Editor's note: This is the third in a series of stories on Rapid City teenager Ali Nowotny, who is being treated at Mayo Clinic in Rochester, Minn., for epileptic seizures caused by a brain tumor. On Thursday, Ali saw her pediatric neurologist and neurosurgeon for final appointments before surgery on Friday. The Rapid City Journal is at Mayo with Ali, documenting her journey.

Neurosurgeon Nicholas Wetjen leans forward, elbows on his knees, and gently gives Ali Nowotny news no one really wants to hear.

No matter how successful he is at removing her brain tumor Friday morning, Ali will lose some of her ability to retain new memories. There's a 10 to 15 percent chance her "memory deficit" could be profound.

"It's a lot," he says. "It's a lot to think about."

Wetjen, a handsome young doctor with dark hair and glasses, explains that the Wada test Ali underwent Wednesday shows her brain's left hemisphere is doing most of her memory and language work. The tumor causing her epileptic seizures is also in her left hemisphere. There's no way to avoid damaging the tissue to some extent while removing the tumor.

While Wetjen talks, Ali and her father Craig sit side-by-side in chairs. Family friend Carol Cooper sits by the door.

Ali's eyes redden and a tear clings to a bottom lash as Wetjen describes the potential outcome. Craig sits forward on his seat, his face flushed. The memory loss has been touched on by other doctors throughout their stay at Mayo, but Wetjen's matter-of-fact pronouncement really drives it home.

Ali started her day in a more cheerful mood, being wheeled around the Mayo campus, following doctor's orders to stay off her feet after her Wada procedure Wednesday. She met with Dr. Elaine Wirrell, her pediatric neurologist, in the morning.

Wirrell's office is located in the T. Denny Sanford Pediatric Center in the Mayo Building, an department designed with kids in mind. Children's drawings of skunks and racoons have been transferred to tiles on the walls, and large animal footprints lead to the various exam rooms.

While waiting in Wirrell's office, Craig, Ali and Cooper chat about homework and home. Craig mentions that Ali's brother Dustin might not be able to make the trip to Rochester because of the weather. Dustin attends the University of South Dakota in Vermillion.

Ali mishears her dad, her eyes registering confusion and a little panic. Craig repeats himself and Ali laughs. "I thought you meant we might not be able to do the surgery Friday because of snow. I'm doing the surgery. I'll walk there if I have to," she says.

Wirrell arrives shortly after and immediatley notices Ali's mohawk. She also asks about the St. Thomas More cheer and dance team. Ali postponed her surgery until now in order to compete with her team in the state competition. The team took home a championship and several firsts. "So it was worth the wait," Wirrell says.

After a quick physical exam of Ali, Wirrell sits down to talk.

Removing the tumor will give Ali a 70 to 80 percent chance of becoming seizure-free. That's the long-term goal, Wirrell says. Once the seizures stop, Wirrell will slowly wean Ali from her seizure medication.

Like Wetjen, Wirrell gently reminds Ali about the memory-loss potential. "You may notice a little more difficulty with verbal memory," she says.

Part of the reason both Wirrell and Wetjen can be almost certain some memory loss will occur is the way Wetjen will operate.

Wetjen will remove the tumor and some of the hippocampus (the portion of the brain affecting memory). It's the best bet for stopping the seizures permanently, he says.

If Wetjen only removes the tumor, he can't guarentee that the seizures will stop nor that Ali won't suffer memory loss anyway. Under that option, she might also need the surgery again some day.

"You can guide me how aggressive you want me to be," Wetjen says. "But it's a lot harder to go through that surgery again … psychologically. That's what we weigh and balance. It's a hard decision to make."

He also reminds Ali and Craig that her seizures are likely causing damage to her memory already.

Ali nods. Earlier, she admitted to Wirrell that her academic life had suffered in the past two years. "I haven't been doing as well as my freshman and sophomore year," she said. "I think it's because I've been so stressed."

Wetjen tells Ali that things will be challenging after the surgery. She will have to work harder to remember things, work harder in school. But Wetjen said rehabilitation can begin immedately and, hopefully, the surgery will mean a seizure-free life for her.

"The trade-off isn't good. The whole situation sucks," Wetjen says.

For long minutes Ali and Craig are quiet. Then Craig looks at his daughter. "What do you think?" he says. Then he looks at Wetjen, "We came here with the idea to get rid of the seizures permanently."

Ali nods, her decision obviously made.

"If I have to work harder at learning stuff, I'll work harder," she said, looking at Wetjen. "Do what you gotta do."

Lynn Taylor Rick can be reached at lynn.taylorrick@rapidcityjournal.com or 394-8414.