Reading Madame Bovary (23 page)

Technique? Oh, technique is very important. If you're no good, you're out. Brains and technique don't necessarily go together but it's like anything, aptitude comes into it, there are people who are gifted at doing certain things. You know, Mozart at the age of four was doing things that I wouldn't be able to do if you gave me a hundred years – there are people like that I've seen in surgery as well.

But a surgeon doesn't have to be very bright intellectually. The brightest people don't do medicine. Let's not kid ourselves. It's not intellectually stimulating enough; I mean, it's just on a different planet compared to things like quantum physics or complex mathematics, it's not in the same ball park. There's nothing hard about it intellectually. There's nothing in medicine I couldn't explain to you in words, very simple words, in an hour. It's not that hard. But technique is essential. My father was a suburban bank manager but his hobby was wood-turning and cabinet-making. Perhaps I got my dexterity from him.

So it's like fixing your car, all the fun is in doing it. If you want to get excited, what you do is you take on progressively harder cases, the ones that are harder to get someone through alive. That's what you do so you can raise the ante each time. As you feel yourself getting better you keep raising the ante, making it harder.

(Sound of pager beeping)
Oh, that's just some bit of nonsense.

Where were we? Why did I choose the brain? Well, I suppose the fact that the brain is still a bit of a mystery, that had to come into it. I mean, what is this thing we call consciousness? How does it work? We're much more sentimental about the heart – love and romance, and all that – but if your brain isn't functioning as it should then romance goes out the window. What are you feeling then? If you've got a clot on your brain you won't be feeling very romantic, I can assure you. That's one thing. And I suppose you'd have to say that, as a resident, neuro appeared to me to be the most difficult area of surgery. As I said, a lot of people don't wake up. Some wake up straight away but many of them lie there for months and never wake up. You get a fair share of zombies. And you want to see people get better. You don't want disasters to hang around to haunt you. No-one wants to sit around and watch people dying. It's hard enough for me when it happens, anyway, and in neurosurgery it happens more than in any other field. You need pretty good nerves. You have to stay detached.

But as for intellectual stimulation, no, I don't get enough of that. There are no secrets to the brain that are going to tell you how the universe works. I only went into medicine because of my father's insistence. I wanted to study pure maths, that was my real love, but he said I couldn't do that. He said I wouldn't be able to support myself on it. And also, he had an agenda of his own. Dad was a fitness nut who believed in vitamin therapy long before it was fashionable. We had a huge bowl of vitamin pills on the table at every meal and if someone dropped in unexpectedly my mother would rush to hide them. She didn't want people to think we were cranks. And my father berated her if she didn't have fresh homemade yoghurt prepared every morning. It was a strict regimen. Do I still eat yoghurt? No, can't stand the stuff. Anyway, it was always assumed by him that I would study medicine and set the unbelievers right. And look, in a way he was right, at least about the maths bit. When I went through university I saw there were maths graduates who ended up driving taxis. And I'm not sure I would have been good as a research mathematician. Those guys are very, very bright. Guys like von Neumann, Turing, Feynman, there's just no comparison to what we do. They solve the problems of the universe while everyone else is asleep.

What's that? Isn't that what I do? You mean put them under and solve their problems while they're knocked out? Well, sort of, but not in terms of the big picture. When they wake up they're alive, sure, but they've still got to go away and figure out the meaning of life. I can't do it for them.

But I've changed a lot since then. I was interested in maths because I thought there were ultimate formulas out there that would provide the answers to life and death. The big Theory of Everything. That was my true interest, really, not so much the maths as finding the answers. I wanted answers as to
why
– why this useless life, where you sort of, you know, you grow up and then you die. It seemed to me so pointless. When I was sixteen I thought about death a lot, it was an affront to me, something that I took personally, like I was one of the few who had been singled out for it. It's very hard to function with that sort of attitude. So I thought mathematical models of the universe would provide the answer.

But not religion. I studied quite a number of religions, but I think Western religion, in particular Christianity, is a religion for kiddies. I mean this Santa Claus business, you know, the old man up there, it's got about as much reality as the tooth fairy and the Easter bunny. I mean it's great when you're a kid but I'm afraid it doesn't fit the bill.

No, I don't have superstitions. You mean when I'm operating? No. That's a poor man's consolation, superstition.

(Pager beeps)
Excuse me a minute.

Am I grateful to my father for talking me out of becoming a mathematician? Yeah, probably. Although it didn't quite turn out as he hoped. Not with the vitamins anyway.
(Laughs)
But look, adolescence is a dangerous period. You could easily just opt out. Some kids do, and some of the brightest. A friend of mine jumped off the top of the fire escape at his boarding school when he was seventeen. You get frustrated when things go wrong, but no, I didn't do anything silly. Life is a game, isn't it? I talked to my parents a bit about the meaning of it all but they didn't have any answers. No, they weren't religious people. Were they rationalists? Yes, that would be the right definition. So was I, intensely so, which was why it annoyed me greatly that I could not, you know, could not solve the problem of life and death logically. You can't solve it logically, I defy anyone to solve death logically. You can only move beyond it with something else. And Western philosophy's so bankrupt it doesn't help you.

I suspect most people carry death with them. Obviously I'm not trained to generalise on that matter but I can speak personally and say that for me that would be correct.

What do I mean: trained to generalise? Well, because in logical thought, if you venture generalisations broadly, you end up in a mess. I mean, you just get lost, you have to backtrack through that mess again. Better to stick with what seems reasonable, I think. But whether it's everybody or most people's experience, I wouldn't know. Have you heard of the neuroscientist V.S. Ramachandran? He was here recently giving a lecture. He made the point that we're not angels, we're just sophisticated apes, yet we think we're angels trapped inside the bodies of beasts, trying to spread our wings and fly off. That's the way the brain seems to work, to foster that delusion, and it's a pretty weird predicament to be in, if you think about it.

Am I interested in consciousness? Well, yes, who isn't? It's what neuroscience is all about. Oh, you mean in the cosmic sense? Do we have a soul and all that stuff? Not my field. But if you ask me if I'm interested in consciousness in the wake up, get up, get on with life sense, then yes. That's difficult enough, especially when you're dealing with someone who's been thrown out of a moving motor vehicle and ended up with nineteen blood clots on his brain. Quite frankly in a case like that I won't have a clue what the outcome will be. In that particular case all I could do was try and restore his brain as close as possible to what it had looked like before the prang and hope for the best. But I was as in the dark as the next person as to what the outcome might be. As it happened, that particular patient made a remarkable physical and mental recovery. He did have delusions for several weeks after and then gradually he settled back into who he had been before. Was I surprised? No. On one level I'm never surprised – with the brain, anything can happen – and on another level I'm constantly surprised. As branches of medicine go, it can be very unpredictable.

(Pager beeps)
I'll just take this around the corner where it's quieter.

Yeah, I've got time for another drink. I've got another half hour, forty minutes. What makes a good neurosurgeon? Well, technique would be ninety per cent of it, technique and judgement. It's not just technique because judgement comes into it as well. You have to know how far you can go; you have to know when to stop. There's a lot of judgement about when to back out. Some surgeons end up killing people and blowing their careers because they don't realise the importance of discretion, doing the things that have to be done and not doing the other things – and that to get out when something is too hard is often very smart.

Most neurosurgeons are pretty ordinary people, sometimes less than. You shouldn't glamorise them. Some of them are pricks, absolute pricks. Why? Well, why wouldn't they be? If you look at people in positions of great power and authority, or positions where they have great skills, many of them still suffer from self-doubt. And most of them put a lot of time and effort into getting where they are so that they can prove themselves. And the trouble unfortunately, as you would expect, is that if you are really driven to show how good you are, just making it with money, or making it to positions of power and influence, doesn't fix your self-doubt, so even the apparently successful ones remain frustrated people who are still trying to prove themselves every day. They've got to be told how good they are, they're constantly exerting their authority in an arbitrary way, which is not necessary, and this is the sort of nonsense that goes on. I'm sure, from my limited understanding of human psychology, that just proving, just achieving something doesn't stop you feeling on the edge. You're always on the edge of getting to where you want to go but you're never quite there. You can't fix the basic problem; you have to be either psychoanalysed or grow beyond it. Look, I speak as someone who's got the same problem, that's why I'm in neurosurgery. I had to go out and prove myself. And in proving yourself, sometimes you do something useful and people think you're brave and wonderful. Take the guy who developed cardiac catheterisation, Werner Forssmann. He was a German who developed the technique in
1929
. First he practised on corpses and then to make his point he threaded a catheter through a vein in the front of his right elbow and threaded it for sixty-five centimetres along into his own right atrium. He did this alone in his lab because no-one would help him, they thought it was too risky. Then with the catheter inserted he walked all the way along the corridor to the X-ray department and persuaded two nurses to help him examine himself through a fluoroscope to confirm the catheter was in his heart. One of the nurses couldn't handle it and passed out. Forss-mann survived and won a Nobel Prize. Would I do that? Who knows? Probably not, though it's amazing what you will do when you get caught up in your research. You can get a bit obsessive, especially when you're convinced that you're right and everyone else is wrong.

(Pager beeps)
Uh, oh. There it is again. The pager runs my life.

No, it's okay, I've got plenty of time, as long as I answer this thing. What were you saying? Does what I do ever seem routine? Well, there is a degree of repetition. Any manual skill, if you want to be good at it, you've got to repeat it a thousand times, and regularly, so it then gets to a stage where it moves out of the thinking mind and into somewhere deeper than that. Then if you're someone who's goal oriented, who's out to prove themselves, you become bored, because you're not doing something different or hard. Whereas I suspect – and this is conjecture – that if you have, say, a mind trained in Eastern philosophy, in fact you can move into this higher state when doing whatever it is you're doing, whether you're chopping wood or just preparing your daily meal – this is not another repetitive, mechanical task, this is expressing one's unity with the universe.
(Laughs)
I've got a sister who's studied Zen Buddhism, and that's what she tells me. This is what operating should be, but it rarely is because none of us are masters of Zen. Not to my knowledge, anyway.

The downside of our job is that you're flat out so you cut corners and the first corner to go is significant interaction with the patient. Which means that for us, most of us, it's not work on people, it's work on … on objects. I think people are transformed in the process of becoming doctors, and the transformation is that a lot of the humanity within you is destroyed or pushed away. And that has to happen. Well, it doesn't have to happen, it happens because it helps you cope, because it's very hard to watch people die and look after people who are dying all the time if you're close to them, so you tend to push them away and lock them out. I think that's what we all do. We have a shield.

People talk about burnout but I think that's nonsense. I think that what happens instead is that sometimes we get dehumanised. In fact a lot of my day's work is boring, the paperwork and so on, and that's partly because I don't know the people I'm operating on. I think it would be much better if I knew them and cared for them as people, not just as a day's work.

But people are often referred very soon before their operation. They might come in the night before and you might see them around eight or nine o'clock in the evening. They're scared, you're buggered, and it's not an ideal situation for a friendly chat. And they're just the ones that are conscious. As soon as anyone arrives everything's stripped off them and they're stuck in a white gown and a sterile bed. They've got nothing around them that even makes them look human and if they're compos, you know, you have to ask them all the questions related to the disease. You might ask them a few personal questions, like what do they do. But that's the way the government wants it. It used to be people came in two days ahead but everything is cost-cutting now and that's expensive. And then there's all the emergency cases where they've suffered major trauma and they're already unconscious on arrival.