Browse content similar to 27/12/2016. Check below for episodes and series from the same categories and more!
Line | From | To | |
---|---|---|---|
have been arrested following the attack. Now, on BBC News it is time | :00:00. | :00:00. | |
for HARDtalk. Imagine you are a patient about to | :00:00. | :00:21. | |
undergo brain surgery. If it goes well, it could save your life, if it | :00:22. | :00:27. | |
goes wrong, you could end up paralysed or dead. You want to | :00:28. | :00:31. | |
believe your surgeon is infallible, a superhero but he is not, he is all | :00:32. | :00:38. | |
too human, just like you. That emerges from the extraordinary | :00:39. | :00:45. | |
honest writing from Henry Marsh, giving us a rare insight into the | :00:46. | :00:50. | |
mind of the doctor. Is that reassuring or troubling? | :00:51. | :01:24. | |
The very job description, "brain surgeon", | :01:25. | :01:27. | |
I think in most people it prompts a sense of awe | :01:28. | :01:30. | |
and maybe a little bit of fear, as well, and certainly mystery. | :01:31. | :01:34. | |
But you've decided to lift the veil on what it is really | :01:35. | :01:37. | |
I was subject to that myth of brain surgery myself | :01:38. | :01:41. | |
when I decided to become a neurosurgeon many years ago. | :01:42. | :01:44. | |
I suppose I was drawing attention to oneself, | :01:45. | :01:46. | |
as any writer is doing when writing a book, | :01:47. | :01:49. | |
I have been drawing attention to myself from an early age, | :01:50. | :01:54. | |
I wanted to convey that medicine is a very uncertain, | :01:55. | :01:59. | |
When I became a doctor, 35 years ago, doctors | :02:00. | :02:03. | |
Doctors were not really held to account for what they did. | :02:04. | :02:13. | |
That has changed profoundly, at least in this country, | :02:14. | :02:16. | |
you cannot open newspapers without seeing the latest medical | :02:17. | :02:18. | |
It is the tabloid headlines that are driving | :02:19. | :02:21. | |
to change things in what is basically a very excellent health | :02:22. | :02:29. | |
service that we have in this country. | :02:30. | :02:31. | |
I wanted to show that medicine is not my going into a shop, | :02:32. | :02:35. | |
ways much more difficult than people realise, | :02:36. | :02:39. | |
people think neurosurgery, brain surgery is very | :02:40. | :02:41. | |
but it is not, once you know what you are doing. | :02:42. | :02:46. | |
But the really difficult thing is the decision-making. | :02:47. | :02:49. | |
But the really difficult thing is the decision-making and dealing | :02:50. | :02:52. | |
with the patients and all the human problems that arise, | :02:53. | :02:54. | |
Well, by conveying that and focusing on the difficulty and sometimes | :02:55. | :02:59. | |
on the fallibility of both yourself and colleagues, isn't the danger | :03:00. | :03:02. | |
that you plant a new and horrible seed of doubt in the patient? | :03:03. | :03:08. | |
No, I don't think so, if, if you thought it through, if... | :03:09. | :03:11. | |
You have to go and see a doctor, if you could only choose one | :03:12. | :03:15. | |
quality: steady hand, famous reputation, nice website... | :03:16. | :03:19. | |
..nice smile, honesty, what would you choose? | :03:20. | :03:22. | |
No, if you do dangerous surgery, which neurosurgery certainly is, | :03:23. | :03:31. | |
the mistakes in my experience all arise in the decision-making, | :03:32. | :03:35. | |
Very occasionally, purely manual errors occur. | :03:36. | :03:45. | |
But actually it is very, very unusual. | :03:46. | :03:47. | |
And in my career, looking at my own mistakes, and colleagues, | :03:48. | :03:51. | |
it is in the decision-making where things go wrong, that is all | :03:52. | :03:54. | |
Indeed, and I guess that when you decided to go | :03:55. | :04:04. | |
into brain surgery, you knew you were going into a field | :04:05. | :04:07. | |
of medicine which came with enormous pressure. | :04:08. | :04:09. | |
There aren't so many branches of medicine where everything | :04:10. | :04:11. | |
that you do could lead to the most catastrophic... | :04:12. | :04:14. | |
as I said in my book, because surgery is a blood sport, in a way, | :04:15. | :04:20. | |
but that is not inconsistent with caring for your patient, | :04:21. | :04:22. | |
because what makes the operation exciting | :04:23. | :04:24. | |
That is interesting, because it's about the patient, | :04:25. | :04:29. | |
but I want to focus on something about you. | :04:30. | :04:31. | |
Do you have to have a supreme self-confidence bordering | :04:32. | :04:34. | |
The answer is the balance, as all of these things. | :04:35. | :04:38. | |
Power corrupts, and absolute power corrupts absolutely. | :04:39. | :04:40. | |
And as surgeons we have an inordinate amount of power, | :04:41. | :04:43. | |
and it is very easy to become arrogant. | :04:44. | :04:45. | |
I guess you need to be insensitive to some extent. | :04:46. | :04:48. | |
This is the whole challenge of all medicine, visible and acute | :04:49. | :04:51. | |
in something like brain surgery, finding the balance | :04:52. | :04:53. | |
between compassion and professional detachment. | :04:54. | :04:58. | |
One way of illustrating that is to say, obviously, | :04:59. | :05:01. | |
the only ethic in medicine is we should only treat patients | :05:02. | :05:04. | |
as we would wish ourselves or our family to be treated. | :05:05. | :05:08. | |
But it's almost impossible to operate on somebody you know well, | :05:09. | :05:11. | |
Finding the balance between compassion and | :05:12. | :05:14. | |
Compassion and detachment is one element but also | :05:15. | :05:17. | |
Do No Harm, and your other writings about the work over many decades, | :05:18. | :05:23. | |
you, as you have gained an experience and reputation, | :05:24. | :05:26. | |
have actually become more self doubtful. | :05:27. | :05:31. | |
you master the purely technical skills of operating, | :05:32. | :05:42. | |
where mistakes arise is in the decision-making. | :05:43. | :05:45. | |
partly because I am in the latter years of my career, | :05:46. | :05:50. | |
that other people are better at seeing my mistakes than I am. | :05:51. | :05:55. | |
It is a profound truth that applies to all of us, | :05:56. | :05:57. | |
we are very bad at seeing our own mistakes. | :05:58. | :06:00. | |
There is a problem in medicine of finding a balance | :06:01. | :06:03. | |
ditto, you need the arrogance and self belief to do the operating | :06:04. | :06:08. | |
but it is critical that you have a good working | :06:09. | :06:11. | |
relationship with your colleagues as well. | :06:12. | :06:13. | |
So that they can criticise you and you can criticise them. | :06:14. | :06:19. | |
Actually that is very difficult to get doctors to do on the whole. | :06:20. | :06:23. | |
Let's get specific and talk about a case, that you have | :06:24. | :06:26. | |
It's a troubling case, early in your career. | :06:27. | :06:29. | |
I think he was a teacher, a man in his late 50s, | :06:30. | :06:32. | |
who came to you with a huge brain tumour, and you were appalled by it. | :06:33. | :06:37. | |
you say you were quite excited, | :06:38. | :06:41. | |
you had never seen anything quite like it. | :06:42. | :06:43. | |
He was sent off to see another consultant, even | :06:44. | :06:46. | |
more senior than you, and it was pushed back | :06:47. | :06:52. | |
to you and they said, you know what, Henry, you deal with it. | :06:53. | :06:56. | |
You went for it, and you were quite excited, | :06:57. | :07:00. | |
the biggest operation you had ever undertaken. | :07:01. | :07:02. | |
..You sucked out virtually all of this tumour, | :07:03. | :07:08. | |
towards the end of the operation, I could stop now, but dammit, | :07:09. | :07:13. | |
I am going to get every single trace of this tumour out. | :07:14. | :07:16. | |
you had accidentally severed a branch of an artery | :07:17. | :07:20. | |
The mistake was not severing the artery, the mistake | :07:21. | :07:25. | |
was deciding to remove the last bit of tumour. | :07:26. | :07:27. | |
The answer is, all neurosurgeons have terrible periods... | :07:28. | :07:35. | |
terrible disasters and terrible periods of despair. | :07:36. | :07:38. | |
When I first became a consultant, | :07:39. | :07:40. | |
I felt quite ill and sick and miserable for weeks on end | :07:41. | :07:45. | |
You have to go on working because you do, | :07:46. | :07:49. | |
Does it change the way that you work, we have | :07:50. | :07:53. | |
talked already about about confidence, and self-doubt... | :07:54. | :08:00. | |
You need to deceive yourself to some extent. | :08:01. | :08:04. | |
I mean, it is one of the ironies of medicine, that a lot | :08:05. | :08:08. | |
It is something you learn very early on as a young doctor, | :08:09. | :08:12. | |
patients do not want a doctor who says, "I don't know what to do, | :08:13. | :08:16. | |
We want our doctors to be experienced and competent, | :08:17. | :08:20. | |
and by my stage, that is easy, because I am experienced, | :08:21. | :08:23. | |
but when you are a young doctor you are not experienced. | :08:24. | :08:26. | |
If you don't take on the difficult cases, | :08:27. | :08:28. | |
You face this ethical problem right from the start, | :08:29. | :08:33. | |
the moment you qualify as a doctor, suddenly you have to start lying | :08:34. | :08:36. | |
to patients, to some extent, you have to pretend a greater degree | :08:37. | :08:39. | |
of competence and confidence than you really feel you have. | :08:40. | :08:42. | |
And the best way of deceiving other people is deceiving yourself. | :08:43. | :08:45. | |
It is a necessary self belief, self-deception, to help one cope. | :08:46. | :08:48. | |
But as you get older, perhaps you can start trying to dispense | :08:49. | :08:54. | |
I wonder whether that incident, and others like it, you very | :08:55. | :08:59. | |
honestly say come you went to a hospital that specialised | :09:00. | :09:02. | |
And others, and you said, you saw for five people on this ward, | :09:03. | :09:09. | |
who you operated on, and they were, in essence, | :09:10. | :09:11. | |
I'm just wondering whether the threshold of risk | :09:12. | :09:16. | |
that you are prepared to take, changed over time? | :09:17. | :09:22. | |
It goes up and down, is the answer, after that | :09:23. | :09:25. | |
case that you mentioned, I became, in a sense, | :09:26. | :09:29. | |
over conservative, but again reflected the working environment | :09:30. | :09:33. | |
Over the years I discover that the way to do these | :09:34. | :09:40. | |
really difficult cases, and they are really rare, | :09:41. | :09:42. | |
you only see a handful, is to do them with another colleague. | :09:43. | :09:46. | |
When I was working in Nepal recently, | :09:47. | :09:51. | |
we had one or two cases like that, and my colleague was on his own, | :09:52. | :09:55. | |
he runs his own hospital, he said how wonderful | :09:56. | :09:58. | |
I think a more collaborative way of working is very | :09:59. | :10:02. | |
to take on the risk of a very difficult operation, which you know | :10:03. | :10:11. | |
has a serious risk of, as you put it sometimes, | :10:12. | :10:14. | |
"catastrophic consequences", or whether it is more | :10:15. | :10:17. | |
difficult to tell a patient, who is desperate for you to operate, | :10:18. | :10:21. | |
even though you have explained all the risks, that in your view, | :10:22. | :10:24. | |
it is simply not the right decision and that nature has | :10:25. | :10:27. | |
That you feel there is nothing more you can give them. | :10:28. | :10:35. | |
It depends to some extent on the nature of the problem. | :10:36. | :10:39. | |
It is harder to say, go away, live with it, | :10:40. | :10:45. | |
Sometimes, sometimes you say that death is the better outcome. | :10:46. | :10:53. | |
And with experience you learn, and I see this with my younger | :10:54. | :10:56. | |
colleagues, I see them operating on cases which I would have done, | :10:57. | :11:00. | |
which I did at my stage in their career, | :11:01. | :11:04. | |
I no longer do emergency work in this country but when I was | :11:05. | :11:12. | |
you are often telephoned at night by the junior doctors | :11:13. | :11:15. | |
I should add that emergency neurosurgery | :11:16. | :11:18. | |
Is it removing blood cots, it isn't difficult. | :11:19. | :11:34. | |
But the decision-making, whether it is worth operating or not, | :11:35. | :11:36. | |
These are people with head injuries and strokes where, | :11:37. | :11:40. | |
in simple and strokes, in simple terms, if you don't operate, | :11:41. | :11:43. | |
they will die, if you do operate, they may survive that they may be | :11:44. | :11:47. | |
And it's a bit like Nero at the Roman games, | :11:48. | :11:51. | |
if I say thumbs up, operate, I get back to sleep. | :11:52. | :11:54. | |
If I say, let them die, I don't, because I worry that | :11:55. | :11:57. | |
There is a built-in asymmetry which always forces us to overtreat | :11:58. | :12:01. | |
Is it important for you to get to know your patients before | :12:02. | :12:04. | |
Well, I used to think it was, that is an interesting question, | :12:05. | :12:09. | |
my son had, as I say in my book, my son had a brain gym | :12:10. | :12:13. | |
my son had, as I say in my book, my son had a brain tumour | :12:14. | :12:17. | |
he's not necessarily the reason I became a Paediatric brain surgeon. | :12:18. | :12:25. | |
I don't know what other doctors are like, but I always felt it | :12:26. | :12:28. | |
gave me a certain understanding and sympathy of what my patients | :12:29. | :12:38. | |
were going through, because I have been through it myself. | :12:39. | :12:40. | |
Therefore I felt it was an essential part to be actually quite close | :12:41. | :12:44. | |
Although that is partly selfish, if you are close to them, | :12:45. | :12:49. | |
if things go wrong, they are likely, they are less likely | :12:50. | :12:51. | |
It is selfish and unselfish, because it also means | :12:52. | :12:55. | |
And therefore it is more hurtful and damaging. | :12:56. | :12:59. | |
When I was working in Nepal, admittedly, my colleague and his | :13:00. | :13:02. | |
team, because of the language barrier, were doing all the talking | :13:03. | :13:05. | |
with the patients, so I was ending up operating on patients I had not | :13:06. | :13:09. | |
seen before, and scarcely saw afterwards. | :13:10. | :13:12. | |
Which in the past to me would have been complete anathema. | :13:13. | :13:15. | |
I was just as focus and intense and anxious | :13:16. | :13:20. | |
Let me switch focus a little bit and talk | :13:21. | :13:30. | |
This most may amazing organ of ours, it is so complex, | :13:31. | :13:36. | |
And yet you approach it with, sometimes drills, saws, | :13:37. | :13:45. | |
and there is some thing quite bizarre about what | :13:46. | :13:50. | |
Something I took for granted when I was younger but for various | :13:51. | :13:59. | |
reasons, as I get older, I am more and more amazed by this | :14:00. | :14:04. | |
fundamental mystery, everything you and I are thinking | :14:05. | :14:07. | |
and feeling at the moment, is electric. | :14:08. | :14:16. | |
It doesn't feel like electric chemistry, it feels | :14:17. | :14:18. | |
But we are the product of the electrical chemical | :14:19. | :14:21. | |
What is fascinating, modern science, we cannot even begin to explain how | :14:22. | :14:27. | |
thoughts and feelings and consciousness arises, | :14:28. | :14:30. | |
Your career has spanned 35 years or so, in brains. | :14:31. | :14:39. | |
You saying to me that in those 35 years, in brains, | :14:40. | :14:42. | |
are you saying that in those 35 years you have learned very little | :14:43. | :14:45. | |
more about how the electrochemistry is works, and how... | :14:46. | :14:48. | |
It is like saying we know how a brick is made. | :14:49. | :14:51. | |
It doesn't tell us anything about the house made by the bricks. | :14:52. | :14:54. | |
So although there is a huge amount of neuroscience going on, | :14:55. | :14:57. | |
what really interests us, as human beings, | :14:58. | :14:59. | |
is ourselves, our own feelings and consciousness. | :15:00. | :15:05. | |
We cannot experiment upon it, you see, either. | :15:06. | :15:13. | |
You write lyrically about this, at one point you write | :15:14. | :15:16. | |
about being struck during an operation, | :15:17. | :15:18. | |
that you sucked jelly out of the brain with, | :15:19. | :15:28. | |
you say - "My sucker is moving through thought itself, | :15:29. | :15:31. | |
through emotion, and that reason, memory and dreams should consist | :15:32. | :15:34. | |
of this jelly is simply too strange to understand." | :15:35. | :15:36. | |
Literally, how dare you suck out all of this jelly when you might be | :15:37. | :15:42. | |
sucking out people's imaginations or thoughts or dreams? | :15:43. | :15:44. | |
The answer to that is the illness you are trying to treat is even | :15:45. | :15:48. | |
worse than the operation, so to speak. | :15:49. | :15:49. | |
Coming back to the question, how do surgeons cope with bad | :15:50. | :15:53. | |
results and convocation, well, you think of the good result, | :15:54. | :15:55. | |
and you know that most of the time, things go well, and for all the poor | :15:56. | :16:00. | |
patients who have not done well in my hands, | :16:01. | :16:02. | |
hopefully there will be hundreds, if not thousands | :16:03. | :16:04. | |
That is ultimately what the balance is about. | :16:05. | :16:09. | |
It is terribly important, maybe it is partly my personality, | :16:10. | :16:12. | |
but success is corrupting, success makes us | :16:13. | :16:14. | |
The worst surgical crime for me is complacency. | :16:15. | :16:21. | |
You mustn't dwell permanently on your complications | :16:22. | :16:23. | |
It is terribly important to remain as humble and modest as you can, | :16:24. | :16:30. | |
even though you must present as more confident and assured | :16:31. | :16:32. | |
Before we go back to practical matters of health care, | :16:33. | :16:38. | |
one more question on the more philosophical side of what you do, | :16:39. | :16:41. | |
you just said to me, I believe in science with a S, | :16:42. | :16:45. | |
but you know, for centuries, philosophers, scientific | :16:46. | :16:47. | |
thinkers, have posited the notion that in the end, our mind, | :16:48. | :16:50. | |
our soul is separate from the physical reality of this | :16:51. | :16:53. | |
Are you telling me that you are absolutely convinced | :16:54. | :17:03. | |
there is no possibility of that being true? | :17:04. | :17:08. | |
I find that infinite mystery rather reassuring. | :17:09. | :17:25. | |
We all know the macrocosm of the Big Bang, all this stuff | :17:26. | :17:28. | |
recently about the anniversary of Einstein's theory of relativity, | :17:29. | :17:30. | |
each of us within our own head and our own consciousness is sitting | :17:31. | :17:34. | |
on a mystery as great as the Big Bang. | :17:35. | :17:38. | |
I'm sure that you have read the science papers which address | :17:39. | :17:42. | |
near death experiences, and under scientific conditions can | :17:43. | :17:44. | |
recollect experiences they have had when nominally the machinery has | :17:45. | :17:47. | |
near death experiences are well recognised as a phenomenon. | :17:48. | :18:03. | |
But they come out of the electrochemistry of the brain, | :18:04. | :18:06. | |
Back to health care, we have talked about you, | :18:07. | :18:12. | |
as an individual doctor, surgeon, and how you have approached | :18:13. | :18:18. | |
a career dealing with the most terrible sort of challenges | :18:19. | :18:20. | |
is exist within a vast health care system, one small cog, | :18:21. | :18:29. | |
Seems to me that you have become very disillusioned | :18:30. | :18:35. | |
You have to look at the NHS internationally, | :18:36. | :18:41. | |
first thing, and if you look at the NHS... | :18:42. | :18:43. | |
There is a lot of criticism in England, you cannot read | :18:44. | :18:51. | |
the newspapers without seeing, some mistake in a hospital and | :18:52. | :18:54. | |
As if it's the responsibility of the NHS as a whole. | :18:55. | :18:59. | |
The National Health Service provides, by international | :19:00. | :19:01. | |
standards, very good health care in terms of overall outcomes | :19:02. | :19:03. | |
Do you still believe in "socialised medicine", | :19:04. | :19:10. | |
I believe passionately in socialised health care, | :19:11. | :19:13. | |
because I have worked and visited so many countries where | :19:14. | :19:16. | |
medicine is commercial and it is terrible, because... | :19:17. | :19:21. | |
But it comes back to the fact that medicine is not | :19:22. | :19:27. | |
like going into a shop and buying something. | :19:28. | :19:29. | |
A, the patients are not in a good position to judge | :19:30. | :19:32. | |
what is good for them, and B, a lot of the decision-making is very | :19:33. | :19:36. | |
And if you look at countries like America, sure, American health | :19:37. | :19:40. | |
care at its best is fantastic, but it is extravagant. | :19:41. | :19:43. | |
All countries in the world, health care costs are rocketing | :19:44. | :19:45. | |
above the rate of inflation, and, I'm afraid, if doctors | :19:46. | :19:48. | |
have a financial interest in what they are doing, | :19:49. | :19:51. | |
they tend to do more and a lot of it is unnecessary. | :19:52. | :19:54. | |
Your message seems to be, taking the British case, | :19:55. | :19:56. | |
of a socialised system which is free at the point of delivery, | :19:57. | :20:07. | |
but politicians have to be more honest that at a time of rising | :20:08. | :20:10. | |
health care costs and ageing populations, politicians | :20:11. | :20:12. | |
need to say to people, you can have this but you are going | :20:13. | :20:16. | |
to need to pay more tax, or you have to accept greater | :20:17. | :20:19. | |
It is basic economics, if you have a good that is free | :20:20. | :20:24. | |
at the point of delivery and scarce supply, you end up with queues, | :20:25. | :20:28. | |
and having all of these targets, introduced by the previous | :20:29. | :20:30. | |
government, can be counter-productive. | :20:31. | :20:31. | |
I don't think they are OK but you have to prioritise and deal | :20:32. | :20:37. | |
with the emergencies first, if you give equal priority | :20:38. | :20:40. | |
to nonurgent cases, then urgent work suffers. | :20:41. | :20:42. | |
A lot of people have made the point about the organisations | :20:43. | :20:45. | |
and the chaos in the system, but it seems to be another | :20:46. | :20:48. | |
interesting point about you, coming back to a word I used | :20:49. | :20:51. | |
earlier, arrogance, you don't like being told what to do | :20:52. | :20:54. | |
by managers, you don't like being told that you can't wear | :20:55. | :20:57. | |
a tie during surgery and you can't wear a wristwatch, you get | :20:58. | :21:00. | |
angry that your car park space has been moved. | :21:01. | :21:02. | |
I don't drive a car, I ride a bicycle, I don't have that | :21:03. | :21:06. | |
particular problem that many of my colleagues do. | :21:07. | :21:08. | |
You are right, some of the reviews of the book commented | :21:09. | :21:11. | |
on my arrogance, but again, that criticism is probably fair | :21:12. | :21:15. | |
to some extent but there is this fundamental tension | :21:16. | :21:17. | |
in medicine, what patients want, they want individual care, | :21:18. | :21:19. | |
from a doctor, they want a sense of personal responsibility | :21:20. | :21:22. | |
As a doctor, most of us have this overwhelming sense of personal | :21:23. | :21:33. | |
responsibility for our patients and their lives and their deaths. | :21:34. | :21:36. | |
And then if you are treated as though you are just another minor | :21:37. | :21:39. | |
cog in the machine it produces a lot of tension. | :21:40. | :21:42. | |
Psychologists have found that many times, one of the most | :21:43. | :21:45. | |
stressful situations that lab rats can be in and human beings can be | :21:46. | :21:48. | |
in is to have a position of responsibility with no power, | :21:49. | :21:52. | |
You've escaped the confines of the National Health Service | :21:53. | :21:55. | |
in the UK, because a lot of your work is done abroad, | :21:56. | :21:58. | |
in Ukraine, in Nepal, and other countries as well. | :21:59. | :22:01. | |
But I want to end by asking you this - having worked | :22:02. | :22:04. | |
with terrible health challenges of the brain, | :22:05. | :22:08. | |
are you now frightened of your own brain, | :22:09. | :22:10. | |
I am, I think it is something that haunts most people of our age, | :22:11. | :22:18. | |
most of us have had one or two demented parents to care for. | :22:19. | :22:21. | |
Dementia is an increasing problem in wealthy countries. | :22:22. | :22:24. | |
I'm much more worried about dementia than dying. | :22:25. | :22:31. | |
The evidence is fairly clear, keeping busy, physical exercise, | :22:32. | :22:34. | |
things like that, are very important, to try to keep it at bay. | :22:35. | :22:37. | |
Interestingly, you are committed to keeping up doctoring, | :22:38. | :22:42. | |
you said once, an ageing doctor is a better doctor, | :22:43. | :22:45. | |
as the wheels start to fall off, you have more energy. | :22:46. | :22:51. | |
Having said that, you need to know where to stop. | :22:52. | :22:56. | |
As with everything in life as with life itself, | :22:57. | :23:01. | |
best to leave too early than too late! | :23:02. | :23:03. | |
But I'm not ready to stop working yet! | :23:04. | :23:05. | |
We began by talking about whether you wanted an honest | :23:06. | :23:08. | |
doctor or a doctor with a steady hand, I don't wish to be rude, | :23:09. | :23:11. | |
but as you age, as I age, your hand becomes unsteady, | :23:12. | :23:14. | |
I was thinking about it quite a lot when I was doing a lot of very | :23:15. | :23:24. | |
but I ended up doing a lot of very major operating, | :23:25. | :23:29. | |
more than I would do in this country. | :23:30. | :23:31. | |
And I felt two things - one, I was pretty sure that purely | :23:32. | :23:35. | |
All this operating is done with a microscope, | :23:36. | :23:39. | |
eyesight is not an issue because everything is magnified. | :23:40. | :23:42. | |
The other thing that struck me, which was curious, | :23:43. | :23:44. | |
I felt increasingly ashamed and embarrassed at how crude | :23:45. | :23:47. | |
the operating I was doing, compared with what I increasingly | :23:48. | :23:49. | |
What I understand about the brain is from reading popular | :23:50. | :23:53. | |
neuroscience books, not from neurological medicine. | :23:54. | :23:55. | |
I need to gradually withdraw from operating, clearly. | :23:56. | :24:01. | |
That's the thought I want to end with. | :24:02. | :24:09. | |
I hope you keep going for quite some time. | :24:10. | :24:12. | |
Thank you very much for joining us on HARDtalk. | :24:13. | :24:40. | |
It looks as though Wednesday will start on a cold note for many | :24:41. | :24:47. | |
But my major concern is the density of the fog. | :24:48. | :24:51. |