Strangers Room

I closed my MacBook Air. I had finally finished correcting the last chapter of the Neurology and Neurosurgery at a Glance. I remember the Glance series since I was medical student. One page text, one page great diagrams. Easy to understand complex concepts, easy to remember. They started with pharmacology and expanded to all sub specialties from anatomy to paediatric cardiology. I was so surprised that they did not have a title in neurology or neurosurgery… When I was in the middle of my residency in Oxford was working very intensely on my “Neurosurgeon’s handbook” so did not have time to take on another project but I knew it was matter of time, months, weeks or even days before someone else had the idea. As a matter of fact many people have great ideas every ideas every day but they don’t take action…I bet many neurologists/neurosurgeons had the idea of writing at the Glance series but they stayed at the stage of wishful thinking…no guts, no glory!… An enthusiastic medical student kept asking me if there were any case reports to write up. So one day I told him, I won’t give you a case report to write! I will give a book to write! For him it would would be a matter of a few months to write and I would correct and polish. Well …the manuscript was ready… nine years later for me to review, and had about a month to finish off in the middle of a chaos of activities and a fed up publisher!

At least I finished it, one a train seat, departing from Lyon. We were off to Genoa, yes, that’s in Italy. The trip started as a business trip in Paris last Sunday. I was invited by a surgical technology company to try and test a new prototype ultrasonic aspirator while its being developed in the lab. What improves surgical technology ultimately improves patient care. So I was happy to help. Then we took the train from Gare de Lyon in Paris to…Lyon. It’s like you take the train from Liverpool street station in London to go the Liverpool…Two hours and a few minutes… Lyon is a big city but without any unique charms, at least none that we’ve seen in two days… The plan was to get a car from Lyon and drive without a… plan to South of France. But all rental cars in Lyon were gone…it turns out Lyon is the capital of sales people, flooding the hotels with their compact suitcase and feed their beer belies at local hotel bars. That was a “without plan” holiday so… new plan. We got the TGV and off to cross the Italian border. The train does not go in a straight line to Nice but heads first south to Avignon, then even more south to Marseilles and then follows the south French coastline, Toulon, Cannes and Nice.

While typing I remembered that last night in Lyon I was watching Tim Cook’s presentation in Cupertino. People were cheering, hysteria in the audience for…a new payment method and…a watch that has internet…Seriously?!! Okay, I am a tech enthusiast, I haven’t read a paper article or paper book in years, I trained (=forced) myself to do everything on a screen and I now find it bizarre to hold paper publications… It’s now such a funny feeling holding a book in my hands…( I do miss the smell of pressed paper though). I even had someone to come to my office and demonstrate the Goggle glass for some projects we are running, I use voice recognition for most of my typing, my office is full of gadgets I use for projects, and I get the most recent versions of advanced software I like, so I do like technology,…(and yes, I will get the new big iPhone, no I will not get the watch, although looks good and will be successful, and yes, credit card payment is very outdated…), but not this love of products…have these people lost it? As you traveling from country to country you see the same images, people standing on shops, bus stops or cafés facing their mobile screen, checking profiles on Facebook, forced friends, artificial lives.

Okay this calls for one of my “Iron Rules”: “develop the skills to distinguish between things that will make your life easier and the things that will make you happy” Put some effort on the first part. Put all your efforts on the second part. A nice house, a good car, the latest gadgets will make your life easier, they will not make you happy. Living in a cool house will not make you cool. Guaranteed! Okay, I am not saying that you don’t need it, but it will not make you happy. But how can you tell the difference? Are you ready? here comes my next Iron Rule: “If something was not around 10,000 or 100,000 years ago, chances are it will not make you happy”. People will not need that either in the distant future when technology will be much more advanced than we can ever imagine. People will always be longing for the same things, in every corner of the earth, when all hunger is gone…when all diseases are cured…when money does not exist…when the concept of salaried work would have  long gone… what made people happy when they did not know how to write or read will make them still happy when when technology will be a transparent bubble around them that they won’t have to wear or even see. So, the new Apple watch won’t make you happy… can someone tell these morons in Cupertino to stop cheering!…

We left Toulon, arrived in Nice, we have 20 minutes to hope on to the next train, then Monaco, and after 10 or so brief stops, we crossed the Italian border photo. Then our third and last train from Ventimiglia heading to Milano centrale, another two and a half hours till Genoa. We crossed from one country to another, no one asked for ID or passport, nobody seemed to care. What a great concept to have a European Union. Trenitalia trains much beer than SFCN but I have to give it to the French, they were on the dot!

Renting a car in Italy requires about… triple the time than… buying the same car in England. I am not exaggerating! They stare at the screens for long periods of time (I wonder if they doze off…), they photocopy everything, write in paper forms and at the same time enter identical data in the computer, make calls to central offices to check if what’s in the computer is correct, then they take more photocopies which they fax to another office, more signatures, more forms, that was a total of about two hours for what in England or USA would take 10 mins tops. Hey ho, at least all was done. You can take a full, “no excess insurance”, but no matter what, they will not insure the rims… I found out later why… From Genoa we set out for a two-hour journey to Manarola, a little village hanging from a cliff with its pink and yellow houses (painted by Paul Klee) so that the fisherman could recognize them from far in the sea.

At the beginning you drive through numerous tunnels, its kind of fun at the beginning, as you see a bit of sunshine and then dive again in the belly of big green mountains with hilltop villages, like playing Asphalt 8… but after a while it becomes tedious…not for long though. The woman in the SatNav with a steady voice gives directions without nagging, pretty accurate. About an hour into our journey the road becomes more and more narrow, it can now barely fit two cars, one on either direction…if a bus or even a van comes from the other side it would be tricky…the SatNav asks to “prepare for a sharp right turn”, okay, I am ready,…but in hundred meters there is no right turn, only a very narrow, extremely steep, uphill kind of “road”, this can’t be it…so we carry on, but the woman in the SatNav in a non-judjemntal tone asks to “make a U turn when possible”…you got to be kidding me, I can hardly drive straight ahead on this country road, how can I make a u turn!……anyways somehow I managed to u-turn and back to this pickle, left now, sharp turn…I eyeballed that goat-road again, that would be a good road for trekking, donkeys would just manage, goats would be okay, but with a car…okay, decision time…time to buy the bullet…left turn it is! Oh boy, I thought the car’s engine was going to give up, this road can hardly fit our car and goes higher and higher… there is no going back now, nowhere to turn or reverse, mountain on the left, cliff on the right…this is some sort of Italian jungle with tree branches on the road, if another car comes our way, any car, we are stuck…there is no going ahead, no reversing…we are going deeper and deeper to this unknown road which looks abandoned…hoping that will be no dead end…

As the SatNav is dead on on every little twist and turn of this tiny path in the middle of nowhere I can’t stop thinking how little brain neuronavigation has progressed during the last 10 years…Neuronavigation is a technology that allows the surgeons to find “where they are” in the brain, but compared to modern car SatNavs it looks like a cassette player compared to MP3…why was I thinking that?…it just came to me…its better to think this than what the Italian newspapers will write next morning when they find us at the bottom of the cliff, about the stupid tourists who drove their car where only goats were meant to go… okay, back to the deadly road, for another 1.5 Km and then another sharp turn, back to some “main road”, that is a road that can squeeze two cars… Manarola, has no beach, just a bunch of massive rocks creating some sort of natural pool good for diving, or plunging, jumping off the rocks.

Driving from Manarola to Coglia, many small villages and endless blue of sea and sky

Driving from Manarola to Camogli, many small villages and endless blue of sea and sky

Then off to Camogli, a town called by Dickens a little pirate place, that’s another hour and a half from Manarola. The road was wrapped on the outside of the mountains, no tunnels this time, no donkey roads, still narrow and steep but fun to drive while having on your left deep blue sea and an infinite blue sky (photo). Inside Camogli, as the SatNav calmy was asking to turn right or left in neighbourhoods with tiny streets, with laundry lines touching the windscreen, I was thinking, that’s someone’s backyard, it’s a dead end, no way this is going somewhere… at the end there was always a miniscule way out where the car could just fit, every now and again I was expecting to hear the noise of a deep scratch on the door. Camogli has a mixed pebbles and sand beach and clear green waters. Then another half an hour drive to Portofino, the jewel of Italian Riviera. Between Portofino and Santa Margarita the road could hardly fit two cars (that now seemed to be a luxury in Italian roads…), in every turn greenery from the side of the road was hitting the car door, buses had to honk in every turn as there was no visibility, most cars were driving on the double line so you had to break and steer the last minute to avoid a crash, and in the middle of all that, add scooters, cycles and motorcycles, joggers and pedestrians totally unaffected by the traffic. Italians do not honk to other drivers often (surprisingly), on the other hand I was honking (and shouting at times!), am Greek!… what can you do about it!…

Portofino at dawn from the hill of the castle.

Portofino at dawn from the hill of the castle.

In the village centre, there was a multi story car park, so followed the signs, the lane was so steep and angled I thought that’s it, either the mirror or the rims are going to get it!… In the village cute taverns, yachts in the port, steep green hills, a castle with the best views of the bay…a tender night was coming…next morning we drove to Milan, another hour and a half and drop off the car by the central train station of Milan. Yes, not a single scratch in these unbelievable (let’s call it) “roads”!…I deserve a medal!… a silver cup!… some sort of certificate!… or at least a “world’s best driver” mug!…from Milan and its spectacular grand train station hall we took the fast train to Geneva and then a plane back to Heathrow closing the circle of our travels.

Seven days, three countries, six cities, I don’t know how many towns and villages, planes, trains, an (unscratched!) car… that was my only proper holiday in two years. Back now to 14-hour work-days, 300 emails a day, non-stop texts and calls but more importantly, back to my patients… old ones and new ones, coming to see me from all over the world, every day a new challenge, a new tumour called “inoperable” by their local neurosurgeons…desperate patients seeking a beam of light…you have noticed that I refer to patients’ cases less and less in my blog. I modify many demographic details, my strictest ethical code is not only that a third party should not be able to recognize the case but the patients themselves should not be able to recognize that this was their case…and I stick to my ethical code.

Patients love my blog and often hope that I will somehow mention their case… patients are telling me again and again how my blog makes them feel much more at ease, a proof that I am not some cold-blooded surgeon but a person who can understand emotions and feelings… their dramas and battles…but my cases have now become so complex and the dramas so intense, its now difficult to modify them… perhaps in a book some time later…being a neurosurgeon dealing with very difficult cases is not being some sort of brain mechanic repairing damaged brains…you have to look into patients’ eyes… take the time talk to them as long as necessary… coach them… give their battles with them…

Back to my blog, I realise how long it’s been since my last blog, 5 or 6 months, things are happening faster than I can think let alone write about them. I can only thank you for reading blogs written months or years ago, I suppose that is part of what I wanted…to write a journal that does not expire like a newspaper article. So time to catch you up on some of the things that happened since my last blog. I declined a few flattering offers to become new the Chairman of Neurosurgery in a couple of countries, one in Australasia, one in UAE and I happily accepted the offer (=honour) to be the new visiting Professor of Neurosurgery in the University of California in San Francisco. No, I don’t need to leave the Victor Horsley Department of Neurosurgery for long, so if you are patients of mine, you are good.

Next, my world course…at the Wellcome Collection Building in Euston Road, a stunning neoclassical beauty built sometime in the 1930s. A museum, a library and a trendy place for coffee is about a mile from Queen Square. This is where people from North and South America, Asia, Europe and Australia came for my third Annual World Course in Advanced Techniques in Neurosurgical Oncology. Although only three years old, this course is considered to be the best course on brain tumour surgery. Three surgeons, one in America, one in France and one in Germany perform awake surgeries so they can test the sensitive parts of the brain before they remove them, maximizing tumour removal and preservation of normal function. The surgeries were projected on a large, cinema-like screen at the Henry Wellcome auditorium, modern and sophisticated, while the delegates, most of them senior neurosurgeons and department’s heads, were looking absorbed trying not to miss a thing. The other two days we had seminars, stunning 3D anatomy shows, lively debates, difficult case discussions.

Mitch Berger giving a spectacular lecture at the Henry Wellcome auditorium

Mitch Berger giving a spectacular lecture at the Henry Wellcome auditorium

and a close up to show how passionately  teaching his unique concepts on tumour surgery

and a close up to show how passionately teaching his unique concepts on tumour surgery

Guilhermes Ribas from Sao Paolo giving a masterclass on cortical anatomy

Guilhermes Ribas from Sao Paolo giving a masterclass on cortical anatomy

Here’s some of the feedback we had at the end of the course: “I could not have imagined a better course. I am impressed beyond anything I can express” The Netherlands – “The course, the content, the venue and the community atmosphere you created, all very special. an exceptional course” USA –  “It was undoubtably a tremendous amount of work putting together the best conference I have ever attended” USA – “I’m very glad to have attended this outstanding and very informative course. It was truly unmissable” Germany –  “You organised an outstanding course of superior quality. I have become inspired to improve my patient care and techniques”  The Netherlabds – An unbeatble  assembly of the superstars  of neuro-oncology”. Germany. When you see the impact that such events have to people’s lives, and subsequently to patients’ lives, it kind of makes you feel good…

Saturday night we had the course dinner at a place that no money can get you in, next to the river with a live quartet under oil paintings…first reception at the strangers room and then dinner at the members’ room at the House of Parliament. As the vast majority of the delegates were from oversees they were stunned by the beauty and tradition of the place. Towards the end of the dinner, before coffee I had to give the …proverbial speech. The course was so hectic, so I gave a very little thought what to say for about an hour before the dinner. I thanked my team for working so hard for this course, I teased a few people, and passed on the microphone to my honoured guests who praised so much this course. the vide was warm and uplifting, what a great way to finish this course! Next year is’s going to be five days long, with the addition of live discussions with the authors of the landmark papers in neurooncology during the last 10 years.

I had this idea when I found out that the author of an important paper, Jakola from Norway was in the audience. When I come up with ideas out of the blue I write them down on my Bamboo app, using a stylus or my finger… I have a folder, one of many, called “ideas” where I jot down whatever comes to my mind and my gut tells me it’s good. Many things I have done and completed now were written down one or two months or one or two years ago.

At the dinner table

At the dinner table

Delegates from all over the world enjoyed British tradition at the house of Parliament

Delegates from all over the world enjoyed British tradition at the house of Parliament

and the proverbical speech I had to give without thinking too much...

and the proverbial speech I had to give without thinking too much…

My “Ideas” folder is password-protected…so don’t try to steal my iPad,  you still won’t be able to read them…!

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