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aneurysm neck is not completely occluded there is some danger – though it is difficult to say how great – that the patient will eventually suffer a further haemorrhage in the future.
    A famous English surgeon once remarked that a surgeon has to have nerves of steel, the heart of a lion and the hands of a woman. I have none of these and instead, at this point of an aneurysm operation, I have to struggle against an overwhelming wish to get the operation over and done with, and to leave the clip in place, even if it is not quite perfectly placed.
    ‘The best is the enemy of the good,’ I will growl at my assistants, for whom the operation is a wonderful spectator sport. They take a certain pleasure in pointing out that I have not clipped the aneurysm as well as I might have done, since they will not have to cope with the consequences of the aneurysm tearing. And if that happens, it is always exciting to watch their boss struggling with torrential haemorrhage – I certainly enjoyed it when I was a trainee. Besides they will not have to experience the hell of seeing the wrecked patient afterwards on the ward round and feel responsible for the catastrophe.
    ‘Oh, very well,’ I will say, shamed by my assistant, but also thinking of the hundreds of aneurysms I have clipped in the past and how, like most surgeons, I have become bolder with experience. Inexperienced surgeons are too cautious – only with endless practice do you learn that you can often get away with things that at first seemed far too frightening and difficult.
    I cautiously open the clip a little and gently push it further along the aneurysm.
    ‘There’s still a little bit out,’ says Jeff.
    Sometimes at these moments my past disasters with aneurysm surgery parade before me like ghosts. Faces, names, wretched relatives I forgot years ago suddenly reappear. As I struggle against my urge to finish the operation and escape the fear of causing a catastrophic haemorrhage, I decide at some unconscious place within myself, where all the ghosts have assembled to watch me, whether to re-position the clip yet again or not. Compassion and horror are balanced against cold, technical precision.
    I re-position the clip a third time. It finally looks well placed.
    ‘That will do,’ I say.
    ‘Awesome!’ says Jeff happily, but sad not have put the clip on himself.
     
    I left Jeff to close, retired to the surgical sitting room next to the theatre and lay down on the large red leather sofa which I had bought for the room some years ago and thought, once again, of how so much of what happens to us in life is determined by random chance. After brain surgery all patients are woken up quickly by the anaesthetist so that we can see if they have suffered any harm or not. With difficult operations all neurosurgeons will wait anxiously for the anaesthetic to be reversed, even if – as with this operation – one is fairly certain that no harm has been done. She awoke perfectly, and once I had seen her I left the hospital to go home.
    As I cycled away from the hospital under dull, grey clouds, perhaps I felt only a little of the joy that I used to feel in the past after successful aneurysm operations. At the end of a successful day’s operating, when I was younger, I felt an intense exhilaration. As I walked round the wards after an operating list with my assistants beside me and received my patients’ heart-felt gratitude and that of their families, I felt like a conquering general after a great battle. There have been too many disasters and unexpected tragedies over the years, and I have made too many mistakes for me to experience such feelings now, but I still felt pleased with the way the operation had gone. I had avoided disaster and the patient was well. It was a deep and profound feeling which I suspect few people other than surgeons ever get to experience. Psychological research has shown that the most reliable route to personal happiness is to make others happy. I