Some months ago, I was on assignment for Monocle covering Philippe Schucht, a neurosurgeon and a close friend of Monocle’s founder, Tyler Brûlé. It’s probably the most interesting piece that I’ve reported. Beside offering a glimpse into the psychology of a figure as committed, empathic and intelligent as Philippe (it’s true what they say: journalism isn’t quite brain surgery, is it?), the assignment gave me insight into a part of life that is reserved, for most of us, to points of crisis.
After receiving permission from Philippe, I will be releasing a longer piece I wrote in response to the experience. This has not been published before and is the first of three parts. Though a warning probably isn’t necessary, I may as well provide one: things get heavy, and things get gruesome. That said, the resilience that I saw in those wards was utterly flooring. I hope to have done it some justice with the words below.
A Complicated Case
Standing before a father are two doctors, the most senior carrying papers bearing MRI scans. Holding one up, the doctor points to one side of the brain where a white growth is visible.
“Malignant?” asks the father.
“Malignant,” he responds.
The father looks down. When he raises his gaze again, his eyes are red-rimmed and swollen. They seek a familiar face, but his wife and daughter have left; there are only the two doctors and I. The neurosurgeon continues after a moment of silence. He speaks in French. His tone is firm, conciliatory, practical. Once he has finished, the father brings a hand to his face. The hand is shaking when he takes it away again. He nods, resolved, but his eyes now thick with tears. There is a nod in return. His daughter will undergo surgery tomorrow.
*
Philippe Schucht considers himself a fortunate man. He has his health, he does not lack good looks or charisma and, still in his 40s, he already has a successful career behind him as head of his hospital’s neurosurgical oncology department in Bern, Switzerland. However, he accounts his good fortune to another cause: he is lucky because he can turn people’s lives around.
From the black desk chair of his office, Schucht explains that when people approach him, they are already at the point of crisis. He can bring them hope again. This morning, he spoke with the parents of two children who are recovering from operations, one of whom faced a slim chance of survival just days ago. “These parents were devastated,” he says. “Now they will see their children grow up.”
Schucht’s patients are grateful; a basket beside his window is filled with thank you cards. He remains an important figure in their lives, long after they have left his ward. And it is normal for them to open up to him emotionally. This is important. As their surgeon, Schucht must understand who his patients are, what makes them tick. If one is a farmer and the only option is to perform an operation that will endanger motor function, Schucht knows that they may choose to avoid surgery altogether.
One inpatient is a writer, who has a tumour growing in the region of his brain responsible for speech and language. Schucht will operate on him while he remains conscious, so that he can speak during surgery. This way, he will see how the operation affects the patient’s faculties in real time, helping to avoid unnecessary damage; a misplaced word will tell him all he needs to know.
Schucht tells me about a similar case in the past, a cello player. She went into an operation that may have affected her left hand’s ability to move with any great accuracy. On his desktop computer, he loads a video of her in the operating room: she’s awake, her head open with a doctor behind her, her body propped up so that the cello rests across her chest. She moves the bow to repeat a six-note melody while the surgeon works. It makes for uncomfortable watching; no doubt experiencing it would also be no joy.
For surgeries such as these, when the patient remains awake, they must spend two hours or so with a neuropsychologist or speech therapist before the operation. “After this, they come in calmly,” Schucht says. This fascinates him. “For the surgeon, our work is easy – it’s the patients that amaze me.”
The relationship between patient and doctor is reciprocal: each must have faith in the other. To work without this trust would endanger the procedure. “This is not how you want to go into surgery,” Schucht says. “If either of you are nervous, this is a catastrophe. This is the worst thing that can happen.” It is why, he assures me, that a neurosurgeon’s confidence, his self-belief, is not blind arrogance; it’s down to experience. When mistakes are made – “and we are all human, and all humans make mistakes,” he counsels – cases are later examined in close detail by the physician and their peers. The team unpacks what went wrong, and how. This way the surgeon knows that, should they come across a similar issue again, they will be equipped to handle it.
“If a guy has been up thousands of mountains, he will be confident of going up again,” says Schucht. “You will feel that confidence and you will follow him.”
Schucht gestures to an expansive black-and-white photograph mounted on the wall of his office, a gift from a former patient of his, about two metres wide and one metre tall. Schucht explains that it shows himself and the patient and on a hiking trip together, some years after the patient has recovered from cancer. It has been taken from a distance and shows the pair, harnessed to one another, metres away from the sheer, snow-capped summit of the Matterhorn, its peak among the tallest points of the Swiss Alps. Thick clouds and rocky terrain spread below them.
“When my patient gave this to me, he said that this is how he felt when he faced cancer,” says Schucht. “And this is how the patient has to feel: it’s very exposed, it’s dangerous and you need someone who secures you, who lifts you up. But we faced it together. I took him on the cord and we made it all the way together.”