Do No Harm: Stories of Life, Death, and Brain Surgery

“Where is Caroline?” I asked as I arrived at the x-ray reception desk, a little out of breath.
“Well, she’s about somewhere,” came the reply.
So I headed off round the department and eventually I found her and explained the problem.
“Have you tried your password?”
“Yes, I bloody well have!”
“Well, try Mr. Johnsons. That usually works. Fuckoff45. He hates computers.”
“Why 45?”
“It’s the 45th month since we signed on to that hospital system and one has to change the password every month,” Caroline replied.
So I ran down the corridor and down the stairs and past the waiting patients back to the consultation room.”

I am looking directly into the center of the brain, a secret and mysterious area where all the most vital functions that keep us conscious and alive are to be found. Above me, like the great arches of a cathedral roof, are the deep veins of the brain – the Internal Cerebral Veins and beyond them the basal veins of Rosenthal and the in the midline the Great Vein of Galen, dark blue and glittering in the light of the microscope. This is anatomy that inspires awe in neurosurgeons.

Are the thoughts that I am thinking as I look at this solid lump of fatty protein covered in blood vessels really made out of the same stuff? And the answer always comes back – they are – and the thought itself is too crazy, too incomprehensible, and I get on with the operation.

I left them in the little room, their knees squeezed together as the four of them sat on the small sofa and wondered, yet again, as I walked away down the dark hospital corridor, at the way we cling so tightly to life and how there would be so much less suffering if we did not. Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all.

I went down the stairs to my office to see if there was any more paperwork to be done but just for once Gail had left my office empty. It had been a good day. I had not lost my temper. I had finished the list. The patients were well. The pathology had been benign. I had been able to cancel the two spines at the beginning of the list rather than at the end. There were no major problems with the patients on the wards. What more could a surgeon want?

None of us felt able to make our usual sardonic jokes at the morning meeting. The first case was a man who had died as a result of an entirely avoidable delay in his being transferred to our unit; another was a young woman who had become brain dead after a haemorrhage. We looked glumly at her brain scan.

'That's a dead brain,' one of my colleagues explained to the juniors. 'Brain looks like ground glass.'

The last case was an eight-year-old who had tried to hang himself and had suffered hypoxic brain damage.

'Can we have some rather less depressing cases please?' someone asked, but there were none and the meeting came to an end.

How strange it is, I thought as I listened to him talking, that after thirty years of struggling with death, disaster and countless crises and catastrophes, having watched patients bleed to death in my hands, having had furious arguments with colleagues, terrible meetings with relatives, moments of utter despair and of profound exhilaration- in short, a typical neurosurgical career- how strange it is that I should now be listening to a young man with a background in catering telling me that I should develop empathy, keep focused and stay calm. As soon as the signing-out register had been passed around, and I had signed it, thus confirming that the Trust could now state that I had been trained in Empathy and Self-control, and the classification of Abuse and of Fire Extinguishers, in addition to many other things I had already forgotten, I charged out of the room despite Chris' protests that he had not yet finished.

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