Do No Harm
Do No Harm

Do No Harm

The idea that my sucker is moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand. (Location 149)

A famous English surgeon once remarked that a surgeon has to have nerves of steel, the heart of a lion and the hands of a woman. (Location 585)

Psychological research has shown that the most reliable route to personal happiness is to make others happy. (Location 613)

Perhaps they never quite realized just how dangerous the operation had been and how lucky they were to have recovered so well. Whereas the surgeon, for a while, has known heaven, having come very close to hell. (Location 627)

I told him that there was a one or two per cent risk of his dying or having a stroke if the operation went badly. In truth, I did not know the exact figure as I have only operated on a few tumours like his – ones as large as his are very rare – but I dislike terrorizing patients when I know that they have to have an operation. What was certain was that the risk of the operation was many times smaller than the risk of not operating. All that really matters is that I am as sure as I can be that the decision to operate is correct and that no other surgeon can do the operation any better than I can. This is not as much of a problem for me now that I have been operating on brain tumours for many years, but it can be a moral dilemma for a younger surgeon. If they do not take on difficult cases, how will they ever get any better? But what if they have a colleague who is more experienced? (Location 656)

Note: The actual percentage didnt matter. There was no other option and it was the best surgeon to do the job

If patients were thinking rationally they would ask their surgeon how many operations he or she has performed of the sort for which their consent is being sought, but in my experience this scarcely ever happens. (Location 663)

I said that there was a poster downstairs saying that iCLIP, the new computer system should only keep patients waiting a few extra minutes. The anaesthetist laughed in reply. I left the room. Years ago, I would have stormed off in a rage, demanding that something be done, but my anger has come to be replaced by fatalistic despair as I have been forced to recognize my complete impotence as just another doctor faced by yet another new computer program in a huge, modern hospital. (Location 685)

Note: Over time anger is replaced by fatalist despair

‘How are you feeling?’ I asked. ‘Fine,’ he replied with a tired smile. ‘Well done!’ I replied, as I think patients need to be congratulated for their surviving just as much as the surgeons should be congratulated for doing their job well. (Location 792)

Note: Congratulate patients on their survival

‘What would you do if it were your mother?’ the son asked. I hesitated before I answered because I was not sure of the answer. It is, of course, the question that all patients should ask their doctors, but one most are reluctant to ask since the question suggests that doctors might choose differently for themselves compared to what they recommend for their patients. (Location 1417)

Tags: questions

Note: .questions what would you do if it were your mother

Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all. (Location 2064)

Tags: hope

Note: .hope

Surgeons must always tell the truth but rarely, if ever, deprive patients of all hope. It can be very difficult to find the balance between optimism and realism. (Location 2101)

Note: Tell the truth, but leave hope

I have learned over the years that when ‘breaking bad news’ as it is called, it is probably best to speak as little as possible. These conversations, by their very nature, are slow and painful and I must overcome my urge to talk and talk to fill the sad silence. (Location 2240)

errors of judgement and the propensity to make mistakes are, so to speak, built in to the human brain. (Location 2267)

Tags: cognitive

Note: .cognitive biases

To the man with a hammer, it is said, all things look like nails. When brain surgeons look at brain scans they see things that they think require surgery and I am, alas, no exception. (Location 2297)

Doctors need to be held accountable, since power corrupts. There must be complaints procedures and litigation, commissions of enquiry, punishment and compensation. At the same time if you do not hide or deny any mistakes when things go wrong, and if your patients and their families know that you are distressed by whatever happened, you might, if you are lucky, receive the precious gift of forgiveness. (Location 2629)

‘Remember my husband, please think of him sometimes,’ she said, reaching a despairing hand out to me. ‘Remember him in your prayers.’ ‘I remember all my patients who die after operations,’ I said, adding to myself as I left, ‘I wish I didn’t.’ (Location 2699)

‘I know one has to accept these things,’ I went on lamely, ‘But nobody, nobody other than a neurosurgeon understands what it is like to have to drag yourself up to the ward and see, every day – sometimes for months on end – somebody one has destroyed and face the anxious and angry family at the bedside who have lost all confidence in you.’ (Location 2775)

‘You can’t stay pleased with yourself for long in neurosurgery,’ my colleague said. ‘There’s always another disaster waiting round the corner.’ (Location 2781)

‘It’s a quite extraordinary feeling to be surrounded by so much love,’ she said two days before she died. ‘I count my blessings.’ (Location 2848)

Tags: mortality

Note: .mortality

Dying is rarely easy, whatever we might wish to think. Our bodies will not let us off the hook of life without a struggle. You don’t just speak a few meaningful last words to your tearful family and then breathe your last. If you don’t die violently, choking or coughing, or in a coma, you must gradually be worn away, the flesh shrivelling off your bones, your skin and eyes turning deep yellow if your liver is failing, your voice weakening, until, near the end, you haven’t even the strength to open your eyes, and you lie motionless on your death bed, the only movement your gasping breath. (Location 2863)

Tags: mortality

Note: .mortality

mother was lucky to believe in some kind of life beyond death but I do not have this faith. The only consolation I will have, if I do not achieve instant extinction, will be my own last judgement on my life as I look back on it. I must hope that I live my life now in such a way that, like my mother, I will be able to die without regret. (Location 2897)

Tags: mortality

Note: .mortality

‘It’s been a wonderful life. We have said everything there is to say.’ (Location 2900)

Tags: mortality

Note: .mortality

Neuroscience tells us that it is highly improbable that we have souls, as everything we think and feel is no more or no less than the electrochemical chatter of our nerve cells. Our sense of self, our feelings and our thoughts, our love for others, our hopes and ambitions, our hates and fears all die when our brains die. (Location 2904)

My old boss, who was really nice – the one who operated on my son – used to say ‘If the patient’s going to be damaged I’d rather let God do the damage than do it myself’. (Location 3042)

As I started to remove the last part of the tumour I tore a small perforating branch off the basilar artery, a vessel the width of a thick pin. A narrow jet of bright red arterial blood started to pump upwards. I knew at once that this was a catastrophe. The blood loss was trivial, and easy enough to stop, but the damage to the brainstem was terrible. The basilar artery is the artery that keeps the brainstem alive and it is the brainstem that keeps the rest of the brain awake. As a result the patient never woke up and that was why, seven years later, I saw him curled into a sad ball, on a bed in the nursing home. (Location 3055)

I had always dreaded becoming a patient yet when, at the age of fifty-six, I eventually did I found it remarkably easy. This was, quite simply, because I realized how lucky I was compared to my own patients – what could be worse than having a brain tumour? What right did I have to complain when others must suffer so much more? (Location 3165)

At least a quarter of the population of Ukraine died violently in the twentieth century. I wanted to ask these dead faces what they had done during those years, and what compromises they must have made to survive, but it seemed to me that they looked back at me as though to say: ‘We are dead. You are still alive. And what are you doing with the time that you have left?’ (Location 3440)

The film about Igor and me was a great success. It has been shown all over the world and won many awards. (Location 3443)

Tags: towatch

Note: .towatch

‘I hope I never see you again,’ she said. ‘I quite understand,’ I replied. (Location 3958)