Humanism in the operating theatre

I am, to coin a phrase, a brain surgeon and one of the things you have to come to terms with fairly early on in your career as a brain surgeon is to understand that everything we think and feel is a physical process. We don’t understand it but you cannot really doubt unless you indulge in severe cognitive dissonance that thought consists of electrochemistry and one piece of overwhelming evidence for that is you will often see people with head injuries, particularly to the front part of the brain, where they suffer a severe personality change and although often the poor patients aren’t aware of the fact that they have changed, it is immediately apparent to their family and colleagues, and the family and colleagues will tell you that that’s not the person they were.

So if you see people who have suffered change of that sort as a result of simple physical damage to the brain, it’s really very hard to believe that there’s any kind of life after death, that we are our brains when our brains we die and this I think is one of for me one of the fundamental tenets of humanism - there’s no after life, no human soul. Well the only after life is how people remember me and anything I may have contributed to make the world a better or worse place during my life.

I mean some of my motivations are, you know, I became a surgeon partly cause it’s exciting, power and glory, but there is also I think I maybe it’s in my DNA, I don’t know. Maybe it’s the way my parents brought me up and I don’t have Christian faith but I think I have a strong sense of duty that we are here to make the world a better place.

I mean it again actually comes down to Popper I think it’s in one of Popper’s books, you know, the basis of decision-making in moral ways to reduce suffering rather than sort of maximize happiness or something like that, and god alone though it’s not like god is likely to exist, there is an awful lot of suffering in the world.

I mean, of course, being a doctor it’s in a sense it’s a bit of a moral luxury that’s why many doctors have become rather corrupted and pleased with themselves because just by doing our job in principle we are reducing suffering and we get paid for it as well, you know, but yes I think reducing suffering is, there’s no need to go round trying to increase happiness. There’s so much suffering around let’s start by reducing that.

Neurosurgery is terribly dangerous and so all neurosurgeons will have memories of patients who have done badly, as we put it, either through our fault, a mistake we’ve made, we’re human, we make mistakes though what constitutes a negligent mistake as opposed to a understandable mistake is obviously very contentious. So we all have terrible experiences but that’s why the triumphs are triumphant, I mean, I’m always saying this to my colleagues, or the juniors if they’re very upset about things going badly, I say well it’s because things can go badly that when things go well it’s so special. If every operation was safe, if nothing ever went wrong, there’d be nothing very special about it.

So you have to accept that the good results come at the price of bad results and most neurosurgeons pay a pretty big price and I’ve had terrible, terrible moments of blackest despair when patients have come to harm. And as the years went by, if an operation went well when I was younger I’d feel terribly pleased with myself but that gets tempered with experience, and in the latter years of my career I just felt deep - I felt very proud and happy if things had gone well - but it was more a sense of deep relief, ‘we’ve got away with it’, ‘the patient got away with it’, ‘I’ve got away with it’, rather than that I was some sort of superhero.

As a doctor, although your relationship with patients is very ephemeral and very transient, and sometimes very painful, nevertheless you have this extraordinary sort of privileged position where you meet people from so many different walks of life. I still do my patient clinics in my hospital in South London, most of the patients are immigrants, they all have extraordinary, interesting stories to tell in fact I usually find their life stories are much more interesting than their back pain which is what the clinic - I have to sort of discipline myself to actually deal with the clinical problem as well as ask them all about themselves.

I just find people terribly interesting and again, as you become more experienced in medicine, you can deal with the diagnosis and management much more quickly because you’re more competent and you’ve seen thousands of similar cases, so I found I got more and more interested in my patients and the complexity of their feelings and their background and the lives they lead, all of it makes me think I’m very privileged and how lucky I have been in my life.