Rupture: A Matter of Life OR Death Page #2

that is has to be completely blocked off.

The problem with that is that it deprives the brain downstream of circulation,

and so in order to protect the brain from a stroke while completely closing off the aneurysm,

one has to do a bypass.

- A 16-hour surgery.

- Yeah.

Personally, I cannot imagine...

a doctor can perform a surgery for 16 hours.

The surface of the brain is here.

We have to open the cleft between two of the brain lobes

and identify this blood vessel.

This will be the area where the bypass is performed.

Now, the clock is ticking when you close off the artery.

You can't close off the brain artery indefinitely,

so we have to work quickly and finish that closure within half an hour,

or the brain is exposed to a period of time

without adequate circulation and a stroke might occur.

The good thing is that children are very resilient.

Their brains are very resilient.

If you can close off the weakness, if you can do a bypass if necessary

to preserve the circulation, their recovery is often fantastic.

And so, for example, if you wanted to pick the glass of water to drink,

how would you do that with your right hand?

Or you would not be able to?

I think I would be able to, but I can use, like, both hands.

Both hands?

OK, so it helps you.

We're very proud of her, taking all this.

And...

..I guess that's what we parents can do.

Aww, making you cry!

I just felt that if I could go through this process,

and if I had the strength to go through it,

then I can endure anything. I can go through anything in life.

- I can feel his heart beating.

- Aww!

They're very, very...

- They've helped a lot of people in recovery, you know?

- Uh-huh.

I mean, he's just a rabbit.

But he's so cuddly!

'There's something wonderful about victims

'who have been through a major operation.

'They really are eager to start again in life

'and there's this sort of, like, childlike quality about them all.

'There's no more cynicism, there's not a judgement.

'And it's heart-warming to see the joy and the humour.'

When you're walking in the streets and the brain's been bruised

and you see people coming at you from all directions...

WHOOSHING..it's like being in a cinema and you're too close to the screen.

TRAFFIC NOISE The traffic, avoiding, you know, being run over by a car.

Just simple things like that, which are completely normal

and we take for granted when we're... when we're normal.

The brain has a consistency of jell-o,

but it's a fragile,

beautiful, pulsating, kind of a pink structure

with a latticework of very fine vessels coursing around,

with an incredible anatomy of nerves and arteries

and wonderful structures that make up who we are.

You are in the human brain,

you are in the most beautiful structure in the universe,

and that experience is always special.

You realise that you are working close to the artwork of God.

I vividly remember one patient

who had two aneurysms.

We had removed about 80 or 90% of the malformation.

And it was just 10% left to remove.

And the one thing you are always taught

is you leave the draining vein,

the vein that is draining all the blood out, until last.

We cut the vein and immediately that vein, you know,

became engorged with blood and stood up erect and everything,

you know, at that point changed.

And it was the one time in my life I felt that this patient

was going to die on the table.

We just had one chance.

Immediately, we just...with everything we can,

working through a pool of blood, you know, just...almost blindly,

took out the last 10% of arteriovenous malformation.

And miraculously, it was like the clouds parted,

the swelling went down, the bleeding stopped and everything was calm.

Aneurysms do call for a very fine, careful dissection.

It's a bit like bomb disposal work,

except it's the patient's life at risk

rather than the surgeon's.

What's crucial about neurosurgery is not really the operating,

it's the decision-making.

If you get too involved, you can't do the work.

And that is particularly the case, in a way, with aneurysm surgery,

which is this very...

more or less, a make or break operation.

You open the patient's head, you then sort of stalk slowly

and microscopically along the major arteries, underneath the brain.

Then you have this climactic moment when you catch the aneurysm

with a clip and you've got to be very careful

the aneurysm doesn't burst in the process.

If it does burst, then you get an intraoperative rupture.

That's very serious.

There's a high risk the patient will die on the table.

Stop, Dave.

I'm afraid.

Everything about neurosurgery, it's not just life or death,

it's quality of life.

You have even more difficult things, like at the front of the brain,

where damage causes personality change.

And people no longer are the people they were.

My mind is going.

I can feel it.

And what's so weird about that is that the patient themselves

doesn't know that.

My instructor was Mr Langley.

And he taught me to sing a song.

If you'd like to hear it, I can sing it for you.

Yes, I would like to hear it, HAL. Sing it for me.

Many of these people, you know, have suffered social collapse.

They've lost their job, their marriage has broken down

and they're sitting at home on, I don't know, disability pay.

They're intellectually intact but no longer able to function socially.

That's very sad. There's not much you can do to avoid that.

# Daisy, Daisy

# Give me your answer, do. #

The functions of the brain are easily warped by disease and injury.

Memories can be shattered, emotions destabilized.

It's a kind of civil war - body in conflict with mind.

Neil Kitchen is one of the world's most distinguished neurosurgeons.

He is in the process of cutting open a flap of skull bone to gain

access to his patient's brain.

The goal of the operation is to remove a cancerous brain tumour.

He performs his task dispassionately,

like a mechanic fixing damaged machinery.

But this machine, the brain,

is also the vessel of his patient's hopes and fears,

his dreams and his memories.

All that he is.

And consider this,

Mr Kitchen's compassionate skills will at best

grant the man but a few months more to live.

Inevitably, the cancer will prevail.

All this for a few months more, to be with his family.

What clearer confirmation of the value of life?

Than love?

"Do not go gentle into that good night,

"rage, rage against the dying of the light."

Think of what's involved here.

Here is the human brain,

which is a three-pound mass of jelly I can hold in the palm of my hand.

And yet it can contemplate the vastness of interstellar space,

it can contemplate

the meaning of infinity and of numbers,

it can even contemplate itself contemplating,

what we call self-awareness.

It can start introspecting on itself and raise profound questions about

the meaning of its own existence and why it has arrived in this cosmos.

To contemplate the brain is to enter a hall of mirrors.

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