Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh Page B

home torn between impotent rage and gratitude.
     
     

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    MELODRAMA
     
    n . a sensational, dramatic piece with crude appeals to the emotions and usu. a happy ending.
    I was recently asked to talk to the script-writing team for the TV medical drama Holby City . I took the train from Wimbledon to Boreham Wood at the opposite end of London and went to the well-appointed country house hotel where they were meeting. There were at least twenty people sitting round a long table. They were thinking of adding a neurosurgical ward, they told me, to the fictional Holby City General Hospital, and wanted me to talk to them about neurosurgery. I talked for almost an hour without stopping, something I don’t find very difficult to do, but I probably concentrated too much on the grim and tragic aspects of my work.
    ‘Surely you have some more positive stories to tell, which our viewers would like?’ somebody asked and then I suddenly remembered Melanie.
    ‘Well’ I said,’ Many years ago I did once operate on a young mother who was just about to have a baby and was going blind . . .’
    There were three patients for surgery on that Wednesday – two women with brain tumours and a young man with a disc prolapse in his lumbar spine. The first patient was Melanie – a twenty-eight-year-old woman in the thirty-seventh week of pregnancy who had started to go blind over the preceding three weeks. She had been referred as an emergency to my neurosurgical department from the ante-natal clinic of her local hospital on Tuesday afternoon. A brain scan had shown a tumour. I was on call for emergencies that day so she was admitted under my care. Her husband had driven her to my hospital from the ante-natal clinic; when I first saw them on the Tuesday afternoon he was guiding Melanie down the hospital corridor towards the ward with one hand on her shoulder and the other hand holding a suitcase. She had her right arm stretched out in front of her for fear of bumping into things and her left hand was pressed onto the unborn child inside her as though she was frightened she might lose it just as she was losing her eyesight. I showed them the way to the ward entrance and said that I would come back later to discuss what should be done.
    The brain scan had shown a meningioma – a ‘suprasellar’ meningioma growing from the meninges, the membrane that encases the brain and spinal cord – at the base of her brain. It was pressing upwards onto the optic nerves where they run back from the eyes to enter the brain. These particular tumours are always benign and usually grow quite slowly, but some of them have oestrogen receptors and, very occasionally, the tumours can expand rapidly during pregnancy when oestrogen levels rise. This was clearly what was happening in Melanie’s case. The tumour did not pose a risk to the unborn child, but if it was not removed quickly Melanie would go completely blind. It could happen within a matter of days. An operation to remove a tumour like hers is relatively straightforward but if the visual loss before surgery is severe it is by no means certain it will restore vision and there is some risk it will make it worse. I have once left one person completely blind with a similar operation. Admittedly he was already almost blind before the operation – but then so was Melanie.
    When I went to the ward an hour or so later I found Melanie sitting up in her bed, with a nurse beside her completing the admission paperwork. Her husband, looking desperate, was on a chair next to the bed. I sat down on the end of the bed and introduced myself. I asked her how it had all started.
    ‘Three weeks ago. I scraped the side of the car on the garage gates when I was coming home from my ante-natal class,’ she said. ‘I couldn’t understand how I had managed to do it but a few days later I realized that I couldn’t see properly out of my left eye.’ As she spoke her eyes moved restlessly with the slightly unfocused look