Mr Nobody

A text gave another little nudge and woke up my iPhone. It was from secretary this time. The “Pearl” had closed. What?! My favorite place for business lunch had closed!… Housed in the neoclassic Renaissance Hotel in Holborn, stunning interiors, understated luxury, and amazing food made by Michelin-starred French chef Tanaka. And only five minutes walk from Queen Square…This was my regular for business lunches. I like business lunches. I find them very worthwhile! No, I am not a businessman closing multimillion pound deals :-) and I don’t close deals involving money (how boring!) but I do close agreements and collaborations. No better way to close than during dessert. That means do not go for a hard sale, rather ease into it… leave It leisurely for the end…If you don’t have a regular restaurant where they know you, by name!, then find one!…you need one! trust me!

So my secretary couldn’t book a table…I was expecting Roger Stupp, Professor of Oncology in Geneva and President of the (very prestigious!) European Organization for the Research and Treatment of Cancer (EORTC). Roger came to deliver the Annual Lecture at Queen Square on 19 September, a lecture given every September to celebrate the memory of Victor Horsley, father of modern neurosurgery and the world’s first brain surgeon! Roger is the man who introduced Temozolamide, a chemotherapy agent that prolongs substantially the life expectancy of patients with Glioblastoma, the most aggressive tumour that affects the human brain, one of the biggest discoveries of the last 80 years.

World-class oncologist Professor Roger Stupp delivering the 5th Annual Sir Victor Horsley Seminar at the lecture theatre of 33 Queen Square.

World-class oncologist Professor Roger Stupp delivering the 5th Annual Sir Victor Horsley lecture at the lecture theatre of 33 Queen Square.

So I could not take Roger at the “Pearl”. I asked my secretary to book the “Axis”, at One Aldwych. Understated but with gravity, perfect for dinner with good friends (like Roger) or for business. Top service and food is what you expect from top restaurants but little touches make all the difference. For example they brought the complimentary, after dinner, sweets in two large, square heavy glass bowls, with a thick layer of brown sugar (and four chocolates) and pink sugar (and four marshmallows). I don’t eat sweets (have my reasons, no I am not on a diet, and no, am not diabetic! :-) but they got top marks for presentation!

Next day I was operating in theaters, then back to my office to look at letters, answer emails and see visitors. I went out of my office for ten minutes, when I got back, I had forty seven new emails in 10 minutes. I usually get a couple of hundred emails a day. No I can’t read them all…I scan the subject…perhaps read the first line and see whether I need to read the whole email…so, if you want to email me (or anybody else whose reply is crucial to you) here are the email rules:

First, choose an attractive (=not boring! title). Avoid abbreviations (such as “TMC outcomes”, “TGM board”, Ref 92321). Sum up in the title the purpose of your email (i.e. Spanish Neurosurgeon seeks fellowship, or “Second opinion from Italy”). Second, be brief. One paragraph is the max. Avoid introductions longer than your arm, avoid complex explanations, be very brief and to the point. Third, make sure the person you are emailing is the right person. Don’t email me if your paperwork for your observership is not ready, I can’t help you there. Fourth and last, speak with your heart, no need to polish or follow etiquete. Enough said…

While in my office during lunch time, I glide my fingers on the trackpad and wake up my gorgeous 27 inch iMac. While munching for ten minutes or so, I watch the 3 daily movie trailers from iMDb. During these ten minutes I get knocks on the door from Hilda, my NHS secretary, my registrar, other registrars, fellows, medical students, observers…Its okay, my office door is always open, well it’s actually always closed physically, but you know what i mean :-) One of the three two-minute movie trailers got my attention…”Mr Nobody” was the title, so I clicked on my iTunes icon and downloaded the movie to watch a few days later in the week.

I can’t watch a whole movie, don’t have the patience…usually takes 2-3 installments…so I watched “Mr Nobody” in three parts, in bed, on the bedroom floor and in the bathtub…the movie starts with “Mr Nobody” a very old man, the last man about to die in a society where everybody else has become immortal. Mr Nobody starts to remember his life as a child… at a train station with the train slowly departing…his mother is on the train…his father on the station (called “Chance”)…his parents are separating and he is torn, which path to take, what decision to make…years go by…snapshots from his life appear…his marriage with a woman who change faces…they are different women…different families…different decisions…whole new different lifes…The young boy does not want to decide while the train with his mum on the train and his dad on the station is departing…he thinks that if he does not decide all possibilities are open…but this does not change the question, which path to take, which decision to make…

Have a think about how many decisions you are taking every single moment. Why are you reading now this blog now, what brought you here and you are not in front of a TV or talking to your friends on the phone or being on a plane to visit Peru for the first time in your life?…Think about the things you do every day, every hour, every minute…Are you govern by the fear of the unknown and you stick to something familiar?…do you follow the path of least resistance and least effort?…you do what you do because everybody else does the same and you want to appear “normal”?…Imagine being “Mr Nobody” of the movie, seconds before you die, imagine things you wanted to do and didn’t do because you weren’t brave enough… because you were afraid of pain…because you worried about what other people would say…think! you are about to die!, where are these people now? and how’s the pain of not having tried what you really, really wanted…So back to the original question, “which path is the right path”?… here’s what Mr Nobody says: “Every path is the right path!”…comforting thought but not sure I agree…

On Friday around 12 pm I was in the coffee room on operating theaters. A quick pit stop as my anesthetists were putting my next patient to sleep. I like to sit cross-legged on a chair in the coffee room… no I don’t meditate in coffee rooms… I do meditate, but usually sitting on the white carpet of the bedroom floor. Not sure what people mean by meditation…well, I know the theory but I don’t particularly care… I have my own method…I like to sit quietly and reflect on my day, thinking what type of person I’ve been during the day; and what type of person I want to become the next day. As you evolve in your life, it’s not important what you learn (some dry facts, short-lived news, destructive gossip…) or what you get (objects you buy from fancy stores or money you earn) but what type of person you are becoming… Everything stems from your identity…what you think of yourself…what’s the opinion of you for… you!… that’s the bottom line of bottom lines, nothing else matters!… Does this sound arrogant?…its one of Mr Samandouras Iron Rules, so get over it! I am not talking about work environment, I am talking about the core of your being!… Do you think confidence is based on feedback, “constructive” criticism, opinions of others? Don’t think so…

So no, I was not meditating, I was chatting to Bob Bradford, one of my senior colleagues. Suddenly the recovery nurse came in and very politely and rather hesitantly told me that my previous patient who had been in recovery for an hour, after he woke up he was not moving the right hand side of his body! I had performed a complex brain operation using a blue dye called Gliolan that is taken up by the malignant cells of the tumour but not the brain. Under a blue filter on the microscope the tumour looks bright pink, like a hot coal, so you can see better the distinction between normal brain and abnormal tumour. My philosophy is aggressive tumour removal, I don’t believe in timid debulkings, is this patient has one chance to prolong significantly his life is by starting with radical tumour surgery. And this can come at a price, a neurological deficit, weakness or paralysis.

I turned to Bob who was sitting next to me. “That’s not possible! Complex brain tumour surgery has a 5% chance of paralysis in all big series, but not mine…”Well, today is the day!” Bob said back to me with the quite wisdom of his 25+ years experience…”No, today is not this day! can’t be” I am sure that everything went extremely well! I went to see the patient myself, he was still drowsy and not fully assessable, I lift his right arm up and left it fall floppy to the bed! Yes it was… paralyzed but I felt a whisper of antigravity resistance, no scale can measure this but I did feel it, I was certain!… “ give him more time” said to the recovery nurse and went back to operating theatre to carry on my case.

If my patient was still paralyzed after an hour, the next step would be to do a CT scan. Was there a haematoma? Did I damage some of the neural circuit? I remember an old boss of mine who every time we were taking someone with a post-op deficit for a scan, while waiting in front of the monitors for a minute until the scan is done and the images appear suddenly on the screen, used to say “I hate this minute”… you don’t know what the scan will show, did you damage this patient or it is just swelling that will settle in a day or two…Two hours later I went back to recovery to see my patient. He was now fully alert and was moving everything, back to normal! I saw Bob in the corridor, “my patient is now intact! Today was not the day!” Bob smiled pleased.

Tuesday evening I just made it to Euston Station on time. I had finished the neurosurgical consultants meeting a few minutes after 6 pm and grabbed a taxi from Guilford Street. I sat down on my train seat, number 3, coach G. While putting by bag on the rack a young woman sat opposite me. “How’s your day” asked her relaxed. “ I am good” said and added “I am sitting here, so you will be seeing my face for the next 2 hours” in a cheeky way. I thought her accent was from Liverpool, it was actually from Manchester. Anyway I can’t tell the difference, other that it was not from London and it was from somewhere North. I was off to a 24-hour trip to Liverpool, invited to take part to an Advisory Board. I normally drive but I had to read a bunch of papers for the board meeting next day so I wound’t mind a couple of extra hours. But my fellow passenger was chatty, so I had to cut down reading time..oh well, nothing goes perfectly as planned, you have to adjust!… but she gave me her… cocoa cookies (how adorable) autographed with her name :-) that was worth the lost reading time…

I got in my room after 10 at night, the Crown Plazza was overlooking the river, it was dark outside, I could see a string of yellow lights in the harbor, I could feel the open horizon in the dark…I couldn’t have for dinner three cocoa cookies, so room service it is. There was no fish on the menu, so Keighley from reception called the chef and in 20 minutes I had in my room a lovely decorated monkfish with green salad, orange juice and a fruit salad. The meeting was good, made new friends from America and got back to train an hour ago. It’s dark outside my window, yes, I am writing this blog on the train, approaching London.

Friday night I went to see my patients who I would operate on Saturday, three complex brain tumours, two spinal cases. Yes, I know, …whole Saturday… My list of patients is so long and…so I have some catching up to do, hence the Saturday list. While walking out from the “Lady Ann” Ward on the 4th floor, a woman with a probe attached to her brain stopped me “are you Mr Samandouras?” I though she was an old patient of mine. She told me that she never met me before, she was under the care of Mr Watkins, one of my very capable colleagues and President of the International Hydrocephalus Society. She’s been in and out hospitals for twenty years…but she’s been reading my blog and recognized me from my photo…apparently my blog is quite an… inspiration and wants to start her own blog with her experiences as a patient! Bless! (PS 25 October: This patient has actually started her blog about donating unused shunts to underprivilledged countries with the help of  Lewis Thorn, one of my colleagues. So she kindly sent me an email, observing all my “email rules”! and with the link of her wortwhile blog, and how she saw our meeting in the ward,

On Tuesday afternoon I went to Lincoln Inn Fields, home of the Royal College of Surgeons. I was running a cadaveric neurosurgical course. Sixteen selected trainees from London in a laboratory with microscopes and instruments dissecting systematically the human brain, one part at a time, once a month for nine months, the whole academic year. the College has a stunning building, history, tradition and gravity…I parked outside the college 10 minutes before the start time and walked in 2 minutes before we started ie on time! Do you ever notice how the same people are always late? How’s that possible? Being late is never factual, is always subconsciouss…Its always the same people who are always late and the same people who are always on time. Anyway the course was tremendous success. When you operate in real patients you can see a small part of the brain through a small corridor, in a cadaveric head you can see the whole picture, vessels, nerves, fibres. Our trainees loved it and wanted to do more but at five we had to stop, my parking time was running out :-)… Next installment is beginning of November…

Sixteen selected London neurosurgical trainees are preparing to start the course at The Royal College of Surgeons on 15 October 2013.

Sixteen selected London neurosurgical trainees are preparing to start the course at The Royal College of Surgeons on 15 October 2013.

Thursday evening of the same week we had a training session, again!, at the operating theatre learning  how to use an ultrasonic aspirator, a sophisticated “hover” that removes parts of the diseased brain. We practiced using oranges (photo)!

Practice on oranges before you use on real brains! some of our trainees in an operating theatre training session.

Practice on oranges before you use on real brains! some of our trainees in an operating theatre training session on Thursday 17 october 2013.

At six I had to go, another committment around the corner…and then back to the hospital to see my patients. People often ask me, how do you find time to do all you do? I have no idea, sometimes I think to myself “is this really me?…is this really happening?…” and that’s for what is in this blog, but mostly, for what’s not here!…but I do feel the delight of every small and big success, I do feel the pain of every challenge, so yes!, it is real…Its late now, but the night is still young, time to go out…in a few hours another big day in a big city will start…

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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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Evening news

On Wednesday I walked in theatres around 8 am in a dark blue suit. My patient who was about to go to (anaesthetic) sleep was surprised, “are you not wearing your scrubs?”, she was worried that I might not do her brain tumour operation myself! No, I don’t normally wear a suit in theatre! But I was coming from an interview… No, I am not leaving Queen Square!… I was interviewed for the position of Clinical Lead, a Neurosurgery Director to join efforts with a senior colleague. A lot of responsibility to run the biggest (and more prestigious) Neurosurgery Department in the country and the most famous in the whole world! At 7:30 am I gave a 10-minute presentation and then answered questions to the interview panel for twenty minutes. How do you convince someone that you are the best person for the dream job? Bombard them with numbers and data? dazzle them with grand plans and inside knowledge? stand straight, make eye contact and smile a lot? I prefer a different approach…I prefer to love and to feel my ideas, to own my words, to let go of what others might think of me…I know it sounds too abstract, but you either feel what I am talking about or you are not…

After the interview I put on my scrubs and went to the operating theatre. There was some stiff competition for the job, but I focused on my patient’s brain tumour who was now my next difficult opponent… for these hours, the only thing that mattered to me in the whole world was to bring my patient back from the other side…these hours the time disappears,  I don’t know if what was elapsed was minutes or hours, I don’t feel thirsty or hungry or tired, no matter for how many hours I ‘ve been standing there, my mind is empty from all thoughts but one, how to bring my patient back alive and intact…My next case was an awake surgery, I had to remove a tumour from a part of the brain that has important functions in moving the mouth and affecting articulation, the safest way is to map the brain and its dangerous areas by temporarily paralysing parts of the brain while the patient is fully awake, talking and moving. You have to select the right patient for this operation. The brain itself has no nerve endings and feels no pain! On my dark operating theatre with dim lights that looks to me like a real-life dramatic painting, I still find looking at a patient, who’s talking normally with a brain exposed, as one of the most extraordinary and magical things I see in my life.

In cases like these the operating theatre is crowded with speech and language experts to test the patient, neurpphysiologists with EEG equipment, numerous assistants and observers and my current entourage of medical students who follow me wherever I go (luckily in the hospital only :-) I sometimes mistake their names but still respond despite being called the wrong name! one of them said “its alright Mr Samandouras, just call me the name you find more easy!” Bless! Then I had to make extra effort not to mistake his name again! When I finished and walked out my operating theatre, I saw happy faces, colleagues were congratulating me and shaking my hand,  people were genuinely happy, you can always tell a fake from a true smile, yes (!) I did get the job!!!

The world's most famous neurological address...

The world’s most famous neurological address on my iPhone…(this bike is not mine!)

The next morning, somewhere on A40, I slowed down as I was approaching a speed camera.  Then I resumed my “normal” speed on a three lane road. I did notice a biker, quarter of a mile behind me, who was riding slightly more carefully than most bikers, but didn’t look like a policeman so I didn’t think much of it and carried on. Well…the “careful” biker started speeding up and a flashing light suddenly appeared on his bike…when he was closer I saw the “Met Police” sign and he signalled me with his hand to pull over… Grrr, “here we go again”, I thought. But while he was riding next to my window for 100 yards or so, we eyeballed each other, and then he must have changed his mind and waved at me to just slow down and took the next exit and dissapeared in the traffic. Phewww, that was close! I was wearing my seatbelt, a crisp shirt, tie, tidy hair (by the way I changed my hair style, now fade-cut and glued at the back… okay, okay I will update my photo!), was that it? or he was in a hurry? don’t know…At least I wearing my seatbelt. Two weeks ago I was stopped by a (quite pretty) policewoman who talked my ear off for not wearing a seatbelt in the city. After fifteen minutes (!) of lecturing stationary in my car, I was so bored that I thinking seriously to go for the three points instead. She finally made me take an online course, where – would you believe it? – at the end I had to answer 40 multiple choice questions! The fact is that, despite being pulled over by the police at least once a month, getting caught on speed cameras, taking speed awareness and seatbelt (and ony other imaginable) courses, my driving license has still zero points, which is hilarious :-) But that’s it folks, I won’t mentioned again my driving adventures (except from when I am banned for driving…)

Last Wednesday night (after a busy day in operating theatres) while getting ready to have a night bath my phone rang. It was my hospital’s switchboard. Channel 4 news wanted an interview for next day’s evening news. A new electronic 3D atlas of the brain at a cellular level would be released worldwide the next day and wanted a brief interview on its impact on brain surgery…So I had to speak on National TV to several million people on a project I new very little (=nothing) about. But I am always camera ready :-) so I accepted! without thinking twice. I had an hour to prepare, so I downloaded the article and read it while soaking in the water (holding my hands outside the water!) and listening to (oriental-trance mix) music. The concept of the paper was easy, I got it in a minute (which was handy as, despite my efforts, the paper was already wet from the bath water). Then I went to the website to view samples and videos from the atlas. But they wanted registration and authorization that can take days before you can log in! Great… I thought, but I registered anyway and put in capital letters that it is “for UK national TV”. I got a reply (and access) in 10 mins! God bless all the computer nerds who stand by their computers! I downloaded videos, played with software, yes! I now knew excactly what this was all about.

Next day I met with the crew and the media and communication lead for the hospital, outside theatres. Bright lights, cameras, no make up artist! They wanted me out of my sleek suit and in my blue scrubs. Apparently viewers looove surgeons in scrubs (I had to play the part) …no problemo…scubs are in my cool book too! Tom Clarke, Science Editor of channel 4, gave me the heads up on what’s coming and started a little Q&A in front of millions… I delivered some great lines!!!… When Tom asked how thin are the slices of the new Atlas, I put my thumb and index finger together and said “look! my fingers, they are nearly touching! This is one millimeter. Imagine a slice 50 times thinner than that!” Tom seem very impressed (these guys are really pros in getting emotions across whithout talking) and asked me surprised “How much information is there in this small space?” “The number of nerve cells in this space, are more than the number of stars in the sky at night”, replied.

With no preparation and without knowing the questions beforehand you have to think on your feet and improvise in front of millions! It turns out (=they told me) that I got a knack! :-) Do you want the trick?…Here’s the trick: forget the camera, forget that you are talking to many million of people. Just imagine that you talking to one person only, someone you really like and trust…We finished shooting and they were all soooo pleased! Later the same evening, while on call taking emergency referrals and after a whole day’s outpatient clinic (what a day!) I sat down to watch the clip on my iMac. I was waiting for everything (or most of  what) we talked about to be on TV. It turns out that TV time is different that real time! :-(  They had a short segment and missed some of the best parts and my punch lines including my “starry night” line!!! :-( They asked me ten questions and showed one! Hey ho… still the short segment was cool, and Tom will be back for more. So don’t despair my lovely funs, my TV career is just starting!! :-) Later that night I had tons of texts and emails from friends who were super excited to see me out of the blue on national TV, some wathced it twice, on channel 4 and then an hour later on 4+1 and recordered it! thank you guys!

Talking to Tom Clark, Scxience Editor of Channel 4 Evening News

Talking on National TV to Tom Clarke, Science Editor of Channel 4 News outside my operating theatre 3, on 20 June 2013

Showing the details of the new atlas to Tom and the viewers.

Showing on my MacBook the details of the new atlas to Tom and to the viewers.

For the last 30 days I am doing a self-experiment (I love self-experiments!) Here it is: No news, no newspapers, no magazines, no TV, no mindless internet browsing (emails and bookings only) for a whole month straight! Some people are shocked!… Can you live your life without news?! No TV?! Why?!…Well…its not that complex. I want to shed (some more!) a false world imposed upon us, some unimportant details blown out of proportion and presented to ourselves as essential facts, what forms “socialization”, which is universally agreed conventions on what matters and how we should live our lives. Fact is, we already know what is important, we know how to live our lives, we know how to get whatever is we are looking for, every man is born with a marvellous internal compass.

Two and half thousand years ago, my great-great-…great-grandfather, Plato, the greatest philosopher to ever walk the face of the earth, theorised that we are all born with the knowledge we need and later in our lives we don’t learn anything new but we only rediscover this knowledge. What an astonishing concept! Would you do something for me? Remember the last time you were in a dilemma, a very difficult situation, especially when the stakes were high…Did you or did not know instantly what you had to do? and I literally mean “instantly“! But what did you do instead? You tried to rationalise, filter it through socialization, “what other people will say”, “is it the right thing to do, seems too bold”, “nobody would do that”. And you did something more convenient, because socialization filters and distorts the internal knowledge, our true voice is being berried in an external amorphous noise…

Have you ever wondered why we go to school, listen to stories, watch movies? why we do research and look down microscopes, send rockets to the stars and study the core of the earth? why we ask friends for opinions, why we are drawn to emotions, why we want to learn pretty much everything from what’s on cheap newspapers to timeless classics? There is a reason, the only reason… in reality we don’t really care about what’s happening in the outside world, we only want to learn what’s happening inside us, we want to understand ourselves, every one of us… famous and totally unknown, ridiculously rich and starving to death, illiterates and scholars, saints and sinners, we all want to understand ourselves…This world does not exist beyond our mind and our heart, this world cannot be more beautiful (or ugly) than our mind is… it cannot be more brave (or timid) than our heart is… All knowledge is self-knowledge… all anger is anger to ourselves… all forgiveness is self-forgiveness…all craving for external power is a cry to battle ourselves, the most difficult battle of all…If we master ourselves the whole world will surrender…

…In the meantime the summer has landed full of promises…This week am off to feel the hot sun of Athens during a conference; then invited lectures in London; short trip to Tate Liverpool to see the seductive colours of  Marc Chagall’s dreamlike paintings (I adore Chagall since I was medical student. Yes, I am even going to Liverpool (!) :-) to indulge his colours. Then my World Course, the biggest in the world (!), with one hundred and twenty people coming from the four corners of the earth (=hundred and twenty new friends!); and then off to… somewhere with silver white sands… infinite tranquil ocean…cerulean waters wrapped in endless sky…but you know it, you’ll never read about it in this blog!

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Saturday Night

What were you doing on Saturday night? Around midnight… where you out drinking with friends, sitting hypnotised in front of a screen panel, were you asleep? (that’s the worst!). As of me, I was looking down at the operating microscope, I was looking at an angry aneurysm, a weak spot at a brain vessel that could burst any second and kill my patient in front of my eyes. Have you ever looked at an angry aneurysm “face to face”? Have you ever felt a dark storm coming?

The operating theatre number three was dark. When I operate I like only the microscope’s light beam to cut through the dark room. Not because its more theatrical (that too!) but because I want to shut out everything outside my hands and my patient’s brain. It was midnight but I had two neurosurgical residents assisting me, two more junior trainees were also observing, two anaesthetic residents, one consultant anaesthetist, three theatre nurses. In my favourite theatre three at Queen Square, around midnight, with eleven people above a patient, you could hear a pin drop. I knew that the aneurysm could burst and cause catastrophic haemorrhage, all beautifully dissected vessels and nerves would be flooded with blood at a split second. Yes, I was ready for the battle, and no, I don’t panic, I never panic. And I have been through quite a lot life and death battles…If I panic my patient will die. But that moment, with eleven people in theatre and another ten million in London, when you are standing there starting your battle, everyone and everything fades away, its only you and your defenceless patient, you are standing there all alone, the loneliest person in London…

An hour later while my team was closing, I went to speak to my patient’s relatives. I got big, happy hugs! On Monday when I told the story to one of my residents she said “Ohhh Mr Samandouras…, I want to hug you too!” Bless! But no, I don’t save lives regularly every Saturday night. Last Saturday night for example we were at a very cool bar in London (read on!).

Wednesday midday tome for a quick bite at Brunswick, next to Queen Square. I love this place, especially when is bathed on sunshine. Every Saturday they have a world cousine fair with home made exotic food from all over the world.

Wednesday 5 June midday, time for a quick bite at Brunswick centre, next to Queen Square. I love this place, especially when is bathed on sunshine. Every Saturday they have a world-cuisine fair with home-made exotic food from all over the world.

On a day like today, 5 June, couple of decades ago, something extraordinary happened in the life of a man. It was the morning after the Chinese army had violently removed protesters from Tiananmen Square in Beijing, China. The huge square was deserted from fear of violence and death. In the massive, empty roads a column of tanks are moving rapidly. Suddenly, a lone man with two grocery bags runs in the empty street and stands in front of the moving head tank. The tank and the entire column stops!!! After a few seconds the head tank tries to manoeuvre the man but again the man places himself in front of the tank. The tank stops again! The man then climbs on the tank and starts to talk to a crew member at the gunners hutch. Have a look at the YouTube video, its breathtaking!  How is it possible for an average man to do this?

Our brain is designed to protect us; to avoid danger; to obey to fear. Our brain will do anything to protect our lives: it will threaten us; it will lough at us; it will lie to us. How come, an average man can overcome his amygdala-evoking fear and can do something so exceptional? It is the same obstacles to overcome for people who dare to do what they dream of, what is right, what their heart desires… Cross the atlantic with a small boat, climb a remote mountain peak, speak up when everybody else put their heads down, move to a different country, make a brave fresh start… Nobody knows what happened to the tank-man with the two grocery bags, nobody knows his name. But he is my hero, well…, one of them, and If he is still alive I would looove to hang out with him one afternoon in some of Beijing’s hutnogs or Forbidden city’s courts.

A man with two grocery bags stops a column of tanks. One of the most iconic photos in human history!

On a day like today, an unknown man holding two grocery bags stops a column of tanks. One of the most iconic photos in human history!

On Wednesday I finished my operating theatre list a bit earlier for a reason. I was off to Sheffield. No, I wasn’t after some Sheffield steel for my surgical knifes. We had the biannual conference of the Society of British Neurosurgeons. My team was presenting our results on a difficult group of patients harboring a rare posterior fossa tumour called medulloblastoma. Never been to Sheffield before. Most people took the train. I prefer (love!) to drive. It took me just over couple of hours to get there. I was happy to see old friends and make some new ones. These days I am used to people who come to talk to me, trainees, students, new consultants. Thing is, I don’t know most of them, but they know me, and that’s fun. A couple of years ago trainees would come and ask me to sign their “Neurosurgeon’s Handbook” copy. It felt a bit unreal at the beginning but now is totally normal.

A medical student, intelligent face, purple shirt, black bow tie(!) came to talk to thank me and tell me proudly that this year his presentation did not raise any questions on the topics I asked him to improve a year ago. I had no idea what he was talking about, but an hour later it came to me. Some neurosurgeons from the audience try to be smart by cornering some inexperienced trainees or medical students. Morons! I usually say something good (they deserve it!) and try to make a suggestion or two so they can have their paper improved and possibly published. This medical student took seriously my 30-second suggestions a year earlier and worked on those and now came to thank me for my advice. What a splendid young man, I am sure he will do very, very well!

In Sheffield I was very proud to see one of my trainees taking the annual Norman Dott Gold Medal for acing in the British Neurosurgical Boards. I am not surprised, Harith possibly knew more than most of his examiners. About three and a half years ago, when I was starting my career as a Consultant Neurosurgeon, Harith was one of my first trainees. Although my practice was still developing back then, Harith was very enthusiastic for going to work for me, (you see, I remember things like that, they make all the difference in the world). We are lucky to have trainees like Harith at Queen Square, smart and polished and with a big smile on their face! I was teasing him that when he stands up to get the gold medal he should say to his acceptance speech that he got the Gold Medal all thanks to my book! which is true! :-) Well done Harith, you finally made it to my blog (and please don’t run around in bars and clubs wearing the gold medal on your chest with an unbuttoned shirt :-)

My trainee Harith (first beneath the middle portrait) getting ready to get the Gold Medal in the black tie dinner. Well done Harith!

My trainee Harith (standing first beneath the middle portrait) getting ready to get the Gold Medal in the black tie dinner. Well done Harith!

At the evenings of both conference days there were some social activities. The social program is always predictable. Black-tie dinner, repetitive toasts, dull chit-chat, neurosurgeons talking about neurosurgery even when holding a glass of champagne (really?!), reps getting drunk… Even when we went later to some bars in Sheffield, I was bored out of my head… Back in London I had to replace these memories :-) with something more trendy and fun. We went to a cool bar (one of my very favorites) at SW3, what a difference in style… But you know the rules! no personal stuff here…One of the songs was so fresh and summery so I shazamed it, here it is, “get lucky” from Pharell Williams. The lyrics is cheese but the tune is like… getting ready to go out to some beach town on a warm, summer evening…

And talking about summer, I am off to the international hydrocephalus conference in Athens in a couple of weeks. My team is presenting a series of rare endoscopic operations of intraventricular tumours. Despite being battered from unemployment and financial problems, Athens remains a charming grand city with cool places to hang out and wonderful people to talk to. The bars have style (nothing like Sheffield!!!) and people are beautifully dressed. I might even show you some photos next time!

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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 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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On New Year’s Day I had a phonecall for a patient who had a seizure and had to be transferred from the ward to the intensive care unit; another call for a patient who had a haematoma in the right side of his brain and became gradually unconscious; and a call for a patient with a spinal lesion who felt that her leg suddenly started to feel dead. No, I was not even on call. But I do want to know if any of my patient develop new problems. Sure, there is an on-call neurosurgeon but I very much prefer to know what’s happening to my patients at all times. I never switch off my mobile, expect of course when I am about to take off (at least on a couple of occasions I boarded on the plain while talking to the on-call resident under the not so happy glances of stewardess and trolley-dollies).

I was on call a few days earlier, just after Christmas day. Yes, something happened during that on call. But first lets go a few days earlier, a few days before Christmas. We took our neurosurgery trainees out for a dinner. We had a brief workshop earlier, how to put screws into spinal models, a useful technique for trainees (photo).

Some of our trainees learn how to fix the top part of the spine, when its falling apart

Some of our trainees learn how to fix the top part of the spine, when its falling apart

Then we headed to The Russell Square Hotel, pretty much next to Queen Square. We had our dinner at the “library room”, tall ceilings, glass bookcases with very old books. After we sat down the a professional man came to introduce himself, was the hotel manager, a Greek/Cypriot living for decades in London. he told me that this is London’d first organised hotel established sometime in the 1850’s, everything in the library room was from that date. Whoa! Our trainees and a few consultant colleagues wore their party hats, pulled crackers and had good time (photo and video). By the way I introduced videos in my blogs, add a bit of action twist.

Surgical masks and hats replaced by party hats!

Surgical masks and hats replaced by party hats!

The weekend after Christmas I was on call . Londoners and tourists alike were fighting for the Sales. I don’t like the sight of people rushing and elbowing each other to grab a shirt or a pair of shoes. Its a bit uncool. And I avoid as much as I can shops anyway, I prefer buying from the internet, street markets that thrived in different forms for thousands of years will become extinct like dinosaurs. Many retailers close down one after the other. Are you surprised that hmv went bankrupt? I am surprised it lasted so long. And by the way, do you understand people who buy CDs or DVDs? what are they going to do with them? Completely unnecessary, everything is online now, even the new 27 inch iMac has no optical drive, couldn’t agree more.

The on-call weekend was busy, people struck with all sort of maladies days only after they spent time with friends, family and loved ones around the Christmas dinner table. Some pulled through, will have more Christmases, will exchange gifts next year, will make new friends, have more dinners and drinks with friends, will achieve more, will see more, will experience more. But not all…

On Saturday my registrar called me about a nineteen year old girl. She had terrible headache. She was taken to the local emergency department where a brain scan showed subarachnoid haemorrhage, bleeding in the space between the brain substance and the membranes that wrap the brain. This is coming from a weak spot in a brain vessel called aneurysm, a ballon-like dilatation of the vessel lumen. Aneurysms are usually present for years before they eventually burst releasing catastrophic blood in the brain. This is the most severe form of stroke affecting young patients.

Patients with this type of haemorrhage are admitted to the neurosurgical unit where they have a blood vessel test called angiogram to identify the responsible vessel and then the weak spot is glued from the inside of the vessels without opening the head. Difficult aneurysm require a brain operation and placement of a titanium-made clip across the neck of the aneurysm to exclude the weak spot from the circulation, thereby avoiding the risk of further haemorrhage.

Upon arrival our nineteen year old patient had another scan that showed that the poor girl had a second major bleed hours after her first bleed. She was taken to the angio suite, at the basement of the hospital where the weak vessel was identified and the aneurysm was sealed off. She was then taken to the operating theatre where my registrar inserted a pressure monitor into her brain. Although her ventricles, the fluid-filled cavities of her brain were not dilated, I felt that we should insert an external catheter to drain some of this fluid to give her the best chance of recovery and instructed my registrar. As she was intubated and ventilated we could only monitor her status by direct readings of her brain pressure. Pressures around 15 mm of mercury  are generally considered normal for her age. Any higher pressure means that we need to intervene immediately. Her initial pressure recording were no more than 10-12 mmHg. so far so good.

Among numerous referrals and phone-calls my registrar called me around midnight. The young girl’s brain pressure has been up to 20s for the last quarter of an hour. Our anaesthetists in Intensive Care Unit had already tried several manoeuvres but the pressures were still high. Her pupils were still working. I asked my registrar to take her immediately to the operating theatre and remove large parts of her skull to decompress the tight brain. Preparing the patient for transfer can take time as anaesthetists need to follow a protocol. I know that even if the patient needs to be transferred only for 30 meters from the intensive care unit to theatre, this can easily take half to one hour. So I was very explicit to him “take her to theatre, now!” “I haven’t done this type of operation yet” was his reluctant reply.

We normally get very experienced trainees at Queen Square, usually at the end of their training, and can do quite complex operations. But not this time. “Okay, take her immediately to theatre, I am coming” said back. I entered the operating theatre when the young girl had just been placed on the operating table. I made a cut in the skin from in front the right ear to the left. I then removed very large parts of skull to relieve the severely compressed brain. The brain is wrapped in a tough membrane called the dura, normally you can see the brain underneath pulsating with each heart beat. Her brain was very stiff, the dura was extremely tight, not a good sign at all. We normally cut around the tough dura but if the pressure is too high this can lead to uncontrolled brain herniation. I made several slits, 10 cm long to release the pressure. The brain started to herniate under high pressure, that’s in keeping with pressures of 50s or 60s, and that’s incompatible with life. I released the brain at all areas possible, and after an hour I left my registrar close up. Twenty minutes later i had a phonecall from theatres, my register had problems closing the skin together as the brain was far too swollen. I scrubbed up again and closed the scalp.

In the morning time to talk to the parent and relatives. How can you tell the parents that their nineteen year old girl won’t live to see another Christmas, get married, become a mother and die someday from old age? You need to tell them that they will die after their child, what a horrible thing for a parent. There are so many communication skill courses these days on how to break bad news, most completely waste of time, if you ask me. I always find that in their darkest hour people appreciate three things. First, honestly, this is not time for false hope. Speak clearly, slowly, give them time to absorb the information, time to cry. Second, release their guilt, there is absolutely nothing they could have done to prevent this, the death of their loved one is not their fault. And third make them feel that their loved one has received the absolutely best care, everything that could possible be done, has been done!

One day all potential diseases will be detected at birth, we will able to tell that this baby when he is 38 years of age he will develop a brain aneurysm and we will able to change his DNA so he will never die from a burst brain aneurysm. It may sound like a sic-fi (have you seen the movie Gattaca?) but it is very tangible.

In the middle of everything we had snow in London. The Square where people sit on the grass for lunch in the warm months was all white!

In the middle of everything we had snow in London. The Square where people sit on the grass for lunch in the warm months was all white!

My senior colleague Michael Powell, one of the world’s most experience pituitary neurosurgeons, has officially retired. his friends came from all over the world to wish him the best. I am talking about real friends, not Facebook friends. Is clicking “like” on a computer screen makes you friend with someone? How about travelling from the four corners of the earth to “like” someone!

Mick is talking to friends and colleagues in the "mouth of the wolf". Ed Laws and Nicholas de Tribolet are absorbed.

Mick is talking to friends and colleagues in the “mouth of the wolf”. Ed Laws and Nicholas de Tribolet are absorbed.

On Wednesday we had dinner at Bocca Di Lupo (literally “mouth of the wolf” but also Italian expression for good luck, sort of “break a leg” equivalent). Edward Laws from Boston with Mrs Laws, Nicholas De Tribolet, editor in chief of Acta Neurochirurgica  (with Mrs Tribolet) Paolo Copabianca, a world-renowned endoscopist and many others were present. Mick is never short of words but when he stood up to say a few things (and most of famous neurosurgeons took out their phones to record Mick) short of choked up in the end and sat down. What a lovely man. The next day another dinner at the dinning hall of Haberdashers in Smithfield’s market in London. The company of Haberdashers was established in medieval era some seven centuries ago. It has now moved from haberdashery (materials related to mens clothing and accessories) to supporting education in England and Wales. The Hall was stunning (photo). I went for the vegetarian option, and I got a lovely starter with sliced celery and a spoonful of mushed potato. More tasty than I thought it would be. “What’s for main” I asked the stiff waiter. The waiter clear his throat and announced ” Hmm, that’s the main, Sir! I will call the maitre d'” No, its alright, time for me to mingle and go from table to table to have a little chat with friends and strangers, while they are finishing their desert. In conferences and functions people hang around people they know. I do exactly the opposite, I avoid people I know and talk to people I don’t know.

The dining Hall of haberdashers, lots of space and impeccable service. If you go for the vegetarian option you better eat at home first!

The dining Hall of haberdashers, lots of space and impeccable service. If you go for the vegetarian option you better eat at home first!

It was sad seeing Mick retiring. I also saw Professor Thomas, Professor of Neurosurgery at Queen Square who retired in 2007, before I started. “I now have your office” said to him smiling, (not to piss him off), he’s a lovely and gentle man. His wife was excited as she started talking about her friends in Thessaloniki and wanted to swap seats with her husband so she can talk my ear off, but luckily! I was seating in a different table. Neurosurgeons can and go, careers wax and wane, but eventually they all go, so much for the politics and power wars. I remember when Mr Adams retired in Oxford, a very powerful and tremendously respected neurosurgeons. Everybody was talking for a year that mr Adams will retire. When he retired, he was forgotten within weeks. Once a new nurse overheard the name and asked “who’s Mr …Adams?”. Poor Mr Adams, forgotten already! If you are a neurosurgeons remember Life is much bigger than neurosurgery!

My friend Kirsten is also leaving Queen Square. Kirsten was organising the neuro-oncology multidisciplinary meeting every week. She now studies psychology and is going to a job relevant to her studies. Kirsty is good fun. We had a few coffees and quick drinks (so to speak as I don’t drink coffee or alcohol) during the last 3-4 years since I’ve known her and she’s always eagerly asking me “when are you going to write about me on your blog?” “Tomorrow” is my usual reply and then she panics “no, no, let me read what you will write first”.  Kirsten always gives me… feedback on how I do in the meeting (from if I fight a lot and cause trouble for example, to her opinion on items of my wardrobe). She’s got good heart, I wish her the best! And sorry Kirsten I haven’t let you read it before its published!

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Tales of two cities

I could see terminal 5 lit in the dark while driving to the long-term car park. It was still before six on a cold October morning. I was off to Paris for a day. After landing and following about an hour of heavy rain and strong wind the sky cleared. When I first moved to Paris in 2008 I was always surprised that the weather in Paris is not so much different from the weather in London. I finished my two meetings, time for a quick glance at the Eiffel tower (photo) and a stroll at Champs-Élysées dodging hordes of tourists. One of the coolest places to have coffee at the avenue (no, its not Hotel George V) is at the top of the Virgin store, best views and no tourists around! After you coffee you can sit on the marble stairs of the store, along with at least a couple of dozens other people, and read a whole comic book (what the Brits call graphic novels). French people absolutely love them (and so do I).

Does the world needs another photo of Eiffel tower? Yes it does, especially this one taken with my iPhone on a chilled October afternoon.

There is something in the air of Paris, the cobblestone streets and the little cafes, you do feel that writers, and poets, and film directors, philosophers and thinkers walked through the same streets and may have sat on the same chairs. I felt that long before I watched Woody Allen’s “Midnight in Paris”, where Gill (Owen Wilson) while vacating in Paris gets lost one night and around midnight goes into half real/half dream state of living that night, and a few other nights, adventures in the 1920s Paris. During these nights he meets a macho Ernest Hemingway and a dandy F. Scott Fitzgerald, gets his book reviewed by Gertrude Stein, talks to surrealist director Luis Bunuel, rides a taxi with T.S. Elliot and falls for Adriana (Pablo Picasso’s mistress) and together they go even further back in time, the 1890’s Belle Epoque, where they have a drink, at Maxim’s, with Paul Gauguin and Edgar Degas. All this time travel takes part in the nights of Paris and in the mornings he is going back to his normal life. He finally decides to leave his disinterested fiancee and live in Paris.

Parisian commuters late afternoon, thankfully not reading the Metro paper like their London counterparts!

Above ground Seine waits for you!

You feel more creative when in Paris, bit more laid back, possibly because everybody is laid back in Paris. Depends what you are looking for, to lay back or to do. There is no right or wrong, is whatever makes you happy. I give the nod to the latter, so time to go back to Orly airport taking the Parisian metro, quite smaller than London’s but overground for quite a bit (photos). Short trip on a plane, before you take off, you start preparing for landing. I left London in the dark, I am coming back in the dark. But the night London is lit, from the plane it’s an eye candy (photo).

Approaching London from air in the night; view through the window is stunning!

A few days earlier I had spent some time with another Frenchman, Hugues Duffau, Professor of Neurosurgery at Montpellier. I had invited Hugues on behalf of the Department of Neurosurgery at Queen Square to deliver the fourth Annual Victor Horsley Lecture. Victor Horsley was the world’s first neurosurgeon and the first person in history who was appointed as a “brain surgeon”, nearly forty years before neurosurgery started to branch off from general surgery in the 1920s and 1930s. There are very few operations that Horsley did not do for the first time in the world: ligation of a carotid artery for an aneurysm, transcranial approach for a pituitary tumour, division of the trigeminal nerve for trigeminal neuralgia, first epilepsy case, removal of a spinal cord tumour, invention of stereotactic frame and many others.

Our department which bears his name, organizes annual lectures to honor his memory. This year we invited Hugues Duffau, I have written about his work in tumours in eloquent parts of the brain in previous blogs. His lectures was streamed live through the web so people could log in and watch it live, no matter where they were. After the lecture I took Hugues out for a dinner. We talked about a lot while he was sipping his red wine (what else for a Frenchman!) and I was drinking my orange juice. No, I don’t drink wine (or alcohol or coffee or tea). People are joking, are you sure you are Greek? We never saw a Greek not drinking alcohol! Thing is, I haven’t drunk alcohol for, give or take, the last five years. When people ask me why I don’t drink, I tell them relaxed “lifestyle”. That’s true but I don’t go into details, as they usually ask me in a bar when everybody else around me drinks, so no need to challenge their reality.

The thing is, my brain is the most important part of me, (and the most important part of you), the cause for all I am and will be. I don’t want anything artificial to affect my reality, how I see the world, how I live my experiences. Yes, some experiences do not feel pleasant but so what, I want my brain to handle everything without an anesthetic. Isn’t this part of being alive, being able to feel? I don’t want to numb my brain with alcohol or give it a kick with caffeine, what a ridiculous idea! Yes, alcohol has been a social lubricant for centuries, but trust me, you don’t need alcohol to be sociable.

I do miss the taste sometimes, the elegant feeling of resting a heavy tumbler half-filled with a single malt on the soft arm of a leather chair, or I do rarely miss the aroma of a Haut-Médoc, but so what, nothing is more important than drinking the world around you with all your senses, that taste is the best!

Not long ago, two brothers came to my clinic. One was the patient, the other was the carer. The patient, a man in his late twenties came as an emergency a year ago with a big blood clot in his the left side of his brain. All this happened during a strenuous bodybuilding session. I was so happy to see him in his last clinic visit walking although his speech was still impaired. I had seen him a few times during the last year. He has done so well, it was time to discharge him from my care. While shaking my hands, tear came to their eyes. “We pray for you every single day” said his brother. When they left I felt a bit heavier. What a concept! people wishing good for you and praying without you having a clue. Do these prayers and wishes attach to yourself, become part of you and influence how you handle things?

Last week I received an email from a woman who had a very difficult operation a year ago. She had a small tumour in a very narrow and critical part of her brain called the third ventricle, anatomically in the centre of the brain. Here’s what she wrote a year after her operation: “Just wanted to say, thank you once again for all you did for me a year ago, this coming Friday.  I can vividly recall the night before I was due to come into hospital.  I had my bags packed, I read my bible the night before.  Woke early the morning of my admission to pray some more.  God was very good to me, for he blessed me with you as my surgeon.  I so cannot believe a year has nearly passed…….  I am back to work, enjoying life and have my health, and so much of this is due to your skill as a surgeon. Thank you.”

Man is matter and heart and spirit. Is spirituality part of the brain, a reflexion of cortical activity? I think not. I downloaded a book written by a Neurosurgeon, Eben Alexander, very well known in the neurosurgical community. This man had a near death experience after being in a coma after life threatening meningitis. At some stage his pupils were fixed and dilated waiting from brain stem stem tests. He did survive and what he describes is quite interesting. Have a look on Amazon.

UK’s most experienced pituitary surgeon, Michael Powell talks to our trainees for the last time before his retirement.

Every Thursday at 5:30 we have a neurosurgical lecture, usually geting a top neurosurgeon to give a lecture to our trainees. We have now started streaming it live on eBrain where it is all saved and can be viewed any time. So if you want to feel that you are at Queen Square, here’ the link (, you need to be member of professional organization to log in). Two weeks ago we had a legend in pituitary surgery, Mr Michael Powell. Mick is retiring (early) this January, so that was his last lecture to our trainees. Mick is one of these people who makes everybody comfortable around them, and virtually has no “enemies”! I was a bit sad to see his last lecture but Mick is excited to continue traveling the world, or hanging out in his flat in Nice, enjoying the sun of the southern France. Yes, there is much more to life than Neurosurgery, the horizon is wide open, but if you had to do something, job-wise so you won’t get bored out of your head, or even better something that blows your mind, what else could someone do?

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