"Every surgeon carries within himself a small cemetery"

Early in my medical school years, I've had the pleasure of scrubbing in and observing a neurosurgery up close. It was a right temporal lobe tumour debulking surgery.  Given the close proximity of the tumour to the parts of the brain controlling movement of muscles and sensation of the skin (the pre-central and post-central gyri), the procedure involved waking the patient up in the middle of the surgery. Honestly, I felt as if I was watching a medical drama! 

The brain matter folded into majestically gyri and separated by sulci of variable depths  became something more than just anatomical structures that were to be memorised for anatomy spotter exams. As I looked into the operating microscope, the attending neurosurgeon kindly orientated me to the neuroanatomy, pointing out important structures such as the pre-central and post-central gyri and the MCA. 

A brain surgery is a risky business; there is a high unparalleled degree of difficulties and technical complexities to it. To me, nothing is scarier than having someone - a stranger probably whom you have talked to for a brief 20 minutes or so consultation - clamping your head to the operating table, drilling holes, removing your hair, scalp and skull off your head and fiddling with the very essence of your consciousness. I am confident that other than the neurosurgeons, no one in the operating room is comfortably familiar with brain anatomy - not enough to be having a part in the surgical procedures. It is almost like a one man show; on hindsight, this was an ill-informed statement, knowing that the surgery would not have been possible without the help of the anesthetists, radiologists, and the nurses.

And then... there was me, observing the surgery up close. I wonder if surgeons ever see us as a pain in the neck. The mind of any surgeon must be and understandably need to be occupied fully with the surgery at hand. Having a student next to him and carrying the possibly burdening responsibility of having to do some teaching may well be an additional challenge. Nevertheless, Mr Neuro spent some time happily showing me the different structures of the brain, explained the approach that he was going to undertake and to my surprise, managed to squeeze out some time to quiz me before refocusing on the surgery. It was nothing short of a amazing! 

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PHOTOGRAPH BY TOM PILSTON / PANOS

VIA THE NEW YORKER

I rarely read non-academic books, especially books that aren't medical related or those which are made truly for the pleasure of reading. Given the amount of materials that needs to be learned, medical school leaves little time for pleasure reading. 

Henry Marsh's ''Do No Harm'' is one worth squeezing time for. Mr Marsh is one of the most reknowned neurosurgeons in the UK, possibly the world. He starred in a medical documentary 'The English Surgeon', a medical documentary that filmed his medical work in Ukraine. (I highly recommend this movie to anyone interested in neurosurgery and medical work in developing countries). 

In UK, surgeons are called mister (and not doctor). The reason for this is quite interesting. In the 19th century, surgeons did not need to learn formal medicine in the university. Essentially, medicine was separate from surgery. In the past, surgeons trained from apprenticeship and thus would not acquire a doctorate. This tradition of naming surgeons ''Mr' was kept up to now, at least in UK. 

'Do No Harm' or in latin Primum non nocere is one of the most popular terms in bioethics (some say The Hippocratic Oath). It is a guiding principle in medical decision-making; one that reminds doctors and surgeons of their duty and responsibility to avoid dealing more harm to the already suffering patients. As medical students, such a term seems irrelevant. But, reading this book or watching this movie has allowed me to appreciate - though not fully-  the gravity and importance of such principle. Ever so often, Mr Marsh was torn between the two choices:

1. to operate and run the risk of causing a major catastrophic problem or
2.  to refuse the operation and watch his patients walk away ... and inevitably die 

link to: The English Surgeon