Brain Doctors: Surgeons of the Body and the Mind

We are our brains. Our memories and personality, the way we perceive the world around us, how we think and behave – it is all the product of that poorly understood organ inside our skull. So when something goes wrong, there are often profound psychological, as well as physical, consequences to deal with.

It is no wonder then that we hold the art of neurosurgery in such high regard. Not only do brain surgeons have a certain amount of power to restore impaired brain functioning, they also have a responsibility to try and avoid further damaging the “self” – the product of the brain – in the process. This accountability to both the physical and mental health of a patient is unique to surgeons who work on the central nervous system. As the famous neurosurgeon Dr Gabriel Munroe once remarked, “The brain is a mysterious, multi-faceted, miraculous complex organ that contains our unique humanity. The heart, when it comes down to it, is just a pump”.

This idea was touched upon in the first episode of BBC 2’s three-part documentary Brain Doctors, filmed in the Neurosciences Intensive Care Unit at Oxford’s very own John Radcliffe hospital. Although it is at times hard to watch, the show provides a fascinating and intimate look at the ups and downs of the everyday working life of neurosurgeons in the ICU.

It was stories of those individuals whose very sense of identity hung in the balance that were the most interesting – and the saddest – of the programme. One patient came into the ICU after having collapsed at home. The doctors found that she had a large tumour affecting much of her brain. Her prognosis was bad, and because the tumour was so large, any operation would involve the removal of a significant proportion of brain tissue as well. The effects this would have on her cognition – in particular her memory – were uncertain. It was difficult watching the surgeons operate, knowing that although they were extending her life, they could be permanently damaging her ability to remember it.

In other cases, it was sudden changes in a patient’s mental state that had brought them into the ICU to begin with. One boy came in to the hospital after suddenly displaying confusion and amnesia. An urgent operation saw neurosurgeon Jay Jayamohan skilfully manoeuvring a long needle-like instrument to pierce a hole in the side of the ventricles in order to release pressure, all the while avoiding damage to important brain structures nearby. In what seemed like no time, the boy was sitting back in bed smiling, memory problems gone. According to Jayamohan, this was his favourite operation, quick and not too difficult.

Throughout the show, we caught glimpses of how fragile life can be, and how everything can so suddenly become derailed. It was especially disconcerting when patients arrived at the ICU not because of a car accident or a bump on the head, but after collapsing out of the blue or experiencing a bout of confusion. Their lives were instantly changed when the doctors discovered the existence of a brain disease they never knew they had.

Yet a problem with the brain can sometimes go undetected for a long time, despite the fact that it may have profound psychological effects. Watching Brain Doctors, I was reminded of a story the neuropsychologist Paul Broks tells in his extraordinary book, Into the Silent Land. A patient, ‘Robert’, experiences a dramatic change in character. This once proper, well-to-do man starts to shop-lift, spends excessive money on possessions he doesn’t need, and one day skips work to drive to a Cornwall beach – from Yorkshire.  Eventually he leaves his family and essentially starts a new life without them. But when he starts getting seizures a couple of years later, he is taken to hospital, where the doctors find – and successfully remove – a tumour affecting the frontal lobes of his brain. When Robert wakes up, he has changed back to the person he was before, and asks when his children will come to visit. Sadly, his family have long since moved on.

In the end, however, the most insightful and touching parts of Brain Doctors were not those that focused on the challenges faced by patients and their families. Rather, they were the points where we saw how profoundly the surgeons were affected by their work. Many of them had been in training for a decade and a half, with years of clinical experience beyond that, yet they had not become numbed to the loss and despair that must be a constant feature of the ICU.

One of the surgeons described his work as like having bipolar disorder: when everything went well, it was the best feeling in the world, but if things started going wrong, it could be devastating. Another was on the verge of tears describing how emotionally draining it was to put everything in to saving a patient and still having to break the bad news to their family.  It was moving to see her return home at the end of the day and become a normal person with a normal family and everyday concerns. How does she do it? “You have to just come in and keep going … and [do] all the things that mums do, whether they’ve just certified someone dead or not.”

But despite all this, it was clear that these talented doctors were doing what they loved. Their obvious satisfaction and delight on the successful completion of an operation was uplifting, despite the sombre feel to the programme. Jayamohan put it best: “Work makes me happy, because I feel like I’ve done something good. Best job ever, without a doubt. There’s nothing else that comes close.”

Brain Doctors airs at 9pm on Wednesdays on BBC2. The first episode is available on BBC iPlayer.