Think brain surgery and you think calm competence, clinical precision. Think again. Top neurosurgeon Henry Marsh sheds light on the chaos, confusion and self-doubt of life inside the operating theatre.
I often have to cut into the brain and it is something I hate doing. With a pair of diathermy forceps I coagulate the beautiful and intricate red blood vessels that lie on the brain’s shining surface.
I cut into it with a small scalpel and make a hole through which I push with a fine sucker. The idea that my sucker is moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand.
All I can see in front of me is matter. Yet I know if I stray into the wrong area, into what neurosurgeons call eloquent brain, I will be faced by a damaged and disabled patient when I go round to the recovery ward.
Brain surgery is dangerous, and modern technology has only reduced the risk to a certain extent. Much of what happens in hospitals is a matter of luck, both good and bad; success and failure are often out of the doctor’s control.
Now that I am reaching the end of my career as a senior consultant neurosurgeon [at St George’s Hospital in South London] I am less frightened by failure – I have come to accept it. Increasingly, I feel an obligation to bear witness to past mistakes, in the hope that my trainees will learn how not to make the same mistakes themselves.
I hope I am a good surgeon but I am certainly not a great surgeon. I once paid a visit to a nursing home devoted to people with catastrophic brain damage and, to my dismay, recognised at least five of the names as former patients of mine. Some of them were people I had simply been unable to help, but there was at least one man – his grey curled up body in its bed – who, as my juniors put it in their naive and tactless way, I had wrecked.
The patient had been a schoolteacher in his late fifties, tall and bespectacled, who walked with a stick and was a little stooped. A local neurologist had arranged a brain scan and as a result, he had been sent to see me. I had only been a consultant for four years but I already had a very large practice, larger than any other neurosurgeon’s I knew. I sat the patient down by my desk with his wife and son next to him and took the films of his brain scans over to the viewing box on the wall. I already knew what the scans would show but I was still startled by the size of the tumour growing from the base of his skull.
A trailer for The English Surgeon – the documentary film based on Henry Marsh’s work.
All of the brainstem and the cranial nerves – the nerves for hearing, movement, sensation for the face, and for swallowing and talking – were stretched over its sinister humpbacked mass. It was an exceptionally large petroclival meningioma. I had only seen tumours this size before in the textbooks. I was not sure whether to feel excited or alarmed.
“What have you been told?” I asked.
“The neurologist said it was benign,” he replied. “And that it was up to you as to whether it should be removed or not.”
He told me how he had noticed that his walking had slowly been becoming a little unsteady and that he was also starting to lose hearing.
“But what will happen if it stays there?” his son asked. I replied that it would go on growing slowly and that he would slowly deteriorate.
I explained that surgery was not without risks. There were so many brain structures involved with the tumour that the dangers of surgery ranged from deafness to death.
The three of them sat in silence for a while.
“We’re told that Professor M is the best neurosurgeon in the country,” he said. “And we’re going to see him for a second opinion.”
I felt humiliated but knew any operation was going to be exceptionally difficult.
“That’s a good idea,” I said. “I’d be very interested to hear what he thinks.”
“I’ve got Professor M on the line for you,” said Gail, my secretary, two weeks later. I picked up my phone to hear the professor’s booming, confident voice. I had known him briefly when I was a trainee and he was certainly a superb surgeon. Self-doubt had never seemed to be one of his weaknesses. I had heard that he would soon be retiring.
“Ah, Henry!” he said. “This chap with the petroclival. Needs to come out. He’s starting to have some difficulties with swallowing so it’s only a matter of time before he gets aspiration pneumonia and that will be the end of him. It’s a young man’s operation. I’ve told them you should do it.”
“Thank you very much, Prof,” I replied, a little surprised but delighted to have been given what felt like a papal dispensation.