Dr. Jennifer Moliterno, left, removed an aggressive, complicated brain tumor from Army veteran Joe Brennan’s brain. The tumor could have been fatal.

Dr. Jennifer Moliterno, left, removed an aggressive, complicated brain tumor from Army veteran Joe Brennan’s brain. The tumor could have been fatal. (Ed Stannard, Hartford Courant/TNS)

(Tribune News Service) — Joe Brennan, a helicopter pilot and U.S. Army veteran, is tough and supremely confident of his ability to fly a chopper, even through a heavy rainstorm.

His toughness couldn’t help him, though, when he was on his knees with an excruciating headache or vomiting for no apparent reason.

Dr. Jennifer Moliterno, chief of neurosurgical oncology at Yale New Haven Hospital and clinical director of the Chênevert Brain Tumor Center at Yale Cancer Center, has no lack of confidence either. She knows she has the ability to remove complicated brain tumors, such as those pressing against the all-important brain stem.

That’s the kind of aggressive tumor that was giving Brennan headaches and nausea. Other surgeons had said it was too risky to try to remove. But when Moliterno looked at his brain scans during a tumor board meeting, she said, “I can help that guy.”

On Jan. 22, 2022, she removed the entire tumor — at least 98% of it — she said.

Today, Brennan, 58, of Shelton, Conn., is still recovering from the aftereffects of the tumor, and he is waiting for medical clearance from the Federal Aviation Administration to be able to fly alone again. But he’s already been in the air with a friend and is back to living his life. He’s riding his motorcycle and looks forward to playing hockey.

He has no doubt Moliterno saved his life.

Brennan had attributed the headaches to “dehydration or maybe migraines or some muscle-related, because I work out a lot and ride a bicycle a lot. Most of the pain was in the back of my head.”

Over-the-counter migraine medication seemed to help. Then, “I started to have what I like to call episodes, where … anytime I clenched my body, or head below the heart situation. … It would literally drive me to my knees.”

“What he’s describing is when people have increased pressure inside of their heads,” Moliterno said. “And they have a backup of fluid like he had because of the tumor and the size of the tumor. It’s absolutely what he’s describing. … It gets worse when you bend over. It gets worse when you cough. It gets worse when you pick up something. Anything that increases the pressure inside the head.”

Brennan tried to relieve the pain by lowering his chin onto his chest, stretching the back of his neck. It helped some. Then one day in the spring of 2021 he was in “dunk training,” in which a mock helicopter is dropped upside down into a pool, with him at the controls.

“I had an episode in the school, drove me to my knees in the hallway,” he said. He went to see a doctor, who did a CT scan, saw the tumor and said, “You need to get to Bridgeport Hospital. They’re waiting for you.”

“What happened was that he had an enormous mass that was obstructing the flow of spinal fluid between his brain and his spine with significant mass effect, threatening his life on his brainstem,” Moliterno said.

The doctors at Bridgeport put a shunt into his skull, draining the fluid that was putting pressure on his brainstem. But they thought trying to remove the tumor was too risky, Brennan said.

“Had I seen him with my experience, with my expertise, with my capabilities, I would have done what I ended up doing in January 2022, which is remove the mass and then let the spinal fluid flow,” Moliterno said. “That is a complicated thing to do. It’s a very high-risk surgery.”

She explained why she could do what other surgeons could not. “It requires an enormous level of — just like his flying, right? — of expertise and experience and doing these sorts of challenging complex cases over and over and over again,” she said. “So I do the most number of brain tumor surgeries in Connecticut. All I do, really, is brain tumor surgery.”

Moliterno, who began training in brain surgery in 2005, has been in full-time practice since 2013.

Dr. Jennifer Moliterno, right, and her patient, Army veteran Joe Brennan, embrace at a recent meeting.

Dr. Jennifer Moliterno, right, and her patient, Army veteran Joe Brennan, embrace at a recent meeting. (Ed Stannard, Hartford Courant/TNS)

The type of tumor, which had been biopsied, was inconclusive, and Moliterno still refers to it only as “aggressive.”

“I’ll never forget when I first saw his films … and I said, I need to see him, I can help that guy,” she said. Others said “it’s so high risk,” but she replied, “I understand, but I can help him. And I can do it safely. And we can get him a diagnosis. And we can remove that mass, and then let his fluid restore itself.”

Meanwhile, Brennan’s symptoms were getting worse. He was “vomiting out of nowhere,” he said. “As an example, before I could get up in the morning, go brush my teeth, and I’m turning to take care of business. I could be sitting at my desk at work and I’m pulling out my trash pail. There’s nothing. I ate nothing.”

“What was happening is the backup of fluid; the tumor had grown,” Moliterno said. “The tumor was getting bigger because it was left untreated. So even though he had the shunt that was alleviating the fluid, the shunt couldn’t keep up, because there was just more and more fluid backing up, so he was becoming more and more symptomatic. If he didn’t have that shunt, he would have died.”

Brennan also found himself “drunk walking and uneasiness on my feet. And I always had this constant, mild, droning headache,” which was getting worse. His oncologist, Dr. Nick Blondin, gave him a list of surgeons and Moliterno was at the top of the list. Brennan did some research on the internet, checked with other doctors. Then he said, “OK, that’s the one. Let’s do it.”

“And we met in her office, and she came right up to me and shook my hand and said, ‘It’s like I’ve known you for weeks, because I’ve been watching you,’” he said.

That was in December 2021, months after his symptoms began. Why did he wait so long to get help? He said it’s because he’s a “military guy.”

“Yeah, rub dirt in it, take some … Advil, just to get through,” Brennan said. “Military aviators, when they get sick, they don’t want to go see the flight doctor because the flight doctor will ground them. I didn’t go into aviation and earn my wings to be grounded. So yeah, I’ll take a lot. I’ll take an awful lot.”

“I had that impression from him,” Moliterno said. “I felt bad for him, because surgeons are the same. … There’s people who need me. It’s like totally true. And I think that is a lot what we have in common in both of our professions. … I hoped that he was trusting me that I could help him and take care of him because I really knew that I could.”

Once they met, Brennan didn’t want to wait any longer. “When I made the decision, I was ready to go the next day,” he said. “I’m a pointy end of the spear kind of guy. So, OK, I got a tumor. You say you can get it. Let’s … get it.”

Moliterno calls herself a perfectionist, but said, “There’s a lot of things that could go wrong, even when everything goes right. … When you’re dealing with this part of the brain, it’s so unforgiving.”

That’s because the brainstem, which begins inside the brain and becomes the spinal cord, controls the basic functions of life, Moliterno said.

“It is the center of the brain, the most important thing that there is, and it’s a very small area, and so it has a lot of function in a very little area,” she said. “And that’s why the other neurosurgeon felt that this was too risky to work in that area.”

“I had to learn how to walk again,” Brennan said. “And I couldn’t write. I couldn’t hold a pen.” He also had trouble swallowing, which he still has a bit of difficulty with. His vocal cords were frozen, so he needed a feeding tube.

“This location is the part of the brain that really causes you to live,” Moliterno said of the brainstem. “It’s what tells the heart to pump, what tells your lungs to breathe. And it also controls swallowing.” The inability to swallow could cause Brennan to aspirate, which caused him to get pneumonia.

At rehab, besides learning to walk again, Brennan had to learn how to pronounce some words, because his tongue “wasn’t working right,” he said.

“To be honest, really, the only function that’s related to the location was swallowing, and maybe some walking and balance trouble,” Moliterno said.

“The rest of what he’s talking about, like the deconditioning, is essentially how sick he was before the surgery,” she said. “Because the brain compensates until it can’t. So it’s always when the tumor is removed that you really see how bad shape the person has been in.”

Doctors also found a bone spur on a vertebra that is pushing against his esophagus.

Then one day, his occupational therapist looked at him, told him to sit down and called an ambulance. Brennan had an infection from the shunt he still had in his head.

“If I remember correctly, he was just really out of it and really confused,” Moliterno said. “Whenever there’s recent brain surgery or a shunt or something like that, you always have to consider some sort of meningitis, which essentially is what that is. … So we removed it, and he didn’t need it anyway.”

Besides Moliterno, Brennan credits his girlfriend, Kim Kanaitis, Blondin, the rehab staff and the rest of the medical professionals for getting him through. “Without my two sisters, Kim, and the rest of my tribe, my friends, my co-workers. I wouldn’t be where I am without them,” he said.

Like Moliterno, Brennan has confidence in his abilities, which he believes is what drew him to his surgeon.

“If I tell you I’m taking your family to Manhattan tonight in a helicopter, that … freezing rain weather, I’m going to look you in the eye and say yes or no,” he said. “If I tell you yes, am I being cocky? … No, I’m just pretty damn sure in my abilities, and my skill, because I have done it, I will do it. … But I saw a bit of me in her.

“I firmly believe God puts people in front of other people for a reason,” Brennan said. “There’s a reason she was put in front of me. And there was a reason I was put in front of her. And we may never truly know that. But that’s the way it worked. And it is OK.”

©2023 Hartford Courant.


Distributed by Tribune Content Agency, LLC.

Sign Up for Daily Headlines

Sign up to receive a daily email of today's top military news stories from Stars and Stripes and top news outlets from around the world.

Sign Up Now