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

know the figures. But what should we do?’
    ‘Ask the radiologists if they can coil it.’
    ‘I’ve done that. They say they can’t.’
    The interventional radiologists – the specialist X-ray doctors who now usually treat aneurysms – had told me that the aneurysm was the wrong shape and would have to be surgically clipped if it was to be treated.
    ‘You could operate . . .’
    ‘But should I?’
    ‘I don’t know.’
    She was right. I didn’t know either. If we did nothing the patient might eventually suffer a haemorrhage which would probably cause a catastrophic stroke or kill her. But then she might die years away from something else without the aneurysm ever having burst. She was perfectly well at the moment, the headaches for which she had had the scan were irrelevant and had got better. The aneurysm had been discovered by chance. If I operated I could cause a stroke and wreck her – the risk of that would probably be about four or five per cent. So the acute risk of operating was roughly similar to the life-time risk of doing nothing. Yet if we did nothing she would have to live with the knowledge that the aneurysm was sitting there in her brain and might kill her any moment.
    ‘So what should we do?’ I asked.
    ‘Discuss it with her?’
     
    I had first met the woman a few weeks earlier in my outpatient clinic. She had been referred by the GP who had organized the brain scan but his referral note told me nothing about her other than that she was thirty-two years old and had an unruptured aneurysm. She came on her own, smartly dressed, with a pair of sunglasses pushed back over her long dark hair. She sat down on the chair beside my desk in the dull outpatient room and put her elaborate designer bag down on the floor beside her chair. She looked anxiously at me.
    I apologized for keeping her waiting and hesitated before continuing. I did not want to start the interview by immediately asking her about her family circumstances or about herself – it would sound as though I was expecting her to die. I asked her about the headaches.
    So she told me about them, and also the fact that they were already better. They certainly sounded harmless in retrospect. If headaches have a serious cause it is usually obvious from the nature of the headaches. The investigation organized by her GP – hoping, perhaps, that a normal brain scan would reassure her – had created an entirely new problem and the woman, although no longer suffering with headaches, was now desperate with anxiety. She had been on the Internet, inevitably, and now believed that she had a time bomb in her head which was about to explode any minute. She had been waiting several weeks to see me.
    I showed her the angiogram on the computer on the desk in front of us. I explained that the aneurysm was very small and might very well never burst. It was the large ones which were dangerous and definitely needed treating, I said. I told her that the risks of the operation were probably very much the same as the risk of her having a stroke from the aneurysm bursting.
    ‘Does it have to be an operation?’ she asked.
    I told her that if she was to be treated it would indeed have to be surgery. The problem was knowing whether to do it or not.
    ‘What are the risks of the operation?’ She started to cry as I told her that there was a four to five per cent chance she would die or be left disabled by the operation.
    ‘And if I don’t have the operation?’ she asked through her tears.
    ‘Well, you might manage to die from old age without the aneurysm having ever burst.’
    ‘They say you’re one of the best neurosurgeons in the country,’ she said with the naive faith that anxious patients use to try to lessen their fears.
    ‘Well, I’m not. But I’m certainly very experienced. All I can do is promise to do my best. I’m not denying that I’m completely responsible for what happens to you but I’m afraid it’s your decision as to whether to have the