do no harm, by henry marsh
Despite all this technology neurosurgery is still dangerous, skill and experience are still required as my instruments sink into the brain or spinal cord, and I must know when to stop. Often it is better to leave the patient’s disease to run its natural course and not to operate at all. And then there is luck, both good luck and bad luck, and as I become more and more experienced it seems that luck becomes ever more important.
Modern binocular operating microscopes are wonderful things and I am deeply in love with the one I use, just as any good craftsman is with his tools. It cost over one hundred thousand pounds and although it weighs a quarter of a ton it is perfectly counter-balanced. Once in place, it leans over the patient’s head like an inquisitive, thoughtful crane. The binocular head, through which I look down into the patient’s brain, floats as light as a feather on its counter-balanced arm in front of me, and the merest flick of my finger on the controls will move it. Not only does it magnify, but it illuminates as well, with a brilliant xenon light source, as bright as sunlight.
Cerebro-spinal fluid, known to doctors as CSF, as clear as liquid crystal, circulating through the strands of the arachnoid, flashes and glistens like silver in the microscope’s light. Through this I can see the smooth yellow surface of the brain itself, etched with minute red blood vessels – arterioles – which form beautiful branches like a river’s tributaries seen from space.
