A senior British neurosurgeon and the subject of two documentary films relates touching selective anecdotes from his long career. He exhibits unusual empathy and understanding of the fears of all patients undergoing brain surgery. Far from the arrogance of many surgeons in elite fields, he demonstrates remarkable humility, acknowledges his mistakes and the severe limitations of what heroic surgery can accomplish He seemingly reserves his condescension for his junior trainees, but he doles out scathing scorn for bureaucratic hospital and government administrators enforcing rules that usually only benefit themselves and complicate the work of front line caregivers. Of long retained NHS records he notes “The greater part of the notes….consist of nursing charts recording the patient’s passing of bodily fluids on previous admissions…. There must be tons of such notes being toted around NHS hospitals everyday in a strange archival ritual which brings dung beetles to mind, devoted to the history of patients’ excretions.”
The several page description of his tender interactions with his dying mother brought to mind the discussions in Shep Nuland’s memorable book How We Die. Like most neuroscientists he rejects any duality of body and mind-consciousness-soul in line with most modern philosophers. According to his agnostic beliefs, our minds are the natural result of neurochemical reactions and electrical activity in our brains.
The timely description of his altruistic work in Ukraine gives readers a peek into the primitive state of medical facilities and practices there, doubtless worse now. I was a bit disappointed that apparently none of his patients who progressed to brain death were referred for organ donation, which is only mentioned briefly once. It is usually, at least here, the responsibility of other physicians to get consent for that, but it is quite proper for attending neurosurgeons to raise the possibility with the family. How a neurosurgeon who failed in pharmacology got appointed to work with the complex of organizations assessing new drugs is never made clear.
The writing is in plain language that does not require a medical background to understand, although including an anatomical diagram of the human brain would have made that easier for non-medical readers.
The chapter titled Angor Animi, filled with anecdotes from his training as a junior house officer (here we were called residents or housestaff) brought back many memories, some sad, some hilarious. Just one for the record. Often on call from a Friday morning until a Monday evening as a senior resident, I caught what little sleep I could in the attached hospital residence quarters. At one point while reviewing the patients on 5 East at 7 a.m. with the head nurse. I enquired about where terminally ill old Joe had gone as his bed was empty. The nurse roared with laughter and told me that, according to the night nurse, I had gone to the ward at 2 a.m, declared him dead, and filled out the death certificate, a visit sleep-deprived me had no recollection of. Now neither housestaff nor surgeons are allowed to work such gruelling hours, although I learned a lot in such circumstances. Like the author, as a student, I also learned a lot about human relations and medicine working in a longterm psychiatric hospital with demented patients.
Even with almost no experience in neurosurgery, I can readily relate to the stress and challenges of dealing with the critically ill or dying in the midst of uncertainty, looking for that elusive balance between honest realism and leaving some room for hope, and I quite enjoyed this book.
The Passionate Reader 