To guard against unanticipated disturbances, the door was locked. Wilson believes that neurosurgery is best conducted in silence, with a scrub nurse who can anticipate his every step, and a resident who does not have to be told what to do, only shown. On this particular day, he would do five, of which the transsphenoidal was the first, but the rituals would be the same. When he was busiest, in the nineteen-eighties, he would routinely do seven or eight brain surgeries in a row, starting at dawn and ending at dusk, lining up patients in adjoining operating rooms and striding from one to the other like a conquering general. He was wearing Nike cross-trainers, and surgical scrubs marked with the logo of the medical center he has dominated for the past thirty years-Moffitt Hospital, at the University of California, San Francisco. He is part Cherokee Indian and has high, broad cheekbones and large ears, which stick out at almost forty-five-degree angles.

His hair is cut very close to his scalp, so that, as residents over the years have joked, he might better empathize with the shaved heads of his patients. He is sixty-nine-a small, wiry man with heavily muscled arms. Wilson entered the operating room quickly, walking stiffly, bent slightly at the waist. She then tunnelled back through his nasal passages until she reached the pituitary, creating a cavity several inches deep and about one and a half centimetres in diameter. He was anesthetized and covered in blue surgical drapes, and one of Wilson’s neurosurgery residents-a tall, slender woman in her final year of training-“opened” the case, making a small incision in his upper gum, directly underneath his nose. Diagnostic imaging revealed a growth, eighteen millimetres in diameter, that had enveloped his pituitary gland and was compressing his optic nerve. The patient was a man in his sixties who had complained of impotence and obscured vision. Illustration by Mark UlriksenĮarly one recent morning, while the San Francisco fog was lifting from the surrounding hills, Charlie Wilson performed his two thousand nine hundred and eighty-seventh transsphenoidal resection of a pituitary tumor.

“It’s sort of an invisible hand,” he says. Charlie Wilson speaks of his surgical prowess as something he doesn’t fully understand.

Vein of stars genius