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

committees and management and paperwork and protocols. There is an extraordinary sense of depth and clarity produced by the microscope’s hugely expensive optics, made all the more intense and mysterious by my anxiety. It is a very private view, and although the surgical team is around me, watching me operate on a video monitor connected to the microscope, and although my assistant is beside me, looking down a side-arm, and despite all the posters in the hospital corridors about something called clinical governance proclaiming the importance of team-working and communication, for me this is still single combat.
    ‘Well, Jeff, let’s get on with it. And let’s have a brain retractor,’ I add to Irwin.
    I choose one of the retractors – a thin strip of flexible steel with a rounded end like an ice-cream stick – and place it under the frontal lobe of the woman’s brain. I start to pull the brain upwards away from the floor of the skull – elevation is the proper surgical word – cautious millimetre by cautious millimetre, creating a narrow space beneath the brain along which I now crawl towards the aneurysm. After so many years of operating with the microscope it has become an extension of my own body. When I use it it feels as though I am actually climbing down the microscope into the patient’s head, and the tips of my microscopic instruments feel like the tips of my own fingers.
    I point out the carotid artery to Jeff and ask Irwin for the microscopic scissors. I carefully cut the gossamer veil of the arachnoid around the great artery that keeps half the brain alive.
    ‘What a fantastic view!’ says Jeff. And it is, because we are operating on an aneurysm before a catastrophic rupture and the cerebral anatomy is clean and perfect.
    ‘Let’s have another retractor,’ I say.
    Armed now with two retractors I start to prise apart the frontal and temporal lobes. They are held together by a fine layer of the meninges which is called the arachnoid, after the Greek word for a spider as it looks as though it was made from the strands of the finest spider’s web. Cerebro-spinal fluid, known to doctors as CSF , as clear as liquid crystal, circulating through the strands of the arachnoid, flashes and glistens like silver in the microscope’s light. Through this I can see the smooth yellow surface of the brain itself, etched with minute red blood vessels – arterioles – which form beautiful branches like a river’s tributaries seen from space. Glistening, dark purple veins run between the two lobes leading down towards the middle cerebral artery and, ultimately, to where I will find the aneurysm.
    ‘Awesome!’ Jeff says again.
    ‘ CSF used to be called “gin-clear” when there was no blood or infection it,’ I say to Jeff. ‘But probably we’re now supposed to use alcohol-free terminology.’
    I soon find the right middle cerebral artery. In reality only a few millimetres in diameter, it is made huge and menacing by the microscope – a great pink-red trunk of an artery which ominously pulses in time with the heart-beat. I need to follow it deep into the cleft – known as the Sylvian fissure – between the two lobes of the brain – to find the aneurysm in its lair, where it grows off the arterial trunk. With ruptured aneurysms this dissection of the middle cerebral artery can be a slow and tortuous business, since recent haemorrhage often causes the sides of the two lobes to stick together. Dissecting them is difficult and messy, and there is always the fear that the aneurysm will rupture again while I am doing this.
    I separate the two lobes of the brain by gently stretching them apart, cutting the minute strands of arachnoid that bind them together with a pair of microscope scissors in one hand while I keep the view clear of spinal fluid and blood with a small sucker. The brain is a mass of blood vessels and I must try to avoid tearing the many veins and minute arteries both to prevent bleeding from