On the road

I was driving from Manchester the other day. Outside Birmingham I took the M6 toll. For years now there are road works in Birmingham. Average speed cameras, slow people driving slow in the fast lane, congestion and gridlocks. So, M6 toll it was! Four lanes with gentle curves so you can feel the grip of the tires on the road and speed like a normal competent driver (as long as you don’t spot a plain police car with a blue light on the dashboard in your tail you are OK!).

I remember when I first came to the UK, some twelve years ago, I was driving on M1, heading from London to Newcastle where I had to give a presentation to a conference. There were no speed limit signs on M1 so I naturally assumed there was no speed limit. I could not understand why drivers on the fast lane where instantly changing lanes on the sight of my car on their rear view mirror and were making space for me. The speed I was driving shall not be named(!) but I was not aware of a speed limit. And it was such a great fun! I had quite a few months of blissful driving until while I was talking to a friend said “its great that there is no speed limit on motorways”.  “…Hmm, actually there is…” was the reply! Damn! :-)

That’s what I was thinking while driving back from Manchester and speeding just a little bit (!) somewhere in Midlands. After an hour and a half, just after Warwick I stopped at the motorway services. I like motorway services. One day I will publish a book with snapshots of motorway services and people who make pit stops, from different motorways of the world. I don’t drink coffee (or tea) so Starbucks, the logical pit stop, was not tempting. I walked in WH Smith and had a look around. The bestselling books were in numbered positions in the bookshelf. A yellow covered book got my attention.

“Stop talking, start doing” was the title. I took a copy from the shelve, flicked through the pages and scanned the contents. In the first pages there was a Picasso quote “only leave for tomorrow what you are willing to die having left undone”. I liked that. The rest of the book was full of cliches, worn out slogans, boring photos. The type of the book someone can write over a weekend. I scanned the book’s barcode with my iPhone and got me straight to Amazon’s website. Four and a half stars by more than fifty customers! Whoa. How’s that even possible? Do all these people have just bad taste? Not quite. I’ll explain.

We all know very well what we want and what we should do to get it! How many people go for it? About 99% of people do not even try. Its so much easier living in the cloud of the past and the fog of the future. Do this for me, think about what you thought during this day. Chances are more than 99% of your thoughts were snapshots from the immediate or remote past and vague plans for the immediate or remote future. The thing is, all we have is this very moment. Take a breath, feel the fresh air flowing in your body. You are here! Now! You either make the best of it now, or live your life in wishful dreams and reveries.

When you want to do something you really want, socialization and conditioning kick in and you start making excuses: “let’s think about it, is it the right thing to do”? “What others will say”? “I need to get a few more opinions from x,y,z”. Thing is you already know what to do.  But you don’t do it. Socialization, bad conditioning, the fuzzy comfort zone, all are terrible enemies. And the time goes by. “Life has the sting in the tail. Its too short!” was at the last pages of the yellow book I was browsing at WH Smith. So I liked the start and the end of the book, and finally bought it too! (which was hilarious because I didn’t actually like 99% of it). At the last page of the book the female author was thanking her mother who raised her “without limitations”. Easy sweetheart!, you will break a nail :-)

Loosing social conditioning does not mean that you will start doing crazy things or become antisocial. Nothing is further from the truth. This is very, very crucial. I’ll come back to that in another blog. For the moment lets go to Piccadilly line, Wednesday, around 7 in the morning. I was sitting in the soft seats, heading to Russell Square, writing a reply to Jan Crosser, Rights Executive of Oxford University Press. She wrote to me a few days ago to let me know that “The Neurosurgeon’s Handbook” will be translated to Chinese! People were sitting around half asleep, few standing, most were reading some ridiculous stories in Metro (what a stupid way to start your day!), some were listening to MP3s, some had their eyes closed, shut the world out. I suddenly heard a thud!

Piccadilly line Wednesday just after 7 am. The sleepwalkers are about to start their day.

Next to the closed door a big young man had collapsed on the train’s hard floor. As a reflex, I stood up, put my MacBook in the soft seat and went to help. The man was looking like a manual worker, had traces of paint and cement in his worn out work clothes. Facial features of an Eastern European. Two of his work mates, same outfit and similar faces, started slapping him, calling “Pavlo! Pavlo”, and tried to grab him and stood him up. “No! No! I shouted, leave him on the floor!”, before I finished my sentence Pavlo was back on his feet. What do you know, their method worked, why they didn’t teach us this in medical school? I looked around, the carriage was fully packed. Everybody was as half sleepy as before, reading their Metros and plugging their ears with headphones. Nobody stood up to give up his seat to poor (and a bit embarrassed Pavlo). This can’t be happening. Social conditioning again in action. “Can someone give up his seat please!” I said rather loud and a bit annoyed thinking what is wrong with these people? A chap stood up and offered his seat. Pavlo sat down, was looking okay, time to go back to my seat and to my MacBook to finish my letter.

Got of at Russell Square, walked to Queen Square, put on my scrubs and went into operating theatre three, about twenty minutes before eight. I always talk to my anesthetist, I tease and have a little chat to my nurses, they need to be relaxed and happy, they need to feel appreciated, we will give together quite a few battles every operating day. No they are not the generals, but they are brave soldiers, no war can be won without them. I usually leave my phone, and dictaphone next to the computer and wait for my anaesthetist’s signal. Showtime!

In the evening back to my office, time to munch a bite, while watching a few movie trailers in IMDb. Two or three looked dead turkeys, but wait, what’s that, fast change of scenes, places, road trips, curious people traveling, and the end of the 2 mins trailer said: from the book “on the road”. I clicked on Amazon’s site, looks like “on the road” is a literature classic. Never heard of it but never’s too late. Time to click on “1-click order” and “get it Friday” if you order within the next 3 hours and 8 minutes. Suddenly Friday seemed too far away. I know I won’t start reading today or tomorrow or next week or even next month but I don’t like to wait. Foyles in Charing Cross Road closes at 9 pm, still got time to get it on the way home.

“On the road” Going somewhere or it doesn’t matter?

The woman behind the till had short blond hair, freckles, two symmetrical piercings in the lower lip. Do you know a book called “on the road” asked. Yes, its by Kerouac, I’ll show you. She swiftly moved between tall bookcases and in the middle of thousands of books like a heat seeking missile following its target went straight to a specific spot on the shelve where “on the road” was siting patiently and said “here it is”.  There were a few different jackets, I went for the one with a collage of road trips, diners and coffee places.  Amazon had this jacket too, 30% cheaper I already told you, can’t wait until …Friday. “A friend of mine just finished it and liked it a lot, I’ll start reading it too” said the blond woman with the piercings as I was sliding my card into the machine. “Many people who read the book started traveling across America” said back. “Careful, you might quit Foyles and start wondering across America you too”! She laughed with a lovely laughter.

Moving on, I know I haven’t written a blog for more than two months now, thanks for waiting and (constantly!) asking. You know by now that you get samples only of the world around me but I do like to share a few facets of what’s happening with you although I know you not. I find amazing that you are not reading only from the Western world but form places like India, Brazil, Pakistan, Thailand, Hong Kong, Venezuela, Iraq, Japan, Sri Lanka, Chile, Moldova, Colombia, Latvia, Nepal, Peru, Viet Nam, Puerto Rico, Morocco, Barbados, Zimbabwe, Kenya, Fiji, Bahrain, Belarus, Kuwait, Ghana, Papua New Guinea, Cambodia, and I better stop here as the list goes on and on! WordPress provides pretty good statistics but worry not, I do not know you! although you do know me, at least to some extend!

Before I finish this blog entry I need to tell you about my July Course. And write about it while listening Lykke Li’s “I Follow Rivers” (rock version). What a magical piece for a September Saturday evening. Yes, the course. It was the the First Annual World Course in Advanced Techniques In Neurosurgical Oncology. I had the idea for the course in April. My senior colleagues thought I was kidding when I said I was planning an international course from scratch in three months time. No, I was not kidding. I wanted to create the best course, invite outstanding speakers, have the best cadaveric dissections, seminars given by the masters, ignite discussions and take them out to a fabulous dinner. The idea was in my head but we had no venue, no speakers, no adverts, nothing. But once the idea was in my head, I had to do it.

Friday late afternoon preparing the delegates bags with the help of secretaries, trainees and …senior consultants who were putting documents, memory sticks, ID cards minutes before the Guy’s facilities close!

Time to call upon my friends. That’s why friends are for. Professor Ribas from Sao Paulo, a legend in anatomy of the cerebral cortex. Professor Duffau from Montpellier, the man who does the impossible, he removes tumours from eloquent areas, areas that other surgeons stay well clear off. Professor Summer from Munsten, the man who came up with the idea of using the fluorescent dye 5-ALA in the surgery of high grade gliomas and designed the trial to test it. And a bunch of my colleagues at Queen Square. I then had to advertise an event to the international community. Delegates had to book leave from work, book flights and hotels. I emailed friends in top positions in european countries to spread the word. Made a deal with neurosurgic.com. Made another deal with the European Association of Neurosurgical Societies. Made a website, drafted a 4-page brochure and found one of the best printers in London to make a top-quality glossy brochure. Created a research fund to direct the funds from the course. And booked the venue.

What about food? Guy’s Campus had catering from the local canteen. I didn’t like that. They even wanted to charge a couple of hundred pounds per day for their staff only to be there in addition to ridiculously expensive and suboptimal quality food. No that, wasn’t a goer. We could do better than that. We had to get special 3D anatomy glasses (you have no idea how many different types of 3D glasses exist! could write a whole blog about my adventures to find the correct glasses). Buy delegates a gift, Bruni’s neuroanatomy book that suddenly sold out, so we had to order from America and waiting to arrive on time. Find free delegates bags, writing pads, memory sticks, IDs. We did not have lanyards, Derek from Baxter sent us a few from his office but we had no clear pocket for the IDs. If I tell you the obstacles, big and small we had to overcome up to running this course, you thought you were watching a Hollywood comedy where anything that can go wrong, does goes wrong.

We had 12 cadavers, which means 24 places. Hands on cadaveric courses usually have 12-14 delegates. Applications flooded within 2 days. Patricia, my academic secretary couldn’t keep tract of the emails. Professors from Korea and Argentina, seniors surgeons from Denmark, neurosurgeons from America, we simply did not have cadavers for all these people. Tried to find more cadavers, import them from America, search Medical Schools. Finally the Professor of Anatomy from Imperial College could give us 8 more cadavers. That’s 16 more places. They vanished within 2 days. 4o places for a hands on cadaveric course is unheard of but I thought we should go for it. Then we had a growing waiting list. We had to book flights for our faculty, hotel rooms, cars to pick them up, organize the Saturday night dinner. As they date was approaching it was time for the Sicily holiday (see The Gates of happiness).

Saturday morning came! In a moment of weakness thoughts go through your head: Would everything be okay? Would all the speakers make it? They had to squeeze this between operations, various speaking arrangements, catch flights, make connections. What if they missed a flight, what if there was a flight delay. What can you tell to delegates from South America and Asia, sorry our celebrity speaker couldn’t make it? And would everything turn out to be as planned, would the delegates enjoy it or think it was a joke? In moments of weakness, you can do only one thing. Recognise the negative thoughts and dismiss them. Yes, everything was going to be okay, no, even better, everything was going to be great!

Saturday morning delegates started flowing to the registration desk. Tiago, my SHO a year ago who was now a registrar in South Africa came to help. He was checking names on his list and handing away the registration desk. getting to Guys Campus from lONDON bridge tube station can be tricky. My colleague and friend Lewis Thorne volunteered to grab a brochure and go the tube station holding it like a flag to collect any half-lost Europeans and Asians.

Professor Stummer sharing his secrets on maximum high grade glioma resection to an absorbed audience.

Another master surgeon, Hugues Duffau giving a masterclass in resection of low grade gliomas.

See how the neurosurgical audience does not want to miss a word.

They all gathered in the dissection room. I welcomed them and gave a brief talk. I told them this was an interactive course, they should talk and ask questions. “If you don’t want to ask questions, I will put you on the spot” warned them. Guilherme Ribas was sensational. He started with 3D anatomy shows, we then went to cadavers to practice and dissect specific structures from the human brain. The delegates, most experienced neurosurgeons, were mesmerised by the dissections, quite and focused. Another 3D lecture, another dissection session. Then coffee break. A chap from an asian restaurant in London bridge provided the hot coffee. Again anatomy lectures, again dissection. Time for lunch. I told you I didn’t like Guy’s catering, so my Secretary had had preordered M&S party food and Tiago who brought hot KFC chicken provided all it was necessary. Delegates cleared the tables!

M&S party food, hot KFC, fresh fruit, cakes in the lunch buffet. My secretary Hilda and my previous SHO Tiago did a spend job. “Having KFC was an inspirational choice” wrote one of the delegates in the feedback form.

Time to eat was limited, I had to push them back to lecture theatre while still munching! :-)

In the afternoon we had the masters’ seminars. True masters sharing their secrets with audience having the permission to interrupt, although they were absorbing every single word. Hugues Duffau, Walter Stummer, neurosurgeon and neurophysiology colleagues from Queen Square, fast pace, intense schedule. Then hands on practical workshop on cortical stimulation and use of ultrasonic aspiration. When they were pretty much exhausted they had about half an hour to get ready for the dinner.

One of Hugues’ slides, the concept on “minimal common brain” that has to be preserved. What a radical idea!

An American couple (Marvin is a flight surgeon) with Antonio Mussi who came from Florianapolis, Brazil to teach anatomy on the course.

One of the practical workshops with the ultrasonic aspirator using liver for practice under the guidance of Scott Smiley from Integra. Scott, Andrew and Integra have helped tremendously during the course.

I wanted this course to be unique in every aspect. They came from all parts of the world, i wanted to remember that weekend for years to come. So I booked a fabulous restaurant, le pond de la tour, next to Tower bridge. We walked from Guy’s campus, under the Shard o Queen Walk, next to the river, with hundreds of people running, basking, taking photos, passed city hall and an outside theatre with live performance, passed the Tower bridge and started walking to cobblestone streets with small shops selling peppers and home made marmalade, like you were in some italian street.

Saturday night dinner at Le Pond de la Tour. Look at the river through the windows. It was a lovely night.

The delegates had just half an our to change from their comfy clothes to something appropriate for the occasion. They all brought something appropriate for the occasion with them!

Le pond de la tour was immaculate. We had reserved an area looking in the river. When we walked in we saw something unexpected. The big round table in the middle, supposedly reserved for the faculty was already occupied by a few delegates who had arrived early and already were drinking the red Chilean wine I had organise with Peter, restaurant’s wine expert a few days earlier. Now what? For a moment I thought, shall we let it slide, so the faculty could sit on other tables. My senior neurosurgery colleague was adamant that the faculty should seat there. He was right. I approached the three trainees sitting there and had a small talk. Then I said, “look guys, we have a very nice table for you next to the window, the waiter will bring your wine there”. They were fine. The atmosphere in the restaurant was great, class and quality and relaxed and unpretentious style. At some point the Tower bridge started to open. Most run out to take photos, they were so happy they could see that. What are the chances! Mr Bradford, my senior colleague said laughing “George organised that as part of the course”!  Everybody had good time. In the feedback forms some wrote “the best place I ‘ve ever eaten!”.

Next day we started again early. 3D anatomy shows, dissections, master’s seminars, practical workshops. I kept the program pretty tight. They always wanted to mingle a bit more during breaks but we had to go through a lot, they were laughing with my strictness! When  Sunday morning before I released them for their coffee break I told them seriously  “you have 18 minutes!” they all applauded laughing! :-) During Sunday lunch Mr Bradford told me “you’ve done it!”, I then knew it, it was almost over. No, I hadn’t done it myself, I’ve done it with the help of at least thirty people, some present, some not, all gave heart and soul, but, oh boy, it was worth it! The feedback forms were unbelievable, most were asking to add days to the course, some were asking when is the course next year, some of their comments: “amazing”, “impressive”, “perfect”, “just great”. These were people who paid plane tickets, hotels and course fees for a two day course. But as the course was coming to my end, and the adrenaline in my veins started to slow down, you know what I was thinking, I started making plans for the course next July. But then I thought to myself, “stop, take a breath, you are here! now!, enjoy this moment now”!

By Sunday early evening it was all over. Time to enjoy the moment!

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