Lessons & Reflections
Reflections from the clinic, the ICU, and a life in neurosurgery — moments that remind us why the work matters. These stories are shared with permission and deep respect for the patients and families who trusted us with their care.
26 July 2026
The Beauty Within
As neurosurgeons, we are given a rare privilege. When we operate on the brain, we are allowed to witness a beauty that very few people will ever see—the extraordinary beauty of the human body from within. The brain is not merely an organ. It is a living network of delicate structures, intricate pathways and countless connections, each arranged with astonishing precision. Nerves, blood vessels and brain tissue lie closely intertwined, every structure occupying its place and serving its purpose. No two operations are ever exactly the same, yet the fundamental design remains remarkably consistent from one person to another. Standing at the operating table, looking at the brain directly, one cannot help but feel humbled. A structure only a few millimetres wide may control movement, speech, vision, memory or personality. The smallest disturbance in the wrong place can change the course of a person's life. A patient may lose the ability to move an arm. Another may struggle to speak. Some may recover remarkably well, while others may live with lasting neurological damage. That is the paradox of neurosurgery. We work within something breathtakingly beautiful, yet unforgivingly delicate. Every movement must be deliberate. Every decision carries weight. Beneath our instruments lies not simply tissue, but a person's memories, emotions, relationships, ambitions and identity. This is why neurosurgery is more than a profession. It is a responsibility. It is also a privilege. At times, I find myself wondering whether neurosurgeons should be paid for the work we do—or whether we should instead be paying our patients for allowing us to witness such extraordinary beauty from within. Of course, surgery is demanding. It requires years of training, long hours, technical precision and immense concentration. But beyond all that, there remains a sense of wonder that never entirely disappears. The human brain continues to remind us how much we know—and how much we still do not understand. The more we see, the more humbled we become. And perhaps that is one of the greatest lessons of neurosurgery: to approach every patient not only with knowledge and skill, but also with reverence. Because inside every human being lies a masterpiece that only a fortunate few are ever allowed to see.
25 July 2026
Where Human Certainty Ends
There are certain patients a neurosurgeon never forgets—not only because of the complexity of their illness, but because their recovery challenges everything we think we understand about medicine, prognosis and hope. A few years ago, in the early hours of the morning, I was called by a paediatrician to review an eight-year-old boy in the general intensive care unit. He had presented with a severe and unremitting headache, accompanied by nausea and vomiting. Shortly before I was called, he developed a seizure and was transferred to the ICU. By the time I arrived, he had already lost consciousness. His CT scan revealed a devastating picture. He had extensive cerebral venous sinus thrombosis, with severe brain swelling and dangerously raised intracranial pressure. Both of his pupils were fixed and dilated—an ominous sign that the pressure within his skull was already critically affecting his brain. I examined him, looked again at the scan, and then caught the paediatrician's attention. I simply shook my head. No words were necessary. My expression conveyed what I feared most: I did not think the child would survive. It was not an admission of defeat. It was an honest recognition of the severity of his condition. Every clinical sign suggested that we might already be too late. But while there was still something that could be done, surrender was not an option. After speaking with his parents and explaining the gravity of the situation, I took him urgently to the operating theatre for a decompressive craniectomy. A large section of skull was removed to give the swollen brain room to expand and to relieve the immense pressure within his head. During the operation, I inserted an intracranial pressure monitor. The reading climbed to approximately 80 mmHg. It was a terrifying number—far beyond the normal range and, physiologically, almost incompatible with life. Despite every measure available to us, we could only reduce the pressure to around 60 mmHg, which remained critically high. His pupils stayed dilated. His brain continued to swell. We used sedation, medication and every available treatment to rest the brain and control the pressure. The intensive care team worked relentlessly, fighting for every small improvement. The days passed. Then the days became weeks. I must admit that there were moments when I began to lose hope. I wondered whether he would survive and, even if he did, whether meaningful neurological recovery would still be possible. Then, slowly and almost imperceptibly, something began to change. The intracranial pressure started to fall. His pupils gradually became smaller and began to react. Then, one day, he opened his eyes. It was only the beginning. Initially, he had significant neurological deficits, just as we had feared. His recovery was slow and demanding. But children possess an extraordinary capacity for healing, and month after month, he continued to improve. He began to move. He began to speak. He began to smile. Eventually, he returned to school. Today, he has recovered remarkably well and is able to participate in normal daily life. Considering how close he had come to death, his recovery was nothing short of extraordinary. What makes this story even more meaningful is what happened afterwards. Over the years, I came to know him and his family well. What began as a doctor-patient relationship gradually developed into a genuine friendship. Whenever I see him now—older, stronger, smiling and living his life—I am taken back to that night in the ICU. I remember the scan. I remember his fixed pupils. I remember silently shaking my head at the paediatrician. And I have never been happier to have been wrong. That child taught me one of the most important lessons of my career. As doctors, we must be honest. We must not offer false hope. But neither should we confuse probability with certainty. We study. We plan. We operate. We use every ounce of knowledge, skill and perseverance we possess. Yet the final outcome is not always ours to determine. There are moments in medicine when science reaches its limits and humility must take over. We treat, but Allah heals. And sometimes, the most extraordinary recoveries begin precisely where human certainty ends.
25 July 2026
The Interview Before the Interview
Some interviews begin long before the first formal question is asked. During my time as a consultant neurosurgeon in Aberdeen, I had the privilege of serving on the University of Aberdeen's medical school admissions panel. It was a responsibility I genuinely enjoyed. Selecting future medical students was never simply about academic results. It was also about recognising qualities that cannot always be measured on paper: empathy, humility, honesty and the ability to connect naturally with others. One afternoon, I arrived early for an interview session. The morning interviews had not yet finished, so I sat outside the venue and waited. A young applicant arrived shortly afterwards and took the empty chair beside me. He had no idea who I was. Rather flatteringly, he assumed that I was another medical school candidate, despite the fact that I was already in my mid-forties. I decided to accept that as a compliment. He began speaking to me in a warm and friendly manner. He asked whether I was nervous about the interview and admitted that he himself was feeling anxious. Our conversation continued naturally. He was polite, open and completely unguarded. Because he believed I was simply another applicant, there was no performance. No carefully rehearsed answer. No attempt to impress an interviewer. He was simply being himself. I offered him one piece of advice: "Do not try to pretend to be someone else. Just be yourself. Interviewers can usually recognise when someone is exaggerating or trying too hard to create the right impression." He listened carefully and thanked me. A few moments later, the door opened. The organiser called out: "Mr Al-Haddad, would you please come in? The panel is ready." I stood up and entered the room—not as another candidate, but as a member of the admissions panel. The young man's expression changed instantly. He was completely stunned. The stranger he had been chatting to so casually outside was about to become one of his interviewers. When his turn came, he entered the room and sat before the panel. Understandably, he looked slightly embarrassed. But he had no reason to be. In truth, his interview had already begun long before he entered the room. During those few unscripted minutes outside, I had already seen something important in him. He had treated a complete stranger with warmth, courtesy and respect, without knowing that the person might later influence his future. His formal interview went well. But what impressed me most was not any polished answer he gave inside the room. It was the character he had shown outside it. He had demonstrated the natural ability to engage with another person. He had shown openness, compassion and humility—qualities that are essential in anyone hoping to become a good doctor. I gave him a high mark. Not because he had performed well for the panel, but because I had been fortunate enough to meet the real person before the interview began. That afternoon left me with a lesson I have never forgotten. We should never reserve our kindness, respect or good manners only for people we consider important. We never truly know who is sitting beside us, what role they may play in our lives, or what silent impression we may be creating. Life is full of interviews we do not realise we are attending. Character is not something we should switch on when we know we are being observed. It is revealed most clearly in the moments when we believe no one important is watching. So wherever you are, and whoever you meet, be kind, be respectful and be yourself. The real interview may have already begun.
23 July 2026
When I Could Not Answer the Call
There are moments in medicine that remain with us—not because of what we did, but because of what we were unexpectedly prevented from doing. About a year ago, on a Monday morning, I was beginning a week of being on call. Early that morning, I received a telephone call from a colleague regarding a young woman who had presented with a headache. Her brain scan reportedly showed a small amount of subarachnoid haemorrhage. I told my colleague that I would review her as soon as I arrived at the hospital. I had a quick shower and began preparing myself for work. Then, without warning, I experienced an excruciating pain in my lower back. The pain was so severe that I collapsed onto the floor and could not move. While getting ready, I had locked the bedroom door. My wife was therefore unable to enter the room or reach me. For approximately two hours, I remained on the floor in agonising pain, unable even to get to my bedside table where I kept some painkillers. Eventually, as the pain eased slightly, I managed to pull myself towards the bed and push myself onto it. It became clear that I would not be able to go to work or continue with my on-call responsibilities. I immediately contacted a trusted colleague and asked him to take over my on-call duties. I also handed over the referral of the young woman with the subarachnoid haemorrhage. The episode marked the beginning of nearly four months of severe lower back pain. However, three days later, when the pain had improved enough for me to move around, I returned to the hospital to continue my outpatient clinics and review my ward patients. While at work, I met the colleague who had taken over the referral. He told me that I had been fortunate to have missed that particular case. Unfortunately, despite the care that had been provided, the young woman had suffered a devastating cerebral infarction. Her condition had deteriorated severely, and I was told that she might not survive. Understandably, her family was deeply distressed and unhappy with the outcome. This was not due to any negligence or fault on the part of my colleague. It was one of those tragic and unpredictable outcomes that can occur in medicine, despite our best efforts and intentions. At the time, my sudden back pain felt like a calamity. I had been lying helplessly on the floor, unable to move, unable to work and unable to fulfil my responsibilities. The pain continued to affect me for months. Yet, looking back, I have sometimes wondered whether what appeared to be a misfortune was, in another way, a form of protection. We make our plans. We prepare ourselves. We believe that we know where we are meant to be and what we are meant to do. But there are occasions when events unfold beyond our understanding and beyond our control. Only God knows what might have happened had I been the consultant who received and managed that referral. I do not know whether the outcome would have been different. It may have been exactly the same. Nevertheless, through His infinite wisdom, God removed me from that situation in a manner I could never have anticipated. The experience taught me an important lesson in humility. Not everything that feels painful is necessarily a punishment, and not every disruption is merely an inconvenience. Sometimes the event we initially regard as a disaster may carry a mercy that we are unable to recognise at the time. In medicine, as in life, we must continue to prepare carefully, act responsibly and serve our patients to the best of our ability. But we must also accept that we are not in control of every outcome. Sometimes, when we are unable to answer a particular call, there may be a reason known only to God.
23 July 2026
Giving Colours Back to Her Life
A few months ago, I treated a university lecturer in her mid-forties who had developed progressive blurring of her vision. Further investigations revealed a large pituitary macroadenoma. The tumour had grown sufficiently to affect the visual pathways, and surgery was necessary to relieve the pressure and preserve her sight. Alhamdulillah, the operation went smoothly. Her recovery was uncomplicated, and she was discharged home well. When she returned to my clinic for follow-up, she smiled and said: "Doctor, I have a present for you." Naturally, I was pleased. She then handed me a box containing a beautiful set of coloured highlighters — the type commonly used to mark important passages in books and notes. At first glance, it seemed like a simple gift. Then she said: "Thank you for giving colours back to my life." Those few words changed everything. Suddenly, an ordinary box of coloured markers became priceless. For her, the colours represented far more than stationery. They represented the recovery of her vision — the ability to see clearly again, to read, to teach, to work and to appreciate the world around her. For me, her words were a powerful reminder that surgery is not merely about removing a tumour or relieving pressure on the optic nerves. It is about restoring something precious to a person's life: independence, confidence, purpose and hope. I still keep those markers, not because they were expensive, but because of what they came to represent. Whenever I see them, I am reminded that even the simplest gift can carry extraordinary meaning. Words have tremendous power. A few sincere words can transform an ordinary object into something unforgettable. I remain deeply grateful that her treatment went well and that I was given the opportunity to play a small part in giving colours back to her life. Alhamdulillah.
20 July 2026
In Loving Memory of My Father
My beloved father, Sayyid Al-Habib Mohamed bin Abdullah bin Abdulkadir Al-Haddad, endured a long and relentless illness — one that gradually took almost everything from him. But it never took his faith. His struggle began with kidney failure, and he became dependent on haemodialysis. Later, obstruction of the superior vena cava made conventional dialysis no longer possible. He then had to undergo peritoneal dialysis at home, carrying the burden of treatment into the very place where he should have found rest. Then came severe peripheral vascular disease. Poor circulation led to infection and gangrene. First, his little toe had to be amputated. Then other toes followed. The disease continued to advance, eventually forcing him to undergo a below-knee amputation. After a prolonged hospital stay, even that was not enough. An above-knee amputation became unavoidable. One loss followed another. He endured repeated infections caused by multidrug-resistant bacteria, numerous admissions to the intensive care unit, liver failure, and severe gastrointestinal dysfunction that left his body unable to absorb nourishment properly. At times, his blood pressure fell as low as 60/40 mmHg. By any ordinary measure, he should have been too weak even to sit up. Yet he continued to attend his outpatient appointments. He remained composed. He remained dignified. He remained strong. As the illness progressed, his hearing faded. Then his vision began to fail. One by one, the functions of his body were taken from him until, near the end of his life, very little remained under his control except his mind and his lips. And still, there were no complaints. From those lips, we continued to hear: Alhamdulillah. Allahu Akbar. His body was surrendering, but his soul was not. Even in extreme frailty, he continued to guard his prayers and remained committed to praying in congregation until the end of his life. He faced every operation, every infection, every admission and every new loss with extraordinary patience. He did not ask, "Why me?" He did not surrender to bitterness. He did not allow suffering to strip him of his dignity. As his children, we often heard him remind us: "The hand that gives is better than the hand that receives." And: "Laziness is the grave of the living." These were not empty sayings. They were the principles by which he lived — generosity, discipline, resilience and service to others. Watching him deteriorate was one of the most painful experiences of our lives. We saw a strong man gradually lose his health, his mobility, his hearing and his sight. Yet in losing almost everything, he showed us what could never be taken away. Faith. Patience. Gratitude. Dignity. His illness taught us that true strength is not the ability to avoid suffering. It is the ability to endure suffering without allowing it to destroy the spirit. He became physically weaker with each passing day. But spiritually, he stood taller than all of us. We are deeply grateful that we were present during the final chapter of his life. We witnessed not merely the ending of a life, but the completion of a journey marked by endurance, remembrance and complete submission to Allah. His was not an ending defined by despair. It was an ending shaped by Alhamdulillah and Allahu Akbar. May Allah forgive him, shower him with limitless mercy, illuminate and expand his grave, and grant him the highest place in Jannah. May every pain he endured become an expiation for him and a means of raising his rank in the Hereafter. And may Allah, in His infinite mercy, reunite us one day with the father whom we loved, honoured and continue to miss beyond words. Al-Fatihah for my beloved father.
20 June 2026
The Promise I Made Before Surgery
Some operations remain in a surgeon's memory not simply because they were technically difficult, but because they reveal how narrow the distance can be between hope and uncertainty. About a month ago, I operated on a woman in her sixties who had a large right petrous meningioma. She had presented with only a slight imbalance, but the tumour itself was substantial and situated in a challenging part of the brain. The operation was carefully planned. I expected it to take approximately six hours. Just before entering the operating theatre, I happened to meet her son. Naturally, he was anxious. I placed my hand on his shoulder and said: "Don't worry. I will look after your mother." At the time, they were simple words of reassurance. But as the operation progressed, those words became a promise that weighed heavily upon me. The surgery began well. Everything proceeded according to plan until, halfway through the operation, I encountered significant bleeding from the tumour. From that moment, the character of the surgery changed completely. What had been expected to take six hours extended to almost ten. There was no opportunity to pause. I did not leave for food, a toilet break or even my prayers. For hour after hour, my attention remained entirely upon the patient. The operation became a test of concentration, endurance and resolve. With the support of an excellent theatre team, and by the grace of Allah, I was eventually able to complete the surgery. When it was finally over, I was utterly exhausted. The first thing I did was perform my Asr prayer. As soon as I completed it, the full weight of the previous ten hours seemed to descend upon me. I collapsed onto the floor from exhaustion. For a brief moment, I thought that had I been at home, I would simply have fallen asleep immediately. But my work was not yet over. The patient was transferred to the High Dependency Unit for close monitoring. By late that night, she was breathing spontaneously, but she was still not fully awake. When I went to review her, I felt a deep sense of apprehension. I had completed the surgery, but I could not yet be certain how she would recover. I did not know whether she would wake fully or whether she would make it safely through the night. I brought her husband and son to see her and explained the situation as honestly as I could. I told them: "There is nothing more we can do tonight. We have done everything possible. Now, we must give her time." That is one of the most difficult parts of being a surgeon. There are moments when knowledge, skill and effort have reached their limit. After that, all one can do is wait — and trust. I returned the following morning with considerable anxiety. I did not know what I would find when I entered the unit. Then I saw her. She was fully awake. She was sitting upright in bed. The transformation was extraordinary. Only hours earlier, I had stood beside her uncertain whether she would recover. Now, she was alert, responsive and doing remarkably well. In that moment, the exhaustion of the previous day seemed to disappear. The bleeding, the prolonged hours, the physical strain, the anxiety and the uncertainty — all of it suddenly felt worthwhile. People sometimes imagine that the greatest reward in surgery is completing a difficult operation. It is not. The true reward is returning the next morning and seeing your patient awake. It is seeing life, awareness and hope where, only hours before, there had been uncertainty. We surgeons plan carefully. We train for years. We study every scan, anticipate every complication and use every skill available to us. But cases like this remind me that we are never entirely in control. We do everything within our ability, and then we place our trust in Allah. That morning, seeing my patient sitting upright in bed, I was reminded once again of the extraordinary privilege of being a surgeon. Before the operation, I had promised her son that I would look after his mother. By Allah's grace, that promise was fulfilled. And for me, there could be no greater gift.
15 June 2026
A Reflection for Myself
Am I still truly grateful for all the countless blessings that God has bestowed upon me? Yesterday, I was asked to stop by the Intensive Care Unit to review a patient who was lying intubated in bed. He was too weak to speak and was breathing through a ventilator. He could only open his eyes, nod, and move his fingers in response to my questions. He had suffered multiple traumatic injuries after being involved in a collision with a lorry in the early hours of the morning a few days earlier. Many of his bones were fractured, including those in his face and around his eyes. It was heartbreaking to see him lying there helplessly. I could not help but think of his family and his young children waiting for him. He had once been a professional with a stable career, but before the accident, he had been working as a food delivery rider to support his family. Today, I returned to see him again, but I was too late as he had already been taken to the operating theatre for further surgery. I managed to speak briefly with the nurse caring for him. She shared that yesterday his young daughter spoke to him over a video call: "Daddy, where are you? I've been waiting for you at home for so long." She continued, "Daddy, why aren't you talking to me? Are you sick? You promised you would come home and buy me a toy..." Her innocent cries went on, unaware of the gravity of her father's condition. May God grant this patient a swift and complete recovery. May He reunite him with the family who loves him dearly and continues to wait for him with hope and longing. May we all constantly remember and appreciate every blessing that God has granted us: the blessing of time, strength, good health, the ability to breathe, the gift of sight, the ability to speak, the ease of earning a livelihood, the provision of food, the companionship of our families, and countless other blessings that are beyond enumeration. May God protect us from ingratitude and from becoming among those who misuse these blessings in ways that displease Him — the very One who has so generously bestowed these blessings upon us.
15 June 2026
The Dash
I read of a man who stood to speak At the funeral of a friend He referred to the dates on the tombstone From the beginning... to the end He noted that first came the date of birth And spoke the following date with tears, But he said what mattered most of all Was the dash between those years For that dash represents all the time That they spent alive on earth. And now only those who loved them Know what that little line is worth For it matters not, how much we own, The cars... the house... the cash. What matters is how we live and love And how we spend our dash. So, think about this long and hard. Are there things you'd like to change? For you never know how much time is left That can still be rearranged. If we could just slow down enough To consider what's true and real And always try to understand The way other people feel. And be less quick to anger And show appreciation more And love the people in our lives Like we've never loved before. If we treat each other with respect And more often wear a smile, Remembering this special dash Might only last a little while So, when your eulogy is being read With your life's actions to rehash... Would you be proud of the things they say About how you spent YOUR dash
15 June 2026
The Traffic Jam
Every morning, two men — Mr Farid and Mr Hakim — drove to work along the same congested road. What should have been a 20-minute journey regularly became a three-hour ordeal. There were roadworks, police checkpoints, heavy rain and, occasionally, an accident. With no alternative route, both men had little choice but to endure the same traffic jam day after day. This had continued for almost two years. Mr Farid responded with anger. "Why can't the government solve this problem? Why don't the police do something? Why can't they widen the road? Why must everyone drive at the same time?" He blamed the authorities, the weather, the other drivers and anyone else he could think of. By the time he arrived home, his frustration had followed him. His wife and children often became the unintended targets of the anger he had carried from the road. Mr Hakim faced exactly the same traffic, but chose to respond differently. He knew that shouting inside his car would not move the traffic even an inch. So, instead of wasting his energy on something he could not control, he asked himself: "What can I do with this time?" He began by calling his mother and siblings, whom he had not spoken to for some time. He checked on their well-being and offered help whenever they needed it. Even when there was nothing urgent to discuss, hearing his mother's voice made the journey feel worthwhile. After that, he resumed the Arabic lessons he had once started but never completed. Every day, while sitting in traffic, he listened to language programmes and practised new words and phrases. Months passed. The traffic did not improve — but Mr Hakim did. Eventually, he became confident enough to speak and understand Arabic. It was an achievement he had never expected, and it even helped him communicate more meaningfully during his travels and deepen his understanding of the language. Both men were trapped in the same traffic jam. One allowed it to fill him with bitterness. The other used it as an opportunity to grow. So, when life brings us delays, difficulties and circumstances beyond our control, we should ask ourselves: Are we responding like Mr Farid, or like Mr Hakim? This story is entirely fictional. Any resemblance to persons living or deceased is purely coincidental.
1 January 2024
What Twenty-Eight Years Has Taught Me
I have spent nearly three decades in neurosurgery, in Ireland, the United Kingdom, and now Malaysia. I have operated on thousands of patients. I have taught hundreds of trainees. I have published research, written a textbook, and founded a training course that spans continents. But the most important thing I have learned is this: the patient sitting in front of you, frightened, holding a scan they do not understand, does not need a hero. They need someone who is competent, honest, and willing to sit down and explain things properly. That is the work. The rest is just the rest.
1 January 2015
The Patient Who Initially Refused My Care
Some cases test a surgeon's technical ability. Others reveal the importance of communication, trust, and timing. Not long after I returned to Malaysia, I was on call when I was referred a patient whose scan showed borderline enlargement of the ventricles. When I examined him, he seemed reluctant to speak to me. I wondered whether he had difficulty understanding my English, whether he was anxious, or whether there was another barrier between us. I did not think too much of it at the time. As I left the room, I met his mother and explained my assessment. To my surprise, she asked for her son to be transferred to the care of another doctor. It was the first time a patient's family had asked to change surgeons after meeting me. Although I was taken aback, I respected her wishes. The case was handed over to a consultant colleague, and I moved on. Some time later, that colleague telephoned me. He had a dinner engagement and asked whether I could review one of his patients that evening. I was already planning to visit the hospital, so I agreed. When I arrived on the ward, I immediately recognised the patient. I approached his bed and tried to speak to him. Once again, he did not respond — but this time, something was clearly wrong. This was not reluctance, shyness, or a communication difficulty. He was becoming neurologically unresponsive. Alarmed, I pulled out his CT scans and reviewed them myself. The cause became immediately apparent: he had developed a significant extradural haematoma. Blood was accumulating between the skull and the covering of the brain, creating dangerous pressure. There was no time to lose. I called the nurse in charge and said that the patient had to be taken to the operating theatre immediately. In fact, this remains the only case in my career in which I personally helped push a patient's trolley to theatre. The situation was so urgent that every minute mattered. We operated without delay and evacuated the haematoma. Fortunately, the procedure was completed uneventfully, and the patient went on to make a satisfactory recovery. Later, after her son recovered, his mother approached me again. This time, she asked whether I would take over his care. It was a striking reversal. At our first meeting, she had not felt comfortable placing her son in my hands. Now, after an emergency in which minutes had separated recovery from catastrophe, she was asking me to become his doctor. I did not regard this as a victory over another clinician, nor did I blame the family for their earlier decision. Complications can occur under the care of any doctor, even when treatment is appropriate and performed with skill. Instead, the case taught me something more enduring. Good medical care begins before an operation and extends far beyond it. It depends upon communication, mutual understanding, and trust. When communication is uncertain from the outset, every subsequent difficulty can be misunderstood, and even an unavoidable complication may be interpreted as negligence or failure. Trust cannot be demanded simply because one wears a white coat. It has to be built — through patience, clarity, honesty, and action. That evening, there was no time for lengthy explanations. The patient's condition required an immediate decision, and the priority was to save his life. But after the crisis had passed, the larger lesson remained: a surgeon may earn a patient's confidence through technical skill, but lasting trust is built through communication — especially when understanding does not come easily at the beginning.
1 January 2012
Shared Decision-Making in the Operating Theatre
Some patients fade from memory with time. Others become part of who you are as a surgeon. This is one of those stories. More than two decades ago, while I was practising in Aberdeen, a 77-year-old gentleman was referred to me with a solitary 3 cm metastatic tumour in the left motor cortex. It was a small lesion, but it occupied one of the most unforgiving areas of the brain — where millimetres separate cure from lifelong disability. At first, I questioned whether an awake craniotomy was justified for such a small tumour. But after careful consideration, we decided it offered the safest chance of preserving his neurological function. The operation began routinely. He was asleep for the opening stages of the surgery and was gently awakened when we reached the critical phase. The theatre was quiet. Every member of the team knew we were entering the most delicate part of the operation. As I carefully began removing the tumour, he suddenly looked at me and said calmly, "Doctor... my right hand is becoming weak." Time seemed to stop. I immediately halted the operation. In that instant, I found myself facing one of the greatest dilemmas of my career. If I stopped, I would leave behind a metastatic tumour — the very reason he had entrusted me with his care. If I continued, I might remove the tumour completely, but at the cost of permanently weakening the hand that had served him for 77 years. No textbook prepares you for moments like these. Then I looked at him. He was awake. He understood. He was thinking clearly. And I realised something profoundly important. This was not my decision alone. I explained the situation honestly. There was no false reassurance, no attempt to influence him — only the truth. Then I asked, "What would you like me to do?" Without hesitation, he replied, "Doctor, remove the tumour." Those four words lifted an enormous burden. They did not make the operation easier, but they gave it clarity. Together, we made the decision. I completed the surgery. As expected, he woke with weakness in his right hand. The following morning, I went to see him, preparing myself for disappointment, regret, or even anger. Instead, he smiled. Then he said something I have never forgotten. "Doctor, thank you for letting me make that decision." He explained that throughout his illness, countless decisions had been made for him — by doctors, by hospitals, by circumstances beyond his control. But for the first time, someone had given him back ownership of his future. He had accepted the consequences because they were his consequences. That conversation changed me. It taught me that neurosurgery is not simply about removing tumours or mastering complex operations. It is about recognising that behind every MRI scan is a human being with values, hopes, fears, and the right to decide what matters most. Even today, whenever I face a difficult decision in the operating theatre, I remember that gentleman from Aberdeen. He came to me to have a tumour removed. Instead, he taught me one of the greatest lessons of my career: the finest surgeons do not simply operate on the brain — they honour the person who owns it.
1 January 2010
In Memory of an Extraordinary Colleague: Dr David Baxter
Mr David Baxter was a remarkable gentleman whom I had the privilege of working with during my time as a Neurosurgical Registrar at the Western General Hospital in Edinburgh. Although David and I worked together for only a relatively short period, he left a lasting impression on me. David was a gifted and dedicated young neurosurgeon who appeared to have everything going for him. His curriculum vitae was one that many could only dream of. He had published numerous papers in peer-reviewed journals and held research positions at Monash University in Australia and at the world-renowned Karolinska Institute in Sweden, where he completed his PhD in brain tumours. He also spent time in Oxford. His achievements extended far beyond medicine. David was also an accomplished athlete who represented Australia at the 2002 Commonwealth Games, where he won a bronze medal. Yet behind these extraordinary accomplishments was an even more extraordinary story of courage. The beginning of David's neurosurgical training in Edinburgh had to be delayed while he underwent extensive treatment for metastatic melanoma. The physical and emotional burden of such treatment could easily have broken a person's resolve. But not David. He returned to his training and continued as though nothing had happened. He never allowed his illness to define him, diminish his commitment or weaken his sense of purpose. As a colleague, David was dependable and meticulous. Whatever task he undertook, he completed it to the highest standard and to the very best of his ability. As a surgeon, he was equally impressive — skilful, composed and naturally gifted. One particular incident remains vivid in my memory. David came to see me one day and asked whether he could take the following day off for what he described as a "minor operation" to remove a newly discovered lump from his neck. Fearing the worst, I agreed immediately. I assumed he would need at least a day or two afterwards to recover. The following morning, at approximately eleven o'clock, I was astonished to see him back on the ward. I asked him what had happened. He replied, quite matter-of-factly: "Yes, I had my operation this morning. Now it is time for me to work." That was David. Even while facing an illness that would have overwhelmed many others, his commitment to his patients and his profession remained unwavering. Sadly, only a few months later, David succumbed to his illness after the melanoma spread to his brain. There was a painful irony in the fact that a neurosurgeon who had devoted his life to understanding and treating diseases of the brain was ultimately taken by one. I admired David greatly. He was a rare individual: intellectually brilliant, technically accomplished, physically gifted and, above all, profoundly courageous. He embodied what it meant to be not only an exceptional doctor, but also an exceptional human being. I hope his story offers strength to those facing adversity and encouragement to young doctors working under immense pressure. David's life reminds us that courage does not always announce itself loudly. Sometimes, it is seen in quietly returning to the ward after surgery, continuing to serve others and refusing to allow hardship to extinguish one's purpose. Dr David S. Baxter, MBBS, BSc (Hons), PhD — 27 March 1977 to 2 July 2010. We all enter this world in much the same way. What distinguishes us is what we choose to do with the time we are given. David used his time with courage, excellence and service — and those who knew him are better for it.