Berlin’s sky

I arrived in Berlin late night. The airport was small, one of the smallest I’ve seen, let alone for an airport of a capital. I took a taxi and headed to east Berlin where my hotel was. Berlin was wet, dark and almost deserted. I was there to take part in a hydrocephalus conference, that is to exchange ideas on a problem affecting patients of all ages; the cerebrospinal fluid, a specialised type of brain water that bathes the brain and the spinal cord either becomes trapped or produced in excessive quantities. The brain is housed within a rigid skull, so the pressure inside the skull raises at very high levels and patients become unwell, insidiously or sometimes very acutely. To divert the trapped fluid should have been a very simple biomechanical problem, some clever plumbing, but at least until the 1950s hydrocephalus was a fatal disease. Even today we have far too many problems to solve around hydrocephalus. The ideal shunt and valve system is yet to be designed.

Next morning things were a bit better in Berlin. The sky started turning into blue, more people in the streets. I made some new friends, surgeons from other parts of the world; an indian neurosurgeon working in Chicago, a balding American from San Diego, a senior southern from Carolina (yes, with the accent and everything), colleagues from Japan and China, and of course the german hosts. All german neurosurgeons have pretty much the same mentality, same English accent and same dress code. Later during that day I met Christoph Miethke, an extraordinary German engineer (photo) who designed a pretty good shunt valve and builded a company from scratch selling 20,000 valves a year around the world. He constantly strives to improve his valves. We visited his valve factory, in a small village in East Germany. People were assembling the valve parts by hand, wearing sterile white outfits, using small forceps like swiss watchmakers (photo).

Christoph Miethke on a hands on workshop showing how physics of shunts works

A technician's putting together parts of a shunt with great patience. Many of them were working as watchmakers.

Philadelphia feeling the music.

In the night they put a show for us. Fabulous dinner while Philadelphia, a new blues/jazz singer who just released her CD was singing with passion and soul on stage (photo).

Christoph Miethke on his Ducati in front of red lights.

Next day while getting into the hotel I saw a man in his Dugati stopped in the traffic light to wave at me. Hmmm, who’s on earth is that? He lifted the visor from his helmet, it was Christoph Miethke, the president of a multimillion company on a motorbike. Awesome.

Goldelse in my Lumix

The schedule was pretty tight, there was free time only between coffee breaks. On Monday during the lunch break I hoped on to a taxi and off for the Brandenburg gate. We coudn’t get close, Turkey’s Prime Minister was visiting Berlin (damn!) and they had closed the streets. I had to walk quite a bit. I could not see the wall. I asked. They told me that it was a few miles away from the gate. How come I always thought that the gate was part of the wall? I took another taxi. First off to see Goldelse (or Golden Else), a fabulous golden sculpture standing on the victory column (photo). I had to see this. I had to see where the angel was sitting at the opening scene of Wim Wenders “Wings of Desire”, an old black and white poetic film (photo). The German title is “The sky above Berlin”.

Goldelse in Wim Wenders camera. An angel rests on her shoulder, in the movie's opening scene.

In the movie, angles live in Berlin. Every man has an angel. They wear dark overcoats, short ponytails, are calm and content. They put their ear at a person’s back and can hear their thoughts. In an amazing scene in Berlin’s library you can see hundreds of people studying and you see hundreds of angles listening to whispers of thoughts. Same elsewhere in Berlin, in houses, cafes, the underground. The camera flies and swirls and changes with speed levels and orientation, like you see with the eyes of a flying angel. In the underground, at the end of the day, you see tired people, blanc faces, someone thinking: “Why I am doing this boring job and have such a miserable life, I had so many dreams, I wanted to do so many things and looked at me know, I achieved nothing”. Then his angel goes next to him, touches his shoulder, and the man now’s thinking “well, I still have time, perhaps it’s not too late, I’ll try again” and a smile comes to his face. In the heart of the movie, a love story, an angel who falls for a circus ballerina with long, blond, cairly hair. To be with her he has to become man, be angel no more. At the end of the movie Wenders speculates that many of the great people around us where once angels who fell from the sky. I like that!

While talking photos the taxi driver, a nice Iranian chap who spent the last twenty years on his life in Berlin, was waiting with the engine on. I was looking at the time, had one hour to do all I had to do. Next off to the wall. The remains of the wall, rather. Pretty thin, grey, couple of meters high. The remains, even now, were such an ugly thing. I mean structurally, let alone as concept. The concept to divide people, people with the same language, living in the same city, close relatives, was so evil. Which sinister mind came up with this idea? Some of my uncles who were living in Germany at the time told me a story about a man in the east side who said “we want to see beyond that wall!”, that was the last time this man was ever seen. Miethke in his presentation showed us bits of history. “One day every wall will fall”, was in one of the slides. People were trying to escape through electric fences risking their lives were in one of his slides. I suppose being free is more important than being alive. Back to the hotel where the rest of delegates were munching desert before the start of the afternoon session. I made it!, Bradenburg gate, Goldelse and wall in under an hour.

Remains of Berlin's ugly wall. "One day every wall will fall"

Back to Heathrow Tuesday night, Heathrow express, Paddington, tube to Russel Square. It was about 10 in the night but i had to see my patients before having their operations the next day. Of course I see them in the clinic and go through the operations in detail. But the night before the operation is important, I have to see them again, promise that I will take good care of them. I woke up a few but they were happy to see me. An operation is a normal event in a surgeon’s day, but for a patient is a once in a lifetime event.

You know how when something dramatic happens you remember where were you when you heard the news? I was in intensive care unit in the morning to look at some scans and my junior doctor and I were talking about the new MacBook air when he said, “now that Steve Jobs died they will not improve it further any time soon”. “what? what did you say”? couldn’t believe it. Steve Jobs gone. One of the greatest minds in history, a genius who did not stay in the lab but he did change the world not with us any more. I still remember I was at school when I listened to a documentary about computers. Jobs was talking to his team, trying to speed up the processor by a few seconds. “Its not just a few seconds, imagine millions of people, we are working to save years from these people lives”. What a cool dude, I thought. (He was the same Jobs many years later when he was driving crazy his engineers to produce the iPhone with one button only). I later was reading his interview in Wired magazine as a medical student (my mega cool Wired magazine! US edition). When they asked him what technological device do you admire most, he did not say some supercomputer or fancy gadget; he said “a Bosche washing machine”.

Jobs was not someone who made a few cool gadgets. Jobs, like any other genius did think differently. One of these people who do not follow the norm, who come up with a new whole way of thinking, who don’t quite care if others will accept them. “Avoid the trap of thinking that there is something to lose. We are already naked” Jobs said in Stanford, 2005, in a speech which is now an all time classic ( Do you think that’s easy to think and be different? When we were living in the African terrain social acceptance was a life saver. If the herd rejected you, you had to be thrown out alone in the jungle where you would be eaten by wild animals. No, then you could not be different. This has been hardwired in our brains. The super vast majority of people seeks acceptance by the peers and society, loves approval, every now and again check that they are normal. But not all. Some are different, misfits, “the round pegs in square holes”. Jobs was one of them. Watch this video on youtube, you’ll se what I am talking about. (

iSad people were tweeting that day. iSad too. But also iHappy. Thanks to Jobs the world is a different place. Better. More beautiful. More brave. Someone tweeted “On Wednesday heaven got an upgrade”. iAgree!

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