Do No Harm: Stories of Life, Death and Brain Surgery Read Online Free PDF Page A

again whether she really appreciated the risks to which she was about to be exposed. Perhaps she was very brave, perhaps naive, perhaps she had not really taken in what I had told her.
    In the changing room I stripped off and climbed into theatre pyjamas. One of my consultant colleagues was getting changed as well and I asked him what was on his list for the day.
    ‘Oh, just a few backs,’ he said ‘You’ve got the aneurysm?’
    ‘The trouble with unruptured aneurysms,’ I said, ‘is that if they wake up wrecked you have only yourself to blame. They’re in perfect nick before the op. At least with the ruptured ones they’re often already damaged by the first bleed.’
    ‘True. But the unruptured ones are usually much easier to clip.’
    I went in to the theatre where Jeff, my registrar, was positioning the woman on the operating table. My department is unusual in having American surgeons from the neurosurgical training programme in Seattle who train with us for a year at a time. Jeff was one of these and, as with most of the American trainees, he was outstanding. He was clamping her head to the table – three pins attached to a hinged frame are driven through the scalp into the skull to hold the patient’s head immobile.
    I had promised her a minimal head shave and Jeff started to shave the hair from her forehead. There is no evidence that the complete head shaves we did in the past, which made the patients look like convicts, had any effect on infection rates, which had been the ostensible reason for doing them. I suspect the real – albeit unconscious – reason was that dehumanizing the patients made it easier for the surgeons to operate.
    With the minimal head shave completed we go to the scrub-up sink and wash our hands and then, gloved and masked and gowned, return to the table and start the operation. The first ten minutes or so are spent painting the patient’s head with antiseptic, covering her with sterile towels so that I can only see the area to be operated upon, and setting up the surgical equipment and instruments with the scrub nurse.
    ‘Knife,’ I say to Irwin, the scrub nurse. ‘I’m starting,’ I shout to the anaesthetist at the other end of the table, and off we go.
    After thirty minutes of working with drills and cutters powered by compressed air the woman’s skull is open and the uneven ridges of bone on the inside of her skull have been smoothed down with a cutting burr.
    ‘Lights away, microscope in and the operating chair!’ I shout, as much from excitement as from the need to make myself heard above the rattle and hum and hissing of all the equipment and machinery in the theatre.
    Modern binocular operating microscopes are wonderful things and I am deeply in love with the one I use, just as any good craftsman is with his tools. It cost over one hundred thousand pounds and although it weighs a quarter of a ton it is perfectly counter-balanced. Once in place, it leans over the patient’s head like an inquisitive, thoughtful crane. The binocular head, through which I look down into the patient’s brain, floats as light as a feather on its counter-balanced arm in front of me, and the merest flick of my finger on the controls will move it. Not only does it magnify, but it illuminates as well, with a brilliant xenon light source, as bright as sunlight.
    Two of the theatre nurses, bent over with the effort, slowly push the heavy microscope up to the table and I climb into the operating chair behind it – a specially adjustable chair with armrests. This moment still fills me with me awe. I have not yet lost the naive enthusiasm with which I watched that first aneurysm operation thirty years ago. I feel like a medieval knight mounting his horse and setting off in pursuit of a mythical beast. And the view down the microscope into the patient’s brain is indeed a little magical – clearer, sharper and more brilliant than the world outside, the world of dull hospital corridors and