“Speed”

On Saturday I woke up around 10 in the morning. The sun was sneaking through the curtains. I hand’t slept for 8 hours for long time. It was a non-stop week. The previous day started with a hospital meeting on morbidity and mortality, then in the operating theatre for surgery on two patients with brain tumours, then ward rounds. My secretary had to cancel my afternoon commitments; I had to go to Oxford and then to Cambridge (with unbelievably slow traffic!) and then back to London, a round trip of five hours. While driving my mobile was bleeping and buzzing with texts and calls. My team was in touch for patients with problems, small and big, and needed my help. My registrar Sophie likes longs texts, which are very descriptive, but not easy to read when you are speeding on the motorway! At least I can use Siri to voice-type my answers. Back in London I had to go through piles of letters, referrals, request, sign clinic letters and clear my desk from pending paperwork. I like to clear my desk every Friday. The whole last week was not less busy, so my body needed a good night (and bit of morning!) sleep. A good sleep, soaking in the water for an hour and my body heals up and is good to go again! My biological clock is very friendly, I can go to sleep any time at night (and fall asleep within seconds/minutes) and get up any time (from very early to early) with no difficulty. Except, well, today, when I got up midmorning. As my body recovered from the last week I thought I better write my blog which I neglected for the last couple of months. I normally write my blog on an airplane’s seat but haven’t been up in the air for more than two months. But today is the day! Read on!

Have you even seen an old movie with Keanu Reeves and Sandra Bullock? Yes, “Speed”. Well it was meant to happen! Its been a while since I had my last speeding ticket, so I wasn’t terrible surprised when I opened up the letter: 3 points off my driving license and a fine. Unless…unless, I would go to a half day “speed awareness course”. Get three points or get bored out of your head? Speed awareness course it is! I had to re-arrange my whole afternoon schedule, punched some strange post code in the SatNav and off I went. It turns out that the place was more far than I thought, so I had to speed in order to make it to anti-speeding course! I thought if the police stopped me I had a good excuse, I was trying to make it to an anti-speeding course. Did you ever notice how your phone rings or bleeps when you don’t want it to? Let’s say when you are holding you bag in one hand, an umbrella in the other and you try to unlock a door with whatever’s left and your mobile goes off? Same thing. For an hour before I got into my car my phone was quite like a churches’ mouse. Once I hit the motorway it was like a mouse when the church is on fire!

I got to the course place about 15 minutes late. I was curious to see who were the other “speed offenders”. People with leather jackets riding motorbikes? Some smarty pants driving a Ferrari? Some tough blokes who play the easy rider? Well…I sat next to a granny who just got over the 30mph limit while doing her Saturday shopping, a pensioner on a similar situation, some housewives driving 4X4s, a few tradesmen trying to make it to the next job on time, what a letdown! :-) The course was lecturing, no interaction allowed. It turns out that motorways are the safest roads for speeding, and the 75% of car-related accidents are not related to speeding. Let me be clear! all efforts should be made to avoid accidents on our roads, every small or big accident can be devastating to the injured, their loves ones and to the society. These are avoidable deaths and they should stop with the help of all of us. But what about an army of incompetent drivers out there? I bump into them very day: drivers who block the fast lane with 60 mph; lorries who decide that with 61 mph they should overtake another lorry that travels with 60 mph, so two lories go side-by-side for a couple of miles until one decides to give up, slow down and let the moron overtake; or another idiot who the other day with more than 100 mph was overtaking all cars from the hard shoulder!
The one thing I discovered about speeding is from the SatNav: the arrival time changes very little based on the speed. Anyway, I learned a couple of things, that still could be summed up in 20 mins not five hours. Do you want to know my speed while going back to London after the anti-speeding course? This I cannot disclose! :-)

Trying to avoid traffic in central London I found myself somewhere towards Heathrow. Airplanes were landing about two every minute. Here's one!

Trying to avoid traffic in central London (i can’t stand still!) I found myself somewhere towards Heathrow. Airplanes were landing about two every minute. Here’s one!

Last week we had the Deanery teaching at Queen Square. This is a new initiative where neurosurgical trainees from all London spend an afternoon, being taught at a specific topic, once a month in a London unit. April was our turn. We chose hydrocephalus, trapped water in the brain. This is such an easy topic for a medical student to understand but so difficult to comprehend at a post-graduate level. Neurosurgical units organizing deanery Teaching have a simple approach. They get 2-3 of the local clinicians to talk for 45 mins each about a topic. Tried and tested but a bit… boring! Do you want a tiny insight into my brain? Okay, here’s how I think when I organize something. I ask myself “what is the best I can do”? At this stage I don’t think if its possible/logical/economical/on time/acceptable/would other people like it? I just imagine what’s the best I can go for and then move everything else around it. If the deadline is close for example I don’t change my aim, I change my plan to make it happen on time.

So I thought, If I can wave my magic wand and bring anybody to Queen Square for one afternoon, who would that be? Let’s see, for a start I would invite Christoph Miethke, a super smart CEO from Berlin who makes tremendously clever shunt valves. I would get Marek, a genius physicist from Cambridge who understands the physics of CSF flow; I would get Hugh Richards the man who studied more that 50,000 shunt operations in the UK; my friend and colleague Laurence Watkins, the next President of the International Society of Hydrocephalus. The event took place at the lecture theatre of Queen Square, huge screen, looks like Odeon Cinema. I asked them to talk for 30 mins each, I like speakers to condense the concepts, anything longer than that and the audience start to glare. The talks were of very high level, you can’t get this level not even at conferences. At the end a round table, I asked them to sit across a (not so) round table table, and the audience and I were throwing questions to them, was very lively, very intelligent (and a bit heated) round table. I want the best for our trainees.

Some of London neurosurgery trainees at lecture theatre of 33 Queen Square.

Some of London neurosurgery trainees at lecture theatre of 33 Queen Square.

A (not so) round table with Laurence (left), Christoph, Martin and Marek. We had some heated moments!

A (not so) round table with Laurence (left), Christoph, Martin and Marek. We had some heated moments!

Then time for a few drinks. As this was a sponsored event we took them to the bar of the Renaissance hotel in St Pancreas, huge ceilings, live music, classy environment (photo), and then for a dinner at one of the Hotel’s private dining areas (photos). The staircase to go the dining area was absolutely Royal. Your shoes dive in the burgundy carpet, the ceiling was sky-high, and the architecture was regal. The service was impeccable, the waiters reminded me dinner at an Oxford College, where 7-8 waiters come out all together, nearly running, leave the plates and then leave all together, again nearly running. Everybody learnt a lot and they had great fun. Do you think my aim worked perfectly well, no hitches in planning? Well, no quite! From having to re-arrange the dates at least six times so all speakers can make it to not having a physical table to run the “round table” to not been able to book the Renaissance as we had no final date and everything was booked. Did I give up at any stage? No, did not!

Having a drink at the bar of  Renaissance Hotel in St Pancras. Huge ceilings, live music, good company!

Having a drink at the bar of Renaissance Hotel in St Pancras. Huge ceilings, live music, good company!

After the drinks time for a private dinner.  stunning interiors, impeccable service.

After the drinks time for a private dinner. stunning interiors, impeccable service.

I know its been nearly three months since my last blog and I do want to catch you up. But life is short and I’d rather do stuff rather than write about it. I have about 10 mins to finish this blog while sitting in the garden this fine evening (despite the mosquitos that are attracted by my laptop screen). When I am writing my blog I usually listen to music, some song I downloaded, looped constantly until I finish my blog. When I like a song I listen to it again and again until I am sick of it! And then I think “best 79 pence I’ve ever spent”! So here’s the song of this blog, “Masar” from “Le Trio Joubran”, three Palestinian brothers carrying a 4,000 years tradition of the oud (a sort of a fat, short guitar). The kind of music that starts slow and steady and builds up in rhythm, intensity and emotion. The sort of music that, when you are out at some mediterranean tavern, makes you finish up your (strong) drink, smash the glass on the floor and then stand up and dance (no, no “holding the roof with your hands” dance), but dance with your body straight, with your arms stretched, with a serious face, the way men dance on the eastern face of the planet. People from the East you understand what I am talking about. People from the West, you might need to do a bit of traveling!

Last topic for today! The World Course everybody is talking about! How would you like to see the world’s best brain tumour surgeons operate live in their own operating room? What if you could talk to them and ask them how they do it while they operate? What are their operative secrets? Long gone the days where surgeons had to travel to foreign places to be apprenticed by master surgeons who did the best they could to keep their techniques secrets, often putting their elbow to block the apprentices’ view! Every time we manage to progress, to reach a breakthrough, to get one more hit to cancer, to perfect one new technique, we are doing it together, progress in science is not one man’s show. We are hear to learn from each other and share our techniques and secrets for the good of our patients who look up to us, we are not here to build our egos at the expense of our  patients and the patients to come.

And this exactly what we will do! Well, my friends, its all happening in July for four days in an unprecedented event! Mitchel Berger, President of the American Association of Neurological Surgeons and Chairman of the Neurosurgical Department in San Francisco will do an awake craniotomy in his own OR streamed live in London. Then Hughus Duffau from Montpellier will do one of his supra-complete resections again on an awake patient with cortical mapping; and Walter Stummer from Germany will show how he’s using the substance that can separate malignant brain tumour from normal brain under the blue light of the microscope, a technique he introduced in neurosurgery. Then next day they will all travel from San Francisco, Montpellier and Munsten to London to discuss with the course delegates their techniques. Does this sound too good to be true? I know, but it its very, very true! Plus we will have 3D anatomy shows and presentations with Guilherme Ribas from Sao Paulo, Master’s Seminar from Roger Stupp, the man who validated Temozolamide in the treatment of Malignant Brain Tumours, the most important progress in the last 50 years; round tables and case discussions.

Motivated neurosurgeons rushed to sign up from the four corners of the earth: South Africa, New Zealand, Hong Kong, all over Europe. I would do the same, for such an event! I would go to the moon! In one afternoon we will have hands-on practical workshops, stations where delegates will get their hands on the most recent surgical technologies. And the in the evenings we have a fabulous social program lines up with drinks at a trendy bar and dinner at an exquisite restaurant. With very few places left, if you are a neurosurgeon, stop whatever you are doing and book a place now, if you are lucky to get one! Go to http://www.neurosurgery-courses.com asap!

Okay, I know I said last topic but I know you want one more. I was on the motorway last Wednesday, just after sunrise, and while on the fast lane my car lost power, dead, completely dead! Have you ever broke down on the fast lane of a motorway? I just! managed to pull over on the hard shoulder, the fast lane is not the place to breakdown! My insurance put me on a priority call. I explained that by 8 am I should be in the operating theatre. A man with a big track arrived, looked like he had waken up not long ago, was about 6:30 in the morning. He loaded my car on his track. We started talking. He was scuba-diving every summer in the blue waters of Halkidiki, and when retired he was planning to open a martial arts school in Japan! He was a part-time body-guard so we exchanged a few stories about bar fights. What a cool dude. Instead of getting me to the closest garage (as per regulation) he said I’ll get you to your hospital! He drop me off and then carry on to drop my car in a garage in East London all by himself! “I am not supposed to do that but my track is not tractable”! This man was the something else. Should he had followed the “regulations” the operations of all my patients would have been cancelled! In the meantime my team was waiting in the operating theatre to start my brain tumour cases. I was in touch with them, so they had the patient positioned and ready the moment I stepped foot in the operating theatre. All thanks to them and my new (bodyguard) friend, my patients did not suffer! What a privilege to be surrounded by competent and dedicated people. And as for the “regulations”, well, there are not for people who can think on their feet, not for the free spirits of this world, no matter if it is Steve Jobs or some track driver driving somewhere on a motorway as you read these lines, God bless their heart!

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