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have made many patients very happy with successful operations but there have been many terrible failures and most neurosurgeons’ lives are punctuated by periods of deep despair.
    I went back into the hospital that evening to see the woman. She was sitting up in bed, with the large black eye and swollen forehead that many patients have for a few days after an operation like hers. She told me that she felt sick and had a headache. Her husband was sitting beside her and looked angrily at me as I quickly dismissed her bruises and post-operative pain. Perhaps I should have expressed more sympathy but after the near disaster of the operation I found it difficult to take her minor post-operative problems seriously. I told her that the operation had been a complete success and that she would soon feel better. I had not had the opportunity to talk to her husband before the operation – something I usually take great care to do with relatives – and he had probably appreciated the risks of the operation even less than his wife had done.
    We have achieved most as surgeons when our patients recover completely and forget us completely. All patients are immensely grateful at first after a successful operation but if the gratitude persists it usually means that they have not been cured of the underlying problem and that they fear that they may need us in the future. They feel that they must placate us, as though we were angry gods or at least the agents of an unpredictable fate. They bring presents and send us cards. They call us heroes, and sometimes gods. We have been most successful, however, when our patients return to their homes and get on with their lives and never need to see us again. They are grateful, no doubt, but happy to put us and the horror of their illness behind them. Perhaps they never quite realized just how dangerous the operation had been and how lucky they were to have recovered so well. Whereas the surgeon, for a while, has known heaven, having come very close to hell.
     

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    HAEMANGIOBLASTOMA
     
    n. a tumour of the brain or spinal cord arising from the blood vessels.
    I arrived at work feeling cheerful. There was a solid cerebellar haemangioblastoma on the list. These are rare tumours which are formed of a mass of blood vessels. They are benign – meaning that they can be cured by surgery – but they will prove fatal if untreated. There is a small risk of disaster with surgery, since the mass of blood vessels can cause catastrophic haemorrhage if you do not handle the tumour correctly, but there is a much greater chance of success. This is the kind of operation that neurosurgeons love – a technical challenge with a profoundly grateful patient at the end of it if all goes well.
    I had seen the patient in my outpatient clinic a few days earlier. He had been suffering from severe headaches for the last few months. He was a forty-year-old accountant, with a head of curly brown hair and a slightly red face that made him look continually embarrassed. As we spoke, I felt embarrassed in return and became self-conscious and awkward as I tried to explain the gravity of his illness to him. Only later did I realize that he had a red face because he was polycythaemic – he had more red blood cells in his blood than normal, since his particular tumour can stimulate the bone marrow to over-produce red blood cells.
    ‘Do you want to see your brain scan?’ I asked him, as I ask all my patients.
    ‘Yes . . .’ he replied, a little uncertainly. The scan made the tumour look as though it was full of black snakes – ‘flow voids’ – produced by the blood rushing through the potentially disastrous blood vessels. I viewed these on the scan with enthusiasm, as they meant that a challenging operation was in prospect. My patient looked cautiously at the computer screen in front of us as I explained the scan to him and we discussed his symptoms.
    ‘I’ve never been seriously ill before,’ he said unhappily.