“Speed”

On Saturday I woke up around 10 in the morning. The sun was sneaking through the curtains. I hand’t slept for 8 hours for long time. It was a non-stop week. The previous day started with a hospital meeting on morbidity and mortality, then in the operating theatre for surgery on two patients with brain tumours, then ward rounds. My secretary had to cancel my afternoon commitments; I had to go to Oxford and then to Cambridge (with unbelievably slow traffic!) and then back to London, a round trip of five hours. While driving my mobile was bleeping and buzzing with texts and calls. My team was in touch for patients with problems, small and big, and needed my help. My registrar Sophie likes longs texts, which are very descriptive, but not easy to read when you are speeding on the motorway! At least I can use Siri to voice-type my answers. Back in London I had to go through piles of letters, referrals, request, sign clinic letters and clear my desk from pending paperwork. I like to clear my desk every Friday. The whole last week was not less busy, so my body needed a good night (and bit of morning!) sleep. A good sleep, soaking in the water for an hour and my body heals up and is good to go again! My biological clock is very friendly, I can go to sleep any time at night (and fall asleep within seconds/minutes) and get up any time (from very early to early) with no difficulty. Except, well, today, when I got up midmorning. As my body recovered from the last week I thought I better write my blog which I neglected for the last couple of months. I normally write my blog on an airplane’s seat but haven’t been up in the air for more than two months. But today is the day! Read on!

Have you even seen an old movie with Keanu Reeves and Sandra Bullock? Yes, “Speed”. Well it was meant to happen! Its been a while since I had my last speeding ticket, so I wasn’t terrible surprised when I opened up the letter: 3 points off my driving license and a fine. Unless…unless, I would go to a half day “speed awareness course”. Get three points or get bored out of your head? Speed awareness course it is! I had to re-arrange my whole afternoon schedule, punched some strange post code in the SatNav and off I went. It turns out that the place was more far than I thought, so I had to speed in order to make it to anti-speeding course! I thought if the police stopped me I had a good excuse, I was trying to make it to an anti-speeding course. Did you ever notice how your phone rings or bleeps when you don’t want it to? Let’s say when you are holding you bag in one hand, an umbrella in the other and you try to unlock a door with whatever’s left and your mobile goes off? Same thing. For an hour before I got into my car my phone was quite like a churches’ mouse. Once I hit the motorway it was like a mouse when the church is on fire!

I got to the course place about 15 minutes late. I was curious to see who were the other “speed offenders”. People with leather jackets riding motorbikes? Some smarty pants driving a Ferrari? Some tough blokes who play the easy rider? Well…I sat next to a granny who just got over the 30mph limit while doing her Saturday shopping, a pensioner on a similar situation, some housewives driving 4X4s, a few tradesmen trying to make it to the next job on time, what a letdown! :-) The course was lecturing, no interaction allowed. It turns out that motorways are the safest roads for speeding, and the 75% of car-related accidents are not related to speeding. Let me be clear! all efforts should be made to avoid accidents on our roads, every small or big accident can be devastating to the injured, their loves ones and to the society. These are avoidable deaths and they should stop with the help of all of us. But what about an army of incompetent drivers out there? I bump into them very day: drivers who block the fast lane with 60 mph; lorries who decide that with 61 mph they should overtake another lorry that travels with 60 mph, so two lories go side-by-side for a couple of miles until one decides to give up, slow down and let the moron overtake; or another idiot who the other day with more than 100 mph was overtaking all cars from the hard shoulder!
The one thing I discovered about speeding is from the SatNav: the arrival time changes very little based on the speed. Anyway, I learned a couple of things, that still could be summed up in 20 mins not five hours. Do you want to know my speed while going back to London after the anti-speeding course? This I cannot disclose! :-)

Trying to avoid traffic in central London (i can’t stand still!) I found myself somewhere towards Heathrow. Airplanes were landing about two every minute. Here’s one!

Last week we had the Deanery teaching at Queen Square. This is a new initiative where neurosurgical trainees from all London spend an afternoon, being taught at a specific topic, once a month in a London unit. April was our turn. We chose hydrocephalus, trapped water in the brain. This is such an easy topic for a medical student to understand but so difficult to comprehend at a post-graduate level. Neurosurgical units organizing deanery Teaching have a simple approach. They get 2-3 of the local clinicians to talk for 45 mins each about a topic. Tried and tested but a bit… boring! Do you want a tiny insight into my brain? Okay, here’s how I think when I organize something. I ask myself “what is the best I can do”? At this stage I don’t think if its possible/logical/economical/on time/acceptable/would other people like it? I just imagine what’s the best I can go for and then move everything else around it. If the deadline is close for example I don’t change my aim, I change my plan to make it happen on time.

So I thought, If I can wave my magic wand and bring anybody to Queen Square for one afternoon, who would that be? Let’s see, for a start I would invite Christoph Miethke, a super smart CEO from Berlin who makes tremendously clever shunt valves. I would get Marek, a genius physicist from Cambridge who understands the physics of CSF flow; I would get Hugh Richards the man who studied more that 50,000 shunt operations in the UK; my friend and colleague Laurence Watkins, the next President of the International Society of Hydrocephalus. The event took place at the lecture theatre of Queen Square, huge screen, looks like Odeon Cinema. I asked them to talk for 30 mins each, I like speakers to condense the concepts, anything longer than that and the audience start to glare. The talks were of very high level, you can’t get this level not even at conferences. At the end a round table, I asked them to sit across a (not so) round table table, and the audience and I were throwing questions to them, was very lively, very intelligent (and a bit heated) round table. I want the best for our trainees.

Some of London neurosurgery trainees at lecture theatre of 33 Queen Square.

A (not so) round table with Laurence (left), Christoph, Martin and Marek. We had some heated moments!

Then time for a few drinks. As this was a sponsored event we took them to the bar of the Renaissance hotel in St Pancreas, huge ceilings, live music, classy environment (photo), and then for a dinner at one of the Hotel’s private dining areas (photos). The staircase to go the dining area was absolutely Royal. Your shoes dive in the burgundy carpet, the ceiling was sky-high, and the architecture was regal. The service was impeccable, the waiters reminded me dinner at an Oxford College, where 7-8 waiters come out all together, nearly running, leave the plates and then leave all together, again nearly running. Everybody learnt a lot and they had great fun. Do you think my aim worked perfectly well, no hitches in planning? Well, no quite! From having to re-arrange the dates at least six times so all speakers can make it to not having a physical table to run the “round table” to not been able to book the Renaissance as we had no final date and everything was booked. Did I give up at any stage? No, did not!

Having a drink at the bar of Renaissance Hotel in St Pancras. Huge ceilings, live music, good company!

After the drinks time for a private dinner. stunning interiors, impeccable service.

I know its been nearly three months since my last blog and I do want to catch you up. But life is short and I’d rather do stuff rather than write about it. I have about 10 mins to finish this blog while sitting in the garden this fine evening (despite the mosquitos that are attracted by my laptop screen). When I am writing my blog I usually listen to music, some song I downloaded, looped constantly until I finish my blog. When I like a song I listen to it again and again until I am sick of it! And then I think “best 79 pence I’ve ever spent”! So here’s the song of this blog, “Masar” from “Le Trio Joubran”, three Palestinian brothers carrying a 4,000 years tradition of the oud (a sort of a fat, short guitar). The kind of music that starts slow and steady and builds up in rhythm, intensity and emotion. The sort of music that, when you are out at some mediterranean tavern, makes you finish up your (strong) drink, smash the glass on the floor and then stand up and dance (no, no “holding the roof with your hands” dance), but dance with your body straight, with your arms stretched, with a serious face, the way men dance on the eastern face of the planet. People from the East you understand what I am talking about. People from the West, you might need to do a bit of traveling!

Last topic for today! The World Course everybody is talking about! How would you like to see the world’s best brain tumour surgeons operate live in their own operating room? What if you could talk to them and ask them how they do it while they operate? What are their operative secrets? Long gone the days where surgeons had to travel to foreign places to be apprenticed by master surgeons who did the best they could to keep their techniques secrets, often putting their elbow to block the apprentices’ view! Every time we manage to progress, to reach a breakthrough, to get one more hit to cancer, to perfect one new technique, we are doing it together, progress in science is not one man’s show. We are hear to learn from each other and share our techniques and secrets for the good of our patients who look up to us, we are not here to build our egos at the expense of our  patients and the patients to come.

And this exactly what we will do! Well, my friends, its all happening in July for four days in an unprecedented event! Mitchel Berger, President of the American Association of Neurological Surgeons and Chairman of the Neurosurgical Department in San Francisco will do an awake craniotomy in his own OR streamed live in London. Then Hughus Duffau from Montpellier will do one of his supra-complete resections again on an awake patient with cortical mapping; and Walter Stummer from Germany will show how he’s using the substance that can separate malignant brain tumour from normal brain under the blue light of the microscope, a technique he introduced in neurosurgery. Then next day they will all travel from San Francisco, Montpellier and Munsten to London to discuss with the course delegates their techniques. Does this sound too good to be true? I know, but it its very, very true! Plus we will have 3D anatomy shows and presentations with Guilherme Ribas from Sao Paulo, Master’s Seminar from Roger Stupp, the man who validated Temozolamide in the treatment of Malignant Brain Tumours, the most important progress in the last 50 years; round tables and case discussions.

Motivated neurosurgeons rushed to sign up from the four corners of the earth: South Africa, New Zealand, Hong Kong, all over Europe. I would do the same, for such an event! I would go to the moon! In one afternoon we will have hands-on practical workshops, stations where delegates will get their hands on the most recent surgical technologies. And the in the evenings we have a fabulous social program lines up with drinks at a trendy bar and dinner at an exquisite restaurant. With very few places left, if you are a neurosurgeon, stop whatever you are doing and book a place now, if you are lucky to get one!

Okay, I know I said last topic but I know you want one more. I was on the motorway last Wednesday, just after sunrise, and while on the fast lane my car lost power, dead, completely dead! Have you ever broke down on the fast lane of a motorway? I just! managed to pull over on the hard shoulder, the fast lane is not the place to breakdown! My insurance put me on a priority call. I explained that by 8 am I should be in the operating theatre. A man with a big track arrived, looked like he had waken up not long ago, was about 6:30 in the morning. He loaded my car on his track. We started talking. He was scuba-diving every summer in the blue waters of Halkidiki, and when retired he was planning to open a martial arts school in Japan! He was a part-time body-guard so we exchanged a few stories about bar fights. What a cool dude. Instead of getting me to the closest garage (as per regulation) he said I’ll get you to your hospital! He drop me off and then carry on to drop my car in a garage in East London all by himself! “I am not supposed to do that but my track is not tractable”! This man was the something else. Should he had followed the “regulations” the operations of all my patients would have been cancelled! In the meantime my team was waiting in the operating theatre to start my brain tumour cases. I was in touch with them, so they had the patient positioned and ready the moment I stepped foot in the operating theatre. All thanks to them and my new (bodyguard) friend, my patients did not suffer! What a privilege to be surrounded by competent and dedicated people. And as for the “regulations”, well, there are not for people who can think on their feet, not for the free spirits of this world, no matter if it is Steve Jobs or some track driver driving somewhere on a motorway as you read these lines, God bless their heart!

Ninenteen

On New Year’s Day I had a phonecall for a patient who had a seizure and had to be transferred from the ward to the intensive care unit; another call for a patient who had a haematoma in the right side of his brain and became gradually unconscious; and a call for a patient with a spinal lesion who felt that her leg suddenly started to feel dead. No, I was not even on call. But I do want to know if any of my patient develop new problems. Sure, there is an on-call neurosurgeon but I very much prefer to know what’s happening to my patients at all times. I never switch off my mobile, expect of course when I am about to take off (at least on a couple of occasions I boarded on the plain while talking to the on-call resident under the not so happy glances of stewardess and trolley-dollies).

I was on call a few days earlier, just after Christmas day. Yes, something happened during that on call. But first lets go a few days earlier, a few days before Christmas. We took our neurosurgery trainees out for a dinner. We had a brief workshop earlier, how to put screws into spinal models, a useful technique for trainees (photo).

Some of our trainees learn how to fix the top part of the spine, when its falling apart

Then we headed to The Russell Square Hotel, pretty much next to Queen Square. We had our dinner at the “library room”, tall ceilings, glass bookcases with very old books. After we sat down the a professional man came to introduce himself, was the hotel manager, a Greek/Cypriot living for decades in London. he told me that this is London’d first organised hotel established sometime in the 1850′s, everything in the library room was from that date. Whoa! Our trainees and a few consultant colleagues wore their party hats, pulled crackers and had good time (photo and video). By the way I introduced videos in my blogs, add a bit of action twist.

Surgical masks and hats replaced by party hats!

The weekend after Christmas I was on call . Londoners and tourists alike were fighting for the Sales. I don’t like the sight of people rushing and elbowing each other to grab a shirt or a pair of shoes. Its a bit uncool. And I avoid as much as I can shops anyway, I prefer buying from the internet, street markets that thrived in different forms for thousands of years will become extinct like dinosaurs. Many retailers close down one after the other. Are you surprised that hmv went bankrupt? I am surprised it lasted so long. And by the way, do you understand people who buy CDs or DVDs? what are they going to do with them? Completely unnecessary, everything is online now, even the new 27 inch iMac has no optical drive, couldn’t agree more.

The on-call weekend was busy, people struck with all sort of maladies days only after they spent time with friends, family and loved ones around the Christmas dinner table. Some pulled through, will have more Christmases, will exchange gifts next year, will make new friends, have more dinners and drinks with friends, will achieve more, will see more, will experience more. But not all…

On Saturday my registrar called me about a nineteen year old girl. She had terrible headache. She was taken to the local emergency department where a brain scan showed subarachnoid haemorrhage, bleeding in the space between the brain substance and the membranes that wrap the brain. This is coming from a weak spot in a brain vessel called aneurysm, a ballon-like dilatation of the vessel lumen. Aneurysms are usually present for years before they eventually burst releasing catastrophic blood in the brain. This is the most severe form of stroke affecting young patients.

Patients with this type of haemorrhage are admitted to the neurosurgical unit where they have a blood vessel test called angiogram to identify the responsible vessel and then the weak spot is glued from the inside of the vessels without opening the head. Difficult aneurysm require a brain operation and placement of a titanium-made clip across the neck of the aneurysm to exclude the weak spot from the circulation, thereby avoiding the risk of further haemorrhage.

Upon arrival our nineteen year old patient had another scan that showed that the poor girl had a second major bleed hours after her first bleed. She was taken to the angio suite, at the basement of the hospital where the weak vessel was identified and the aneurysm was sealed off. She was then taken to the operating theatre where my registrar inserted a pressure monitor into her brain. Although her ventricles, the fluid-filled cavities of her brain were not dilated, I felt that we should insert an external catheter to drain some of this fluid to give her the best chance of recovery and instructed my registrar. As she was intubated and ventilated we could only monitor her status by direct readings of her brain pressure. Pressures around 15 mm of mercury  are generally considered normal for her age. Any higher pressure means that we need to intervene immediately. Her initial pressure recording were no more than 10-12 mmHg. so far so good.

Among numerous referrals and phone-calls my registrar called me around midnight. The young girl’s brain pressure has been up to 20s for the last quarter of an hour. Our anaesthetists in Intensive Care Unit had already tried several manoeuvres but the pressures were still high. Her pupils were still working. I asked my registrar to take her immediately to the operating theatre and remove large parts of her skull to decompress the tight brain. Preparing the patient for transfer can take time as anaesthetists need to follow a protocol. I know that even if the patient needs to be transferred only for 30 meters from the intensive care unit to theatre, this can easily take half to one hour. So I was very explicit to him “take her to theatre, now!” “I haven’t done this type of operation yet” was his reluctant reply.

We normally get very experienced trainees at Queen Square, usually at the end of their training, and can do quite complex operations. But not this time. “Okay, take her immediately to theatre, I am coming” said back. I entered the operating theatre when the young girl had just been placed on the operating table. I made a cut in the skin from in front the right ear to the left. I then removed very large parts of skull to relieve the severely compressed brain. The brain is wrapped in a tough membrane called the dura, normally you can see the brain underneath pulsating with each heart beat. Her brain was very stiff, the dura was extremely tight, not a good sign at all. We normally cut around the tough dura but if the pressure is too high this can lead to uncontrolled brain herniation. I made several slits, 10 cm long to release the pressure. The brain started to herniate under high pressure, that’s in keeping with pressures of 50s or 60s, and that’s incompatible with life. I released the brain at all areas possible, and after an hour I left my registrar close up. Twenty minutes later i had a phonecall from theatres, my register had problems closing the skin together as the brain was far too swollen. I scrubbed up again and closed the scalp.

In the morning time to talk to the parent and relatives. How can you tell the parents that their nineteen year old girl won’t live to see another Christmas, get married, become a mother and die someday from old age? You need to tell them that they will die after their child, what a horrible thing for a parent. There are so many communication skill courses these days on how to break bad news, most completely waste of time, if you ask me. I always find that in their darkest hour people appreciate three things. First, honestly, this is not time for false hope. Speak clearly, slowly, give them time to absorb the information, time to cry. Second, release their guilt, there is absolutely nothing they could have done to prevent this, the death of their loved one is not their fault. And third make them feel that their loved one has received the absolutely best care, everything that could possible be done, has been done!

One day all potential diseases will be detected at birth, we will able to tell that this baby when he is 38 years of age he will develop a brain aneurysm and we will able to change his DNA so he will never die from a burst brain aneurysm. It may sound like a sic-fi (have you seen the movie Gattaca?) but it is very tangible.

In the middle of everything we had snow in London. The Square where people sit on the grass for lunch in the warm months was all white!

My senior colleague Michael Powell, one of the world’s most experience pituitary neurosurgeons, has officially retired. his friends came from all over the world to wish him the best. I am talking about real friends, not Facebook friends. Is clicking “like” on a computer screen makes you friend with someone? How about travelling from the four corners of the earth to “like” someone!

Mick is talking to friends and colleagues in the “mouth of the wolf”. Ed Laws and Nicholas de Tribolet are absorbed.

On Wednesday we had dinner at Bocca Di Lupo (literally “mouth of the wolf” but also Italian expression for good luck, sort of “break a leg” equivalent). Edward Laws from Boston with Mrs Laws, Nicholas De Tribolet, editor in chief of Acta Neurochirurgica  (with Mrs Tribolet) Paolo Copabianca, a world-renowned endoscopist and many others were present. Mick is never short of words but when he stood up to say a few things (and most of famous neurosurgeons took out their phones to record Mick) short of choked up in the end and sat down. What a lovely man. The next day another dinner at the dinning hall of Haberdashers in Smithfield’s market in London. The company of Haberdashers was established in medieval era some seven centuries ago. It has now moved from haberdashery (materials related to mens clothing and accessories) to supporting education in England and Wales. The Hall was stunning (photo). I went for the vegetarian option, and I got a lovely starter with sliced celery and a spoonful of mushed potato. More tasty than I thought it would be. “What’s for main” I asked the stiff waiter. The waiter clear his throat and announced ” Hmm, that’s the main, Sir! I will call the maitre d’” No, its alright, time for me to mingle and go from table to table to have a little chat with friends and strangers, while they are finishing their desert. In conferences and functions people hang around people they know. I do exactly the opposite, I avoid people I know and talk to people I don’t know.

The dining Hall of haberdashers, lots of space and impeccable service. If you go for the vegetarian option you better eat at home first!

It was sad seeing Mick retiring. I also saw Professor Thomas, Professor of Neurosurgery at Queen Square who retired in 2007, before I started. “I now have your office” said to him smiling, (not to piss him off), he’s a lovely and gentle man. His wife was excited as she started talking about her friends in Thessaloniki and wanted to swap seats with her husband so she can talk my ear off, but luckily! I was seating in a different table. Neurosurgeons can and go, careers wax and wane, but eventually they all go, so much for the politics and power wars. I remember when Mr Adams retired in Oxford, a very powerful and tremendously respected neurosurgeons. Everybody was talking for a year that mr Adams will retire. When he retired, he was forgotten within weeks. Once a new nurse overheard the name and asked “who’s Mr …Adams?”. Poor Mr Adams, forgotten already! If you are a neurosurgeons remember Life is much bigger than neurosurgery!

My friend Kirsten is also leaving Queen Square. Kirsten was organising the neuro-oncology multidisciplinary meeting every week. She now studies psychology and is going to a job relevant to her studies. Kirsty is good fun. We had a few coffees and quick drinks (so to speak as I don’t drink coffee or alcohol) during the last 3-4 years since I’ve known her and she’s always eagerly asking me “when are you going to write about me on your blog?” “Tomorrow” is my usual reply and then she panics “no, no, let me read what you will write first”.  Kirsten always gives me… feedback on how I do in the meeting (from if I fight a lot and cause trouble for example, to her opinion on items of my wardrobe). She’s got good heart, I wish her the best! And sorry Kirsten I haven’t let you read it before its published!

Tales of two cities

I could see terminal 5 lit in the dark while driving to the long-term car park. It was still before six on a cold October morning. I was off to Paris for a day. After landing and following about an hour of heavy rain and strong wind the sky cleared. When I first moved to Paris in 2008 I was always surprised that the weather in Paris is not so much different from the weather in London. I finished my two meetings, time for a quick glance at the Eiffel tower (photo) and a stroll at Champs-Élysées dodging hordes of tourists. One of the coolest places to have coffee at the avenue (no, its not Hotel George V) is at the top of the Virgin store, best views and no tourists around! After you coffee you can sit on the marble stairs of the store, along with at least a couple of dozens other people, and read a whole comic book (what the Brits call graphic novels). French people absolutely love them (and so do I).

Does the world needs another photo of Eiffel tower? Yes it does, especially this one taken with my iPhone on a chilled October afternoon.

There is something in the air of Paris, the cobblestone streets and the little cafes, you do feel that writers, and poets, and film directors, philosophers and thinkers walked through the same streets and may have sat on the same chairs. I felt that long before I watched Woody Allen’s “Midnight in Paris”, where Gill (Owen Wilson) while vacating in Paris gets lost one night and around midnight goes into half real/half dream state of living that night, and a few other nights, adventures in the 1920s Paris. During these nights he meets a macho Ernest Hemingway and a dandy F. Scott Fitzgerald, gets his book reviewed by Gertrude Stein, talks to surrealist director Luis Bunuel, rides a taxi with T.S. Elliot and falls for Adriana (Pablo Picasso’s mistress) and together they go even further back in time, the 1890’s Belle Epoque, where they have a drink, at Maxim’s, with Paul Gauguin and Edgar Degas. All this time travel takes part in the nights of Paris and in the mornings he is going back to his normal life. He finally decides to leave his disinterested fiancee and live in Paris.

Parisian commuters late afternoon, thankfully not reading the Metro paper like their London counterparts!

Above ground Seine waits for you!

You feel more creative when in Paris, bit more laid back, possibly because everybody is laid back in Paris. Depends what you are looking for, to lay back or to do. There is no right or wrong, is whatever makes you happy. I give the nod to the latter, so time to go back to Orly airport taking the Parisian metro, quite smaller than London’s but overground for quite a bit (photos). Short trip on a plane, before you take off, you start preparing for landing. I left London in the dark, I am coming back in the dark. But the night London is lit, from the plane it’s an eye candy (photo).

Approaching London from air in the night; view through the window is stunning!

A few days earlier I had spent some time with another Frenchman, Hugues Duffau, Professor of Neurosurgery at Montpellier. I had invited Hugues on behalf of the Department of Neurosurgery at Queen Square to deliver the fourth Annual Victor Horsley Lecture. Victor Horsley was the world’s first neurosurgeon and the first person in history who was appointed as a “brain surgeon”, nearly forty years before neurosurgery started to branch off from general surgery in the 1920s and 1930s. There are very few operations that Horsley did not do for the first time in the world: ligation of a carotid artery for an aneurysm, transcranial approach for a pituitary tumour, division of the trigeminal nerve for trigeminal neuralgia, first epilepsy case, removal of a spinal cord tumour, invention of stereotactic frame and many others.

Our department which bears his name, organizes annual lectures to honor his memory. This year we invited Hugues Duffau, I have written about his work in tumours in eloquent parts of the brain in previous blogs. His lectures was streamed live through the web so people could log in and watch it live, no matter where they were. After the lecture I took Hugues out for a dinner. We talked about a lot while he was sipping his red wine (what else for a Frenchman!) and I was drinking my orange juice. No, I don’t drink wine (or alcohol or coffee or tea). People are joking, are you sure you are Greek? We never saw a Greek not drinking alcohol! Thing is, I haven’t drunk alcohol for, give or take, the last five years. When people ask me why I don’t drink, I tell them relaxed “lifestyle”. That’s true but I don’t go into details, as they usually ask me in a bar when everybody else around me drinks, so no need to challenge their reality.

The thing is, my brain is the most important part of me, (and the most important part of you), the cause for all I am and will be. I don’t want anything artificial to affect my reality, how I see the world, how I live my experiences. Yes, some experiences do not feel pleasant but so what, I want my brain to handle everything without an anesthetic. Isn’t this part of being alive, being able to feel? I don’t want to numb my brain with alcohol or give it a kick with caffeine, what a ridiculous idea! Yes, alcohol has been a social lubricant for centuries, but trust me, you don’t need alcohol to be sociable.

I do miss the taste sometimes, the elegant feeling of resting a heavy tumbler half-filled with a single malt on the soft arm of a leather chair, or I do rarely miss the aroma of a Haut-Médoc, but so what, nothing is more important than drinking the world around you with all your senses, that taste is the best!

Not long ago, two brothers came to my clinic. One was the patient, the other was the carer. The patient, a man in his late twenties came as an emergency a year ago with a big blood clot in his the left side of his brain. All this happened during a strenuous bodybuilding session. I was so happy to see him in his last clinic visit walking although his speech was still impaired. I had seen him a few times during the last year. He has done so well, it was time to discharge him from my care. While shaking my hands, tear came to their eyes. “We pray for you every single day” said his brother. When they left I felt a bit heavier. What a concept! people wishing good for you and praying without you having a clue. Do these prayers and wishes attach to yourself, become part of you and influence how you handle things?

Last week I received an email from a woman who had a very difficult operation a year ago. She had a small tumour in a very narrow and critical part of her brain called the third ventricle, anatomically in the centre of the brain. Here’s what she wrote a year after her operation: “Just wanted to say, thank you once again for all you did for me a year ago, this coming Friday.  I can vividly recall the night before I was due to come into hospital.  I had my bags packed, I read my bible the night before.  Woke early the morning of my admission to pray some more.  God was very good to me, for he blessed me with you as my surgeon.  I so cannot believe a year has nearly passed…….  I am back to work, enjoying life and have my health, and so much of this is due to your skill as a surgeon. Thank you.”

Man is matter and heart and spirit. Is spirituality part of the brain, a reflexion of cortical activity? I think not. I downloaded a book written by a Neurosurgeon, Eben Alexander, very well known in the neurosurgical community. This man had a near death experience after being in a coma after life threatening meningitis. At some stage his pupils were fixed and dilated waiting from brain stem stem tests. He did survive and what he describes is quite interesting. Have a look on Amazon.

UK’s most experienced pituitary surgeon, Michael Powell talks to our trainees for the last time before his retirement.

Every Thursday at 5:30 we have a neurosurgical lecture, usually geting a top neurosurgeon to give a lecture to our trainees. We have now started streaming it live on eBrain where it is all saved and can be viewed any time. So if you want to feel that you are at Queen Square, here’ the link (www.ebrainjnc.com, you need to be member of professional organization to log in). Two weeks ago we had a legend in pituitary surgery, Mr Michael Powell. Mick is retiring (early) this January, so that was his last lecture to our trainees. Mick is one of these people who makes everybody comfortable around them, and virtually has no “enemies”! I was a bit sad to see his last lecture but Mick is excited to continue traveling the world, or hanging out in his flat in Nice, enjoying the sun of the southern France. Yes, there is much more to life than Neurosurgery, the horizon is wide open, but if you had to do something, job-wise so you won’t get bored out of your head, or even better something that blows your mind, what else could someone do?

On the road

I was driving from Manchester the other day. Outside Birmingham I took the M6 toll. For years now there are road works in Birmingham. Average speed cameras, slow people driving slow in the fast lane, congestion and gridlocks. So, M6 toll it was! Four lanes with gentle curves so you can feel the grip of the tires on the road and speed like a normal competent driver (as long as you don’t spot a plain police car with a blue light on the dashboard in your tail you are OK!).

I remember when I first came to the UK, some twelve years ago, I was driving on M1, heading from London to Newcastle where I had to give a presentation to a conference. There were no speed limit signs on M1 so I naturally assumed there was no speed limit. I could not understand why drivers on the fast lane where instantly changing lanes on the sight of my car on their rear view mirror and were making space for me. The speed I was driving shall not be named(!) but I was not aware of a speed limit. And it was such a great fun! I had quite a few months of blissful driving until while I was talking to a friend said “its great that there is no speed limit on motorways”.  ”…Hmm, actually there is…” was the reply! Damn! :-)

That’s what I was thinking while driving back from Manchester and speeding just a little bit (!) somewhere in Midlands. After an hour and a half, just after Warwick I stopped at the motorway services. I like motorway services. One day I will publish a book with snapshots of motorway services and people who make pit stops, from different motorways of the world. I don’t drink coffee (or tea) so Starbucks, the logical pit stop, was not tempting. I walked in WH Smith and had a look around. The bestselling books were in numbered positions in the bookshelf. A yellow covered book got my attention.

“Stop talking, start doing” was the title. I took a copy from the shelve, flicked through the pages and scanned the contents. In the first pages there was a Picasso quote “only leave for tomorrow what you are willing to die having left undone”. I liked that. The rest of the book was full of cliches, worn out slogans, boring photos. The type of the book someone can write over a weekend. I scanned the book’s barcode with my iPhone and got me straight to Amazon’s website. Four and a half stars by more than fifty customers! Whoa. How’s that even possible? Do all these people have just bad taste? Not quite. I’ll explain.

We all know very well what we want and what we should do to get it! How many people go for it? About 99% of people do not even try. Its so much easier living in the cloud of the past and the fog of the future. Do this for me, think about what you thought during this day. Chances are more than 99% of your thoughts were snapshots from the immediate or remote past and vague plans for the immediate or remote future. The thing is, all we have is this very moment. Take a breath, feel the fresh air flowing in your body. You are here! Now! You either make the best of it now, or live your life in wishful dreams and reveries.

When you want to do something you really want, socialization and conditioning kick in and you start making excuses: “let’s think about it, is it the right thing to do”? “What others will say”? “I need to get a few more opinions from x,y,z”. Thing is you already know what to do.  But you don’t do it. Socialization, bad conditioning, the fuzzy comfort zone, all are terrible enemies. And the time goes by. “Life has the sting in the tail. Its too short!” was at the last pages of the yellow book I was browsing at WH Smith. So I liked the start and the end of the book, and finally bought it too! (which was hilarious because I didn’t actually like 99% of it). At the last page of the book the female author was thanking her mother who raised her “without limitations”. Easy sweetheart!, you will break a nail :-)

Loosing social conditioning does not mean that you will start doing crazy things or become antisocial. Nothing is further from the truth. This is very, very crucial. I’ll come back to that in another blog. For the moment lets go to Piccadilly line, Wednesday, around 7 in the morning. I was sitting in the soft seats, heading to Russell Square, writing a reply to Jan Crosser, Rights Executive of Oxford University Press. She wrote to me a few days ago to let me know that “The Neurosurgeon’s Handbook” will be translated to Chinese! People were sitting around half asleep, few standing, most were reading some ridiculous stories in Metro (what a stupid way to start your day!), some were listening to MP3s, some had their eyes closed, shut the world out. I suddenly heard a thud!

Piccadilly line Wednesday just after 7 am. The sleepwalkers are about to start their day.

Next to the closed door a big young man had collapsed on the train’s hard floor. As a reflex, I stood up, put my MacBook in the soft seat and went to help. The man was looking like a manual worker, had traces of paint and cement in his worn out work clothes. Facial features of an Eastern European. Two of his work mates, same outfit and similar faces, started slapping him, calling “Pavlo! Pavlo”, and tried to grab him and stood him up. “No! No! I shouted, leave him on the floor!”, before I finished my sentence Pavlo was back on his feet. What do you know, their method worked, why they didn’t teach us this in medical school? I looked around, the carriage was fully packed. Everybody was as half sleepy as before, reading their Metros and plugging their ears with headphones. Nobody stood up to give up his seat to poor (and a bit embarrassed Pavlo). This can’t be happening. Social conditioning again in action. “Can someone give up his seat please!” I said rather loud and a bit annoyed thinking what is wrong with these people? A chap stood up and offered his seat. Pavlo sat down, was looking okay, time to go back to my seat and to my MacBook to finish my letter.

Got of at Russell Square, walked to Queen Square, put on my scrubs and went into operating theatre three, about twenty minutes before eight. I always talk to my anesthetist, I tease and have a little chat to my nurses, they need to be relaxed and happy, they need to feel appreciated, we will give together quite a few battles every operating day. No they are not the generals, but they are brave soldiers, no war can be won without them. I usually leave my phone, and dictaphone next to the computer and wait for my anaesthetist’s signal. Showtime!

In the evening back to my office, time to munch a bite, while watching a few movie trailers in IMDb. Two or three looked dead turkeys, but wait, what’s that, fast change of scenes, places, road trips, curious people traveling, and the end of the 2 mins trailer said: from the book “on the road”. I clicked on Amazon’s site, looks like “on the road” is a literature classic. Never heard of it but never’s too late. Time to click on “1-click order” and “get it Friday” if you order within the next 3 hours and 8 minutes. Suddenly Friday seemed too far away. I know I won’t start reading today or tomorrow or next week or even next month but I don’t like to wait. Foyles in Charing Cross Road closes at 9 pm, still got time to get it on the way home.

“On the road” Going somewhere or it doesn’t matter?

The woman behind the till had short blond hair, freckles, two symmetrical piercings in the lower lip. Do you know a book called “on the road” asked. Yes, its by Kerouac, I’ll show you. She swiftly moved between tall bookcases and in the middle of thousands of books like a heat seeking missile following its target went straight to a specific spot on the shelve where “on the road” was siting patiently and said “here it is”.  There were a few different jackets, I went for the one with a collage of road trips, diners and coffee places.  Amazon had this jacket too, 30% cheaper I already told you, can’t wait until …Friday. “A friend of mine just finished it and liked it a lot, I’ll start reading it too” said the blond woman with the piercings as I was sliding my card into the machine. “Many people who read the book started traveling across America” said back. “Careful, you might quit Foyles and start wondering across America you too”! She laughed with a lovely laughter.

Moving on, I know I haven’t written a blog for more than two months now, thanks for waiting and (constantly!) asking. You know by now that you get samples only of the world around me but I do like to share a few facets of what’s happening with you although I know you not. I find amazing that you are not reading only from the Western world but form places like India, Brazil, Pakistan, Thailand, Hong Kong, Venezuela, Iraq, Japan, Sri Lanka, Chile, Moldova, Colombia, Latvia, Nepal, Peru, Viet Nam, Puerto Rico, Morocco, Barbados, Zimbabwe, Kenya, Fiji, Bahrain, Belarus, Kuwait, Ghana, Papua New Guinea, Cambodia, and I better stop here as the list goes on and on! WordPress provides pretty good statistics but worry not, I do not know you! although you do know me, at least to some extend!

Before I finish this blog entry I need to tell you about my July Course. And write about it while listening Lykke Li’s “I Follow Rivers” (rock version). What a magical piece for a September Saturday evening. Yes, the course. It was the the First Annual World Course in Advanced Techniques In Neurosurgical Oncology. I had the idea for the course in April. My senior colleagues thought I was kidding when I said I was planning an international course from scratch in three months time. No, I was not kidding. I wanted to create the best course, invite outstanding speakers, have the best cadaveric dissections, seminars given by the masters, ignite discussions and take them out to a fabulous dinner. The idea was in my head but we had no venue, no speakers, no adverts, nothing. But once the idea was in my head, I had to do it.

Friday late afternoon preparing the delegates bags with the help of secretaries, trainees and …senior consultants who were putting documents, memory sticks, ID cards minutes before the Guy’s facilities close!

Time to call upon my friends. That’s why friends are for. Professor Ribas from Sao Paulo, a legend in anatomy of the cerebral cortex. Professor Duffau from Montpellier, the man who does the impossible, he removes tumours from eloquent areas, areas that other surgeons stay well clear off. Professor Summer from Munsten, the man who came up with the idea of using the fluorescent dye 5-ALA in the surgery of high grade gliomas and designed the trial to test it. And a bunch of my colleagues at Queen Square. I then had to advertise an event to the international community. Delegates had to book leave from work, book flights and hotels. I emailed friends in top positions in european countries to spread the word. Made a deal with neurosurgic.com. Made another deal with the European Association of Neurosurgical Societies. Made a website, drafted a 4-page brochure and found one of the best printers in London to make a top-quality glossy brochure. Created a research fund to direct the funds from the course. And booked the venue.

What about food? Guy’s Campus had catering from the local canteen. I didn’t like that. They even wanted to charge a couple of hundred pounds per day for their staff only to be there in addition to ridiculously expensive and suboptimal quality food. No that, wasn’t a goer. We could do better than that. We had to get special 3D anatomy glasses (you have no idea how many different types of 3D glasses exist! could write a whole blog about my adventures to find the correct glasses). Buy delegates a gift, Bruni’s neuroanatomy book that suddenly sold out, so we had to order from America and waiting to arrive on time. Find free delegates bags, writing pads, memory sticks, IDs. We did not have lanyards, Derek from Baxter sent us a few from his office but we had no clear pocket for the IDs. If I tell you the obstacles, big and small we had to overcome up to running this course, you thought you were watching a Hollywood comedy where anything that can go wrong, does goes wrong.

We had 12 cadavers, which means 24 places. Hands on cadaveric courses usually have 12-14 delegates. Applications flooded within 2 days. Patricia, my academic secretary couldn’t keep tract of the emails. Professors from Korea and Argentina, seniors surgeons from Denmark, neurosurgeons from America, we simply did not have cadavers for all these people. Tried to find more cadavers, import them from America, search Medical Schools. Finally the Professor of Anatomy from Imperial College could give us 8 more cadavers. That’s 16 more places. They vanished within 2 days. 4o places for a hands on cadaveric course is unheard of but I thought we should go for it. Then we had a growing waiting list. We had to book flights for our faculty, hotel rooms, cars to pick them up, organize the Saturday night dinner. As they date was approaching it was time for the Sicily holiday (see The Gates of happiness).

Saturday morning came! In a moment of weakness thoughts go through your head: Would everything be okay? Would all the speakers make it? They had to squeeze this between operations, various speaking arrangements, catch flights, make connections. What if they missed a flight, what if there was a flight delay. What can you tell to delegates from South America and Asia, sorry our celebrity speaker couldn’t make it? And would everything turn out to be as planned, would the delegates enjoy it or think it was a joke? In moments of weakness, you can do only one thing. Recognise the negative thoughts and dismiss them. Yes, everything was going to be okay, no, even better, everything was going to be great!

Saturday morning delegates started flowing to the registration desk. Tiago, my SHO a year ago who was now a registrar in South Africa came to help. He was checking names on his list and handing away the registration desk. getting to Guys Campus from lONDON bridge tube station can be tricky. My colleague and friend Lewis Thorne volunteered to grab a brochure and go the tube station holding it like a flag to collect any half-lost Europeans and Asians.

Professor Stummer sharing his secrets on maximum high grade glioma resection to an absorbed audience.

Another master surgeon, Hugues Duffau giving a masterclass in resection of low grade gliomas.

See how the neurosurgical audience does not want to miss a word.

They all gathered in the dissection room. I welcomed them and gave a brief talk. I told them this was an interactive course, they should talk and ask questions. “If you don’t want to ask questions, I will put you on the spot” warned them. Guilherme Ribas was sensational. He started with 3D anatomy shows, we then went to cadavers to practice and dissect specific structures from the human brain. The delegates, most experienced neurosurgeons, were mesmerised by the dissections, quite and focused. Another 3D lecture, another dissection session. Then coffee break. A chap from an asian restaurant in London bridge provided the hot coffee. Again anatomy lectures, again dissection. Time for lunch. I told you I didn’t like Guy’s catering, so my Secretary had had preordered M&S party food and Tiago who brought hot KFC chicken provided all it was necessary. Delegates cleared the tables!

M&S party food, hot KFC, fresh fruit, cakes in the lunch buffet. My secretary Hilda and my previous SHO Tiago did a spend job. “Having KFC was an inspirational choice” wrote one of the delegates in the feedback form.

Time to eat was limited, I had to push them back to lecture theatre while still munching! :-)

In the afternoon we had the masters’ seminars. True masters sharing their secrets with audience having the permission to interrupt, although they were absorbing every single word. Hugues Duffau, Walter Stummer, neurosurgeon and neurophysiology colleagues from Queen Square, fast pace, intense schedule. Then hands on practical workshop on cortical stimulation and use of ultrasonic aspiration. When they were pretty much exhausted they had about half an hour to get ready for the dinner.

One of Hugues’ slides, the concept on “minimal common brain” that has to be preserved. What a radical idea!

An American couple (Marvin is a flight surgeon) with Antonio Mussi who came from Florianapolis, Brazil to teach anatomy on the course.

One of the practical workshops with the ultrasonic aspirator using liver for practice under the guidance of Scott Smiley from Integra. Scott, Andrew and Integra have helped tremendously during the course.

I wanted this course to be unique in every aspect. They came from all parts of the world, i wanted to remember that weekend for years to come. So I booked a fabulous restaurant, le pond de la tour, next to Tower bridge. We walked from Guy’s campus, under the Shard o Queen Walk, next to the river, with hundreds of people running, basking, taking photos, passed city hall and an outside theatre with live performance, passed the Tower bridge and started walking to cobblestone streets with small shops selling peppers and home made marmalade, like you were in some italian street.

Saturday night dinner at Le Pond de la Tour. Look at the river through the windows. It was a lovely night.

The delegates had just half an our to change from their comfy clothes to something appropriate for the occasion. They all brought something appropriate for the occasion with them!

Le pond de la tour was immaculate. We had reserved an area looking in the river. When we walked in we saw something unexpected. The big round table in the middle, supposedly reserved for the faculty was already occupied by a few delegates who had arrived early and already were drinking the red Chilean wine I had organise with Peter, restaurant’s wine expert a few days earlier. Now what? For a moment I thought, shall we let it slide, so the faculty could sit on other tables. My senior neurosurgery colleague was adamant that the faculty should seat there. He was right. I approached the three trainees sitting there and had a small talk. Then I said, “look guys, we have a very nice table for you next to the window, the waiter will bring your wine there”. They were fine. The atmosphere in the restaurant was great, class and quality and relaxed and unpretentious style. At some point the Tower bridge started to open. Most run out to take photos, they were so happy they could see that. What are the chances! Mr Bradford, my senior colleague said laughing “George organised that as part of the course”!  Everybody had good time. In the feedback forms some wrote “the best place I ‘ve ever eaten!”.

Next day we started again early. 3D anatomy shows, dissections, master’s seminars, practical workshops. I kept the program pretty tight. They always wanted to mingle a bit more during breaks but we had to go through a lot, they were laughing with my strictness! When  Sunday morning before I released them for their coffee break I told them seriously  ”you have 18 minutes!” they all applauded laughing! :-) During Sunday lunch Mr Bradford told me “you’ve done it!”, I then knew it, it was almost over. No, I hadn’t done it myself, I’ve done it with the help of at least thirty people, some present, some not, all gave heart and soul, but, oh boy, it was worth it! The feedback forms were unbelievable, most were asking to add days to the course, some were asking when is the course next year, some of their comments: “amazing”, “impressive”, “perfect”, “just great”. These were people who paid plane tickets, hotels and course fees for a two day course. But as the course was coming to my end, and the adrenaline in my veins started to slow down, you know what I was thinking, I started making plans for the course next July. But then I thought to myself, “stop, take a breath, you are here! now!, enjoy this moment now”!

By Sunday early evening it was all over. Time to enjoy the moment!

The Gates of Happiness

Wednesday evening I suddenly realized that I was walking with my hands in my pockets. I don’t like walking with my hands in the pockets. It feels like a defense, like you are protecting yourself from something (and a bit lazy)! I then felt that my arm muscles where aching. It then came to me: I spent most of the day with my arms stretched above my head during a long operation. A woman with a giant tumour in the most awkward part of the brain, half of the tumour above the “tent” a tough membrane that separates the cerebellum from the back of the brain or occipital lobe and half of it below the “tent”. The tumour was compressing the brain stem, the clockwork of the brain. The whole area is densely populated with important arteries, deep and superficial veins, crucial nerves. Try this, put you hand at the back of your skull, roughly at the level of the top of your ears, in the middle, and feel a very thick bony spike. This is the thickest part of the skull. Its thick for a reason, because it has to protect the joining point of all veins at the back of the brain, the confluence of sinuses, described by Herophilus, a great Greek anatomist of the fourth century BC. These veins stuck and burred in the skull should be completely exposed; tearing even a small part of them will cause major stroke or death.

To make things even more complex the whole operation should be made with the patient “sitting” while asleep, a nightmare for anesthetists (but not mine very experienced anesthetist) as air can be sucked into the veins and trapped in the heart, causing sudden death. When the surgeon operates in the sitting position he should be looking from below up and his arms are stretched. Try something else now: lift your arms up so that your elbows are at the level of your shoulders and your hands are above your head. And time yourself. How long can you keep it like that? Three minutes? Four minutes? If you can keep it more than five, do let me know! The surgeon should be in this position, on and off for 8-9 hours while walking through a minefield, a wrong small step and a disaster happens. American colleagues usually need double that time, slightly different schools of surgery. Time does not matter. As a matter of fact, when you start difficult operations, time disappears. Nor you feel hungry or thirsty or with a full bladder. Time is irrelavent. Einstein was correct, time contracts! The only thing matters is your determination to remove the tumour, identify and protect all vital strictures buried in the tumour and bring the patient from a risky sleep back to their families.

So yes, my arms were hurting a bit that evening and while walking I felt tired. It was a lovely evening. I saw some steps in a Victorian house, next to the pavement, I sat down. I had some dried mangos in a bag, they were very sweet. I thought again about the operation of that day. All went well. Is this why I wanted to become a neurosurgeon? Is this why people want to become neurosurgeons? The challenge? the nearly impossible? the adrenaline rush? Is this the same reason that physicists study particles (that if Einstein was wrong they shouldn’t reach the surface of the earth) and look at the origins of the universe? Are they trying to see the face of God?

Sunday I took some guests to Hyde Park. No better way to spend a sunny Sunday in London. Start from Marble arch in the speakers corner, where various people make a speech about absolutely everything and everybody else argues with them. Of course its cool to believe what you want and be brave about it but what’s the need to convince others that they are wrong, do you really need to save them? (photo) If you’ve never been to Hyde Park have a look at the triathlon in the July Olympics, it takes place around “the serpentine”. A very specific tree on the hill overlooking the serpentine is my favorite spot in Hyde Park.

“I am right, you are wrong!” “No you are wrong, I am right!”. What a wonderful non-sense.

Talking about arguing, I remember a story I read, when I was at school, on a Greek literature magazine called “Tetarto” (very cool) which is greek for “Quarter”. Here’s the story. Long, long time ago in the far east a very old master and ruler was meditating in his quarters. He was known to the whole country for his fairness and good judgment. His hair and his sparse and long beard were snow white. By his feet a young apprentice was sitting quietly. Suddenly a man enters punting his quarters and starts talking furiously. “My wise master, something terrible happened, my neighbor came to my house, hit my wife and children, killed my animals and burned my house down. I want justice!” “You are right my poor man”, said the ruler, “go back to your family and I will give you justice”. Not long later, another man enters in a bad state and upset says “Please give justice to me and my family my wise ruler”. “My neighbor treated badly my family, let my animals loose and burned my house down”. “I am sorry to hear that” said the master, “you are right, I will give you justice”. When the second man left, the apprentice who was watching quietly, said: “Forgive me wise master but I don’t understand! Two people came and asked for the same but opposing things and you told them they are both right! How is that possible?” The wise master opened his eyes for a brief second and said “My young pupil, you are right too!” and closed again his eyes to continue his meditation.

Tuesday I operated on an adolescent boy in the intraoperative MRI suite. He had quite a few operations earlier by other surgeons. The anatomy was distorted and the main arteries in the left and dominant side of his temporal lobe had fallen into the cavity at unexpected places. I find that no tumour cannot be removed with a Rhoton dissector number 8 and a low setting suction. neurosurgery is not just about what good you can do but also the harm you can cause. Damaging one artery hidden by a wall of tumour could cause this boy to be paralyzed down his left side and loose his speech, for the rest of his life. But this did not happen. Then, a woman who became depressed a few months earlier and her behavior was unusually strange had a scan that showed a very extensive tumour in her brain. I removed most of it on Wednesday.

Thursday was the BMA strike. On Thursdays I have routine outpatients clinics. I felt that I should take a stance. Not for the outcome, that was irrelevant but for the principle. Money are not important. At least that’s how I was raised. Principles are! Principles always weigh much more heavier than outcomes. At least in my mind! So I took part in the strike as a principle. I did go to the hospital as usually, did my rounds, rescheduled my outpatients clinics and got a pay cut for that day! But took an action as opposed to non-action. Somehow my brain is programmed with a bias to action, one of the reasons I became a surgeon!

Trying a new ultrasound based neuronavigation (gold star on the right) in addition to standard navigation (blue star on the left) on Friday 22 June 2012.

Friday two more operations. A young man had a fit at the airport just after security check. He was known to have a low grade astrocytoma but the scan showed intense enhancement, usual indicators of higher grade and hence more aggressive tumours. There were quite a few cystic components, so perfect indication to try a new equipment called SonoWand, an ultrasound-based neuronavigation (photo). It proved to be much more useful than I expected (sorry for my doubts Robin!). Robin is the rep who corners me in every conference and meeting and tries to give me 30 mins presentations in 10 mins coffee breaks. But you are right, it is useful! My second patient was an elderly man with a tumour in the left side of his cerebellum, close to what is called cerebelopontine angle, a space between the cerebellum and the pons, part of the clockwork of the brain. Then ward round, dictating replies to letters, answering emails. It was Friday late night, the weekend had landed!

It was time for blue skies and sandy beaches, time for a few days off. Quite a few friends were bragging about Sicily, how “its like Greek Islands!”. OK then, Sicily it is! We arrived Wednesday evening in Palermo. In the main arrival hall a massive (theatre-like) poster with “Mafia” as a main title (photo). We had no idea what what it was advertising, so we maid up a few translations :-) “Sicilian Mafia welcomes you in Palermo!” or “If anybody mess with you in Palermo, call little Tony, competitive prices!” or “No job is too small or too big for us! call Pepe on this number” :-)

“Sicilian mafia welcomes you to Palermo”

They often say that the Sicilian “Godfather” is the greatest movies of all times. I never saw the movie more than once, so I have my doubts! Talking about Sicilians in movies, there is a scene in Tarantino’s movie “True Romance” where Denis Hoper cornered by mafia in his trailer, tries to talk himself out of being shot and saving his son who messed up with Walker’s “business” and is hiding somewhere. Walken instantly figures out that Hopper is lying and tells him how “sicilians are the best liars; I am Sicilian! you cannot lie to a Sicilian!”. Then Hopper goes on to tell the most magnificent story (and an obviously blatant lie!) and while having a last drag of his Chesterfield cigarette, knowing that he will be shot seconds later, says completely cool! to the “Sicilian” Walken: “Now tell me! am I lying?!” Astonishing performances! What a fine moment in cinema!

Christopher Walken as Vincenzo Coccotti “I am Sicilian!” Magnificent cinema!

Palermo is full of little streets, buzzing Italians, street markets in very! narrow streets (photo). People walk densely the market streets, there is hardy any space to walk. Then out of the blue a scooter tries to go through these streets, starting and stoping, and trying not to run over any pedestrians. How bizarre!, you think. Until you see two scooters coming from opposing directions in the tiny crowed market street. And then three scooters! This can’t be happening! Then a Fiat Pundo!, oh my God you think, they will kill someone. Everyone acts normally though, just moving their feet the last second so the car can squeeze through. And then, can’t believe our eyes! a Van! That’s it, time to get out of here, before a bus appears! Off to Porta Felice, we had no idea what exactly meant but we made something up, again: “The Gates of Happiness”.

Street market in Palermo. No, not for pedestrians only! Look out for scotters, cars, vans and… buses!

In Palermo (and most Italian cities for that matter) most people drive tiny cars so they can park everywhere, and I mean everywhere (photo) but (sorry Italian friends!) they are sloppy drivers (photo). Most cars have dents! (Perhaps not as sloppy as Moroccan, where you think if you stand on the street for five minutes you will! witness a couple of spectacular crashes! That said after 4 days days in Marackesh and no car crash to witness I thought something was terribly wrong about my views on driving until on the way to the airport a crash finally restored the order of the world. Nothing serious, except from the drivers arguing in very loud arabic).

No space to park? No problem! That’s what pavements are for! Life should be that simple!

Saturday night in Via Roma. The result of some fine Italian driving. Italians gathered around the scene in seconds!

Back to Italians, who also love driving scooters. Thursday afternoon two big! dudes in their fifties, riding massive scooters, some short of local “rebellious” easy riders, stopped in the middle of a small street one next to the other, all macho and ready to have a chat about kicking someone’s… backside (we thought!) but instead they …kissed on the cheek! :-) That didn’t go as we imagined! By the way, Italians kiss once (not just overweight dudes on bikes, but everyone), French twice except Parisians (three times), Dutch also three times, Greeks twice, Brits…variable (you have to take the lead!). No need to know exact kissing etiquette, just improvise and as long as you act natural you will pull it off.

Looking at the sea from a Sicilian beach

There are few good beaches in Sicily, Mondelo and Cefalu for the locals, S Veto (Sicilians say its the best beach in Italy) and Taormina, quite far from Palermo. Blue waters, clear skies (photo); small shops, with Sicilian souvenirs “made in China”; simple restaurants looking at the waters (photo). You feel the hot air hitting your face; sweet smell of sunblock on the skin; North Africans selling cloths, umbrellas, toys (and whatever you can imagine!) on the beech; takeaway pizza, slim base, tomato sauce, cheese.

You ask for directions, “where is piazza Marina?” for example and locals start to argue between them which is the shortest way (as far as we understand by the hand movements), with the fingertips of both hands like five-finger pinch, forth and back and shouting in Italian. We haven’t got a clue what they are saying. Then they shout “Antonio!, English”. From within the crowd, suddenly Antonio emerges, cool, riding his… stationary scooter with the engine off, full of importance. People are making space for Antonio’s scooter pushed by his feet. We were psyched up that Antonio will be super fluent. That’s it we’ll get our directions! After a pause Antonio begins: “me, English no good!”. “Go…erhh… bread… store, Guiseppe parlare English!”. Top marks for the effort (and the drama!) to Antonio!

The view from the veranda of a simple garden restaurant. Do you feel the hot air hitting your face?

I had three books with me, for light summer reading and to hold some sand grains trapped between pages like unique souvenirs: Frayn’s “Skios”, Asimov’s “The end of eternity” and Dalh’s “George’s Marvelous medicine” that my registrar Victoria gave me as a Christmas present when i took my team out for a Christmas lunch last December. Skios was a comedy of errors and mishaps, mistaken identities between a professor and a charming (and “harmless”) impostor, American, Russians and of course Greeks, as the whole plot tales place in the imaginary island of Skios. (In case that the island does exist! and you live in it! please do let me know). It was like reading the script of a comedy, I am sure someone will turn it into a summery movie.

“The end of eternity” one of (genius) Asimov’s masterpieces revolves around Andrew Harlan, a “Technician”, very powerful member of an exclusive organization that can travel through past and future centuries and alter cause-effects relationships. At the beginning Harlan was moving towards the 2456th century! Whoa! Can you imagine how life will be not in two and half thousand years from now but in two and a half thousand centuries!!! I am still reading it on the plane (had to stop to write this blog), but it looks like Harlan meets Noys. What do you know, in 2456th century love still exists! I did not have chance to read “George’s marvelous medicine” (sorry Victoria!) but its now at the top of list for my next break.

Out the plane’s window the afternoon sun glows on the Adriatic sea. It must be summer!

Wednesday was the take off, Sunday touching down in Heathrow, that is three days in the beach plus two days on the road and air (also fun). So was it like the Greek Islands? No way!!! So my dear blog readers (you are now nearly 10,000) go for the real thing! The most spectacular day light on the planet, the most seductive blue you’ll ever see! I will report live from there before the summer ends (and finally read Victoria’s book!).

Up in the air

Thursday I found myself on the smallest plane I’ve even seen! Two seats (per row) in the right one in the left. You couldn’t walk straight in the aisle, you had to bend and slouch. Unusual and fun! I was off to Aberdeen for the spring meeting of the Society of British Neurological Surgeons. I was invited to chair a session in neuro-oncology. And I’ve never been in Aberdeen before. So it was a win-win situation.

At the local airport I hoped on the bus and off to the city centre. Aberdeen was grey, rainy and windy. Houses are  build with a grey stone, (hence the nickname “granite city”). Houses look super strong, like they ‘ve been build to withhold some biblical catastrophe. In the city centre next to the train station there was a super long cue of people waiting to get a taxi. I don’t like queues of any sort. I find the idea of queing up completely ridiculous! I can’t understand people who are queuing outside restaurants and clubs. How absurd! And I don’t like standing still for no reason. You know how they say “good things happen to those who wait”? Rubbish!  Nothing happens to those who wait! Good things happen only to those who take action.

I headed to what looked like a busy street outside the station planning to snatch a taxi before entering the train station. Sure enough, after 3-4 minutes a taxi stopped in front of me to offload a passenger with a three-piece suit! From some distance was somehow familiar. It was Derin, a friend of mine working for BBraun, a neurosurgical technology company who also came for the same conference!

The taxi driver knew well the way to the Ardoe Hotel, venue of the course, he’s been at least 10 times! since that morning. I always talk to taxi drivers. My driver fought at the Falklands!, he told me about a surprise party they were planning to an old friend (and a reunion of 100 ex-solders!) after 30 years that weekend! Talking to taxi drivers always reminds me of Max, the taxi driver in “Collateral” one of the slickest thrillers you’ll ever see (photo).

Late night in LA, Vincent (Tom Cruise) gets into a random taxi. Max, a timid taxi driver (Jamie Foxx), agrees to take him that night to six business stops for a few hundred bucks. Soon enough, Max finds out that Vincent is a professional killer and he is contracted to kill six witnesses of a high profile trial. If you haven’t seen the movie you are in for a treat. Watch it late night with no other lights in the room and (preferably) high volume. Spectacular views of night LA from the air; soft background with vivid colour strokes; fantastic music. Some of the dialogs between Max and Vincent will blow your mind!

Everything happens in one night, in LA. Vincent is talking to Max in Mann’s super sleek thriller.

The hotel of the conference was an old castle (photo). Pointed rooftops and tall windows surrounded by old trees, golf courses, and wild animal life. Early in the morning you can see deers and pheasants. Six rooms only were in the main (stunning!) building. Most of the rooms were in an annex. I arrived at the end of the second day of the conference, so didn’t have my hopes up. I knew there were no rooms in the main building when I booked it a month ago, but I asked for it anyway, (a habit of mine to ask!). Not sure how, but I did end up with a room in the main building. In the room there was long corridor, a massive room with heavy curtains, enormous bathroom. Lovely! Then suddenly I noticed a strange spiral staircase at the end of the corridor in my room! I climbed up and found an upper floor with another lounge with fireplace and views to the forrest (photo)! And from the lounge floor there was yet! another spiral staircase, all within my room! (can’t be possible!). I climbed again the steps but the door (likely leading to the roof) was locked! Phew, it was started getting weird!

A stunning castle, The Ardoe house Hotel, venue of the conference.

Scottish highlands through the windows of the upper floor room.

I had just a few minutes to put my bow tie and off to the Gala dinner. There was a huge, wooden dance floor and free salsa lessons from the course organizers. A couple of pros showed how its done (photo). I thought that most neurosurgeons (especially the senior ones) won’t dare to have a go on the dance floor. How wrong was I! Nearly all! got up and started swinging and bouncing happily. They were adorable. I got a few photos on my iPhone but for the interest of public safety I will not display them :-) I have kept the photos thought, in case I need them someday for blackmailing :-)

Dancing lessons for British Neurosurgeons. What we saw later on the dance floor didn’t quite resemble what you see here!

Next morning there was the neuro-oncology session. Just as I clearing my throat (so to speak!) to start the session my mobile went off, was my registrar from London to discuss an emergency! Typical! Fortunately it could wait for an hour. After each presentation I like to ask an (easy) question first just to loosen people up so they can start participating. Sometimes people from the audience might clump up, thinking “I want to ask something but is it a good question?” “lets wait for someone else to ask a question first” “what if the answer is very obvious?” “is this a clever question to show to everybody how clever I am?” And while all these universal thoughts going through their heads, they keep quite. One of the chairman’s duties is to break the ice!

Before leaving Aberdeen, Muhammad, one of the local hosts offered me a tour of Aberdeen in his car. We had two other interesting passengers, two neurosurgery legends (photo). Ossama Al Mefty, Professor in Harvard and Raymond Sawaya, Professor in Houston. They were both invited speakers for the conference. We chatted quite a bit, I tried to steer the conversation away from neurosurgery (not very easy with senior neurosurgeons!) but finally managed to talk a bit about Paris (Ray has sisters living there and always stops in Paris when going to Europe), the glorious French lunches, the red wine. We got a few photos in the waterfront with a super strong wind, trying to stay still for the photo (not very easy).

With Sam (aka Professor Ossama Al Mefty, Brighams and Women Hospital, Boston and Harvard Medical School) on my right and Ray (aka Professor Raymond Sawaya, MD Anderson Centre, Houston and Baylor College of Medicine) on my left. A (very!) windy afternoon on Aberdeen waterfront, 20 April 2012.

On the way back, same super small plane but flying above the clouds was breathtaking (photos). That was my (just less than 24 hours) trip to Aberdeen.

Lovely sunshine above the clouds (like a giant bubble bath), miserable rain underneath. What you see, often depends on where you stand…

Outside my plane window the evening sun glows on the sea water south of the English coast. Look at the curved horizon, earth is definitely round!

A calm sea of clouds, you feel like you can walk on top of them!

The following Monday I was off to Gatwick to pick up relatives. M25 was gridlocked. Start and stop again. And again. And again. Was a raining, grey evening. Couldn’t see fifty feet ahead. Radio songs were coming out of the speakers. Was flicking stations. Then there was this song, a woman’s voice, I felt like it was suddenly a summer evening, one of these evenings when you wear a white shirt with rolled up sleeves, you feel a warm breeze on your face, one of these evenings you want to drive with the windows down, when you feel everything is possible. It was still raining but my feeling was now different, my brain was sending different messages, amazing how a sound, a friendly voice, a loving memory, can change how you feel instantly. I shazamed it from my iPhone before it was over and got the title. OK, OK here’s the song Blue Jeans from Lana Del Ray.

What music do neurosurgeons listen to? I don’t know about others but I can tell you about myself: not boring! Here’s another favorite of mine the last few days: Pafuera Telarañas from Bebe. Don’t listen to it on headphones and not in the gym/tube/walking (no need to shut out the world; the world around you is full of wonders and opportunities, don’t miss them!). Listen to Bebe on speakers, loud, you need to feel some vibration on your skin and guts.  Super cute accent, a bit of sweet sadness, a wisp of hope. Its like a walk in the streets of Havana, passing outside bars with neon signs. Yummy song.

Tuesday morning I was going through my correspondence, dictating  replies, sorting requests, nearly managed to go through a tall pile of letters and notes. As I was started feeling liberated and ready to leave my desk my secretary walked in with a fresh big pile! At the top of the pile a card got my attention. It was a very unusual “Thank You” card. It  was custom-made professionally. Not the ones that you can customize online, but uniquely made (photo). In the inside a photo of my patient, a young woman in her twenties, in ITU, giving me the thumbs up! I instantly remembered Sophie, how could I forget? She came in a pretty serious condition with a large blood clot in her brain, paralyzed in one side of her body and in a coma.

The blood clot came from an arteriovenous malformation in her brain, a tangle of abnormal arteries and veins, most likely formed at birth. This malformation had been discovered a few days earlier and she was waiting to see a colleague of mine the following week! The malformation didn’t wait though! and completely unpredictably, as it usually happens, bursted releasing catastrophic blood clot. The scan looked horrible, I spoke to her mother and explained that she might not make it. Always the most difficult part, how can you tell a mother that her daughter might not make it? I find that in difficult times is even more important to be honest.

I took her the theatre, removed to blood clot and excised the malformation. She stayed in Intensive Care Unit for weeks. We were monitored her intracranial pressure and other parameters. She gradually turned the corner, started talking alghough still paralysed in the left. But she had a big smile on her face, with extreme determination to get better, extraordinary courage, always thanking me when I was going round to see her progress until she left for renab. So that’s the story behind her card. It will go on the wall of fame.

Front page of Sophie’s card

Inside the card, Sophie is giving a masterclass in courage! (I had her consent to post her card online), thanks Sophie!

Wednesday I had operating theatre, a young woman with a large fourth ventricle medulloblastoma, a woman with a cavernous malformation in the brain, a man with a malignant glioma in the speech area of his brain who needed an awake craniotomy. A bunch of medical students from London, Bristol and Munich were observing in theatre. One of them decided to become my personal photographer, here’s a photo from that day.

Operating on a posterior fossa medulloblastoma in  operating theatre 3, Queen Square. No, I haven’t started bodybuilding, it was a lucky shot! :-)

Thursday I had invited a legend of biology and genetics, Professor Stephen Beck to talk to our neurosurgery trainees. Stephen was one of the key people behind the human genome project that broke the DNA code. It started 15 years ago and decoded 2.85 billion nucleotides of the human DNA.  The legendary paper was published in Nature in 2001. (Nature 409, 860-921 – 15 February 2001). I always invite some of the best people to talk to our trainees, so they can get inspired, make connections, further their career. I do want to give them opportunities I never had when I was a trainee. Do all trainees turn up to these lectures? Although I know that some they don’t, I am still surprised every single Thursday that they don’t! Have they go something better to do, someplace else to go? I stopped asking these questions to them (and to myself) quite sometime ago. And stopped trying to explain it. You can’t force anybody to learn or get inspired.

A legend in molecular biology in the 6th floor Seminar Room, Queen Square, looking fondly at the video of his pet project bidding for 1 billion euros!

Of course there are the keen trainees, pretty much the same croud every week, who absorb and enjoy (some of them take notes). You can always tell who is going to go up like a rocket and is going to take his/her time.  Its alright, everybody is different, but you can always tell. Back to Stephen  Beck, you could see his enthusiasm about genes and disease. He spoke about technology. What needed 15 years of hard work to decode the DNA, now it takes less than an hour. And what needed huge laboratories of more than 20 institutions now needs a device in the size of memory stick that costs less than $900. Stephen spoke about personalized medicine and a massive project at UCL bidding for 1 billion euros. In the photo you can see Stephen watching with pride his 5-mins promotional video. This project might change the way we practice medicine. That was the first time that he showed this exclusive video anywhere in the world! And still there were quite a few of our trainees who missed that. I shouldn’t come back to that, but still can’t get my head around it and never will!

On the other hand the whole world is within our reach, so people with the burning desire to learn can travel either through cooper wires or in the flesh, like the forty people who are coming to my course (www.advancedneurosurgery.moonfruit.com) from every corner of the earth. The initial 24 exclusive places disappeared within two days, so we created another 16 exclusive places but that’s all folks! Forty super lucky participants will be taught for two days by some of the best surgeons and scientists on the planet. And for the Saturday night dinner for delegates and faculty at a secret place :-) with stunning night views of the glorious Tower bridge and the Thames river in a summery London! What more can you ask for?

Nuts!

On Sunday I spoke to a National Medical Students conference in London. The conference was about students who want to follow a surgical path. They had invited speakers from all surgical specialties. I was there to talk about brain surgery. The conference was at the cruciform building of UCL. The tickets were sold out weeks before the event. It was Sunday morning so I found a spot to park and off to meet the people who invited me and never met before. I tested my Mac, the projector couldn’t see it. I converted it to Power Point but the memory stick was too small for the movies. Between ten medical students we find a large memory stick to transfer the converted files. Ready to go!

A urologist hiding behind the lectern spoke before me. I was sitting there watching him showing rigid instruments going through various…routes. Explained how urology combines medicine and surgery, how wonderful specialty it is. Hmmm…The Neurosurgery session out of three parallel session was oversubscribed. I left the lectern and went close to the students. “I consider myself to be very clever” said with emphasis and paused after starting my talk. The students laughed! “Not because I am a brain surgeon but because I am being paid to do a job I would do for free! As a matter of fact I would pay to do what I do! But the people who pay me don’t know that, please don’t tell them!” Laughs again.

I carried on: When I was two years of age I wanted to be rubbish collector (prolonged laughs). Staying at home I could see these big men come everyday in a big track (in Greece they collect rubbish daily! not every two weeks, that’s civilisation by the way), grab the rubbish with their tough gloves, throw it on the track and then hop on to disappear to some mysterious place. Yes, at the critical age of two my career path was set in stone, I was going to be rubbish collector! A bit later I thought that rock star was a bit more glamourous (photo). The medical students laughed again with my photo. I told them why I finally decided to be neurosurgeon, long before going to Medical School, if it wasn’t for neurosurgery I wouldn’t go to medicine at all, which is completely true!

One of my presentation slides to medical students, an aspiring rock star, a little before I decided to sacrifice my music career for brain surgery!

I gave them a glimpse of a life less ordinary but also what matters is being happy! It doesn’t matter if you are a goat herder in the mountains if you enjoy it! I told them that and I meant it! You should never do a job because you think that you will be cool. Cool comes only from inside! I spoke to them exactly how I felt. They were so quite and hanging on every word. They were adorable! And a bit worried that its too competitive. Truth is they won’t get it unless they believe in it.

I showed them images of what it takes of being a neurosurgeons, the good and the small print. At the end, I told them about an operation I performed on a lovely and very brave young woman the week before. A woman in her thirties with a very difficult type of brain tumour. We did the operation with the patient awake to avoid damage to her language function. She was draped with transparent drapes, her head fixed on a clamp, her brain was exposed, the most stunning structure in the know universe, right in front of us. Electrodes were attached to her brain and connected to an EEG machine interpreted by two neurophysiologists. A neuropsychologist was performing tests asking her to count or name objects.

My patient was so chatty to all (like being at the hairdresser)! My anesthetic team was monitoring closely all aspects of a very difficult operation. I was looking through a powerful microscope, using ultrasonic aspirator, switching from white to blue light to see fluorescent parts of the tumour. In the operating theater there must have been fifteen people. And holding the stimulator and touching the brain I could see the brain being temporarily paralyzed, my patient was unable to count or name a common object such as a watch or a a car.

While operating and helping this patient of mine, for a split second I thought what an extraordinary experience that was (and what I experience every single day), standing there at the operating theatre 3 at Queen Square, the world’s most famous neurological institute. “When I was medical student, like you!, I wanted to do that, I saw it in my dreams! If you have dreams, follow them, don’t let anyone or anything stop you!” I wished best of luck and finished my talk. At the end there was a super long queue of students waiting to talk to me. The organising committee of medicals students worried about delays draw a line after 4-5 students and said “that’s it, you can’t speak to Mr Samandouras any more”! Hey guys, go easy on the students!

On thursday we had Professor Schramm from Bonn, Germany talking to Neurosurgeons and Neurologists. Months before he retires, a man who’s seen it all in Neurosurgery was relaying his experiences. His talk was delayed for half an hour as we could not get his laptop to talk to the projector. With a full lecture theatre of quietly observing delegates we were trying to swap projectors, memory sticks, convert files. When the first slide appeared on the screen everybody cheered and applauded. There you go, we got an applause even before we started. I am not sure what’s with me and computers, they always try to play games with me but not for too long, my shiny darlings!

Prof. Schramm at a gastropub of Great Queen Street. My colleague Laurence Watkins on his right.

We took Johannes at a gastropub at Great Queens Street after his talk. He is lovely chap although rumors are that he has been quite a tough boss in Germany.

Next day I had an email from the editor of Nuts magazine, yes the one that… some male readers might be aware of. The one demonstrating women with…how can I put it medically…fat distribution at strategically important anatomic areas. No, no photo this time folks! They wanted an interview. I was very… flattered :-) but I passed!

Next week we had another VIP speaker at Queen Square, Professor Isaam Awad from Chicago, USA, a well known vascular neurosurgeon. Funny thing happened, computers and projectors worked well this time! What’s going on, it didn’t feel right! :-) We went for a few drinks with our trainees at the Swan (photo) and then for a dinner at VATS in Great Conduit Street. Lovely chap, he invited us to spend sometime in Chicago before the next CNS meeting in coming fall.

Prof. Awad talking to our trainees (and also talking to "the hand"!) at The Swan pub.

Monday I went to a two-day “Communications Skills Course”. Everybody who deals with cancer patients has to do it! Two of the participants were months before retirement but still had to do it! Don’t get me started on the course, I’ll only say that it was two days of my life I will never get back :-) Moving on to a more interesting course in Debrecen, Hungary, that was three days well spent. We were discussing minimally invasive surgery and endoscopy, cadaveric dissections and lectures. I made new friends, had a road trip from Budapest to Debrecen (second in size city in Hungary), saw the semi-westernized Hungary, tried Hungarian cuisine in old cellars with the course members while hungarian violins were sobbing  (photo), and bought paprika, the hungarian secret of spicy food.

Private dinner at a lovely restaurant in Debrecen, Hungary. This is what they mean "bring out the violin"

On the way back, while boarding on the plane the smiling BA stewardess asked me routinely “how are you?” “Great!” I said, as I normally do reply (my friends and colleagues often lough at me when I say things like that!). She was a bit surprised and after a second said “we are…great here too”! and smiled. A bit later came to my seat and started chatting as I was writing my blog (I am writing this blog on the way back from Budapest), and she saw the title “Nuts”, so I had to tell her the story. She told me all the gossip from the crew :-) The rest of passengers were looking as they couldn’t figure out if I was some celebrity traveling incognito so the stewardess spent so much time above my seat chatting like old friends :-)

We are used to standard ways of communication and behaviour. For example, look at the people in underground. One copies the other in behaviour, they are all so desperate to look “normal” not deviation from average behaviour. Standard questions, standard answers. People avoid small talk, avoid looking at the eyes, social conditioning at its best.  That applies to all types of behaviour, people want to have average behaviour, not hostile, not overly friendly. They don’t say what they think, they don’t act what they think. I am talking about free spirited thoughts and acts, not sociopathic or malicious behaviours! Social conditioning is great for society but detrimental for persons. Average behaviours will very rarely bring results more than average. Every time you deviate from the average there is only one factor which determines if you will come across as weird or cool: how strong your reality is, how comfortable you are in your own skin.

On landing it was well passed ten in the night, the sparkling London from the air was exquisite. Then back to hospital as I had a long operating list on Wednesday. In the end of March and close to midnight London was nearly summery, warm breeze, tourists in the streets, people holding glasses outside pubs, London’s ambitious buzz of the day transforms to a laid back chatter in the night.

Oh, I nearly forgot! Do you know Gray’s Anatomy? No, not the TV soap, the one where every single doctor lives at least a few tremendous personal dramas every day while saving lives and hooking up to every other doctor in the vicinity :-) I am talking about the real thing, the most influential anatomical text in history.  I had an invitation from Susan Standring, the Editor-in-Chief of Gray’s Anatomy to become one of the editors in the forthcoming 41st edition. Imagine an iconic book that has survived forty one editions and its going from strength to strength. A book that started in 1858 by Henry Gray an anatomy lecturer in St George’s Hospital Medical School and its life has exceeded a century and a half. What a unique privilege to help shaping the new edition!  My brain cannot explain why but I feel excited and humbled at the same time!

The poster of a legendary course. I know it hasn't happened yet, but its still legendary! For a full brochure go to http://www.online-neurosurgery.com or email Patricia.Laube@uclh.nhs.uk

 

Do you remember about a big neurosurgery event I told about coming up in May? Scratch that date! Here’s the new and final one: Saturday 7 and Sunday 8 July 2012 (photo). An “All Star” faculty from all over the world at Guys Campus under the shadow of “The Shard”, London’s most modern skyscraper (photo).  No, no tower can scratch the sky, but its a physical gesture of the human spirit, higher and higher, nothing wrong with that, especially when its stunningly imbalanced, like “The Shard”. Symmetry can be boring, a little bit of “messing up” sparkles attraction, very much like the two halves of human brain. More about that in my July course, that is if (!) you are one of the very fast and very lucky to get one of the twenty four exclusive places!

Its not Mordor from The Lord of the rings, its the peak of The Shard (of glass), a pyramid shaped skyscraper designed by Renzo Piano (what a name for an architect! shouldn't he be a musician?), and is the tallest building in Europe.