Like most of my collegues, I am normally on call once a week. That week, somehow I managed to be on call 3 weekdays in a raw; Tuesday, Wednesday and Thursday. Not easy taking all referrals for 3 days straight, in addition to my all fixed commitments.
Tuesday morning started with the neuro-oncology multidisciplinary meeting. Around eight o’clock we sit at a nearly dark seminar room while images of brain scans and colourful histology slides are flashing on two large screens. Participants are specialists from different disciplines: surgeons, radiation oncologists, neuro-oncologists, neuroradiologists, palliative care consultants, physiotherapists and specialist nurses, all in all about forty people putting together all the skills, knowledge and experiences to decide how to best manage each individual patient. Does the patient needs surgery,
radiotherapy and what type, chemotherapy and what type, more surgery? We go
through twenty-twenty five cases each Tuesday, that is we decide for twenty-twenty
five lives, someone’s wife or husband, someone’s son or daughter, someone’s
father or mother. Each patient’s life touches in turn so many other lives,
family and close friends, you can almost see the strong ripples of each decision
spreading in all directions in the previous quite waters of someone’s life.
After the meeting it was time for my ward round, I took my trainees and my medical students and spent time with each patient in the ward, see how they progress, discuss the results of tests, make them feel they are not alone in their journey. Then time to
see trainees and visitors in my office: residents who need advice how to handle
a specific problem, superkeen medical students who tell me their life would
have no meaning unless they become neurosurgeons :-) reps who want to present
new devices and instruments… Then it was time to talk to the fifth year medical
students at the historic Wolfson lecture theatre on my introductory topic: “Neurosurgery
Early afternoon I had a visitor from John Hopkins, Professor Alfredo Quiñones-Hinojosa, a neurosurgeon who directs the clinical and research services of brain tumour unit. His life story is extraordinary, from illegal Mexican immigrant to top-of-his-class Harvard graduate and then Professor at John Hopkins (photo). His life story appears often in American media, have a look at a clip from the popular American show “Today” (http://www.youtube.com/watch?v=mU-gTNZ6g8E). What an inspiring story! I showed Alfredo around Queen Square, the old building where some of the world’s first ever brain operations were performed, and the new wings where the tradition continues.
We then headed to Ciao Bella, an Italian restaurant in Old Conduit Street for (very late!) lunch. Alfredo is such a pleasant and warm person, it’s like we’ve been friends for years! We chated about this and the other, plans of collaborations, training and books, time flew. Then back to Queen Square to talk to my patients who would be operated on
Wednesday morning I had a challenge, a man with a strange lesion at the top part of his brainstem, the clockwork of the brain. He’s been suffering for a year and a half, getting worse by the day. Other hospitals have turned him down. My aim was to establish diagnosis by taking a tiny sample from an area less than a cubic millimetre buried at the depths of the brain called the superior collicullus. Any mistake could cost this man’s life. To add to the challenge the patient should be during the operation in what we call the “sitting position”, literally sitting than lying flat on the operating table, a
nightmare for all anaesthetists as air can be easily sucked in the deep veins
of the brain and travel instantly to the heart blocking the constant pumping
action of the heart, what is called air-embolism. Air embolism can cause instant
death. I feel so fortunate that my anaesthetists are so experienced and cool,
have seen it all and know what to do, how and when. The journey to the centre
of the brain was well planned and the anatomy on the way to the tumour was stunning:
critical nerves, crucial arteries, brain structures neatly packed and individually wrapped with multiple layers of thin membranes. After a two-hour dissection under the maximum magnification of the operating microscope the superior collicullus finally appeared like a small hill in a tropical jungle. I dissected a minute specimen and sent it off. I thanked my team and carried on with the rest of the list.
Thursday was all day outpatients clinic, post-surgery follow ups and new referrals, looking at scans, talking to patients, taking “thank you cards”, shaking their hands. I am always surprised by how easy patients who met you for the first time ten minutes ago decide pretty much instantly, there and then, to have major and complex surgery, whether they goggled you earlier or not! Patients don’t read your CV, do not go to conferences, do not read your articles, but they have their own way of telling. As a surgeon it is your duty
to develop skills to connect with them, as it is you duty to develop skills to
take decisions or navigate around the brain.
Midday was time for a quick break, I like to go to Paul in high Holborn, five-minutes walk from Queen Square. I like the vegetarian quiche, with goat’s cheese and aubergines, warmed up, and stone-baked pie with caramelised apples. Paul is a French bakery (http://www.paul-uk.com) and although a chain store has style and character. I think I like to go there because it reminds me the time I was buying baguettes from Paul in Paris three years ago. You can find Paul nearly everywhere in Paris, main streets and small streets, train stations and tube stations, each slightly different, and somehow unique. With
the goodies in a paper box, I walk through the borders of the financial district,
“the city”, men and women with suits walking briskly, Alan Sugar and Donald
Trump wannabes, and heading back to the clinic. When the clinic came to an end
sometime after five, it was time to lecture our trainees, show them operative
videos while they were munching Domino pizzas, we do spoil them :-)
Friday morning was time for another ward round to see new
admissions. Of course I didn’t tell you about all the referrals the residents
were taking for the last three days, head injuries, strokes and blood clots in
the brain, tumours, spinal problems, all imaginable pathologies. Some of them had to be operated on in the middle of the night, some were scheduled for a day list. I had to go
around to talk to them and to their families, explaining the facts, honestly
but gently, they already have been through a lot. Time spent talking to
patients and relatives is time well spent. What trainees sometime have
difficulty to grasp is that time spent talking to patients is as important as
time spent in the operating theatre.
Then I went down to audio-visual department in the basement of the hospital for my latest project: to put voice over a surgical video I was working on for the last month, where I recorded the critical parts of a difficult operation. I put my headphones on and started talking to a microphone imagining that I talking to a junior surgeon, what to do and what to avoid in that particular difficult operation. This is part of a supercool project with the contribution of “who’s who” in international neurosurgery. Experienced surgeons will explain all their tips and tricks, “how they do it”. Nothing to keep for themselves,
everything to share! My recording would serve as a sample for them to follow my
idea and help thousands of trainees in all corners of the earth. Then back to
my office to sort out my correspondence, dictate replies, review reports, sign
letters, reply to emails.
It was just after two, I was on call for more than eighty hours. Seven residents rotated during that time but not me. It was fun but I could see sunshine through my window, time to go. The sky was blue, people were sitting on the grass at the Square, I decided to walk, Holborn, Covent Garden, Leicester Square. It was warm, business people had loosen up their ties, tourists wearing shorts and T-shirts, schoolchildren were eating ice-creams, people form offices had their break in the parks. My eye caught a big poster on top of Vue cinema in Leicester Square (photo). “Limitless”, Bradley Cooper, Robert De Niro. I approached and read the plot at the board: an average blocked writer Eddie Morra (Cooper) is handed an “experimental” pill that allows him to tap to the full potential of his brain, write books, learn new languages, appreciate art and take Wall Street by storm. The pill however, has lethal side effects, and Eddie who’s running out of pills (!) is chased by professional killers in New York. Until five I had two hours to myself, what to do? enjoy sunshine, go to a museum or watch a story? I love stories (to watch, to listen to and to tell!), was easy decision!
Here’s your homework until my next blog, go and see Limitless, I will not say now what I think of it, but it’s a sleek urban thriller, so you won’t waste your evening.
Limitelss got me thinking about the potential of the human brain, the lives
we live (as a complete routine or with various levels of awareness), better or worse versions of ourselves and even scenarios in parallel universes. But you have to wait
until my next blog!