Here is a link to part 1, for those of you who haven’t read it yet. And part two below:
Schucht has received an emergency call. He stands in a control room where neuroradiologists are overseeing an operation from behind thick panels of glass. This department is responsible for making and analysing scans of the brain; Schucht has been requested as he specialises in vascular neurosurgery – dealing with veins and arteries – alongside oncological, for patients with cancer.
Speaking in English for my benefit, a senior radiologist briefs Schucht on the patient: she suffers from an arterial-venous fistula, an irregular connection between an artery and vein found on the exterior of the brain or spine. The condition is often acquired within the patient’s lifetime. If left untreated, it can result in sudden bleeding, then death. She had been living with the fistula for years and was scheduled to undergo surgery in three days’ time to rectify the problem when, today, the bleeding began.
Looking through the glass panel, the patient can be made out, lying down and covered with green sheets. None of her body is visible, but a scan of her brain is up on the monitors. “This hole here,” Schucht says to me, pointing toward the left hemisphere: “It looks big. It looks as though there is a lot of bleeding. But it is just one millimetre wide.” Now, it must be closed.
In the operating room there is a team of six or so doctors, dressed in blue surgical scrubs, facemasks and papery green caps. A senior physician stands beside the patient, holding a long, thin tube. This is a catheter, Schucht explains, used to treat the condition from within, potentially preventing the need for a surgeon having to enter through the skull.
The catheter must be threaded through the body by way of an artery, the doctor working it by hand and using live neuroimaging to guide him. Were the catheter to reach this millimetre-wide hole, a small amount of substance could be issued from it to block the gap and stem the bleeding. The procedure will continue for another hour. It is minimally invasive and, if successful, the patient will return home in a few short days. If not, Schucht will operate.
*
The auditorium is small and low-lit with red cushioned seats. Schucht sits at the front with twenty or so doctors behind him. A woman moves a cursor across MRI scans on a large screen as she speaks in German. Occasionally, a doctor asks a question and she answers comprehensively.
Schucht’s job might easily be assumed to be a one-person affair: the neurosurgeon a lone wolf, with an uncanny knack for diagnosing and treating a problem. But in truth, forward-planning and collaboration is crucial. In the operating room, this means Schucht has a team around him who are quick to respond to his needs. It also means that he must work well across departments, such as with the neuroradiologists who called him in on emergency. And, now during the conference taking place, it means discussing the hospital’s new inpatients with colleagues as they come in.
The first scan is of a head that has sustained damage from a car crash, the cranium visibly knocked out of shape and white marks on the brain indicating a lesion. In another, a large indent has been caused by a phone that was dropped onto the patient’s head from the fourth floor of a building. The third scan causes some discussion.
The patient suffers from advanced Parkinson’s disease, a condition visible on the parts of the brain responsible for motor function. The department intends to operate on them using a method of treatment called Deep Brain Stimulation. For this, the surgeon must effectively rewire the brain, hooking it up to a small device that’s not dissimilar to a pacemaker. This is strapped to the patient’s waist and sends electric pulses that reactivate the degenerated part of the brain, preventing the resting tremor you will see in typical sufferers of Parkinson’s. This technique has also been used to treat anything from OCD to depression.
There’s not always consensus on the right mode of treatment. A physiotherapist might argue that performing neurosurgery on someone with Parkinson’s, often someone who is already in their old age, would only damage the quality of the time they have remaining. Positive gains would be limited to just a handful of years. Instead, the physiotherapist might recommend their own remedy of regular exercise. Or else, a GP may prefer prevention to cure, choosing to prescribe medicine that would help stave off the worst effects of Parkinson’s, though never fully staving them off altogether.
These disagreements are common, Schucht explains. Each department wants to take on more cases, believing their own method of treatment to be the best. Competition encourages discussions that help physicians consider their positions more carefully. They make compromises, eventually agreeing on the best plan of action according to the needs of each case.
When the conference is finished, Schucht stays behind to speak to a young doctor. He puts her at ease when he talks, elaborating generously on points where she requires more detail. She nods, taking notes. Once finished, she thanks him and leaves.
Minutes later, he receives another emergency call, the same department as earlier. The radiologists’ attempt to close the fistula and stem the bleeding has failed. The operating theatre is being readied. In thirty minutes, surgery will begin.