I felt kinda hungry, it was close to midnight, bit late for dinner…even for Greeks…! I have been sitting in my chair for 5 or so hours, working from home, remotely, with my team, with texts, facetime, Skype and voice calls, a race with time to finish sending four abstracts of our work to the four-yearly (!) World Congress of Neurosurgery, this coming August, in Istanbul. Monday, March 27 at midnight was the deadline for abstract submission, we had a few hours to crunch the numbers, filter the data, make sense out of spreadsheets, databases, outcomes and results. When everything was ready, members of my team in London and Glasgow pressed the “send” button, minutes before midnight…we made it!

The World Congress is a fun-fair of Neurosurgery…surgeons gathering from the four corners of the earth, different races, skin colours, faiths, but all sharing the same privilege, to operate on the human brain. My good friend Ugur Ture is the Chairman of the XVI Congress tasked with a super demanding event… Ugur was my guest a week earlier at the Royal College of Surgeons, at Lincoln Inn Fields, as my co-director of the First White Matter Dissection Course in Glioma Surgeons. This was a course for Consultant Neurosurgeons only…When we release the dates, within hours we had about sixty UK Consultants, for 10 places


At the end of the second day, a gift, a silk time of the Royal College of Surgeons, to my good friend Professor Ugur Ture, President of the XVI Congress of the WFNS, while Professor Yasargil is taking a snapshot…!


Prof Ture (right) helping his mentor Prof Yasargil to set up

We spent two days dissecting brains under the microscope and discussing ways to remove tumours while preserving function. With us we had another guest, who flew with Ugur from Istanbul…Gazi Yasargil, a living legend of Neurosurgery…named man of the century from Neurosurgery Journal…you can hardly go to a conference and not hear about Yasargil techniques, methods, and results…at 92 he rarely travels but was just a great surprise to see him coming to our course…how did it happen? I had a sudden, crazy idea to ask Ugur Ture to invite him on my behalf, it worked! I like to act on sudden ideas…within seconds…before my rational mind kills them as impossible to happen…!


Professor Yasargil, 92-years young, stayed throughout the workshop on both days and gave a 60 minutes lecture in the end!


It was Yasargil’s turn to get the blue silk tie with the emblem of the Royal College of Surgeons,  at the end of the two-day course.

In his talk, Ugur Ture showed us slides of Bosphorus, a narrow strait that separates the sea of Marmara with the southern eastern black sea also know as euxeinos pontos (hospitable sea). This is the breathtaking sea that, the poet of poets, Homer, calls in Odysseyοἴνοπα πόντον (yes, this is ancient Greek! for “wine-dark sea” btw, translating these Homeric sounds is nearly a sacrilege…the depth and the sounds of the ancient language are impossible to translate and feel!).

When I was in med school I stumbled upon a stunning essay, “Νηφάλιος μέθη” written by a Peruvian monk, Father Symeon, who had travelled the world and spent years in Paris studying art and poetry, with the money that his mother gave him after selling her beloved original art. His father was Mayor of Lima at the time…Symeon ended up at the Mount Athos where he became an orthodox monk… I still remember some of the phrases, so I googled it and found it! (God bless Google…!).

In his short essay, written by him, not in his native Spanish, but in a staggering, impeccably formal Greek language, he concludes asking his audience to pray for him in order to “τιμονεύω μὲ νοῦ καὶ λόγο, σοφά, τὴν ψυχή μου, ἀκάτιον στὸν γλυκὺ οἴνοπα πόντο“. No way to translate this folks…! but, as a (very) loose meaning, he’s wishing, as he lives now and as he prepares to die, to wisely navigate his soul, like a small, open boat, crossing the “sweet, wine-dark sea” of life…!

On a separate, linguistic note, such is the power of the ancient language, that if I see the word “sweet” means very little…my brain just brings in mind something sugary…but if I see the word “γλυκὺ” makes my mouth physically water…! Even so, you get the idea of the οἴνοπα πόντον…!

Pontos has a special meaning for me, as my great-great-grandmother was forced to leave from there, leaving everything behind, along with nearly a million other Greeks, during the exile of Greek refugees in 1922, after Greece’s defeat in the Greek-Turkish war, where they were forced to… walk! to Greece with thousands dying en route over several months…Like many other families, from my great grandmother’s 9 children, only two arrived alive.

The family, of course, lost all their wealth and settled in northern Greece but from the ashes, they built a new life…I still remember visiting, as a little child, the village and still remember the fresh smell of little mountains of grain inside the barn, while my grandfather, a man of few words, standing tall, would paint Laurie, the family’s favourite dog on the exterior white wall of the barn. Of course, the Greeks and Turks were close, then and now, but politicians (what a surprise…!) and their senseless greed for power resulted in the national catastrophe of 1922….

Out of some strange coincidence, I am writing this blog while listening to Pierluca Chimienti playing a mix of ethnic/Anatolia (Greek for East) music on Radio Istanbul…one tune stood out… emotional and dreamy…I shazamed it, here it is… Vilken Arman’s “Rosas”, Remix by NU, had to download it from iTunes, best 99p ever spent…!


A dinner on Monday night at the Savoy with all delegates and Professor’s Yasargil and Ture. We had time for a few speeches at the end…!

A couple of weeks earlier had flown to Lisbon, invited to speak about a new technology, an ultrasonic aspirator for safe brain tumour removal. The scientific program was a great success and the organisers very hospitable.


A little welcome gift from the Hotel Epic Sana, when I asked other delegates if they enjoyed it, they said what gift? Clearly having a little banter during check in does help!

But had the weekend free, time to rent a car and explore. I don’t like touristy stuff…looking at maps…taking taxis…searching for sights…waiting in lines…how boring! I prefer to explore and discover… as they say “be a traveler not a tourist”…and what a place to be true to that, other than Lisboa, where Columbus started one of his four voyages when he discovered the new world. Okay, never been to Lisbon before but the place is stunning. Beautiful sandy beaches, lighthouses, centuries-old churches, open spaces, and endless sea.


No, its not Santa Monica, its Costa de Caparica, endless golden beach, with perfects waves for surfing. The seaside restaurants serve fish that actually smells and tastes like fish…!

One of our recovery Portuguese nurses told me earlier its easier to drive in London than in Lisbon. I thought what was the big deal, until… I decided to drive in the old city…! Narrow, steep roads where you have to start and stop and start and stop, competing with local taxis, tricycles, bicycles and…trams!


Driving in the old city dodging scooters, pedestrians, and the yellow cable car, Lisbon’s landmark

At the end of my talk, I played a little clip, from my two days travel around Lisbon and Southern Portugal. I know everybody else preferred the hotel and walking in the old town, so I thought to show them a bit of Portugal outside the city. Here’s the clip I played, 60 (edited) seconds, with the music captured from the radio stations, during driving…!

Driving to Souther Portugal we bumped to a stunning lighthouse, Cape Espichel Lighthouse.


Ok, am not an expert but isn’t this lighthouse far too back from the rocks?


The view from the lighthouse, look at the size of people at the top, humans are mysterious, tiny dots in nature.


While waiting for lunch to be cooked, had a walk around an old deserted monastery.


Okay, I started writing this blog a couple of weeks ago and now that I sat down to finish it, all our four papers have been accepted for oral presentations at the World Congress of Neurosurgeons in Istanbul (well-done team!) and I am preparing my bags for another trip to Lisbon, in less than a couple of weeks, invited to speak at an oncology seminar on low-grade gliomas And now, I have a new favorite song, the hypnotising Amor (Original) by the German genius NU!

Yes, yes, you are right, I have to write this blog more often…!

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Friday evening, I was waiting in the security line, terminal 3. The fast track lane, was not so fast… passengers were piling up clogging up the line. I love airports…! security lines… not so much… you (and various strangers) have to mess with your bags, laptops, your clothes, empty your pockets, your belt, cufflinks, pens…no, I don’t like that… hey ho, what can you do…so was waiting there, reading news on my mobile…my day started many hours earlier… In the morning I had decided to go for a run, hadn’t run for a looong time!

The street had tall trees, a thick layer of yellow leaves were covering the pavements, was chilly but the sky blue, beautiful early winter scenery, perfect for running, so off I went…! People were going to work and university wrapped up in many layers of clothes, hats, gloves…comfort is overrated! After 10 minutes started getting tired and thinking to give up, but pushed for another 10 minutes, that’s it, enough for a first day, at least made the start.

One of the best advice I ever heard is to just start the process, any process. Doesn’t matter if you start small, just start. Something magical happens, and with time, the small becomes big. I heard this in an audiobook from Jim Rhon, a businessman, He said with his clear, melodious voice “a man drops on the floor to do push-ups, after 2 he gives up, he can’t do it. After a month he can do a 100. How did this happen? How did he go from 2 to 100? It’s a miracle!” This applies to everything. My great, great grandfather Aristotle said it perfectly “The start is half of the whole”.

Later at the hospital had a long day, rounds, taking to my patients, and surgeries. I left my registrar to close up the last case and run to the tube. Friday evening is not the time to drive to Heathrow, the tube is much quicker. Arrived just about on time, checking-in was instant but was now stuck in the security line. My turn came, both of my hand luggage were flagged up, so they had to manually search them. Behind me was a constantly moaning man, moaning about everything, the wait, the officers, the airport, his life…he was a British living in Hong Kong, traveling every 2-3 days, or so he said…he was tall, overweight, reeking of alcohol…his bag was pulled out too, so were waiting…

A pleasant officer opened my first bag…what could have been there…this is my emergency bag in case I have to go for a short trip somewhere, and normally lives at the boot of my car… first off, she found two bottles of water, the Hong Kong Man started shaking his head with disapproval, then she started pulling out small bottles of shampoo and shower gel…hair mud…couple of hand disinfectant…two tubes of toothpaste…aftershave, she was putting patiently everything on the side forming a little mountain…she then found a lighter, no idea how it got there, “do want to keep this?”, the officer asked me, “yes, why not said”, while the Hong Kong man was about to have a fit…was hilarious. She then asked me to choose a few of these items and tried to squeeze them in the clear plastic bag but could not zip it, so she gave up and gave it to me as it was. Then it was the turn of my briefcase, they retrieved my black Swiss army knife from the front pocket…the blade was less than 6 cm, they let me keep it…the Hong Kong man was delirious, keep saying “in Hong Kong they would never do this!!!…in Hong Kong they would never do that!!!” I was still chatting to him, he was OK, just shocked…!

So after breaking the Heathrow record for bringing (I swear, unintentionally!) the most liquids, flammables and knives, and getting to keep them, boarded the plane for a short flight to Lyon. I was invited by a medical technology company to give feedback to a new surgical equipment, technology help surgeons produce better and safer results, so I am always up for it…met with a few old friends, Hugues Duffau from Montpellier and Michael Sobel from Dusseldorf. Lyon has an old part, charmingly aged town, and a new part, full of hotels and shops and, as I saw on my way to the hotel, Interpol’s headquarters.

Christmas came and went, before you know it its summer and then Christmas again…! where does time go…Before the first week of the new year ended I was off to Mumbai to give a lecture, invited by my good friend Atul Goel, an innovative and extremely hard working neurosurgeon based on K.E.M., a high volume public hospital. The conference was a great success, neurosurgeons came from all parts of India, hunger to learn and help patients is the same everywhere in the world.


A man sharpening his knives, hard working Indians are everywhere, and at the back, a bookshop! used technical and scientific books piled on the floor.


People hungry to learn anywhere in the world

Had a couple of extra days to explore Mumbai, crazy city, people everywhere, imagine every street like Oxford street in London…people don’t have a lot, but they smile, and look happy, genuinely happy! What more do you need? A lot of contrast, many poor, few wealthy, very, very wealthy…Phoenix is the largest shopping mall in Mumbai, something like Westfield, but much more expensive compared to London, with many Indians shopping there. Next to it, St Regis hotel, super luxurious, and on the 38th floor, its restaurants and rooftop bar have stunning views of Mumbai at night. We had dinner in one of them, Luna. Service and hospitality in hotels are impeccable.



The view from Luna



If poverty in India brings you down, here’s a motivational quote in a Mumbai church to cheer you up!

I usually rent a car when visiting a country, but not in Mumbai, there are no lanes, no rules, and constant honking, even if there is no reason to honk, just for the sake of it…all cars have dents and scratches, and I know why…plus Atul Goel’s legendary hospitality meant that I would be usually driven everywhere. There are different types of taxis in Mumbai, hotel taxis (too expensive, avoid!), small yellow cabs (no AC, windows rolled down), cooled cabs (blue with AC) and something between a bike and a car that many locals like to use. The best way to move around is to use Uber or Ola (similar to Uber), reliable and cheap. You need an Indian phone to download the apps, but you can easily get a SIMM card from local stores, just bring your passport. I had a wonderful time and been invited to three more Indian conferences before the end of the year…


Driving (or more accurately being driven) on the Bandra-Worli Sea Link, a spectacular cable-stayed bridge connecting the western to south Mumbai. From far at night, Mumbai looks like any American city but the darkness hides a lot…

Eight hours to go, 10 hours to come back. On the way back, about 6 hours after take-off, out of the blue, the plane started shaking…really shaking…strong, strong turbulence. Imagine driving fast on a country road full of potholes. Never felt that… Things started falling off the seat tables…From the curtain opening, I glanced the stewardess trying to stand up holding from the walls…she couldn’t…after a few attempts, she gave up and sat down…It didn’t seem to settle…The plane started to tilt…Two thoughts crossed my mind.

First, the plane could crash…! and I could die…this could be the day…you hear about planes crashing in the middle of nowhere, not that often, but you do…I looked outside the window, we were above dense, fluffy clouds, no chance to see if we were above sea or land…there was still light outside, felt like the end of the day… a strong, sharp orange line was touching the clouds, giving them a levanter shade, all looked so beautiful and peaceful…the thought crossed my mind calmly…no! my life did not flash in front of my eyes :-) contrary to what I would have expected, I did not review the past or bargained for my life…I just accepted it with some unusual, unexpected, and total peace…

My second thought was who’s the pilot…Never cared before, I usually assume is someone competent, when it is all smooth, who cares? But now I started thinking, how competent and how experienced is he… has he dealt with this before…I instantly thought about complex brain surgery, its exactly the same…when things are tough, when unexpected problems occur, this is when you want your surgeon to be the most competent there is…after 15-20 minutes things started to settle, and in a few hours landed at terminal 5 without a scratch, so, I did survive to tell the tale :-)

No planned trip for a few weeks, time to plan for a brain dissection course coming up in March, in Lincoln Inn Fields, the house of the Royal College of Surgeons…a stone’s throw away from the city, London’s financial district, status, wealth, and tradition…nothing like Mumbai…but did people smile more in Mumbai?…I think so!…

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The perfect wave

We were standing casually at the front of the plane, talking, Barry, Jeff, Maria and me. The plane was halfway between St Louis and Phoenix. Jeff is the vice president of Nestle, and air-miles heavy weight champion, something like George Clooney’s movie “up in the air”. Barry is a retired entrepreneur, after selling his mortgage business, apparently one in every ten mortgages in America were sold through his company! Maria is a stewardess, pleasant, topping up wine for Jeff and Barry and white coffee for me. “I am telling you guys, I spent most of my life in planes, but never seen this before, to let us stand here and drink and talk’. He was very happy.

All started when I unplugged my laptop from the plane’s socket in my seat. I noticed that the USA-type prongs from the multi-piece adapter I bought earlier at Best Buy had disappeared, was not in the socket, not in the floor, not in my seat…Jeff who was sitting next to me, volunteered to have a look with the flashlight of his phone behind the seat, nothing…Another man, Barry, who was sitting next to us volunteered to help, he said my son will find it, he’s a champion. He was not kidding. We all stood up and the 11-year old boy tear the sit apart! Removed the cushions, the belt, the life jacket, left the metal frame only! It was a good thing we were on Amaerican Airlines plane, there is no way any BA stewardess would allow to touch the seat. But no adapter…! All other passengers who had no idea what was going on, and were looking very curiously. “Thank you so much for coming to our country to visit us” said Barry at the end, one of the extremely friendly Americans you find in many places. He then passed on his card and said my wife Dana and I would love to have you for dinner next time you are in St Louis…! Again, correct me if I am wrong but I think you see this only in America.

I was on a plane left St Louis, where I was invited to give a visiting Professor lecture at the Department of Neurosurgery. My trip started 24 hours earlier, from London with a three- hour stopover in Chicago (which became 6-hour stopover, due to plane being delayed in Minnesota from storm). Saleem Abdulrauf, Chairman of Neurosurgery in St Louis was a perfect host. He is building a young and dynamic department and the Walter Dandy Society he founded in 2012 is thriving. Was a pleasure to deliver a lecture on my awake craniotomy techniques and then have a ride with one of his two sports cars. From St Louis flawn to Phoenix and then off to San Diego.


OK, this is during landing in the first days of my trips but not sure which airport, am not kidding! I am fascinated looking from the air lit streets and buildings and light beams coming out of tiny homes’ windows.


Arrived in San Diego Thursday night invited by the Congress of Neurological Surgeons to their annual meeting. As you get off the plane, a wave of hot air is hitting your face. San Diego is spread out, wrapped around the see. Massive (I mean massive!) hotels overlooking the ocean, boats, bicycles. Despite seeing sea from everywhere there is no beach for swimming. You can take the boat and after a 20 mins ride you get off the Coronado island with a small sandy beach. We found a Greek gyros shop (these Greeks are everywhere!) and watched the first presidential debate on the big screen TV amongts (mostly indifferent) Americans.


One of the many San Diego marinas, under a hot, hot late September sun. You can rent a bike (like London’s bikes) and cycle across the “beach”, pass the airport (I never saw an airport so close to a city) and go to a little harbour with a pier.

I gave a talk on Saturday morning at 8 am on surgery of tumours on eloquent parts of the brain, along with Mitch Berger, Hughues Duffau, Lorenzo Bello and Richard Byrne. Alhtough my battery was full, minutes before I had to give my talk my macbook died! all battery juice drained! Never seen this before, I did not have an adapter, ok, what do you do? I asked Hughues Duffau and Mitch Berger to go before me and I run out to get an adapter. I had about an hour to go to Westfield San Diego to get another one and come back before the session ended. I got into a cab, gave the address and off we went. The driver, a nice Indian guy, started telling me his medical problems, and that his doctor does not believe him that he has serious brain probelms, while strolling leisurely on the roads despite telling him he had to run like the wind. After a while he started telling me that he had studied engeneeiring in India and could fix the problem by changing my mobile…! OK, not the best time to be driven by a crazy driver!

After several insane technical suggestions, including ordering parts from India! we finnaly arrived at the mall. I run to the electronic store when I realised that it opens at 10 am and it was just before 9…!  OK, back to the conference centre, with the same crazy driver who was waiting outside. I had at least loaded all my talks to Dropbox, not ideal as all conferences run on Windows and will completely distrort my slides, but now was no time for aesthetics. The IT guys were nowhere…! After running into different sessions we finally got hold of them. One guy had no idea, so we found the top nerd : -) who knew what to do and started to download my talk with several videos and photos. “OK, will download in 35 mins“said triumphantly. “you got to be kidding me!” said back.  “OK, I will use my own IP and will download faster, remotely to your session’s PC“, added with remorse. I walkded back to the conference room, an hour and 10 minutes had gone, seemed liked hald a day. Lorenzo Bello was finishing his talk. I waived to Mitch Berger, was ok for my talk.


My budge (of honour)!

I approach the lectern, I had no idea if my talk was there, and how it will look like. I moved the mouse, the screnn lit up, i saw a file with my name, clicked, it opened, and worled like a magic, not even change of slides from Mac to PC!  All videos played perfectly! “Great talk” Mitch said later, delegates asked questions, good discusiion follwoed, nobody in the room knew what happened for the previous two hours.

Like all American meetings, CNS was big! with more than 3000 attendees, and many speakers including non-surgeons, like Steve Wosniac, co-founder of Apple. Wosniac was happy, chatty, genuine and, of course, super nerdy :-) what did u expect?! Also Daniel James Brown, the author of “Boys in the boat” a hugely successful book, about the American rowing team who won the gold medal in 1936 Berlin Olympics under the eyes of Nazi Germany.


A jolly Steve Wozniac with his nerdy shoes (left) talking to the President of the CNS Russell Lonser (middle) in a massive conference venue (I am sitting in the first raw) with more than 3000 seats.

The scientific program was also productive with discussions on ARUBA trial on AVMs from Spetzler, where only 6 patients randomized for surgery! And a talk from my friend Mitch Berger on personalized and targeted treatment for glioblastomas. There was also live surgery daily, sponsored by medical companies, good effort but nothing like the surgery was have at the annual neuro-oncology course every summer in London, no I am not biased! :-) During reception I saw my friend Charlie Teo from Sydney, high energy and good spirit as always. Outside the scientific program I had the chance to run by the beach, cycle passed the airport and swim in pools and the ocean. It’s much easier to be active in hot weather, you are outside wearing shorts and tee, by the sea, where everyone is running, all you have to do is walk faster and faster, move your arms a bit more, and this is it! you are running!


During the evening reception, everybody did the same thing when getting out of the Marriot, stood at the top of the strairs, took a photo with their mobile and then walk down the stairs and get in line for food. I was no exception, so here’s my photo!

Between CNS in San Diego and my next talk in Boston had a full week, time to get a car and hang out in California. The car was a white, cabriolet Mustang, black soft top, bold red lights, still smelling new.


Driving somewhere in America in a cabriolet Mustang

San Diego to LA is just over a couple of hours, that is if there was no the legendary LA traffic. Around LA cars go fast, lanes are narrow, and there is no such thing as slow lane, everybody goes pretty much with the same speed. That’s good for me (I love speed) but you will never see some of the slow cars that you often see in the right lanes in UK’s motorways.


Can you believe I took this photo in Venice beach with a cheap Lumia phone I bought in San Francisco two years ago?

A couple of things are different in US, for example, when on crossroads, if you are on the right lane you can make a right turn, even with a red traffic light, this is legal. Also at a stop sign you have to stop completely! I know this is what the stop sign means, but in the UK drivers slow down a bit and carry on. In American roads you have to come to a complete halt! LA is a great city, has everything, great beaches in Malibu, amazing houses in beverly Hills, and trendy shops everywhere. You can go to Santa Monica Pier in an hour, with massess of tourists, or hang out in Venice beach, rent a board and surf in the not so massive (but coooold!) waves. Venice beach is so enormous, tons and tons of white sand, lifeguards are driving red pickups and run like crazy in the beach. Walking around in Venice beach with no surfboard or skateboard under your amr is like walking in Alps with slippers.


Venice beach at dusk. This is beggining of October…!

But if you are looking for the perfect beach… Driving from Santa Barbara to LA, long lines of RVs, traffic, had to make a stop. Could have been the time of the day, early evening but sun still strong…  or the sound of the waves drawning all sounds…or the straigh line of sign into the infinite…never seen or felt a better beach…the water was cold… but the waves perfect…you could feel a vast ocean, you could be part of it…looked at the sign, Faria beach, a perfect beach… or a perfect moment…!


You find the perfect beach when you are not looking for it! The feeling of looking at the line where the sky touches the sea was new

From LA took the plane to Boston for my next talk, at Mass General Hospital (Harvard Medical School!) for my next lecture on 6 October. I like Boston, the most european city in US, reminds me a big version of Oxford, intellectual, sophisticated, with rowers in the river, many foreigners looking for a better education, and the new high impact publication in research journals. What a difference from Venice beach, what drives people to do one or the other? Now hang on, am not taking sides, I don’t know what drives people riding waves or studying at a lab, and can’t be sure that pleasing our ego has nothing to do with either. But would like to take the  (naive) view that helping others makes life a bit more worthwhile…!

The nurses and doctors are walking around the Mass General in scrubs, I mean in shops, in the train, even the local bar, Harvard Arms…in the UK many NHS people would freak out. The symposium was great, and made new friends. Two days in Boston was added to two weeks in America, London, Chicago, St Louis, Phoenix, San Diego, LA, San Francisco, back to LA, Boston… time to jump back to BA’s plane to the familiar Heathrow terminal 5 and to my patients. Like a man with a brain tumour deemed “inoperable”. He finally came to my service and had an awake craniotomy and complete tumour removal. His two young children came to meet me with their parents with two handmade “thank you” cards. Adorable!


Thank you card 1 – Mr Samandouras vs the tumour


Thank you card 2 – Mr Samandouras, “the tumour destroyer” holding the knockout knife while the “angry tumour” cries Aggghhhh….how cute is that? Both cards posted with the permission of parents and the (young) artists.

So back to London…No surfboards here…no perfect waves…but same people in the core, looking for ways to feel happy and fulfilled (and try desperately to look cool!)…happiness is in the moments…you can capture these moments wherever you are…you just need to wait for a tall wave and jump on it…no, there is no perfect wave! don’t spend all our life at the beach waiting for it…stand tall…feel the sun on your face…the wind on your body…lock eyes with the next big wave…and go for it…!



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It was a long day, several hours drive… Yes I had the SatNav on, how else could I drive around the great lakes, but still not entirely sure. So I googled, “where am I?” In less than 0.136 secs google had the answer Latitude :: 41.03916091992087, Longitude :: -85.24132144166595…turns out I was close to Dearborn, Michigan, about an hour from Detroit. Started from Chicago, two days earlier. I was invited by the American Association of Neurological Surgeons (AANS) to give three talks on brain mapping and surgical techniques in excising tumours from eloquent parts of the brain…the only one from the UK, quite an honour for such a prestigious meeting.

The meeting was in an enormous venue, McCormick convention centre, that could accommodate thousands of people, and that was McCormick West only…AANS conferecnces are always great success, delegates arrive from all parts of the world. There are so many topics and themes that lectures are broken down to the many conference rooms, and usually meet at the escalators or coffee breaks. The most junior delegates (and some senior ones) are “chicken-heads”… :-) looking constantly right and left to identify people they know, common sight in these conferences…you always give value to people you look at…and always get value when people look at you…one of society’s unwritten rules…

On Friday there was the first international brain mapping course with honoured guest George Ojeman, now retired, Professor of Neurosurgery in Seattle who popularised the concept of cortical mapping during awake surgery in epilepsy surgery. Mitchel Berger, now Chairman at the university of California in San Francisco spent many years in the faculty with the aim to transfer these skills to tumour surgery. Hughes Duffau from Montpellier also visited Ojeman and subsequent Berger starting a movement to removed tumours in eloquent parts of the brain previously thought to be inoperable and untouchable.

So this all was in honour of Ojeman, his intellectual “children”. That was the first time I saw him and shook his hand, humble and pleasant like all great men. In the morning there was a “How I do it” session, 10 neurosurgeons with expertise and experience in awake surgery and removal of tumours from eloquent parts of the  brain, including 5 surgeons from USA, 3 from Europe, one from China, and one from the UK (me!).

At the main meeting, during the oncology sessions there were discussions on Buckner’s paper on effect of adding chemotherapy to radiotherapy in the treatment of low grade gliomas (LGGs). Buckner showed that survival is increased by several years when adding PCV (a chemotherapy cocktail) on radiotherapy…however the responses by the many oncologists were underwhelming…they felt that they would add PCV only when radiotherapy is indicated (which in LGGs is rare)…which means safe radical resection is still the gold standard in these challenging tumours. There were many discussion on tumour vaccines, immunotherapies and vaccines is the way that treatment is going…

During the international reception at Chicago’s cultural centre met with old friends and made new ones. Evey year I always bump to Kwang Tu, current president of the World Federation of Neurosurgical Societies (WFNS), the organisation of all neurosurgical organisations of the world. Kwang is a smart leader and already contributed many positive changes to the WFNS, always great fun to meet him. This time invited me to visit him in Taiwan…yes, will do! And talking about WFNS, the 2017 host, Ugur Ture invited me to speak in Istanbul in September next year, this is the biggest event for any neurosurgeon. I met Ugur in Antalya, middle of April when invited to speak to the Turkish Neurosurgical Society meeting. What a great meeting and an oportunity to see again Yasargil, just turned 90!, running up and down like a teenager.

He said how when he was a young surgeon travelled to see the legends of his time, to see how they operate, how they move their hands, how they move their feet…never heard this before, looking at how surgeons move their feet…! not a lot for a start! but I guess energy flows in the body in the same manner, arms, trunk feet…balance, composure, intensity, focus is the same everywhere…I took a 10 secs phone-video of him talking, capture a great man talking in his own language…


Arriving at Antalya’s airport 12 April 2016, an advert of the Annaul Neurosurgical Conference in one of the terminals.













Yasargil on a shaky photo on my iPhone, standing in front of one of his slides, talking about the “ego of the neurosurgeon”. He spoke about techniques, skills, art, history and philosophy. He influenced more modern neurosurgeons than anyone else…















Catching some of April’s sun in the hotel’s balcon













Back to Chicago, 29 April, was not sunny, at least not for the first 3 days. My umbrella that lasted all english winter broke in the first day, I had to throw it in the bin… when they say windy city it’s not a joke…but the next 3 days was (mostly) sunny. Chicago is supposed to have a good vide with jazz clubs, a sandy beach, cool neibourhoods…was good but did not get the vibe…surprised by how few people were on streets…Michigan avenue is the equivalent of Oxford Street in London…was nearly deserted after-hours, and not that busy daytime…Still the skyline was breathtaking, looking at some of the world’s tallest buildings at night is someting…interesting, the first 10-15 floors of most skyscrapers are car parks, how great would that be for London, that is until… London real estate agents convert them into cozy flats…

The AANS was productive, stimulating, large-scale event! I enjoyed it and of course was grateful for the invitation and the honour…every time I give a talk at the end people come to talk to me and ask me to spend time with me in my hospital or invite me to speak to more conferences and events…so got invites for New York, LA, and Cancun, Mexico…as far of Chicago might have to give it another chance some other summertime!


Chicago river at a cloudy, wet night

Two days left to have some time off, so rented a car, (a silver mustang!), at the O’Hare Chicago airport and explored a bit of America, country roads, small towns, quite coffee shops. In one of them, somewhere in Indianapolis, a police car parked outside, a few bikers, families with children, couples in a car with windows rolled down so they can attach a tray with burgers and fries, all like taken out of a movie, but very genuine…


Amazing coffee/burger/ice-cream shop somewhere in Indiana

Friends often ask me how I can drive in America, well with Sat Nav…they still think it is impossible…I have no idea what they are talking about! Driving is so easy, anywhere in the world (well, expect Mumbai…! its crazy there). You can’t feel a place unless you take the detour, drive to country roads, see people sitting at the porch, drinking lemonade, watching strangers walk by, talk to locals, make a bit of noise. Contrary to what you think, the best way to blend in is to stand out! People are the same all over the world, no matter where they live, how they look, what’s their wealth or poverty status, illiterate or highly educated, they all respond to the same things, to interesting (not boring!), genuine (not fake!) people…so don’t think too hard, avoid talking about the weather (or anything similarly boring) and act naturally, how they call it…let me think…yes! be yourself…!

Last week I left my iPhone at the reception of the intraoperative MRI, anything metal should stay away from strong magnets, then at the end of the day I could not find it… there is a “find my iPhone” app which I had activated, was hoping to tell me its under a pile of books in the reception office, turns out it tells you its in London…yea, great, I will now stop looking to find it in china…! I looked at my office, nothing…that’s a bummer…how can u live without a phone? well, looks like its not that difficult…most people text, so I get the messages on my macbook, or they come and find you in person…yes, I got another phone, not an iPhone this time, I got so bored about the same, year-in, year-out design and apps, and the non stop prompts to update the software, “do you want to update now or in the evening”, no I don’t want to update at all!…there was a time when apple was a cool rebel, now its a boring mainstream…so got a different phone and still playing with the new interface and apps…change is good for the brain…! and contacts easy to transfer from iMac to Google contacts and then to android phone even if you lost your iPhone. If I find it, will sell it for charity, no going back now…!

Okay, I know, its been a while, my blog was closed…why and where was I all this time?…I know you want to know… I got hundreds of emails from doctors, friends, patients, asking to grant them access…well, you will find out “why” in its own good time…my life and adventures carried on in the meantime…for now all you need to know is that I am back and will be writing frequently…I know you missed this blog , I missed writing it…! I can’t catch you up on what happened since my last blog, (October 2014, unbelievable!)…but will catch you up with what’s will be happening from now on. A few things coming up, talking to medical students in Sheffield, 11 June, preparing for my fifth annual world course in neurosurgical oncology (this would be a blast!) June 22-26, bigger and better than any previous years, and a week to relax under the July-hot, hot mediterranean sun…and, by the way, if you find somewhere a (slightly!) battered white iPhone, its mine!


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Strangers Room

I closed my MacBook Air. I had finally finished correcting the last chapter of the Neurology and Neurosurgery at a Glance. I remember the Glance series since I was medical student. One page text, one page great diagrams. Easy to understand complex concepts, easy to remember. They started with pharmacology and expanded to all sub specialties from anatomy to paediatric cardiology. I was so surprised that they did not have a title in neurology or neurosurgery… When I was in the middle of my residency in Oxford was working very intensely on my “Neurosurgeon’s handbook” so did not have time to take on another project but I knew it was matter of time, months, weeks or even days before someone else had the idea. As a matter of fact many people have great ideas every ideas every day but they don’t take action…I bet many neurologists/neurosurgeons had the idea of writing at the Glance series but they stayed at the stage of wishful thinking…no guts, no glory!… An enthusiastic medical student kept asking me if there were any case reports to write up. So one day I told him, I won’t give you a case report to write! I will give a book to write! For him it would would be a matter of a few months to write and I would correct and polish. Well …the manuscript was ready… nine years later for me to review, and had about a month to finish off in the middle of a chaos of activities and a fed up publisher!

At least I finished it, one a train seat, departing from Lyon. We were off to Genoa, yes, that’s in Italy. The trip started as a business trip in Paris last Sunday. I was invited by a surgical technology company to try and test a new prototype ultrasonic aspirator while its being developed in the lab. What improves surgical technology ultimately improves patient care. So I was happy to help. Then we took the train from Gare de Lyon in Paris to…Lyon. It’s like you take the train from Liverpool street station in London to go the Liverpool…Two hours and a few minutes… Lyon is a big city but without any unique charms, at least none that we’ve seen in two days… The plan was to get a car from Lyon and drive without a… plan to South of France. But all rental cars in Lyon were gone…it turns out Lyon is the capital of sales people, flooding the hotels with their compact suitcase and feed their beer belies at local hotel bars. That was a “without plan” holiday so… new plan. We got the TGV and off to cross the Italian border. The train does not go in a straight line to Nice but heads first south to Avignon, then even more south to Marseilles and then follows the south French coastline, Toulon, Cannes and Nice.

While typing I remembered that last night in Lyon I was watching Tim Cook’s presentation in Cupertino. People were cheering, hysteria in the audience for…a new payment method and…a watch that has internet…Seriously?!! Okay, I am a tech enthusiast, I haven’t read a paper article or paper book in years, I trained (=forced) myself to do everything on a screen and I now find it bizarre to hold paper publications… It’s now such a funny feeling holding a book in my hands…( I do miss the smell of pressed paper though). I even had someone to come to my office and demonstrate the Goggle glass for some projects we are running, I use voice recognition for most of my typing, my office is full of gadgets I use for projects, and I get the most recent versions of advanced software I like, so I do like technology,…(and yes, I will get the new big iPhone, no I will not get the watch, although looks good and will be successful, and yes, credit card payment is very outdated…), but not this love of products…have these people lost it? As you traveling from country to country you see the same images, people standing on shops, bus stops or cafés facing their mobile screen, checking profiles on Facebook, forced friends, artificial lives.

Okay this calls for one of my “Iron Rules”: “develop the skills to distinguish between things that will make your life easier and the things that will make you happy” Put some effort on the first part. Put all your efforts on the second part. A nice house, a good car, the latest gadgets will make your life easier, they will not make you happy. Living in a cool house will not make you cool. Guaranteed! Okay, I am not saying that you don’t need it, but it will not make you happy. But how can you tell the difference? Are you ready? here comes my next Iron Rule: “If something was not around 10,000 or 100,000 years ago, chances are it will not make you happy”. People will not need that either in the distant future when technology will be much more advanced than we can ever imagine. People will always be longing for the same things, in every corner of the earth, when all hunger is gone…when all diseases are cured…when money does not exist…when the concept of salaried work would have  long gone… what made people happy when they did not know how to write or read will make them still happy when when technology will be a transparent bubble around them that they won’t have to wear or even see. So, the new Apple watch won’t make you happy… can someone tell these morons in Cupertino to stop cheering!…

We left Toulon, arrived in Nice, we have 20 minutes to hope on to the next train, then Monaco, and after 10 or so brief stops, we crossed the Italian border photo. Then our third and last train from Ventimiglia heading to Milano centrale, another two and a half hours till Genoa. We crossed from one country to another, no one asked for ID or passport, nobody seemed to care. What a great concept to have a European Union. Trenitalia trains much beer than SFCN but I have to give it to the French, they were on the dot!

Renting a car in Italy requires about… triple the time than… buying the same car in England. I am not exaggerating! They stare at the screens for long periods of time (I wonder if they doze off…), they photocopy everything, write in paper forms and at the same time enter identical data in the computer, make calls to central offices to check if what’s in the computer is correct, then they take more photocopies which they fax to another office, more signatures, more forms, that was a total of about two hours for what in England or USA would take 10 mins tops. Hey ho, at least all was done. You can take a full, “no excess insurance”, but no matter what, they will not insure the rims… I found out later why… From Genoa we set out for a two-hour journey to Manarola, a little village hanging from a cliff with its pink and yellow houses (painted by Paul Klee) so that the fisherman could recognize them from far in the sea.

At the beginning you drive through numerous tunnels, its kind of fun at the beginning, as you see a bit of sunshine and then dive again in the belly of big green mountains with hilltop villages, like playing Asphalt 8… but after a while it becomes tedious…not for long though. The woman in the SatNav with a steady voice gives directions without nagging, pretty accurate. About an hour into our journey the road becomes more and more narrow, it can now barely fit two cars, one on either direction…if a bus or even a van comes from the other side it would be tricky…the SatNav asks to “prepare for a sharp right turn”, okay, I am ready,…but in hundred meters there is no right turn, only a very narrow, extremely steep, uphill kind of “road”, this can’t be it…so we carry on, but the woman in the SatNav in a non-judjemntal tone asks to “make a U turn when possible”…you got to be kidding me, I can hardly drive straight ahead on this country road, how can I make a u turn!……anyways somehow I managed to u-turn and back to this pickle, left now, sharp turn…I eyeballed that goat-road again, that would be a good road for trekking, donkeys would just manage, goats would be okay, but with a car…okay, decision time…time to buy the bullet…left turn it is! Oh boy, I thought the car’s engine was going to give up, this road can hardly fit our car and goes higher and higher… there is no going back now, nowhere to turn or reverse, mountain on the left, cliff on the right…this is some sort of Italian jungle with tree branches on the road, if another car comes our way, any car, we are stuck…there is no going ahead, no reversing…we are going deeper and deeper to this unknown road which looks abandoned…hoping that will be no dead end…

As the SatNav is dead on on every little twist and turn of this tiny path in the middle of nowhere I can’t stop thinking how little brain neuronavigation has progressed during the last 10 years…Neuronavigation is a technology that allows the surgeons to find “where they are” in the brain, but compared to modern car SatNavs it looks like a cassette player compared to MP3…why was I thinking that?…it just came to me…its better to think this than what the Italian newspapers will write next morning when they find us at the bottom of the cliff, about the stupid tourists who drove their car where only goats were meant to go… okay, back to the deadly road, for another 1.5 Km and then another sharp turn, back to some “main road”, that is a road that can squeeze two cars… Manarola, has no beach, just a bunch of massive rocks creating some sort of natural pool good for diving, or plunging, jumping off the rocks.

Driving from Manarola to Coglia, many small villages and endless blue of sea and sky

Driving from Manarola to Camogli, many small villages and endless blue of sea and sky

Then off to Camogli, a town called by Dickens a little pirate place, that’s another hour and a half from Manarola. The road was wrapped on the outside of the mountains, no tunnels this time, no donkey roads, still narrow and steep but fun to drive while having on your left deep blue sea and an infinite blue sky (photo). Inside Camogli, as the SatNav calmy was asking to turn right or left in neighbourhoods with tiny streets, with laundry lines touching the windscreen, I was thinking, that’s someone’s backyard, it’s a dead end, no way this is going somewhere… at the end there was always a miniscule way out where the car could just fit, every now and again I was expecting to hear the noise of a deep scratch on the door. Camogli has a mixed pebbles and sand beach and clear green waters. Then another half an hour drive to Portofino, the jewel of Italian Riviera. Between Portofino and Santa Margarita the road could hardly fit two cars (that now seemed to be a luxury in Italian roads…), in every turn greenery from the side of the road was hitting the car door, buses had to honk in every turn as there was no visibility, most cars were driving on the double line so you had to break and steer the last minute to avoid a crash, and in the middle of all that, add scooters, cycles and motorcycles, joggers and pedestrians totally unaffected by the traffic. Italians do not honk to other drivers often (surprisingly), on the other hand I was honking (and shouting at times!), am Greek!… what can you do about it!…

Portofino at dawn from the hill of the castle.

Portofino at dawn from the hill of the castle.

In the village centre, there was a multi story car park, so followed the signs, the lane was so steep and angled I thought that’s it, either the mirror or the rims are going to get it!… In the village cute taverns, yachts in the port, steep green hills, a castle with the best views of the bay…a tender night was coming…next morning we drove to Milan, another hour and a half and drop off the car by the central train station of Milan. Yes, not a single scratch in these unbelievable (let’s call it) “roads”!…I deserve a medal!… a silver cup!… some sort of certificate!… or at least a “world’s best driver” mug!…from Milan and its spectacular grand train station hall we took the fast train to Geneva and then a plane back to Heathrow closing the circle of our travels.

Seven days, three countries, six cities, I don’t know how many towns and villages, planes, trains, an (unscratched!) car… that was my only proper holiday in two years. Back now to 14-hour work-days, 300 emails a day, non-stop texts and calls but more importantly, back to my patients… old ones and new ones, coming to see me from all over the world, every day a new challenge, a new tumour called “inoperable” by their local neurosurgeons…desperate patients seeking a beam of light…you have noticed that I refer to patients’ cases less and less in my blog. I modify many demographic details, my strictest ethical code is not only that a third party should not be able to recognize the case but the patients themselves should not be able to recognize that this was their case…and I stick to my ethical code.

Patients love my blog and often hope that I will somehow mention their case… patients are telling me again and again how my blog makes them feel much more at ease, a proof that I am not some cold-blooded surgeon but a person who can understand emotions and feelings… their dramas and battles…but my cases have now become so complex and the dramas so intense, its now difficult to modify them… perhaps in a book some time later…being a neurosurgeon dealing with very difficult cases is not being some sort of brain mechanic repairing damaged brains…you have to look into patients’ eyes… take the time talk to them as long as necessary… coach them… give their battles with them…

Back to my blog, I realise how long it’s been since my last blog, 5 or 6 months, things are happening faster than I can think let alone write about them. I can only thank you for reading blogs written months or years ago, I suppose that is part of what I wanted…to write a journal that does not expire like a newspaper article. So time to catch you up on some of the things that happened since my last blog. I declined a few flattering offers to become new the Chairman of Neurosurgery in a couple of countries, one in Australasia, one in UAE and I happily accepted the offer (=honour) to be the new visiting Professor of Neurosurgery in the University of California in San Francisco. No, I don’t need to leave the Victor Horsley Department of Neurosurgery for long, so if you are patients of mine, you are good.

Next, my world course…at the Wellcome Collection Building in Euston Road, a stunning neoclassical beauty built sometime in the 1930s. A museum, a library and a trendy place for coffee is about a mile from Queen Square. This is where people from North and South America, Asia, Europe and Australia came for my third Annual World Course in Advanced Techniques in Neurosurgical Oncology. Although only three years old, this course is considered to be the best course on brain tumour surgery. Three surgeons, one in America, one in France and one in Germany perform awake surgeries so they can test the sensitive parts of the brain before they remove them, maximizing tumour removal and preservation of normal function. The surgeries were projected on a large, cinema-like screen at the Henry Wellcome auditorium, modern and sophisticated, while the delegates, most of them senior neurosurgeons and department’s heads, were looking absorbed trying not to miss a thing. The other two days we had seminars, stunning 3D anatomy shows, lively debates, difficult case discussions.

Mitch Berger giving a spectacular lecture at the Henry Wellcome auditorium

Mitch Berger giving a spectacular lecture at the Henry Wellcome auditorium

and a close up to show how passionately  teaching his unique concepts on tumour surgery

and a close up to show how passionately teaching his unique concepts on tumour surgery

Guilhermes Ribas from Sao Paolo giving a masterclass on cortical anatomy

Guilhermes Ribas from Sao Paolo giving a masterclass on cortical anatomy

Here’s some of the feedback we had at the end of the course: “I could not have imagined a better course. I am impressed beyond anything I can express” The Netherlands – “The course, the content, the venue and the community atmosphere you created, all very special. an exceptional course” USA –  “It was undoubtably a tremendous amount of work putting together the best conference I have ever attended” USA – “I’m very glad to have attended this outstanding and very informative course. It was truly unmissable” Germany –  “You organised an outstanding course of superior quality. I have become inspired to improve my patient care and techniques”  The Netherlabds – An unbeatble  assembly of the superstars  of neuro-oncology”. Germany. When you see the impact that such events have to people’s lives, and subsequently to patients’ lives, it kind of makes you feel good…

Saturday night we had the course dinner at a place that no money can get you in, next to the river with a live quartet under oil paintings…first reception at the strangers room and then dinner at the members’ room at the House of Parliament. As the vast majority of the delegates were from oversees they were stunned by the beauty and tradition of the place. Towards the end of the dinner, before coffee I had to give the …proverbial speech. The course was so hectic, so I gave a very little thought what to say for about an hour before the dinner. I thanked my team for working so hard for this course, I teased a few people, and passed on the microphone to my honoured guests who praised so much this course. the vide was warm and uplifting, what a great way to finish this course! Next year is’s going to be five days long, with the addition of live discussions with the authors of the landmark papers in neurooncology during the last 10 years.

I had this idea when I found out that the author of an important paper, Jakola from Norway was in the audience. When I come up with ideas out of the blue I write them down on my Bamboo app, using a stylus or my finger… I have a folder, one of many, called “ideas” where I jot down whatever comes to my mind and my gut tells me it’s good. Many things I have done and completed now were written down one or two months or one or two years ago.

At the dinner table

At the dinner table

Delegates from all over the world enjoyed British tradition at the house of Parliament

Delegates from all over the world enjoyed British tradition at the house of Parliament

and the proverbical speech I had to give without thinking too much...

and the proverbial speech I had to give without thinking too much…

My “Ideas” folder is password-protected…so don’t try to steal my iPad,  you still won’t be able to read them…!

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Mullholand Drive

I was seating comfortably practicing my talk. I was wearing a suit and a tie. My fellow passengers wore something more comfortable. It was an eleven-hour flight….The stewardess had already asked me a few times if I was comfortable in my suit…yes, yes I was! Some people are a bit uncomfortable on suits, keep putting their finger in the collar, play with the tie knot, unbutton the top button…not me, I feel comfortable in my suits… So I had my MacBook on my lap, and was rehearsing animated :-) … I was off to San Francisco, invited by the American Association of Neurological Surgeons (AANS) to give a talk on “Neuro-oncology in the UK”. Quite an honor… especially as I was the only one invited from the UK. After a couple of hours I was happy that I was ready, so time to change to my long boxing shorts and a T-shirt. Most people came in jeans, slept in jeans and arrived on jeans. I tried a different approach, boarded in my suit, slept in boxing shorts and arrived in my suit again. If you have to travel, travel in style!

Once finished with practicing on the plane, time to finally watch the… “Secret life of Walter Mitty”! I wanted to see that movie for quite sometime. I have actually pre-ordered it on iTunes. But I could watch it sooner… that is… now! on an airplane seat…my gut was right, what a sweet thing!… a happy, upbeat little gem about courage, about going to the unknown… I also watched the “Wolf of Wall Street”, nicely acted but I was expecting something different… that was a let down, don’t waste time with this one, instead watch something like “Margin Call” with Kevin Spacey…elegant and clever!

Got off the plane, had my ten fingers scanned and that it was, “Welcome to America”, quick and easy. Saturday was dedicated to residents so some free time for me. Yes, you can get in a hundred year old cable car (if you can stand the queues), or walk down the market street (a bit boring) or you can get to Columbus street, rent a bike from “Blazing saddles” to ride across fisherman’s Warf and then cross the (very windy!) Golden Gate bridge (photo). San Francisco has some serious uphill roads, I mean really…uphill…If you get bored (or loose the will!) to ride back you can always take the ferry and arrive to San Francisco by sea having the island of Alcatraz on your left. Rumor has it that no one has ever escaped from that prison, well, except in the…movie!

Around midnight (London time) here's the view from the top of Golden Gate Bridge (I had to hold my iPad with both hands, the wind was so strong I was about to fly with my iPad!)

Around midnight (London time) here’s the view from the top of Golden Gate Bridge (I had to hold my iPad with both hands, the wind was so strong I was about to fly with my iPad!)


On the way back you don't need to bike again, get the ferry and see San Francisco from a different angle

On the way back you don’t need to bike again, get the ferry and see San Francisco from a new angle

Sunday lunch at John's, the place of Maltese Falcon. I have seen the Humphrey Bogart movie long time ago...can't actually remember the plot, but the restaurant is quite a pull and they have a ...wooden Falcon in a display cage!

Sunday lunch at John’s, the place of Maltese Falcon. I have seen the Humphrey Bogart movie long time ago…can’t actually remember the plot, but the restaurant is quite a pull and they have a …wooden Falcon in a display cage!

American meetings are big!…really big! 3,000 delegates and above. Conference centers are also big, like football stadiums, but structured, wified and carpeted. Actually some of the carpets of the trade exhibit were bouncy, I mean really bouncy…they had springs, so when you were walking you felt like walking on a trampoline, all they can do to attract attention…Sunday there were some non-neurosurgical talks. Americans are used to spice things up with a few culture, politics and management celebrities, including Bob Geldof, Robert Gates, Secretary of Defense, 2006-2011 (he looked tough…really tough!) and Clayton Christensen, a Harvard Business School Professor and author of many bestselling books on innovation and economy (check him out on Amazon).

I met old friends and made new ones, like the President of the World Federation of Neurosurgical Societies (WFNS) Tu Yong-Kwang… a lovely senior surgeon from Taiwan, he invited me to help with the oncology section of the WFNS and also with training of neurosurgeons from developing countries. Of course I was happy to help with both. While talking to Yong-Kwang a hand was placed on my shoulder and a smiling face… it was my good friend Mitch Berger; San Francisco is his town. As a matter of fact when going from the airport to the hotel, an enormous street poster was advertising the UCSF Medical Centre with… Mitch Berger looking thoughtfully at a brain scan!…Mitch is coming to London as my guest this July for my course. He told me he “can’t wait!”.

I also met again with Bil Couldwell (and his wife), President of the AANS who I met a year or so ago in London, in the retirement dinner of Mick Powel, my senior colleague and friend, an expert pituitary surgeon; David Adelson, Chief of Paediatric Neurosurgery at the Barrow, Phoenix and Chairman of the AANS Scientific Committee. David is also helping with one of the forthcoming projects.

Reception at the City Hall tuesday night. Moscone was a Mayor who was shot in the very same City Hall. Mitch Berger told me that Moscone was a Mayor that was shot in the City Hall. Before entering everybody has to go through metal detector frame!

Reception at the City Hall Tuesday night. Moscone was a Mayor who was shot in the very same City Hall, Mitch Berger told me. Before entering everybody has to go through a metal detector frame!

I also had lunch with David Kline, a living legend and possibly the best peripheral nerve surgeon, retired long time ago. Dr Kline and his wife were kind enough to invited me as their guest at the university of Michigan dinner on Tuesday night at “The View” a lovely restaurant at the 40th floor the Marriott, at the Mission street and fourth. We had never actually met before but we exchanged emails a few times. How lovely of them! On Tuesday night I was however invited at the San Francisco City Hall (photo above), so we swapped dinner for lunch. Dr Kline now lives in South Carolina, took up gardening and helps his community.

I don’t like standing behind the podium, I like to walk around…my talk was received well, very well…a lot of questions about measuring performance of individual surgeons, all these data will go on the public domain in the UK, that means all data on quality indicators of individual neurosurgeons will be available for patients to review on the internet. Americans are a few steps behind on this section, some institutions collect data but not a word about publicizing it on the internet…

At the end of each busy day, the view from the hotel room was spectacular!

At the end of each busy day, the view from the hotel room was spectacular! At the far end one more of San Francisco’s bridges.

There were quite a few, new interesting concepts at the congress: one group from Arkansas showed interesting results when a small group of patients with severe cognitive problems after head injuries underwent deep brain stimulation (DBS); the next step would be to try DBS in a larger cohort of patients and possibly in patients with chronic vegetative status. Its amazing what stimulating the brain can result in!

A second important paper was the results of the BRAT trial comparing clipping to coiling of cerebral aneurysms, weak spots in the brain that can cause subarachnoid hemorrhage, a potentially lethal type of stroke. Nearly ten years ago, another trial, coordinated from Oxford, called the ISAT trial showed better results in patients undergoing endovascular coiling (that does not requite an operation) compared to surgical clipping (that does require to cut the head open). The impact of this trail was tremendous as shifted the paradigm from clipping to coiling and therefore more than 90% of aneurysms in the UK are now coiled than clipped.

As coiling is performed by radiologists rather than surgeons, the ISAT trail resulted in nearly shrinking terribly vascular neurosurgery in the UK and most parts of the world. Except…the United States, where they never accepted the results of the ISAT trial and they wanted to run their own. Robert Spetzler, a legendary vascular neurosurgeon from Phoenix (photo), presented the results of the BRAT trial that showed no superiority of the coiling versus clipping and actually better long term results with surgical clipping. I like Spetzler, skillful and innovative, a master surgeon who inspired a whole generation of neurosurgeons. I also like him as he wrote several chapters on “The Neurosurgeon’s Handbook” and also five video chapters on my new endeavor that I will not disclose as yet!

Robert Spetzler concludes the results of the BRAT trial. Has ISAT got it wrong? We do need another trial!

Robert Spetzler concludes the results of the BRAT trial. Has ISAT got it wrong? We do need another trial! Do you notice the tele-prompters?!! Spetzler did not use them but quite a few speakers did!

At the congress there were 3D surgery shows; face-offs debating neurosurgical opposites; “top gun” competition for residents (to see who knows more!); and trade exhibit with recent surgical technologies. Most congresses have (inevitably) repeated elements: delegates who always are looking lost; those who always checking their mobiles; others try to find their buddies to hang out; some are headed for the reps stands; and others photograph every single slide projected on the screen. All in all, the congress was a wonderful experience and being member of the faculty and an invited speaker was tremendous! Next spring the meeting is in Washington, DC.

On Tuesday night I saw a man who did not look like a neurosurgeon! I know, how a neurosurgeon looks like?!! Well, he did not look comfortable in his surroundings for a start. Okay, that dosn’t exclude too many! He was tanned, with a stubble and a bit… rough… Well…he turns out he was an actor! (and brother-in-law of the President of the AANS Bill Couldwell). We started chatting, he played in many movies and TV shows, I knew none! :-) except MacGyver! He knew many actors, mentored by Michael Douglas, and was buddies with Nick Nolte (Nolte is tough!…). I told him my plans to get to LA for a day, so he gave me a few insider’s tips.

I had one more day, Wednesday, time to go to LA. For a couple of days the TV news in San Francisco were going on about an impending…earthquake in LA…nothing I can about it, other than avoid forty (and over…) storey hotels. From San Francisco it’s about an hour flight to LAX. I don’t often rent cars, but time was of essence. Upon arrival I checked on my iPad online offers, turns out all cars from major companies were gone. One left, “Budget”, I had no other choice, so “Budget” it was!… When arrived at the rental site I spoke to Raoul, a cool Spanish American. Well, turns out “Budget” has some very nice cars, so Raoul for an extra $35 pimped my ride… a black Merc, not a shabby old Merc but a smooth new one, still had the smell of the new car! Sweeeet!

Descending to LA. The bunch of skyscrapers is the financial district at downtown LA.

Descending to LA. The bunch of skyscrapers is the financial district at downtown LA.

My hotel was downtown LA. I like LA…spread out, disconnected, a bit rough, but somehow honest, and real, at least in certain parts…It was a hot night… good time for a walk through the nearly deserted financial district and the more posh fashion district. Around midnight you can have the best burritos in LA (veggie for me) at a dodgy Mexican joint at Hill Street and 4th, sitting at a backyard guarded with iron rails, and then have a chat with a bunch of homeless people lying under one of several bridges off Hill Street. Thursday morning early start for hanging out in LA before hitting the beach. Before heading for West Hollywood check out the silver, futuristic Walt Disney Concert Hall on Grand avenue and 1st Street, there are parking spaces but you need coins to park!, so no time to check out the interiors this time…then you can head to Hollywood Boulevard and see the Kodak theatre (where Oscars ceremonies take place) and next to it, the Chinese Theatre. You can walk on the “Walk of Fame” on a few of some 2400 marble stars…you would expect to be a bit more glamorous…parking here was easier, $15 for a day (or in my case, after haggling! $10 for 60 mins). Then driving through Sunset Boulevard time to do the ride I was planning to do since I arrived to LA (and the main reason I rented a car)…

Driving downtown LA...

Driving downtown LA…

then crossing Sunset Boulevard while heading to my ultimate destination...

then crossing Sunset Boulevard while heading to my ultimate destination…

I first saw the dark, bone fide David Lynch’s masterpiece “Mulholland Drive” on a DVD as a junior resident some 12 years ago. The movie starts with a limo’s headlights showing parts of a dark road while the Angelo Badalamenti’s melodically imposing and peacefully powerful score will glue you to the screen (I can’t describe the score in a different way, you have to listen to it to understand what I am talking about…) The movie has many stories, some linked more obviously than others. All stories are dark and difficult to interpret but somehow they draw you more and more into the movie. If you don’t understand what this movie is about, not to worry… nobody else does…but this will not stop you to absorb the atmosphere… pure beauty…some powerful scenes (from those I can describe here…) is the scene of the “cowboy”… how can someone have such an effect and be so potent using the most simple words…and of course the legendary phrase “this is the girl!” Classic!

So yes, time to make the same journey, some 24 miles of bends and turns, on a very narrow, steep, uneven and, at parts, damaged road. Some things you cannot only see on a screen, you have to feel with your body, like being pulled back and to the front, every time you speed up and break, being pulled on the side with each sharp turn, glancing for a second downtown LA, San Fernando Valley and Hollywood before getting your eyes back to the dangerous road. There are no streetlights and I can imagine driving fast on this road on a dark night, like on Lynch’s film. I don’t have a bucket list (can’t tell you why…) but if I did, that would be one in the list to take off: drive on Mulholland Drive! Check!

At the end of long-winded road on Mullholand Drive through Santa Monica mountains, look at the top of the mountain across...can you read the sign?...

At the end of long-winded road on Mullholand Drive through Santa Monica mountains, look at the top of the mountain across…can you read the sign?…

Then time to head to Santa Monica, a beach town with a legendary Pier with carnival games, amusement park and beach sports. Also fabulous fish tacos served at the bar by the beach. Perfect lunch! Santa Monica was a pitch stop only to my way to Malibu. If you love the beach this is the place… Drive along the Pacific Coast Highway having 27 miles of gorgeous natural beauty to your left…listening to some pure rock songs on the radio… like “come a little closer” from “Cage the elephant”… of course you can stop at the Getty Villa, a first century Roman Villa replica that attracts the crowds, but if you are not into touristy things… carry on for the Malibu town, stylish, affluent and laid back…you can almost see Charlie Harper’s imaginary house from “Two and a half men” somewhere there, amongst other houses…but if you want the most stunning beach you have to drive much further, El Matador’s state beach is stunning… rock formations planted on golden sands. Malibus’ best beach! By far!

The drive back was a treat, you can actually park on the road by the beach…in a little while outside LA one of the usual LA traffic jams…if I had a bucket list (again!…), that would be another one…get stuck on a LA traffic jam! Check! Bucket list or no bucket list I didn’t want to miss my plane, that was enough for a day, time to head back to LAX (much less glamorous than you may imagine…I have yet to see a better airport than Heathrow’s Terminal 5). One last night in San Francisco before boarding Friday afternoon for my flight to London. We left Friday around 5 pm San Francisco time, arrived Saturday 11 am London time. Got to my car, started driving, for a second I blocked, which side of the road I am driving, right or left?!!

I am not working for “Trip Advisor” but here are a few tips for when traveling to America. First, to avoid jet lag forget your original time zone from day one. If you feel sleepy daytime, sit it out until its dark. Then sleep. That’s it, you will wake up in the new time zone. Same when you come back. Second, do not use your own phone or payphones. Buy an AT&T pre-paid phone. $15 for the phone plus $20 of international credit will get you 750 mins; for this amount of time you would need more than £1000 if you were to use your own phone (£1.5/min). Third, tip and tip well. This is the local culture, its bizarre not to. America is built on customer services, and they are impeccable! I’ve never seen better customer services anywhere in the world. They will take good care of you and the people who will come after you.

And last (I need to finish this blog, got things to do… :-) but not least! do not attempt to imitate the locals, do not pretend that you are one of them, that you belong there… because you don’t! and that’s okay, contrary to what you see in movies and TV programs, Americans are very open and friendly to visitors, foreigners, even to drifters and outsiders…feel comfortable in your skin and people will accept you…that applies to wherever you go…so what if you are not one of the locals? the locals are hanging there all of their lives, they just happened to be there… you! are the traveller… the curious…the adventurous… you! are the one that will have stories to tell after you leave…and then go to another place and another one…and from one traveler to another, I wish you travel far and always come back, every time, a little bit happier and a little bit wiser…and one day you may reply like “explorer” Walter Mitty, in one of his dreams, to Cheryl Melhof when asked “where’ve you been?”… (with hilarious Spanish accent)…“testing the limits of the human spirit”…!

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My car’s fuel light was on for about an hour…it was yellow by the way, shouldn’t they make it red? It was 9ish on a Friday night. I don’t like activities that waste time, like pumping petrol to a car, going to the grocery store or watching telly. But you have to do them from time to time…Time to get some fuel, not a great idea to break down because you run out of petrol in central London…I pulled over at a BP petrol station in Perivale. You have to walk through a full version of Mark and Spencer food section before you go to the tills…whole chickens, racks of lamp, vegetables and fruits, birthday cakes…all I wanted was to pay for a full tank of petrol.

I always have a little talk to the people behind the tills, they are usually bored to death with the same vocabulary they’ve being asked to use. “Sorry to keep you waiting Sir” “Did you have any petrol today?” “Would you like a big Canterbury chocolate bar for just a pound?”….“How was your day?” said back to the young woman behind the till. It turns out she was stock trading during the day! How about that??!! Stock trading during the day and serving the tills at night. Be careful my friends, some of you might have the fate of your shares in the hands of this lovely but (I think…) not very experienced trader…

“What do you think about Lehmans brothers?” I asked her while the queue behind me started to grow. She didn’t see to mind the queue, so she said “who?”. “The bank who nearly busted the financial system in 2008”… In September 2008, Lehman Brothers, USA’s fourth biggest investment bank filled for bankruptcy, the biggest in the history of US. It was also the first time in history that the Federal Reserve Bank, and in reality the Government, did not support bailout of the investment bank hemorrhaging money. Many other investment banks were on the line, including Merrill Lynch, Goldman Sachs and AIG, actually an insurance company.

The movie went straight to number 1 at the Box Office in UK and USA. I can't remember the last time I went to a movie theatre, I prefer HD downloads. It won;t be long until we can watch movies online the day of their release.

The movie went straight to number 1 in the Box Office in UK and USA. I can’t remember the last time I went to a movie theatre, I prefer HD downloads. It won’t be long until we can watch movies online the day of their release (at least that’s what I am hoping for). The movie I want to see now is “The secret life of Walter Mitty” but it has to wait a bit…

It was all decided during a rainy weekend in New York, 17 to 19 September 2008. The CEO’s of America’s biggest investment banks were at a meeting under the director of Federal Reserve Bank trying to solve the problem with no success…by Sunday night it was all decided, they would let Lehman Brothers sink and drown, hoping that they could contain the crisis. Do you think that movie scripts are more excited? Yes, “The Wolf of Wall Street”, a new Leonardo DiCaprio blockbuster is meant to be good,…but watch instead the real deal, a two-hour Hearing of Dick Fould, the then ruthless ex-CEO of Lehman Brothers testifying to the “Financial Crisis Inquiry Commission” set up by the Government.

No movie can capture the events of that period…youtube some of these names, and watch it, no adds every 15 mins like TV…gripping! no movie script can ever measure up to real life events…thing is that in real life events and dramas…acts of heroism and sacrifice…acts of greed and ruthlessness… lived by everyday people and will never make any viewers to feel touched or lifted…inspired or motivated…appalled and discussed…other than perhaps the very close circle of people involved in it…

Most people have no idea how banks work, how credit is created, how money is created. Politicians are mostly clueless as they all strongly suggest savings, which in reality would shrink the economy, as banks create money by loans and mortgages. Do I care about money? Why would someone love money?…I was raised with the principle that money is not important, helping other people, that’s what matters…and this guides me still…

These were going through my mind as I was driving away from the petrol station…people I helped during the last week…patients who came to see me from the four corners of the earth, Canada, Mauritius, Nigeria, Rome…Patients with brain tumours, spinal tumours…a young man in his twenties paralysed for three weeks from a tumour inside the membranes wrapping the spinal cord…nealry hopeless case…at the end of a five-hour operation after removing the tumour I saw the spinal cord trying to pulsate…was there still hope? Two days later he was walking unassisted!…how’s that for a bonus my banker friends?!

Holidays have gone but London’s Oxford Street still got the Christmas lights up, everything that can help shops sell more and people buy…how do you feel when you buy something new and shiny?…and for how long?…an hour? a day? a week?…a couple of weeks earlier there was Sales panic in the streets…outside London many shops had even velvet ropes to create orderly queues outside the shops and security guards at the doors to allow shoppers inside like there was  some exclusive venue… What I found even more extraordinary was that people were actually queuing patiently to get to the shops…I despise queues, I wouldn’t queue for anything in the world! I find incomprehensible that people would queue for an hour to get into a restaurant or a bar…how little do they think of themselves to do that…

People queuing to get to a SuperDry store. What the world has come too?!

People queuing to get to a Superdry store. What the world has come too?!

The only queue I would tolerate for a few minutes is at a coffee shop while waiting to pay for a sandwich…and I usually strike a small talk to the person in front or behind me in the queue…life’s too short to waste it with standing still…unless of course you are doing it to look inside you, quietly, and peacefully…most people when standing, at a queue or while waiting for the lift, or sitting on a train, they are focused on their smart phones, checking their connections? reading text messages? sending emails?…if you notice most of them they are actually playing games, bursting balloons or align coloured squares…pushing simple buttons for stupid rewards… have you seen monkeys in a lab pushing buttons to get bananas?…same thing!

Last Saturday was the Name day of Gregorios, the Orthodox Archbishop of Great Britain. He kindly invited me to the celebrations in Craven Hill and to the celebratory but elegantly simple dinner table with other distinguished guests, ambassadors, benefactors and the Nuncio (Pope’s ambassador) to the Great Britain Antonio Mennini. On the ground floor there is a beautiful small church with hand-painted icons and wall art, small windows allowing sharp beams of light to get in, and peaceful colour combinations. Antonio Mennini told me that archbishop Gregorios has been like a father to him… archbishop Gregorios has served the Orthodox communities of Great Britain for five decades now and still remains energetic, wise, humble and a great new friend.

Archbishop Gregorios on a peaceful evening in the small church of Cavern Hill

Archbishop Gregorios on a peaceful evening at the small church of Cavern Hill

I know its been a while since I wrote my last blog…and I will let you into a little secret, I was thinking to stop my blog…so many things are happening, I could write a blog a day…but when? and most importantly why?…but looking at the statistics, the number of readers remain rock steady, every single day, from all over the world, no matter if the last blog was four months ago, people looove this blog…so I won’t let you down, I won’t stop, until not for now, I promise…I know that there is nothing similar anywhere in the world, an open journal, I know, partially! but still open!

The postcard I received Thursday night.

The postcard I received Thursday night.

Thursday night I received a post card from a patient who had a difficult but successful brain operation. I won’t tell you all there was in the card, but two sentences read ” Words and gifts could never be truly enough to tell you just how thankful I am for my family and I, and the fact that we found you to be my Neurosurgeon”… “Liked the quote in this card, I feel it sums up what it truly is to be in many ways “radical” as you indeed are”.

The same evening we went with a few medical students and my team for a drink at Perseverance, an old pub at Lamb’s Conduit Street, close to Queen Square. They wanted to take me out on a dinner, how adorable!, but life’s short, so drinks it was. People who come to spend some time with me, students, residents, qualified neurosurgeons, from all over the world, always tell me before they leave, how much it meant to them that they have met me…I know it sounds kind of strong, but I have heard it so many times, it has become normal, so no!, I am not bragging, that would be weak…just quoting a fact. When these doctors leave to go to their countries, sometimes I feel that parts of me go with them, our lives as human beings are linked…and some parts of them stay with me…the miracle of genuine human relationships!

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