Summer’s dream

My flight to Athens was delayed for an hour and a half. It was the 28th of June. At least BA’s lounge at Heathrow’s terminal five was one of the best I’ve been. Individual armchairs, floor lamps, quite carpets. I was lounging with my MacBook on my knees. Every now and again one of my neighbors would stand up to go and refill their breakfast plate with pastries and muffins, and more coffee, and then some more. I know it was free but still can’t comprehend how much these people are having for breakfast! You know what they say: “The most important meal of the day”. Rubbish! Nothing more than some easy pleasure before starting a (potentially) difficult day… I had my usual breakfast at home, thank you. A glass of water. And a glass of milk. “Breakfast for champions!” At least that’s what one my senior colleagues told me once, when after an early morning run I was having my “breakfast” in operating theaters coffee room.

I was looking at the screens. Two more hours delay! I looked at my MacBook, half of the battery’s juice had already gone. And the mains had already been checked in in some plain’s big belly. Time to start chatting to some people. I regularly talk to strangers… I never met anyone who wasn’t friendly, or at least someone who looked annoyed. I like to give more credit to the people even if they look a bit withdrawn. I like a brief chat. But genuine. Not, they haven’t got a clue that they are talking to a brain surgeon. Sometimes I don’t feel like it but I still do, I want to do what might feel uncomfortable, every day! I have my reasons!… More delay on the screens! Now my fellow passengers were gearing up for lunch. How much can these people eat?… Our plane had some technical issues and a plane from Stockholm was diverted to Heathrow to save the (my) day. We finally sat on our seats. Do you know what is the best moment in a flight? When the wheels are spinning on the ground, the plane has its maximum ground speed and the plane just lifts up to cut through the air. If there is one moment when freedom takes some material form, this is it!

When I arrived at the conference hotel it was after ten at night. The smiling receptionist typed my name to check me in, and then continued to type and type and type…I was thinking unless she is writing a novel, something isen’t quite right! Sure enough after five minutes of typing and typing she reluctantly said that could not find my name…But let me take you back, there is a story behind it…A week ago I had called the hotel myself. I used to make hotel bookings via, superfast and easy. But I then started using Julie, my agent, who has connections and can find the best rooms in the best prices. With the conference hotel in Athens the price Julie found was still high, I had left it for the last minute, so I thought to practice my Greek and call the hotel myself. The woman from the hotel I called myself was very helpful, I chatted to her before getting to business (I always do that, not because I expect anything in return… again, I have my reasons…) and she gave me a great price, but then she said, “you should get a balcony suite, 792, is great!” but the price was too high. But she was insisting “please get this one…” and I was thinking to myself “was are you insisting? I am not going with you…:-) She was so nice, so she gave me the balcony suite with the standard price! That’s the background, so when the receptionist could not find my name, I thought, that must be it, they gave it away…then the manger came, they started making calls, and then the manager said, “I am sorry Sir, we will give you our special suite for no extra cost”. “Special suite? How big is it?” Asked. “Its bigger than my house, Sir”. Oh boy, it was big! With dinning room, study, three sofas, stunning views of Acropolis! Plus complementary wine brought every night…

The welcome reception of the International Hydrocephalus conference was on Friday night. They had some (very basic) nibbles, dry bread with olives, tomatoes and mozzarella (I checked around, no, I was not in Italy, what happened to feta cheese?!) and that’s all! Not very impressive my greek friends despite the €700 registration fee, the most expensive I’ve ever seen (and paid!) in any conference, anywhere in the world! That’s one for the Guinness book! On the same evening there was a talk by a Engineering professor on antikythera mechanism, an extraordinary ancient analog computer that could predict astronomical events and eclipses decades from present time. The mechanism was phenomenal and someone said it is “more valuable than mona Lisa” but the talk was over an hour, far longer than my attention span for anything outside the human brain…

The conference was international with delegates from different parts of the world but quite a few Japanese. The men are very polite but they speak with a very firm, sharp, nearly… angry way. You think that they might pull a sword and slice you :-) But they are lovely! I was talking to a Japanese rep from Tokyo. She’s spent a few years in Boston before moving to Tokyo. Instead of saying who I am and what I do I asked her if she’s a fun of Kurosawa, a legend of Japanese and world cinema. It just came to me…I wanted to hear from a Japanese what she thinks about “dreams”, a very old movie based on eight (real!) dreams seen by the “master” Kurosawa. She… never saw the movie!!! What?! Its like an American who never saw “Casablanca” or an Italian who never saw “La Dolce Vita”.

So I had! to tell her one of the dreams…”The blizzard”…On a mountain top four men are trying to find their camp in the most horrible snowstorm…they can hardly see anything expect dense snow, they can’t hear anything but the frozen wind…they been struggling for three days…they are exhausted and start to hallucinate. Two already lied down in the snow and died. One tries to walk but has no idea where he is going. Then, suddenly, a beautiful Japanese woman in a kimono comes and talks sweetly to him urging him to lie on the snow and sleep. With her elegant, white hands is covering him slowly with sheets of fine silk, saying (nearly singing) “the snow is warm, the ice’s burning…” luring the man to sleep in the snow and ultimately death… seconds before this happens the man thinks “no! I must not sleep, I will find the camp!” and stands up. Suddenly the beautiful woman transforms into a horrible creature, the great gripper, and in front of the man’s strong will, evaporates in the snow. The man carries on and within the blizzard he finally spots the camp…he’s saved! The Japanese woman who was listening to me completely quite, put up her arm in front of me and said “Look, I have goosebumps!” that was kind of adorable. I find this a slightly better way to introduce myself than providing name and occupation…

The hydrocephalus conference was good, if I say I was excited it wound’t be accurate. Some talks were interesting, some were dull…that’s the norm with most conferences. But I saw so many old and new friends, we caught up. I got many invitations to go back and give talks to different universities in Greece, I happily accepted. One of the evenings we went with a couple of friends to eat in lovely little tavern near Mikrolimano of Piraeus, which was handy as the conference food was, well…, you already know…We drove by the sea, and ate fresh fish overlooking the sunset in the east coast of Saronic Gulf. My friends read my blog regularly and every time we were passing through some nice scenery they were saying “look! that’s a beautiful shot for your blog!” :-)… The following night we went with some other friends to walk in old plaka, a neighborhood beneath the slopes of Acropolis, narrow streets, cute taverns with tables arranged in stairs, smell of barbecued food, tourists eating frozen yogurt, live music every 2-3 minutes walk, people strolling leisurely like they have all the time of the world, all swimming in a hot, hot night.

Colourful taverns under the slopes of Acropolis, live music, on a hot summer evening

Colourful taverns under the slopes of Acropolis, live music, on a hot summer night

Four days later I was back to London. On Tuesday afternoon, 9 July I was giving a talk about present and future of Neurosurgery at the Queen Square Alumni, neurologists and scientists who excel all over the world having been trained at QS. They came from America, China, Australia, Africa…I told them about the recent past, our present, what we have achieved, what we expect from the future! Here’s a photo form that day.

Talking to Queen Square Alumni from all over the world on Monday 8 July 2013. I prefer to walk up and down rather than hide behind the lectern.

Talking to Queen Square Alumni from all over the world on Monday 8 July 2013. I prefer to walk up and down rather than hide behind the lectern.

On Thursday morning at 8 am, on the first floor of the education centre, I was standing in front of one hundred and twenty delegates who travelled from the four corners of the earth and along with guests and personnel were adding up to hundred and forty people. Ninety percent were senior neurosurgeons, Professors of Neurosurgery and Chiefs of Departments who came from Brazil, Argentina, Hong Kong, New Zealand, South America, Africa and all over Europe.

First day of the course, Thursday morning, setting the rules of the game with our 140 guests.

First day of the course, Thursday morning, setting the rules of the game with our 140 guests.

What we were about to do on that Thursday morning never happened before, anywhere in the world. We had live three operations from three countries (France, Germany and USA), one after the other, performed by three top surgeons (legends) in their own operating room with their own teams. Although we have been working on this for two months you would be surprised for how long it takes to solve technical problems. A huge number of people was working behind the scenes and except Germany the day before the course we had not done the final tests. “Four months ago I had a crazy dream…” told to my delegates starting my talk. “…”that today we will show you live in London three operations, three awake craniotomies from three of the world best surgeons…and you will be able to talk to them, ask questions and see their operative secrets….”. “Although a huge number of people have been working behind the scenes, with crews moving across France to Montpellier, and equipment shipped from Boston to San Francisco, the truth is that I don’t know if this will work today, there are so many steps that this project can go wrong…” “but I am prepared to take the risk…in life you have to take risks…if it doesn’t work I’ll be telling you stories for eight hours…”

Looking at one of the two screens and commenting on live surgery from Germany

Looking at one of the two screens and commenting on live surgery from Germany

We started with Hugues Duffau who was operating at an insular glioma on a young patient who travelled from Brazil to France the day before. We had picture-in-picture, big picture the brain, small picture the awake patient’s responses. I was talkative but Hugues not so much…(he later told me he was a bit nervous as he didn’t know if everything will work), I was describing was he was doing as I did spent sometime with Hugues a couple of years ago and know his techniques…for a few minutes we lost signal from France but I continue talking knowing that the signal will come back (and it did!). The first case finished in three hours, all went well. I sent everybody for a coffee break and got ready for the second country, Germany. Professor Stummer had two cases lined up, one asleep case using Gliolan and one awake again using Gliolan to identify a malignant focus in a low grade glioma. So we had to switch from one theatre to another which was great but the split signal lowered the resolution. My German guest-surgeons were very chatty, so there was a lot of banter and with two cases time flew…Both cases were successful, delegates were asking questions, the vibe was great.

I told everybody at the beginning the house rules, no talking, no commenting to people sitting next to them. I did tolerate a few whispers every now and again but three senior surgeons were talking at the back. I made a general comment to be quite, nothing, then I ask them if they had anything to ask. They said “no”. “Then stop talking!” I said back and didn’t think much of it. Later that evening, my registrar Sophie told me “that was fantastic, only you could have said that!”. I am not sure what was the big deal…but I had to be strict many times… with so many senior people around it is not difficult for a big meeting to get out of hand. I also put out a friendly vibe to the discussions, like a group of friends who discuss interesting questions…I’ve seen people being difficult and unpleasant in conferences and this is not what I wanted for my course, hence the challenge of striking a balance between friendly and strict with the balance tipping over to the latter…

The last live surgery for the day was from San Francisco, with a surgeon a legend, Mitch Berger. We had signal from America, Mitch appeared on our double screens with his scrubs (photo) and we had a little chat. In video-conferences there is a couple of seconds delay, so you need to give the other person a chance to talk but you get used to it very quickly. Mitch was moving without rush, talking without rush, with authority and experience. He explained the case, showed us the scans, introduced his team. He then started. His cameraman could not zoom in (!) and there was too much glare from the theater lights. For the first part we couldn’t see much in the surgical sight but we could see the set up, the choreography of movements…but when he brought the microscope in the views were spectacular. The awake patient was talking and performing tasks while Mitch was temporarily paralyzing the brain to map eloquent parts that had to be preserved.

Talking live with Mitch Berger in San Francisco just before he starts his awake surgery.

Talking live with Mitch Berger in San Francisco just before he starts his awake surgery.

On our London screens master surgeon Mitch Berger while operating live in San Francisco on Thursday 11 July, 7:30 am California time.

On our London screens master surgeon Mitch Berger while operating live in San Francisco on Thursday 11 July, 7:30 am California time.

The delegates were holding their breath seeing this unusual sight, a grand master surgeon in action. Its like hundred and forty people were standing behind Mitch Berger’s shoulder in the OR. In reality, even if they were physically present in San Francisco they wound’t see so clearly as they were in London. We started at 8 in the morning. It was now after seven in the evening. Mitch had not finished yet but he was close. Our delegates did not move but they had three more busy days so I let them go to get some rest and then go for drinks and nibbles at the Blu Radisson Hotel across the Education Centre. When the first day was over, I thought “that’s it”, the most difficult part is over.

Before we did this, every friend and colleague who knew about the project was telling me two things: first, “what a great idea!” and second, “it can go wrong big time!”. Yes, sometimes you do a simple presentation and you have glitches more than hot lunches, and now with this massive project…the kit could have problems, the signal could have been lost, the cases could have been cancelled because a patient had a chest infection, there might have been a major complication during surgery, the patient might had fits… And that’s times four, in four different cases in three different countries! But guess what! Everything that could have gone wrong, went well! But I was prepared, I was thinking if something had gone wrong, so what…human activities are full with imperfections and mistakes, if you are afraid to make a mistake then you wound never achieve anything…the fear of criticism stops about ninety nine percent of people trying to achieve anything worthwhile in their lives…

Here’s what I think: with the exception of patient care, its okay to make mistakes, its okay to fail, again and again, people who want to be “perfect” they “exist” but never “live”. When it comes to patient care you should always do what you would have done if the patient was a close relative, a beloved friend… but outside the operating theatre, be bold! accept your imperfections, accept your rough edges, only objects are super polished… And if you accept you rough edges, if you accept that you vulnerable and go for it anyway, a strange thing happens, people will support you and they will be attracted to you! That’s a fact, why it happens I don’t know… but I suspect! it is because only very powerful people can expose themselves openly and publicly to failure…

The following day, Friday the 12 July we had 3D anatomy shows. The 3D screen was made for us in America and shipped (just!) in time. The linear polarization 3D glasses with our logo which arrived the night before(!) despite ordering them a month earlier did not work! But I had foresee this and I had asked Guilherme Ribas and Antonio Mussi to bring spare pairs from Brazil. This could have been a disaster as all images are blurred unless you have the right glasses.

On Friday my guest surgeons had time to get in the plane and travel to London for the weekend’s lectures. Mitch Berger arrived the same evening. I met him at the lobby of St Pancras’ hotel. That’s the first time I met Mitch in person. Tall, tanned, silver hair, looked like a movie star. We met Hugues and took a cab to go for drinks and nibbles to the top floor of the Center Point in New Oxford Street along with the rest of delegates.

I wanted this course to have the best of everything, scientifically and socially, so the venues were outstanding! From the top floor with wooden floors and glass windows all around you could see stunning London, Saint Paul’s Cathedral, city’s sand Canary’s Wharf skyscrapers, the lit west end, an eye candy. Delegates were taking photos, eating nibbles, moving from window to window to indulge the night summery London.

Top floor of the centre point on Friday evening.

One corner of the top floor of the Centre Point on Friday evening.

On the 31st floor of Centre Point, having a drink (=water) with Hugues (left) and Mitch (right)

On the 31st floor of Centre Point, having a drink (=water for me) with Hugues (left) and Mitch (right)

View of the Centre Point Friday night

The city from the top floor of the Centre Point Friday night

The weather all days was fabulous, sunny days and hot evenings, you could see parts of London miles away. One junior resident from Croatia looking at this glorious view from the top floor of the centre point asked me “how did you come from Greece and made it here?”. Now, that’s a question!… Hard work? High IQ? Dedication? Lots of energy? No, that’s not it, many, many surgeons have these ingredients, (that’s the absolutely minimum), but they don’t go very far…”You have to be able to tolerate pain…” I told her. She looked me surprised…No, I was not talking about backstabbings, that starts even from medical school and carries on (yes, I have quite a few deep scars in my back and a few in my forehead, but its okay…), I was referring to something else. Every time you go one step further, every time you push your limits… every time you risk to stand out, you risk to stand alone… and this can hurt…failure is uncomfortable but so is success…  at least until your mind catches up with the new reality… until your next challenge and your next success! anything outside your status quo can hurt! this is how brain is designed, to keep you where you are now! your primitive brain does not want you successful, wants you safe, and that is where you are right now, stagnant…you also need people around you, people who like you and share your dreams…but do not expect for other people to believe in you unless you believe in yourself first, and I mean really! believe in yourself.

On Saturday 13 July, I was standing in front of the delegates to introduce Mitch Berger. How I was reading his articles and books during to my residency years to the present time, how he influenced thousands of neurosurgeons worldwide and how he shaped neurosurgical oncology all over the world… I also told them about the time as a junior resident I emailed him for the first time asking him to write the neuro-oncology chapters in my (bestselling!) “Neurosurgeon’s Handbook”. Me, a completely unknown resident and him, the most well known oncological neurosurgeon on the planet. I’ve sent him an email expecting to get an answer days later…I saw a reply in my inbox within two hours… That must be a quick “no”, I thought! It was an easy “yes”!… Then I asked him to come to the lectern and give his talk with rounds of enthusiastic applause for the eager delegates. Mitch did a beautiful introduction and thanked me saying that “George since his residency has evolved into a wonderful colleague and wonderful friend”. I know I was running the course but while sitting there I was thinking to myself “is this my residency hero Mitch Berger talking about me?!” Mitch is a great speaker, speaks with ease, authority, and pace.

I had invited to the course the best neuro-oncologist in the planet, Roger Stupp who validated the use of temozolamide in glioblastomas, the most important advance during the last fifty years. Roger, a passionate Swiss was an animated speaker and his contribution to round tables was lively! I had also invited the best neuro-pathologist in the planet, Andreas von Dieseling from Heidelberg, the man who discovered the 1p19q prognostic deletions in oligodendrogliomas, the IDH1 mutations in transformed low grade gliomas, the EGFR amplifications, you name it, he found it!

Co-ordinating questions after Andreas von Diemling's lecture

Co-ordinating questions after Andreas von Diemling’s lecture

Round table discussion with our expert panel

Round table discussion with our expert panel; I am coordinating standing with (left to right) Stupp, Duffau, Berger and Rees.

Every afternoon was were having lunch at the Blu Radisson at the top of Tottenham Court Road. I had striken a good deal with the managers, so we had three course hot buffet lunch. But I faced a little problem. The queue of 140 people was straitening from the restaurant to the pavement. And with three courses the had to queue thee times. This wasn’t a goer! So I asked them to put starter and main on the same plate and keep moving, this was not time to chat. We had one hour only before they went back to the course.The food was excellent, great presentation and impeccable service.

Lunch time at the Blu Radisson Hotel

Lunch time at the Blu Radisson Hotel

On Saturday afternoon we split the delegates into four groups for four hands-on workshops: cortical stimulation, ultrasonic aspiration, fluorescent dye and topographic skull anatomy. The program was tight, so I was strict (again!) to move groups from room to room in time.

Professor Ribas from Brazil discussing the topographic anatomy of the skull

Professor Ribas from Brazil discussing the topographic anatomy of the skull in one of the four workshops

In another workshop, discussing cortical stimulator with Mitch Berger

In another workshop on Saturday afternoon, discussing cortical stimulator with Mitch Berger (standing opposte to me on the left)

One of the brief coffee breaks

One of the brief coffee breaks

Do you know what impressed me more than anything watching all these great surgeons and clinicians, the best of the best, during my course? Here it is. How these extremely knowledgable people, when they were not lecturing and were just sitting in the audience, they were completely absorbed by the speakers, sooo eager to learn! They asked me for copies of other speakers presentations at the end! Professor Ribas told me the only downside of his anatomy workshop was that he couldn’t attend the other workshops! Professor Berger was dissapointed to miss Prof Ribas’ lectures during his flight! The stamp of great thinkers is that they always want to learn more, no matter how much they know and high they have climbed. A couple of years ago I attended a 7 am toastmasters workshop in central London. Do you know who were the only other ten people who attended the early morning workshop (open to all)? Very, very articulate top CEOs while their “busy” employees opted for a an extra hour of sleep or just they couldn’t bother or they think they were articulate enough, or any other excuse that came to their mind. But you see there is a reason why some people are CEOs and some are not, life always works this way, its never chance or luck!

During the discussion Mitch Berger stood up to make a drawing at a flip chart. I wasn't sure if Panos (the medical student who was taking the shaky photos) would get it, so I used my iPhone to capture the unique moment.

During the discussion Mitch Berger stood up to make a drawing at a flip chart. I wasn’t sure if Panos (the medical student who was taking the dark, shaky photos, okay Panos you took some good ones too) would get it, so I used my iPhone to capture the unique moment.

Faculty and delegates on the first floor of the UCLH Education Centre. Look at the attention of Mitch Berger and Hugues Duffau

Faculty and delegates on the first floor of the UCLH Education Centre. Observe the attention of Mitch Berger and Hugues Duffau

Saturday night was time for the formal dinner. I asked them all to dress formally, tie for the men and evening dress for the women. Some of them had to leave the last workshop to go to the shops… One neurosurgeon from Norway sent her husband to buy her a dress! The dinner was at the top of Milbank tower, in Westminster with breathtaking views of the Big Ben, the river and House of Parliament and greater London. This is a place you cannot go privately, its only booked for big functions.

Having a drink at St Pancras bar with Mitch (right), Hugues, Andreas and yours truly before going to the Saturday night dinner.

Having a drink at St Pancras bar with Mitch (right), Hugues, Andreas and yours truly before going to the Saturday night dinner.

On the way to Milbank tower with Mitch, Andreas and Hugues, Mitch could not believe how many people were in London streets. We got off half a mile before the venue to walk by the summery riverside and also for Mitch to light up with Cuban cigar we got earlier at the St Pancreas bar. I could not join him, I haven’t smoked cigars in years and I hadn’t had alcohol in five years… At the “360 view” restaurant delegates from all over the world were beautiful dressed, sociable and very happy. When the years go by, they will remember seeing live great surgeons performing awake craniotomies. But they will also remember stunning views of a summery London on a few hot July evenings…everything matters!

I’ve opened publicly one of my dropbox folders for you to browse more photos from the course:

Saturday night dinner at the top floor of Milbank tower.

Saturday night dinner at the top floor of Milbank tower.

The German group: Prof Szelzinsky, Prof Sobel and Prof Stummer among others. Look at the view at the back: Big Ben, House of Parliament, and the wheel. Which other place can offer these views?

The German group: Prof Szelzinsky, Prof Sobel and Prof Stummer among others. Look at the view at the back: Big Ben, House of Parliament, and the wheel. Which other place can offer these views?

Views from the Milbank tower window...

Dusk on a hot Saturday evening as seen from the Milbank tower window…

The feedback was amazing. Delegates said that this “wasn’t the best course we’ve ever been, it was the event we’ve ever been” or “we didn’t want to miss a minute!”. By Sunday night, 14 July it was all over, we went for a last drink with Mitch at St Pancras and made plans for the future. Monday morning, 15 July back to work, seeing my patients, teaching my trainees, planning operations… From my trip to Athens to the end of my course in London, that’s what happened during those two weeks (well, some of it…) Tuesday afternoon, 16 July I was off to my afternoon oncology clinic to the UCLH Cancer institute. I normally walk, its about ten minutes walk from Queen Square across the University Campus. While walking past Russell Square I saw dozens of people sunbathing and lounging under the sun in the park. Was I jealous and temped to do the same? Work and play are both needed, but lying on a park will give you only temporary comfort and fuzz, which its okay if that’s what you are looking for… but some people are looking for the adrenaline rush… that severe challenge… and then another one…and another… and somehow… I know exactly why!…

Russell Square park on a Tuesday afternoon

In the heart of central London, Russell Square park on a hot Tuesday afternoon

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