Read Do No Harm: Stories of Life, Death and Brain Surgery for Free Online

feels much longer – I can stand it no longer.
    ‘You’re fumbling. I’m sorry but I’ll have to take over.’
    Jeff says nothing and climbs out of the chair – it would be a rash surgical trainee who ever complained to his boss, especially at a moment like this – and we change places again.
    I take the applicator and place it against the aneurysm, pressing the springs of the handle together. Nothing happens.
    ‘Bloody hell, the clip won’t open!’
    ‘That was the problem I was having,’ Jeff says, sounding a little aggrieved.
    ‘Bloody hell! Well, give me another applicator.’
    This time I easily open the clip and slip the blades over the aneurysm. I open my hand and the blades close, neatly clipping the aneurysm. The aneurysm, defeated, shrivels since it is now no longer filling with high pressure arterial blood. I sigh deeply – I always do when the aneurysm is finally dealt with. But to my horror I find that this second applicator has an even more deadly fault than the first: having closed the clip over the aneurysm the applicator refuses to release the clip. I cannot move my hand for fear of tearing the minute, fragile aneurysm off the middle cerebral artery and causing a catastrophic haemorrhage. I sit there motionless, with my hand frozen in space. If an aneurysm is torn off its parent artery you can usually only stop the bleeding by sacrificing the artery, which will result in a major stroke.
    I swear violently while trying to keep my hand steady.
    ‘What the fuck do I do now?’ I shout to no one in particular. After a few seconds – it feels like minutes – I realize that I have no choice other than to remove the clip, despite the risk that this might cause the aneurysm to burst. I re-close the applicator handle and to my relief the blades of the clip open easily. The aneurysm suddenly swells and springs back into life, filling instantly with arterial blood. I feel it is laughing at me and about to burst but it doesn’t. I throw myself back in my chair, cursing even more violently, and then hurl the offending instrument across the room.
    ‘That’s never happened before!’ I shout but then, quickly calming down, laugh to Irwin, ‘And that’s only the third time in my career I’ve thrown an instrument onto the floor.’
    I have to wait a few minutes while yet another applicator was found. The faulty ones, for some strange reason, turned out to have stiff hinges. Only later did I remember that the surgeon I had watched thirty years ago, and whose trainee I became, had told me that he had once encountered the same problem, although his patient had been less fortunate than mine. He was the only surgeon I knew who always checked the applicator before using it.
    Doctors like to talk of the ‘art and science’ of medicine. I have always found this rather pretentious, and prefer to see what I do as a practical craft. Clipping aneurysms is a skill, and one that takes years to learn. Even when the aneurysm is exposed and ready to take a clip, after the thrill of the chase, there is still the critical question of how I place the clip across the aneurysm, and the all-important question of whether I have clipped the aneurysm’s neck completely without damaging the vital artery from which the aneurysm has grown.
    This aneurysm looks relatively easy but my nerves are too frayed to let my assistant take over again and so, with yet another applicator, I clip the aneurysm. The shape of this aneurysm, however, is such that the clip does not pass completely over the neck – I can just see a little part of the aneurysm neck sticking out beyond the tips of the clip.
    ‘Not quite across,’ Jeff says helpfully.
    ‘I know!’ I snap.
    This is a difficult part of the operation. I can partly open the clip and re-position it to get a more perfect position but I might tear the aneurysm in the process and be left looking at a fountain of arterial blood rushing up the microscope towards me. On the other hand if the