , t h e rema ining ha lf of the bra in w i l l ta ke over¦ a nd¦ rew ire itself," he says. " If a ch i ld su r v ives, he or she i s goi n g t o get bet ter. The question is how long it will ta ke¦ a nd how much bet ter will the child get." CATCHMENT AREA NS P C 's s er v ic e a r e a i s a l l of L on g Isla nd, which includes about 5 million people. Dr. Gra nt wou ld like to reach more patients in Brook lyn a nd Queens because it wou ld be ea sier for t hem t o v i sit N Y U Wi nt h rop i n M i neola , where he h a s pr iv i leges , t h a n t o go into Ma nhatta n. " If you r ch i ld is t h row i n g up, you wa nt t he closest ER . You wa nt to be told 'we've got this, your child is sa fe, you're not going to get a ny t hing bet- t er somewhere else,'" he says of t he world-cla ss ca re ava i lable at NSPC. "I'm comfor table saying that." BEYOND PEDIATRICS For t he va st major it y of Dr. Gra nt 's patients, any follow-up usua lly involves ot her c a r e pr o v i der s . I f h i s y ou n g pat ient s do need f u r t her su rger y a s t hey get older, he cont i nues to of fer t hem t reat ment s a nd con su lt at ion s they might not have access to at a purely children's hospita l. " You don't outgrow my care at 18 years old," he says. " Ver y few places ca n ta ke ca re of both chi ldren a nd adu lts, a nd NSPC is one of them." T here's a pa r t ic u l a r t r u s t t h at i s bu i lt when pa t ient s put t hei r l ive s i n t he ha nds of a neurosurgeon, a nd Dr. Gra nt ha s occa siona l ly ended up per forming procedures on siblings or ex tended fa mily members. EASING CONCERNS Above a ll, Dr. Gra nt wa nts to prevent fa milies from avoiding consultations with him because of fea rs about what they might lea rn. He sees patients with abnorma l CT sca ns, of course, but he a lso welcomes those who have concerns but haven't yet had a sca n performed. " If a patient comes to see me a nd I say ' t his is no big dea l a nd you don't need a n operation,' that 's probably the most usef u l t hing I do f rom a public hea lth point of v iew," he says. " If you br i ng your ch i ld to see me a nd he or she does have a n issue, the outcome is by no mea ns hopeless." For more information, visit nspc.com. ■ Five years after Dr. Grant successfully removed a pineal tumor from a patient's brain, he is enrolled in nursing school. Dr. Grant confers with his secretary, Erika Tenaglia, about his next patient. 1 0❱❱❱❱❱ C O V E R F E A T U R E