Operating on the Brink: the truth about brain surgery

Operating on the Brink: the truth about brain surgery

– interview with Henry Marsh, British neuro-surgeon
– he has written a book about his experiences & sense of profound awe (the last section also includes discussion about assists dying for intractable human illness)
– he has also made a BBC documentary
– his parents founded Amnesty International
– his son had a brain tumour requiring surgery, when his son was 3 months old
– brain surgery is very dangerous – catastrophic personality change, permanent disability
– a lot of brain surgery is palliative in nature & focused upon removing blood clots, tumours or damaged brain as a result of ABI (Acquired Brain Injury)
– he notes how it is difficult to know where a tumour ends & where is healthy brain tissues – he uses electrical stimulants to prompt the body to move involuntarily (& also why he keeps patients awake
– brain does not grow back (tissue – does not heal like a muscle), but recovers through Neuoplasticity (re-wiring)
– all brain surgery involves damage
– he talks about eloquent brain (still functioning) & silent brain (no longer working due to damage)
– hope & realism about surgery – what he had to convey to a patient
– talks about the importance of a trusting relationship between dr & patient
– some of his operations are done while the patient is awake
– he talks about there being no pain receptors in the brain
– he cites how pressing a finger is an “illusion” modelled & created by the brain
– all our thoughts & feelings – are electro-chemistry
– he notes too that sight, sound, smell, touch, taste are all just neuro-electro-chemistry – & are therefore quite similar, even though to us in everyday life, they seem terribly different
– the mind is not a computer
– each age uses latest technology to describe it
– 18th century – hydraulics
– late 19th century – a telephone exchange
– now – computer
– talks about monkeys having 35 different areas of the brain being involved in vision
– drilling into the skull – he uses a fast/short-acting general anaesthetic
– the brain pulsates in time with the heart & with respiration
– 25% of the body’s blood goes to the brain
– the brain apparently has the consistency of cream cheese, & surgery involves much blood & therefore use of a vacuum sucker
– the outcome of brain surgery is known almost immediately
– he notes the need to balance professional compassion with professional emotional detachment
– he discusses communication, & he notes that the relationship between dr & patient is asymmetrical, further explaining why communication is difficult
– he notes human limitations of being a surgeon
– bias to not ask for help, to not admit failures (experience helps us)
– bias to not discuss problems because of competition
– bias to not talk about emotions
– brain/mind/self
– damage to the frontal lobes causes personality change (typically for the first)
– he notes how success is bad for us – blunts us, corrupts us
– we learn best from mistakes, & that other people are best to see our mistakes
– he talks of need for judgement – as a surgeon
– medicine is profoundly meaningful & there is a sense of service [he notes too how he likes being useful, of being “important”]

Source: ABCRN Conversations | Podcast date: 29 May 2017



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