Life on a Knife's Edge by Rahul Jandial

Author:Rahul Jandial [Jandial, Rahul]
Language: eng
Format: epub
ISBN: 9780241461853
Publisher: Penguin Books Ltd
Published: 2021-06-24T00:00:00+00:00

6.

Threat

The patient was a mother in her thirties, with kids, and a manageable tumour. If we removed it all, she would be cured, but that was difficult. It was better to leave behind a little tumour, and still significantly extend her life, than risk profound injury by being too aggressive. In a case like hers, most senior surgeons could get most, if not all, of her tumour and not injure the patient.

I was a neurosurgery resident, a brain surgeon in training, and I’d scrubbed in for a case with the professor of the department, who was about to make a mistake that would ruin this person. The woman’s skull was open, the forehead bone removed, and both frontal lobes were exposed. The professor and I were standing on either side of the patient, sharing a surgical microscope with eyepieces directly opposite each other. It’s like two people using the same set of binoculars. Our hands were outside the patient, but our instruments were about eight inches deep in the brain, so deep the broad spray of light in the operating theatre failed to shine into the small area where we were working. Instead, we relied on an intensely bright light shining straight down from the microscope. In this illuminated area we would need to perform several hundred steps, using delicate instruments under high magnification.

For hours, we spread, pruned and dissected inside natural valleys of brain tissue, working our way deeper into the patient’s brain to get to the tumour. As I worked, the professor watched and assisted. Many of the arteries and veins in the brain have names. Many do not. A vital part of the seven years of neurosurgery training is learning the rare vessel that can be sacrificed and which ones need to be preserved, which ones can be cut safely and which ones can’t. You won’t find this information in Anatomy 101. Even physicians who aren’t brain surgeons don’t know the terms. It’s not taught until you are in the trade. The brain is such a unique and convoluted structure, the neck, chest and abdomen look basic by comparison.

I reached a branch off the main trunk of the anterior cerebral artery, which delivers blood to the front and centre of the brain. This particular branch tricks novices into thinking it is something that can be divided. It isn’t. It’s the recurrent artery of Heubner, so infamous in neurosurgery it’s hammered into residents from day one. The artery is called recurrent because it breaks off the main trunk and loops backwards like a hairpin turn on the Formula 1 course in Monaco. It’s infamous because it supplies blood to unique structures in the brain. Damaging it can harm a patient in a bizarre constellation of ways.

When you’re performing surgery inside a living person, anatomy does not look like a picture in a textbook. You get only glimpses, often obscured by blood and fatigue. The recurrent artery of Heubner resembles a backward-turning knuckle. It is the red wire that needs to be avoided at all costs.

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