Visit from the spirit of Christmas gone

The meeting was at one pm. I had left half an hour aside to prepare the material, colour printouts, sample chapters, load the videos, make sure they can play on the projector. I was meeting with the executive editors of a major publishing house coming all the way from Stuttgart to discuss my new book/video proposal, an original idea that will change for ever the way neurosurgeons learn how to perform neurosurgical operations. The publishers were the most prestigious in Neurosurgery and suitable for my new project. You can always propose a book online, send paper drafts, talk on the phone… but nothing can replace an eye to eye, where, in business all major decisions are made.

When two or more people meet in person the brain scans billions of bytes of information, the shadow of an expression, the warmth of the eyes, a hint of a concern. From the billions of information bytes reaching our sensory systems, a group of cells living in our brainstems and collectively called Reticular Activating System (or RAS) filters all this information and allows only a few percent to reach our awareness. For example, stop reading this blog for a second and notice all sounds around you, traffic noise, chatter from next door, TV in the background, whatever. How come you didn’t notice these sounds before I pointed out to you? Your RAS blocked all this information so you can focus on reading.

So yes, the meeting was important. We had organised it two months ago. I had 30 minutes to prepare. Not too much time, just enough. What could possibly go wrong? I switched on my desktop. The login screen was upside down! Hmmm. Never seen that before. Tried to move the mouse. The cursor was moving on a mirror environment, ie up and left instead of down and right. Never seen that before either. Hmmm. Five minutes gone, twenty five minutes left. Time to switch the machine on and off. “It will be fine” was my immediate thought. The screen lit up again. Same. Hmmm. I normally love computer hiccups, this is when you really learn (similarly to neurosurgery!) how things work but with twenty minutes left, this was no the time to fiddle. I grabbed my two terabyte external drive and off to my secretary’s PC.

Fifteen minutes left. I’ve sent all the documents to printer, grabbed some glossy paper folders, and load the videos to the projector. No sound was coming out. Hmmm. The voice description of the operation was crucial part of the project, we do need sound on the the demo videos. After fiddling for two minutes, sounds came back to life. At that point my registrar enters with a bunch of notes and papers, cases to discuss, arrange dates for operations. Okay, I can squeeze in a few minutes. Then time to put the documents into the folders, close the PC files of the meeting room so it all looks unrehearsed :-) and back to my office. Five minutes left! Pheww! At that point me secretary enters: “your visitors from Germany have just arrived!”. Good, I was starting to get bored :-)

The meeting lasted two hours. A lot to discuss. The big picture and the small print. There are dozens and dozens books on operative techniques in neurosurgery, how can you pitch yet another project? Here’s the bottom line: you can never convince anybody for any idea of yours if you haven’t convinced first yourself! People will believe in your project (and yourself!) only if you believe in your project (and yourself!). No exception to this rule! Yes, my (just over five thousand) precious blog readers, you are the first to know that we did agree on the new project. We will change for ever the way neurosurgery is taught!

At the same time, seven floors down, at the main lecture theatre at 33 Queen Square a series of lectures was taking place. The theme was “Infections in Neurosurgery”. We had invited seven specialist speakers, who ‘ve been studying a small subtype of infections for a good part of their lives and they came to share and condense all they learned over years and years into a thirty minutes lecture. In the audience there were neurosurgical trainees, future neurosurgeons from all London hospitals. The only way we can advance our understanding of a disease (or anything else for that matter) is to share and learn from each other. For example, I took myself two courses on molecular biology at Boston’s MIT that week. The speaker was Robert Weinberg, a top cancer scientist. No, I did not have to go to Boston (although I have a soft spot for the most … european city in America), I watched it all in my London office, as ones and zeros of the binary code travelled three thousand and four hundred miles through copper wires and transformed into a passionate speaker.

Here’s a fact: a single human brain is designed to hold all (I mean all!) available information on planet earth. However, abundance of information has little survival value, so the evolution of human brain has moved away from “storing information” and moved towards “understanding” which has tremendous survival value. Now that information is so easily stored and accessed lets say, with a voice search of the internet, I would easily predict that human memory will regress ever further over the few next thousand years. That’s okay provided that new neural networks will power understanding, imagination and creativity. Professor Einstein said it well: Imagination is more important than knowledge (photo). Einstein reinvented the way we perceive the physical world not by doing experiments inside a laboratory but thinking in his office!

Every fabulous technological, cultural or societal wonder in our lives was once a crazy idea in one person's mind only!


Next day I visited the UCL Cancer Institute at Huntley street after my multidisciplinary neuro-oncology clinic at Rosenheim Building in Grafton Way. I was meeting with two top-notch scientists to discuss a new research project: how to unlock secrets held in the DNA of patients with Glioblastoma (the most aggressive and horrible tumour that can affect the human brain) who for reasons we don’t quite understand survive much longer that expected. The theme is the same: how to share our perspectives and understanding from basic science and clinical perspectives to get the bigger picture.

The following morning around ten o’clock I was catching up with letters and emails. Among them the usuall requests from medical students and junior doctors from UK, Europe, Australia asking to come and spend time with my team. I know how they feel, I’ve been in their shoes. While finishing a reply my secretary came in and hand-delivered a Christmas card: “A patient in a wheelchair just brought this”. I went out to the corridor. I instantly recognized a woman in her fifties on a wheelchair, with her husband waiting for the lift. How could I forget? I operated on this woman three months ago. She had a tumour in the spinal cord, the bunch of nerves that leave the brain to go and supply with nerves (and life!) the arms and legs. The operation could not have gone any better. I removed all the tumour without damaging any of the delicate nerves in less than two hours. When she woke up she was completely normal. “I am sooo good! thought quietly to myself”. If you think am an arrogant bastard :-) its okay  I am only trying to make a point, so keep reading!

When they asked Yasargil, a great neurosurgeon of the twentieth century which operation he enjoys more he said “none!”. “The only time I am happy is when I wait for my patients to wake up so I can see that I have not damaged them”. I often remember that when I go around to see my patients after they wake up. So I felt great when she woke up completely intact neurologically. Next day I was at the airport getting ready to take off when I got a phone call from the on call team that my patient had developed during the evening, twenty four hours after her operation, progressive weakness, her legs started becoming weaker and weaker. An MRI scan showed that she had developed a haematoma, a blood clot at the operative site compressing the spinal cord. Neurosurgical pathologies can do that, can turn around and bite you when least expected, so you can never relax in your triumphs, and you never forget what ferocious enemies they are! The on-call team operated on the patient on the early hours of the morning and removed the blood clot but my patient was still paralyzed. I was (very!) angry that they did not inform me when this happened! They did not want to disturb me in the middle of the night and preferred to discuss this with the on call consultant.

When I returned from a two-day trip to Berlin I went straight to hospital to see her. She was completely paralyzed! But with a smile on her face and faith in her heart that she will get better. A week later we saw a flicker in her right big toe. Two weeks later she could feel hot and cold in her right leg. Four weeks later she could just bent her knee a tiny bit. No other movement. “I will walk out of here” she told me with a big smile. Her progress was very slow, but she had such a faith! She went for intensive rehab in the fifth floor of the hospital, where I visited her a couple of times, with minimal improvement. All this flashed through my mind when my secretary gave me her Christmas card. I caught her outside the lift with her husband. We chatted a bit. Then she exclaimed: “look!” and got out of the wheelchair (!) standing on her own feet unassisted! They couldn’t thank me enough! And I couldn’t be happier! What a perfect Christmas present from a patient to their doctor!

I placed their Christmas card on a white board in my sixth floor office along with all other “thank you” cards I get from my patients (photo). My visitors often ask me why do I keep all these crowded cards plastered one on top of the other on my office wall? I suppose because I want to be surrounded with all good thoughts, all positive energy, all heartfelt wishes. Before every difficult operation I glance at them, I like to think this case will also be another “thank you” card and all the genuine good wishes that comes with it, like a simple paper trophy on my wall, a humble trophy, not for display on a glass case, just pasted with a bit of adhesive tape, no matter If I earned it after long and tough battles.

Part of my office wall is covered with an exquisite wallpaper that money cannot buy!

Holiday cards are not bad either! I might send you one :-) from a super short break coming up end of January. Here”s a hint: involves a breathtaking valley of sixteen villages, the white summit of Mont Blanc where your eye catches mountains spread over three countries, and lots of fun in the snow!

And here’s a message for the on call team that day: If you want to call me about a patient, please call me early!, don’t wait until I am buckling up on the airplane seat!

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