Neurosurgery Resident’s Book Helps Ease Youths’ Fears About Brain Surgery

Parker has no appetite even for his favorite food — strawberry ice cream cones — because his head and belly don’t feel well at all.

After visits to many doctors, he finally goes into the city to meet Dr. Spott E. Dogg, who tells Parker and his mother some bad news: Parker has a brain tumor.

But the pediatric neurosurgeon also has some good news. He can perform surgery that will make Parker feel a whole lot better — and want his strawberry ice cream again.

So begins a story titled “Parker’s Brain Storm” by Dr. Jennifer Moliterno, a fifth-year neurosurgery resident at Yale. She wrote and illustrated the tale — which features a young bear as its title character — while she was a medical student as a way to ease the fears of young children about to undergo brain tumor surgery. About a year ago, “Parker’s Brain Storm” was formatted into a short video that has been translated into several languages and can be viewed online by children and their parents around the world.

For Moliterno, the popularity of the book has been quite a surprise. She completed it over the course of just one weekend and presented it as a thank-you gift to Dr. Jeffrey Wisoff, a pediatric neurosurgeon at New York University (NYU), and his patients after she completed a summer internship there. She never expected “Parker’s Brain Storm” to be seen by children and their families beyond Wisoff’s practice.

Moliterno recently took the time to discuss her book and her work in neurosurgery. Here is what we learned:

Little bear: There are a couple of things that Moliterno knew for sure about herself as she was growing up. One was that she wanted to be a surgeon, and the other is that she loved to draw and write.

Her parents used to tease her about her plan to become a doctor because she was afraid of blood. Nevertheless, Moliterno plowed ahead, eventually overcoming her fear. In fact, her first interest was in cardiac surgery.

After earning an undergraduate degree in psychology as a pre-med student at the University of Florida-Gainesville, she continued her education there as a medical student. In her first year of medical school, she studied neuroscience, and was fascinated by the field.

During her summer internship in the Department of Neurosurgery at NYU, Moliterno met young children with brain tumors and observed first-hand the anxieties they faced about their surgery and recovery.

To help them, she created an original story about a little bear called “Snuggles” — named after a stuffed animal that was her own childhood companion — and the “brain storm” that tumors cause. As Dr. Dogg explains in her story, a brain tumor is a little bit like a storm, during which wind and rain can wreak havoc across a wide area. A brain tumor, he tells the little bear, can also make his stomach feel badly.

A new name: Eventually, the Children’s Brain Tumor Foundation discovered Moliterno’s book (she’s not exactly sure how) and asked if it could be used as an Internet video to allay children’s fears about their surgery. “Snuggles,” however, had to be renamed so as not to be confused with the bear of SnugglesTM fabric-softener fame. Moliterno decided to name her little bear after pediatric neurosurgeon Dr. John Parker Mickle, one of her mentors in medical school.

The Children’s Brain Tumor Foundation published “Parker’s Brain Storm” and makes the book available for free to children who request a copy after seeing the video. Young survivors of brain tumors voice the lines of the characters in the video.

While Moliterno has retained the copyright for “Parker’s Brain Storm,” she donated its use and any proceeds from the book to the Children’s Brain Tumor Foundation to support and treat children who have been diagnosed with brain or spinal cord tumors. According to the foundation, approximately nine children a day are diagnosed with a brain or spinal cord tumor, and about three children die from them daily.

Parker goes to school: Moliterno is now working on a second book about Parker, this one dealing with issues that children face in recovery.

“It describes the little bear going back to school after his surgery and how the other bears treat him,” explains Moliterno. “For kids in recovery, there are additional challenges that they face after their surgery, and the second book addresses some of those.”

Moliterno is about halfway finished with the second book, squeezing in her writing and drawing while working long hours as a neurosurgery resident. She notes that the Children’s Brain Tumor Foundation hopes to receive funding to make its publication possible in the near future.

Gaining recognition: In the seven-year residency program in neurosurgery at Yale, Moliterno has gained experience working with patients during rotations in various neurological specialties. She has a particular interest in the treatment of brain tumors, and recently was awarded the Louise Eisenhardt Resident Travel Scholarship from Women in Neurosurgery, part of the American Association of Neurological Surgeons.

The annual award recognizes research she was involved with during a neuro-oncology clinical research rotation in the Weill-Cornell Medical College’s Department of Neurological Surgery. Working along with the laboratory of Dr. John A. Boockvar, she helped investigate the significance of phosphatases in glioblastoma multiforme, the most common and aggressive kind of brain tumor in humans — the type that the late Massachusetts Senator Edward M. Kennedy had.

Coincidentally, the Louise Eisenhardt scholarship is named for a neuropathologist who worked alongside Dr. Harvey W. Cushing, known as “the father of neurosurgery.” He moved to Yale late in his career, and Eisenhardt became curator of his brain tumor registry, which is now housed at the Yale School of Medicine. Eisenhardt was also one of the world’s leading experts on the diagnosis of brain tumors.

Although Moliterno appreciates the importance of basic science research, her personal interest lies with clinical research and, particularly, clinical trials.

“I’m very interested in clinical trials because I enjoy interacting with patients and seeing firsthand whether these interventions which have been studied in the lab are in fact potentially useful in humans,” says Moli­terno, who was first attracted to clinical research while completing coursework through Yale’s Robert Wood Johnson Clinical Scholars Program.

Like Dr. Dogg: Looking back at her early interest in cardiac surgery, Moliterno says she can’t quite imagine how she had ever considered a career other than neurosurgery.

“The human brain is surreal,” she says. “There’s nothing that can describe what it is like to see a person’s brain for the first time during surgery. That feeling has never gone away for me — that sense of awe and respect when you are working on someone’s brain.”

Coupled with her fascination, however, is the acknowledgement that she treats some of the sickest patients at Yale-New Haven Hospital.

“Many of the patients we see have a life-threatening disease,” she says, noting that her most challenging cases were those where she and her colleagues were unable to save a patient’s life.

“But when we can make a difference, it’s beyond great,” she adds. “I’ve seen more successful outcomes than bad ones, or maybe you just try to remember the successes. In any case, there are many of them, too.”

The Yale doctor, whose primary interest is in neuro-oncology, says she is very excited about Yale’s new Smilow Cancer Hospital, and she hopes to continue her career in academic neurosurgery when she completes her residency.

Like the Dr. Dogg character in her book, Moliterno views it as her job to help her patients through their fears about having a brain tumor.

“All of my mentors, both at Yale and elsewhere, have taught me by example to be a caring surgeon who gets to know my patients, to be involved,” says Moliterno. “If we can’t make the outcome better — and sometimes we can’t — we can at least help them and their families cope through an incredibly difficult period.”

To watch “Parker’s Brain Storm” online, visit www.cbtf.org/cms/parkers_brain_storm.

— By Susan Gonzalez

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