In a long line of photos of physicians lining the wall of MetroWest Medical Center, Dr. William Wiener’s is the very first. At 93 years old, the retired neurologist was in the medical field for over six decades and served in leadership roles at MetroWest.
Throughout his long medical career, Wiener, who lived in Brookline and goes by Bill, had many mentees. So, when the time came for Wiener to get brain surgery, he knew who to go to.
Dr. Krishna Nirmel, a neurosurgeon affiliated with MetroWest Medical Center, operated on Wiener in August. Wiener had been diagnosed with normal pressure hydrocephalus (NPH), a neurological condition caused by spinal fluid build-up in the skull.
As a mentor, Wiener trained medical students and residents who came through MetroWest, bringing them with him on his rounds and teaching them the basics of neurology, Nirmel said. Wiener also taught seminars for psychiatrists and neurologists hoping to pass their board exams.
When Wiener went to Nirmel for treatment, he’d been having moments of confusion and couldn’t stand on his own. Despite risks like site infection and subdural hematoma, getting a shunt was a “no-brainer,” Wiener said.
The shunt uses a catheter inserted in a brain ventricle to drain excess spinal fluid into areas in the body where it can be more easily absorbed, like the peritoneal lining, which has a very fine membrane that can eventually return the spinal fluid back into the bloodstream, Nirmel explained.
“I know a lot about this condition, and I understand that it may take me months to recover,” Wiener said. “But the alternative is permanent dementia and incontinence.”
Now, after the operation, Wiener can walk for short periods of time with the assistance of a walker, he has less cognitive impairment and no longer struggles with incontinence, he said.
For Nirmel, the procedure was slightly nerve-racking, because “anytime you open somebody’s head, there’s a risk.”
“The last thing I want is somebody I care for, who is my friend, to have a complication,” he said.
Despite the nerves that accompany most medical procedures, Wiener found comfort in knowing Nirmel would be operating on him.
“I knew this guy for years,” Wiener said. “I’d rather have somebody I know open up my brain than someone I didn’t know.”
At MetroWest, Wiener served as a mentor for those around him. When faced with a challenging issue, Wiener tackled it head-on and was the doctor people sought out for advice, Nirmel said.
“The more complex the problem, the better,” Wiener said. “You have to be a bit like Sherlock.”
One of the key lessons Nirmel learned under Wiener is that “observation is the key element” for diagnosis, he said. It’s that very lesson that helped him diagnose Wiener with NPH.
Cognitive confusion, mobility issues and incontinence are all symptoms of dementia. But they are also symptoms of the much lesser-known, though often curable, NPH, which Nirmel contributes to the condition being particularly challenging to diagnose.
“Less than 20 percent of people with [NPH] are properly diagnosed,” according to the Alzheimer’s Association, an organization that seeks to accelerate global research and end forms of dementia.
For NPH, an essential part of diagnosis is the patient’s gait, or the manner in which a person walks. People with NPH often take wide, short steps and have trouble turning in a few steps, Nirmel said.
Oftentimes, by the time a doctor sees a patient, the patient has already had preliminary tests done and is often seated for the entirety of the visit. This can lead to doctors not seeing any noticeable gait abnormalities, Nirmel said.
“Even smart doctors, they don’t think of NPH as one of the things that you look for,” he said.
While awareness of the condition increased when singer-songwriter Billy Joel announced in May that he had NPH, Nirmel said there’s a long way to go. He hopes “education and awareness” can bridge the gap, he said.
Now that Wiener has the shunt in, the valve that regulates the flow of spinal fluid can be adjusted using a magnetic device to change the opening pressure, to prevent over- or under-drainage. The shunt catheter has two antibiotics that leech out for 30 days after the operation, which Nirmel says “dramatically decreased” risks of infection post-surgery.
Being able to change the shunt’s pressure has been a “fantastic” medical advancement, Nirmel said. Shunts used to have a fixed pressure, so to change it would mean changing the valve in an operation under anesthesia.
Now using the magnetic device, Wiener’s valve pressure can be easily changed with no pain.
While the surgery was largely a success, Wiener hopes to further improve his mobility and his hearing in the coming months. As for his memory?
“I’m a little forgetful, but most 93-year-old people are,” Wiener said with a smile.
This story is part of a partnership between Brookline.News and the Boston University Department of Journalism.
This article was originally published on October 2, 2025.