The tricky business of unblocking your brain
Don’t read this if you’ve got an aneurysm.
By Michael Brooks Published 07 September 2012 15:07
Spend 24 hours in the company of a couple of hundred brain surgeons and you’d have a sense of unease too. I’m at a conference where “minimally invasive neurological therapies” are being discussed. My take-home message? No one knows anything for sure. Until it’s too late, that is.
Not that they aren’t good at their job – they’re the best in the world at getting at blockages and other problems inside your brain. But they are here to discuss the things they don’t know. And those are conversations you’d rather not overhear.
The typical presentation goes like this. “So, we went to perform an angioplasty on patient A, who was suffering from acutely reduced vision” (I may be paraphrasing badly). “Here’s the imaging.”
On the screen appears a picture of some loopy, tangled-looking blood vessels. There are murmurs and sharp intakes of breath. A voice just behind me mutters “ay-ay-ay”.
I have no idea what I’m looking at. I’m only here to give a talk about more general issues in scientific research. But I have that sinking feeling, like in the first five minutes of an episode of Casualty, that something bad is about to happen.
“I’d like to know: what would you have done?” the presenter asks. She offers two options. The room votes. The split is even, an observation that makes me hugely uncomfortable. There is no consensus. Why is there no consensus? Surely there’s a right thing to do in any situation? The presenter goes on to explain what she did. There is another round of murmuring in the room. Clearly, many people – approximately half – think this was a very bad idea.
The next presenter describes a surgery that started to go wrong 4 hours into an operation. He talks like it’s Who Wants To Be A Millionaire. “What do you think?” he asks the audience. “Shall I go on or stop now?” A voice from the back shouts, “No, no, no. Stop. You have to stop!”
He did go on, as it happened. He describes how the procedure progressed, blow by blow. “No, no, don’t do that!” comes an anguished shout, like this is Surgery Live. It’s not: this all happened last year. “Yeah,” the presenter mutters. “Thanks, I know that now.”
The next presentation ends with, “Well, I’ll never do that again.” Then comes another: “So, I’d like your opinions – should I treat this? If so, how?” The audience is calling out answers like a classroom full of show-offs. The session chair asks for calm.
Not all the answers are helpful. “If you get bleeding there, that’s going to be catastrophic.” The presenter furrows his brow. “I know,” he says. “That’s why I’m asking.”
This one is not a done deal, as it turns out. “Thanks,” the presenter says as the deluge of conflicting answers abates. “I’m due to see her again in ten days, so that’s really helpful.”
Here’s hoping she’s not reading this.
Latest tweets
More from New Statesman
- Online writers:
- Steven Baxter
- Rowenna Davis
- David Allen Green
- Mehdi Hasan
- Nelson Jones
- Gavin Kelly
- Helen Lewis
- Laurie Penny
- The V Spot
- Alex Hern
- Martha Gill
- Alan White
- Samira Shackle
- Alex Andreou
- Nicky Woolf in America
- Bim Adewunmi
- Glosswitch
- Kate Mossman on pop
- Ryan Gilbey on Film
- Martin Robbins
- Rafael Behr
- Eleanor Margolis
- Tools and services:
- Polls
- Predictions
- Archive
- Magazine
- PDF edition
- RSS feeds
- Advertising
- Subscribe
- Special supplements
- Stockists





















3 comments
All I want from my doctor is his absolute best effort. I know every doctor will not know absolutely everything about everything, just as I don't know absolutely everything about my profession. We are just expecting the doctor to do everything they can to help us.
It's when a doctor cares more about his wallet than his patients...thats when I get mad.
Doh! Where's the edit function. "neurosurgery isn't a textbook science" - I meant an exact science.
That's the trouble - neurosurgery isn't a textbook science, and while there is consensus on procedures, each patient has his or her own anomalies. Different reactions to anaesthetic drugs. Different tissue reactions. Slight, sometimes seemingly miniscule, differences in anatomy.
While the room might have been divided between the "for God's sake, man, don't do that!" and "that's what I've done and it worked fine", that simply reflects the anomalies between patients and the different experiences of different surgeons. (No I'm not a brain surgeon, but I spent some years working in operating theatres on the nursing side and that's the way of it.) Chilling though that conference was, it has to be better than rummaging about in patients' skulls and never wondering if you might be able to do things better, or not passing on your skills and discoveries.
The positive in all this is that surgeons are collaborating. Exchanging ideas, sharing knowledge and experience. It's all part of the continuing professional development that goes on anyway, no matter where you are on the hierarchy of surgery. A professor at the top of her tree can still learn from a new consultant who's been to a recent conference elsewhere. You're committed to improving your skills and keeping abreast of developments and discoveries throughout the world.
It's harder these litigious days to explain to patients that nothing is 100% certain in neurosurgery. There's no magic wand, and no cast-iron guarantee that nothing whatsoever will ever go wrong. While we should expect the highest possible levels of competence and accountability from our neurosurgical teams, there's still an area of grey that can't ever be predicted, and that should be explained carefully in the pre-op consultations before the consent form is signed.