Full moon


Last Sunday I made a discovery! Big discovery! At Gatwick airport. After queuing for forty minutes in front of EasyJet I discovered that when you have a hand luggage and printed pass you don’t need to queue. Apparently they don’t eyeball, weight or interview your luggage. They don’t even ask you if you packed yourself or you had an al-Qaeda member pack it for you. There you go fellow EasyJet passengers, I saved you at least half an hour
(Don’t try this on the inbound flight, doesn’t work).

What I was doing at Gatwick? I was off to Montpellier for a couple of days, invited by Professor Hughes Daffau. I met Hughes in June in Athens where he showed us some very aggressive tumour resections and claimed no post-operative deficits. I couldn’t resist my natural curiosity I had to see this. Hughes was kind enough to invite me.

Montpellier is a small city, several miles from the sea.  The first thing you notice at the airport, like all French airports, are heavily armed soldiers and policemen; news kiosks with graphic novels; Algerian and Moroccan taxi drivers who drive like maniacs; and
Galleries Lafayette, a French type of John Lewis in every French city.  The city’s centre is small, you can walk from one end to the other in twenty minutes; ice cream shops, cafes, an outdoor evening club in a central residential street with music to the max, if you get
lost in the small streets, just follow the noise (ehrr, .. the music) and you are back in the centre.

Sunday evening in Montpellier. I thoroughly recommend the kebab shop on the left.

I watched a couple of Hughes’ operations, two awake craniotomies on patients with low grade gliomas, that is brain tumours that  grow very slowly, over years but eventually
become malignant and patients deteriorate quickly. There is a difference of opinions, whether radical surgery affects the outcome and prolongs survival. Myself, like Hughes, believe that early radical surgery helps patients and can change the natural history. Both cases were re-dos, cases which have been previously operated on in different hospitals and patients were told that more radical resection was impossible.

Hughes technique is simple, as a matter of fact simpler than other surgeons. He does not use microscope or neuronavigation. He uses a simple ultrasound probe before he begins. The patients are awake for the major part of the operation. This is standard in most hospitals. The brain itself has no pain  nerve endings, can feel no pain. I am always surprised how patients not only are not terrified with the idea of awake craniotomy but sometimes ask for it, even when it’s not necessary. During the operation Hughes uses a standard bipolar stimulation to temporarily paralyse a part of the brain checking if
subsequently removing this part will affect the patient’s movements or speech.
This is the way we do it at Queen Square and this is how it’s done in most
parts of the world. Hughes is well known in this field. Have I seen anything
different or new? Not really. What’s new is his determination to prove that
radical surgery can change the natural history of these tumours. Couldn’t agree
more!  I thanked him for his hospitality and invited him to Queen Square when he’s in London. In the two evenings I had the chance for a swim in the rooftop pool of my hotel, top up my summer suntan, do a bit of running, and of course stroll the very hot streets eating ice creams from the local braserrie.

I spent all Wednesday in the operating theatre (such a relief to be back to my Hospital!). Thursday is an outpatients’ clinics day. One patient after the other, reporting on their progress, asking questions, handing “Thank you” cards. Midmorning one man in his early eighties, entered my office, tall, skinny, high cheek bones, full head of white hair, pressed suit, cream overcoat. He looked like a retired professor. This man had the most polished Cockney accent I ever heard. His speech was smooth, even, descent, and colourful. Every
now and gain he interjected “and thank you for listening, sir” or “I am so grateful for your time, sir” and continued to speak. It was like he escaped from some movie set and was giving a personal performance for me in my clinic. I asked him, no, he was not a retired professor, before he retired he was working as a labourer in water tanks (whatever that is). I told him “I asked you because you have lovely manners”.  His eyes started to water. What a lovely man. You see so many different personalities in the clinics. Not long ago I saw in the same clinic a professor of Philosophy in the University of London followed by a street cleaner. Different facades, different ways of thinking, different ways of expressing themselves, but of course similar feelings as vulnerable patients and identical value as human beings.

In order to go to Montpellier 21-22 August I had to swap my weekend with a colleague without realising I was swapping for the bank holiday weekend (26-28 August) plus my previously allocated on call for Monday (again Bank holiday!) I managed to land four consecutive (bank-holiday) days on-call! Nice work genius! The on call was busy, starting from Friday (mega busy) and cooling down towards Monday.

Monday Bank Holiday around five I headed to the hospital to see what’s going on. I took the tube from Marble Arch heading to Holborn. The central line was coming from Notting Hill, (carnival day!) so the train was jam packed with the usual crowd of tourists, shoppers, and drifters. In my carriage there was a group of five young people, three girls, two boys, early twenties, full of carnival spirit (and quite a bit of alcohol). There were signing (veeeryyyy loudly, clapping their hands, having good time). Always nice to see happy people around. But then they started shouting more and more with a few swear words every now and again. I suddenly started feeling annoyed. I looked around. Tourists and shoppers were completely indifferent. They either didn’t care (unlikely, unless they were completely deaf) or they were “playing dead” a very primitive and effective defence mechanism started in the African terrain ten million years ago and still thriving in modern cities. You can spot the “playing dead” mechanism hundred times a day.

I thought, have I suddenly become like one of these grumpy people who are annoyed with anything? I looked down to my clothes. I was wearing a stone-washed, a (bit shredded) pair of jeans, cool T-shirt, boots. No, I was not some conservative corporate drone annoyed with a few free-spirited drunken people. Two of them started screaming with all the air in their lungs in a very crowed carriage where we were all standing one next to each other! My ears were hurting. I knew I was getting off in two stops. I knew they were drunk
and could not have any sort of reasonable conversation. But I didn’t like that
and it was matter of (my) principle to say something.  I tapped one of the guys in the shoulder and said “can you stop shouting in my ear!” They all stopped and started mumbling. I turned around. The guy came back and tried to shout in my ear. I turned back to him “why did you shout in my ear?” He stepped backwards, he knew he was in trouble. He said “if you don’t like that you shouldn’t take the tube”. “It’s the other way round”, I said. “If you want to shout, you! shouldn’t take the tube”. The girls of the group like world class diplomats calmed things down in seconds. They said melodically “we are so sorry” and started patting me and asking me where am I from… When I said I am Greek they started throwing Greek words, they were funny. The other guy with a fashionable hat said they just had a lot to drink. I said to one girl pointing at him “he’s a good guy after all”.
“This is such a lie!”, she said laughing. Believe it or not within 7-8 mins until I got off, we were chatting like a group of friends. Before I got off they gave me hugs and kisses. I am sure that the rest of passengers were wondering “what just happened?” To be honest this is pretty much what I was thinking too!

So, this is what I make of it:

1)     People are good. Inherently good. I am not talking about a group of misbehaving
drunk young people (thinking of it now, it was rather funny and sort of cute). I am talking about people with deliberately unpleasant behaviour. These people are not bad, they are only angry with themselves and transfer this anger outwards.  Here’s my advice: don’t lock horns with these people and more importantly don’t try to reason them and don’t try to fix them. Avoid them. And spend time with people who are happy with themselves.

2)     Your subconscious determines your reactions.  How you reacted on the last similar occasion went straight to your subconscious and will determine how you will react on the next similar occasion. If you said last time that you were annoyed “well, it doesn’t matter” chances are you will say “it doesn’t matter” next time as well. If you are really not bothered it’s fine. But be careful! if you are bothered and you say “it doesn’t matter” you say to yourself (and to your subconscious) “how I feel and what I want is not really important”.  There is nothing worse for your self-esteem. Confidence has absolutely nothing to do with other people. It’s a matter only between you and your quite perception of self-worth.

3)     If you don’t like something, say it! Don’t hesitate to express yourself. Not with
confrontation but politely, sometimes with a smile but firmly, with the right social skills. Say it to the person directly, face to face, no need to ask for the supervisor/manager/other authority figure, that belittles people and is childish (stemming from “I’ll tell your parents”). It doesn’t matter if it’s something small or big, chances are if you stay quite in something small you’ll be quite in something big. Behaviour is based on patterns not on quantities. Once you establish a pattern, quantity is irrelevant.

4)     If you like something also say it! That’s even better! Speak out your (kind) mind. Say well done to a colleague for a nice piece of work, complement a stranger for a stylish briefcase, write a good online review for a book/movie/product you bought from amazon, say what a good service you received when you check out from a hotel, they will love it!

When an urgent decision is needed, no, the brain does not think analytically and weights risks and benefits, the subconscious takes over and decides instantly based on thousands decisions and actions, small or big, taken in the past, what consists a person’s personality.

St Katharines docks in the evening (photo borrowed).

But enough with all that! It’s a full moon in the capital tonight and the last night of the proms. If you go to the Royal Albert Hall for the (cultural) party of the year (with soprano Bullock and pianist (mega talent) Lang among others) (http://www.bbc.co.uk/proms/whats-on/2011/september-10/85)
enjoy the full moon over the capital. The sky is clear, so head east to St Katharine docks, (one of London’s best kept secrets), (http://www.skdocks.co.uk/) have a drink in
the marina, glimpse at the moonlight on Thames, let the tranquil light wash over you. And if you bump into a group of five youngsters, shouting drunk and spoiling the moment, give them some slack, I made friends with them!

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