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

at their expense. We sit in a semi-circle, a small group of a dozen or so consultants and junior doctors, looking as though we were on the deck of the Starship Enterprise.
    Facing us is a battery of computer monitors and a white wall onto which brain scans are projected, many times larger than life-size, in black and white. The scans are of patients admitted as emergencies over the preceding twenty-four hours. Many of the patients will have suffered fatal haemorrhages or severe head injuries, or have newly diagnosed brain tumours. We sit there, alive and well and happy in our work, and with sardonic amusement and Olympian detachment we examine these abstract images of human suffering and disaster, hoping to find interesting cases on which to operate. The junior doctors present the cases, giving us the ‘history’ as it is called – the stories of sudden catastrophe or of terrible tragedy that are repeated each day, year in, year out, as though human suffering would never end.
    I sat down in my usual place at the back, in the corner. The SHO s are in the front row and the surgical trainees, the specialist registrars, sit in the row behind them. I asked which of the junior doctors had been on call for the emergency admissions.
    ‘A locum,’ one of the registrars replied, ‘and he’s buggered off.’
    ‘There were five doctors holding the on-call bleep over twenty-four hours on Friday,’ one of my colleagues said. ‘Five doctors! Handing over emergency referrals to each other every four point two hours! It’s utter chaos . . .’
    ‘Is there anything to present?’ I asked. One of the juniors got up from his chair and walked to the computer keyboard on the desk at the front of the room.
    ‘A thirty-two-year-old woman,’ he said tersely. ‘For surgery today. Had some headaches and had a brain scan.’ As he talked a brain scan flashed up on the wall.
    I looked at the young SHO s and to my embarrassment could not remember any of their names. When I became a consultant twenty-five years ago the department had just two SHO s, now there are eight. In the past I used to get to know them all as individuals and take a personal interest in their careers, but now they come and go as quickly as the patients. I asked one of them to describe the scan on the wall in front of us, apologizing for not knowing who she was.
    ‘Alzheimer’s!’ one of the less deferential registrars shouted from the darkness at the back of the room.
    The SHO told me that she was called Emily. ‘This is a CTA of the brain,’ she said.
    ‘Yes, we can all see that. But what does it show?’
    There was an awkward silence.
    After a while I took pity on her. I walked up to the wall and pointed to the scan. I explained how the arteries to the brain were like the branches of a tree, narrowing as they spread outwards. I pointed to a little swelling, a deadly berry, coming off one of the cerebral arteries and looked enquiringly at Emily.
    ‘Is it an aneurysm?’ Emily asked.
    ‘A right middle cerebral artery aneurysm,’ I replied. I explained how the woman’s headaches had in fact been quite mild and the aneurysm was coincidental and had been discovered by chance. It had nothing to do with her headaches.
    ‘Who’s doing the exam next?’ I asked, turning to look at the row of specialist registrars who all have to take a nationally organized exam in neurosurgery as they reach the end of their training. I try to grill them regularly in preparation for it.
    ‘It’s an unruptured aneurysm, seven millimetres in size,’ Fiona – the most experienced of the registrars – said. ‘So there’s a point zero five per cent risk of rupture per year according to the international study published in 1998.’
    ‘And if it ruptures?’
    ‘Fifteen per cent of people die immediately and another thirty per cent die within the next few weeks, usually from a further bleed and then there’s a compound interest rate of four per cent per year.’
    ‘Very good, you