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

obscuring the view and also for fear of damaging the blood supply to the brain. Sometimes, if the dissection is particularly difficult and intense, or dangerous, I will pause for a while, rest my hands on the arm-rests, and look at the brain I am operating on. Are the thoughts that I am thinking as I look at this solid lump of fatty protein covered in blood vessels really made out of the same stuff? And the answer always comes back – they are – and the thought itself is too crazy, too incomprehensible, and I get on with the operation.
    Today, the dissection is easy. It is as though the brain unzips itself, and only the most minimal manipulation is required on my part for the frontal and temporal lobes to part rapidly, so that within a matter of minutes we are looking at the aneurysm, entirely free from the surrounding brain and the dark purple veins, glittering in the brilliant light of the microscope.
    ‘Well. It’s just asking to be clipped, isn’t it?’ I say to Jeff, suddenly happy and relaxed. The greatest risk is now past. With this kind of surgery, if the aneurysm ruptures before you reach it, it can be very difficult to control the bleeding. The brain suddenly swells and arterial blood shoots upwards, turning the operative site into a rapidly rising whirlpool of angry, swirling red blood, through which you struggle desperately to get down to the aneurysm. Seeing this hugely magnified down the microscope you feel as though you are drowning in blood. One quarter of the blood from the heart goes to the brain – a patient will lose several litres of blood within a matter of minutes if you cannot control the bleeding quickly. Few patients survive the disaster of premature rupture.
    ‘Let’s have a look at the clips,’ I say.
    Irwin hands me the metal tray containing the gleaming titanium aneurysm clips. They come in all shapes and sizes, corresponding to the many shapes and sizes of aneurysms. I look at the aneurysm down the microscope and at the clips and then back at the aneurysm.
    ‘Six millimetre, short right-angled’ I tell him.
    He picks out the clip and loads it onto the applicator. The applicator consists of a simple instrument with a handle formed by two curved leaf springs, joined at either end. Once the clip is loaded at the instrument’s tip, all you have to do is press the springs of the handle together to open the blades of the clip, position the opened blades carefully across the neck of the aneurysm and then allow the springs to separate gently apart within your hand so that the clip blades close across the aneurysm, sealing it off from the artery from which it has grown, so that blood can no longer get into it. By finally letting the springs of the handle separate even more fully the clip is released from the applicator which you can then withdraw, leaving the clip clamped across the aneurysm for the rest of the patient’s life.
    That, at least, is what is supposed to happen and had always happened with the hundreds of similar operations I had carried out in the past.
    Since this looks a straightforward aneurysm to clip I let Jeff take over, and I clamber out of the operating chair so that he can replace me. My assistants are all as susceptible to the siren call of aneurysms as I am. They long to operate on them, but the fact that most aneurysms are now coiled rather than clipped means that it is no longer possible to train them properly and I can only give them the simplest and easiest parts of the occasional operation to do, under very close supervision.
    Once Jeff is settled in, the nurse hands him the loaded clip applicator, and he cautiously moves it towards the aneurysm. Nothing much seems to happen, and down the assistant’s arm of the microscope I nervously watch the clip wobble uncertainly around the aneurysm. It is a hundred times more difficult and nerve-wracking to train a junior surgeon than it is to operate oneself.
    After a while – probably only a few seconds though it