Quality of life (QOL) is a multidimensional concept that includes an individual’s subjective evaluation of all aspects of their life – physical, mental, emotional, social and even philosophical and spiritual. The last two are my personal incorporations into the definition since this is what human beings become when faced with adversity.
Thankfully, the entity of a Vestibular Schwannoma is benign one, but unfortunately in a ‘malignant’ location of the head. Patients with small tumours can sometimes have exasperating tinnitus and those with larger ones, disabling ataxia. Some people with tiny tumours have the apprehensive option of watchful waiting, while others with giant masses have no choice but an operation. Surgery includes encountering vital cranial nerves, blood vessels and the brain stem in the vicinity of the tumour. If any of these vital structures are disturbed, the event can damage QOL.
Hence, QOL becomes a moving target from one individual to another and more so at different time points in people’s life. It varies with age, sex, character, socio-economic status, job satisfaction, the nature of our relationships and our willingness to accept our situation and make the most of it.
I’d like to tell the story of Paul Kalanithi, a brilliant neurosurgeon. While in his final years of residency at Stanford and fielding job offers from several major universities, he was suddenly diagnosed with metastatic lung cancer. In a single moment of recognition, everything he had imagined for himself and his wife evaporated, and a new future had to be imagined. For him, exemplary QOL transgressed from the desire of achieving academic excellence and stepping onto center-stage, to being able to hold his newly born daughter’s hand to whom he dedicated the heart-wrenching story of his life. In his book titled "When Breath Becomes Air", the quest for 3-year-old is what makes his life more meaningful. It’s a book of two halves: the first is about becoming a doctor and saving a life, the second about becoming a patient and facing death. I encourage you to read it.
Fortunately, in acoustic schwannomas death is a rarity, almost never seen in this era of modern medicine.