Part I: Fort Worth surgeon holds young lives -- and parents' hopes -- in his skilled hands

By TIM MADIGAN

tmadigan@star-telegram.com

Part one of a five-part series

Monday, April 26

FORT WORTH -- Leticia Gutierrez hears the playful drumming of fingertips on the other side of the exam room door. When it opens, a short, trim man in his late 50s pokes his head inside, smiling impishly, looking around.

"I had to make sure there was nobody hiding behind the door," the man says, chuckling as he crosses the small room. He sits on a sliding stool next to Leticia and extends his hand.

"Dave Donahue, neurosurgery."

He is dressed in khakis and a polo shirt, and he has the look of an absent-minded professor, with brown-rimmed glasses and graying reddish hair that is wildly tousled from the morning drive to work in his 13-year-old Miata convertible. The head of pediatric neurosurgery at Cook Children's Medical Center in Fort Worth looks over Leticia's son Roberto Dominguez, who lies fidgeting on an exam table.

"So," Donahue says. "How long have you had him?"

Roberto is a long, thin boy who wears jeans, a T-shirt and a protective blue helmet with a Dallas Cowboys star affixed to the front.

The helmet is necessary because, up to 20 times a day, an electrical storm begins to rage in Roberto's head, epileptic seizures that cause him to drop to the ground like he's been shot. Profoundly autistic, the boy has never spoken, and he functions at the developmental level of a toddler.

"He's 6 years old," Leticia says.

"We won't hold that against him," Donahue says, smiling. "He's had lunch?"

"Not yet."

"Poor guy," Donahue says. "We'll take as much time as we need, but we won't make him wait any more. Tomorrow's the big day."

"Yeah," says the 30-year-old mother. "I'm scared."

"Well, that's good," Donahue says. "I'm glad you're scared, because if you weren't I would say you're crazy."

"I'm terribly scared."

The smile fades from the surgeon's face. He sets Roberto's case file down on a desk and leans toward her, his voice just above a whisper.

"What are you scared of most?"

"Of losing him," Leticia says.

The surgeon sighs deeply.

Finding his calling

The youngest of four boys, David Donahue spent his childhood in the affluent northern suburbs of Chicago and in Memphis. One brother, Bill Donahue, remembers him as a bright, curious and very cautious child who attended a Catholic boarding school for boys in Kentucky and briefly considered becoming a priest. David Donahue later majored in history and minored in French at Georgetown University.

His interest in medicine began while working part time in a laboratory as a teenager. After college, Donahue took remedial science courses and was accepted into medical school at the University of Tennessee.

He began his career performing brain surgery on adults, though his true passion lay elsewhere.

From the time he was a teenager, relatives noticed Donahue's uncanny ability to relate to younger children.

"There was just an affinity there," Bill Donahue says. "He wouldn't talk down to them, yet he could communicate with them at a level that they felt very comfortable with. It wasn't too adult; it wasn't too childlike."

One day about 25 years ago, he was called to consult on a case at a Memphis children's hospital.

"There was a kid in the ICU with a malignant tumor on the spine," David Donahue said. "I hadn't been in a children's hospital for several years. So I went to see this kid and I realized, 'This is where I need to be. I can't believe I didn't do pediatrics.'"

The surgeon received extra training. Donahue and his family moved from Memphis to a children's hospital in Washington, D.C., then to Fort Worth in 1994. He now hurries down the corridors at Cook Children's, rushing in and out of operating rooms, or from room to room in the neurology clinic, always walking like he is late.

In Donahue's case, looks do not deceive. He is absent-minded. His wallet, cellphone and car keys too often end up in places unknown.

"If he didn't have a belt, we'd see him walking around without his pants on," Bill Donahue says.

One of his neurosurgeon colleagues at Cook Children's, Dr. Richard Roberts, suggests that David Donahue isn't so absent-minded at all. In fact, the opposite is probably closer to the truth.

"It's just thought to thought to thought," Roberts says. "And let me tell you, if you're worried about brain surgery, where you put your keys is probably the last thing on your mind. If you're thinking about taking out a piece of someone's brain, your keys are just not important. It just falls by the wayside."

Some days there is an epilepsy surgery in the morning and a malignant brain tumor in the afternoon, with about 300 pediatric brain operations in Donahue's typical year. His sleep is regularly interrupted by worries about his next surgical procedure, or by a call from the emergency room in the middle of the night because a child has been injured in a car wreck or by an abusive adult.

This week in late April will be one of the most difficult in recent memory, a marathon series of operations on one young patient, with frustrations and mounting concerns about the boy, Roberto. It is there, in the operating room with Roberto, that Donahue is not distracted at all. Nor are there any preoccupations when he sits in an exam room with the boy's terrified mother, because a long time ago, one of David Donahue's brothers was sick like Roberto, and Donahue had been terrified, too.

'It's normal to be scared'

In the days leading up to her first meeting with Dr. Donahue, Leticia Gutierrez suffers the same nightmare almost every night. She is sitting in a hospital waiting room while Roberto undergoes brain surgery. But in her dreams, Leticia always wakes up before the operation ends, before she learns whether he has made it safely through the surgery.

The morning she will meet Donahue, Leticia shakes herself awake at 4 a.m., her fists clenched so tightly that she breaks off a long fingernail on her left hand.

Several hours later, with her fiance starting a new job as a construction worker and her three older children at school, Leticia drives Roberto to the hospital, where Donahue listens to her fears. Roberto is the youngest of her four children, the baby. What will Leticia do if he dies?

The surgeon's face reddens noticeably.

"Well, that's pretty unlikely," Donahue says. "It's possible. Any time you're doing brain surgery, it's possible. It's like when you go to war. There's a chance you won't come back. But most of the time, the kids seem to do OK. A lot of it is just the good Lord, or luck, or whatever, but the kids seem to get through it. We're going to do everything one step at a time. Brain surgery is little steps, so we'll try to get through it so he'll be safe."

The words themselves are not that reassuring, but somehow, as Donahue speaks, the mother's terror subsides. She had expected some cocky guy who thought he was Superman and talked down to his patients. Instead, here is this short fellow with a silly grin, hair that needs combing and an earnest manner that suggests he already cares about Roberto as much as his mother.

For years, Leticia had resisted suggestions that her son's epilepsy be treated by cutting out the piece of his brain that's causing his seizures. But more and more, it seemed like she had no choice. So she had prayed and prayed and prayed, and now wonders whether this unusual man before her is the answer to those prayers.

Donahue explains what will happen in the week to come. The next morning he will remove part of the boy's skull and place strips of electrodes directly against Roberto's brain. The electrodes will help pinpoint the source of his seizures. A day or two after that, Donahue and his team will undertake another surgery to cut out, or resect, the areas of the brain causing the seizures. The electrical storm that has raged in Roberto's head might finally subside. It is possible that Roberto could learn to talk and interact with his family and surroundings in more profound ways.

"It's not as though he's safe the way things are," Donahue tells her. "He's probably in more danger having the seizures than he would be during this operation. I think you're doing the right thing. I mean, you feel like you're putting him in harm's way. The decision to do this requires a lot of courage. It's normal to be scared. I wouldn't say that I'm scared, but I tell you that I take it very seriously that every child I touch could die. But do you know how many deaths we've had during epilepsy surgery?"

"How many?" Leticia says.

"None."

"Thank God," Leticia says, wiping her eyes.

"Let's see if we can find you some Kleenex," Donahue says.

Prayers and hopes

Donahue stands to examine Roberto, manipulating his arms and legs, looking into his eyes with a light. He scoops the boy into his arms and sits down, rubbing Roberto's back.

"OK, sweet boy," Donahue says. He turns toward Leticia. "Did I answer any of your questions?"

"Yes," she says.

"Does it make sense?"

"I've been praying for God to work through your hands," Leticia says.

"Well, thank you for doing that," Donahue says.

"I'm sure you're a good doctor," she says. "I've heard very good things about you. A lot of good things, actually."

"We're not above praying, that's for sure," Donahue says. "It sounds crazy, but so much of it is in His hands. But obviously, he's my responsibility. I feel full responsibility for him, and I will as long as I'm alive. He's my boy, too."

Donahue hands Roberto back to his mother.

"I think he's good to go," he says. "We'll take good care of him. Thank you for being so kind to me."

Donahue hurries from the room, headed toward his next young patient, walking like he was late.

TIM MADIGAN, 817-390-7544

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