A steady hand: A veteran’s return to precision

Brian Marshal Smith Jr. remembers the exact moment he held his hand out in front of him — flat and steady. For most of his life, that simple act wasn’t possible. His hands had always moved — subtly at first, then enough to interfere with everyday tasks. Enough to change how he worked and moved through the world. Now, at 42, the Dupont resident could do something he hadn’t done in decades: hold still.

Life before the diagnosis was named

Mr. Smith spent 20 years in the Navy. Structure, precision and discipline were all part of the job. But in the early 2000s, he noticed something he couldn’t control. “I realized I had the shakes,” he recalls. “I probably had them for a while, but that was the first time I noticed.” A Navy neurologist diagnosed him with essential tremor, a neurological condition that causes involuntary shaking in the hands. At first, he just lived with it. Later, after moving back to Virginia, he tried medication. It didn’t help. Instead, it gave him new problems, including nerve pain in his arms and legs. So he adapted and worked around the tremor. But the condition followed him into civilian life — into classrooms, his career and the things he loved most.

3 surgeries, 1 goal

After retiring from the Navy, Mr. Smith moved back to Pennsylvania in 2022. A visit to a Veterans Affairs neurologist introduced a new option: deep brain stimulation, or DBS. He asked for a referral. By then, the tremor was affecting nearly every part of daily life. At Johnson College, where he was training to become a biomedical equipment technician, even routine classwork had become frustrating. “I was in class trying to put components on an electronic circuit board,” he says. “I knew how to do it — but I was shaking so much that I couldn’t.” At Geisinger Wyoming Valley Medical Center, neurosurgeon Philip Lee, MD, PhD, and Maria Torquato, PA-C, walked him and his wife through the process — what the surgery involved, how the device works, what life could look like after. “My wife was my backbone,” Mr. Smith says. “She’s a registered nurse, and her knowledge helped me decide to get the procedure.” DBS works by sending electrical signals to specific areas of the brain to interrupt the abnormal activity that causes tremors. For Mr. Smith, it meant 3 separate procedures over 3 months. First, they created a custom head frame. Then they placed thin electrodes in his brain. And finally, they connected those wires to a small neurostimulator implanted in his chest. Each procedure required precision. Dr. Lee's expertise in navigating the delicate neural pathways meant the electrodes could be placed exactly where they needed to be — targeting the specific brain regions responsible for the tremors without affecting surrounding tissue. “It was a process,” Mr. Smith says. “But I felt confident throughout the procedures. I had faith in Dr. Lee, Ms. Torquato and the whole team.” Dr. Lee saw the impact of the condition and the outcome clearly. “Sometimes people who don’t experience it don’t understand how debilitating it is,” he says. “But for Mr. Smith, it was very debilitating.” The result, he adds, is exactly what the team hopes for. But the recovery came with a brief setback. After the electrodes were placed, he noticed something wasn’t right with his walking. A CT scan showed swelling in his brain. Dr. Lee called him right away and started steroids to reduce the inflammation. It worked. Soon after, the team turned on the device and fine-tuned it. That’s when everything changed.

Getting back to the things that matter

Today, the tremors are controlled. The device, which Mr. Smith recharges at home, is expected to last up to 15 years. More importantly, his hands do what he asks them to do.

“It changed my life,” Mr. Smith says.

He sees it in the small things: working on a car with his uncle, handling delicate equipment at his job and even tying fishing knots — something that once took longer than the fishing itself.

Mr. Smith was so confident in the outcome that he recommended Dr. Lee to his father-in law for back surgery. “I said, ‘you want one of the best neurosurgeons around?’” he recalls. “Go see Dr. Lee.”

Dr. Lee says that kind of trust often grows from the results patients see — and share with others.

“Mr. Smith has been very enthusiastic about and appreciative of the care he received,” Dr. Lee says. “As a result, I’ve gone on to operate on several of his family members as well.”

Still, the adjustment isn’t just physical. After living with tremors for so long, letting go of them can feel unfamiliar — even unsettling at first. “You grow accustomed to the shaking,” he says. “It feels like a safety net.”

That’s why he encourages others to give themselves time. “If I were to talk to myself, and the technology was there when I was younger, I would say do it — do it,” he says.

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