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

branches of the trigeminal nerve in the face.
    Once I had sawn open the woman’s skull and opened the meninges I found to my horror that her brain was obscured by a film of dark, red blood that shouldn’t have been there. It probably meant that something had already gone wrong with the operation. The light from the battered old operating lamp above me was so dim that I could scarcely see what I was doing. The possible repercussions for my colleague and me did not bear thinking about. I had to fight to control my mounting panic.
    I was operating on a woman with an agonizing facial pain called trigeminal neuralgia (which is also known as tic douloureux ) – a condition that was considered by her doctors to be inoperable. A television crew was filming the operation for the national news. There were many doctors and nurses, looking down on me like gods through the glass panes of a large dome built into the ceiling above the operating table. Many of the panes in the glass dome were cracked and broken and the view outside through the large windows of the operating theatre was of snow falling onto a grey wasteland of broken machinery and derelict buildings. I often have an audience when operating and I dislike it when things are going badly – but this was many times worse. I had to radiate a calm, surgical self-confidence, which was not what I felt.
    This was Ukraine, in 1995. I was 2,000 miles from home, operating without any official permission – probably illegally – doing a dangerous operation on a woman’s brain never done in the country before, using second-hand equipment that I had driven out myself from London a few days earlier. My colleague was an obscure junior doctor who had been declared in an interview on the BBC World Service, by the senior professor of neurosurgery in the hospital where I was operating, to be suffering from schizophrenia. Nor was I being paid to do this – indeed, it was costing me a lot of my own money.
    I muttered unhappily to myself as I tried to stop my hands shaking: ‘Why on earth am I doing this? Is it really necessary?’
     
    I had first gone to Kiev three years earlier in the winter of 1992, almost by accident. I had been a consultant for five years by then and already had a large and busy practice. It was a few months after the collapse of the Soviet Union. An English businessman, hoping to sell medical equipment in Ukraine, rang my hospital to find out if any neurosurgeons were interested in joining him on a trip to Kiev. There was a famous neurosurgical hospital in Kiev and he wanted to take some British neurosurgeons with him to deliver lectures about modern brain surgery and the equipment needed for it. The switchboard operator was rather puzzled by the enquiry and so put the call through to Gail, my secretary, who has the well-earned reputation of being able to solve most problems. I was in my office and she put her head round the door.
    ‘Do you want to go to Ukraine next Thursday?’
    ‘Certainly not. I’m far too busy and I’ve got a clinic then.’
    ‘Oh go on. You’re always saying how interested you are in Russia and you’ve never been there yet.’
    Gail is usually the first person to complain if I cancel an outpatient clinic as she will then have to field all the phone calls from the disappointed and sometimes angry patients and rearrange the appointments, so I had to take her advice seriously.
    And so, with two colleagues, I travelled to the newly independent Ukraine. There had never really been a separate Ukrainian state before the Soviet Union fell apart, and it was not at all clear what independence would mean. What was clear was that the country was in utter chaos, with the economy close to collapse. The factories were all closed and everybody seemed to be out of work. The conditions in the hospitals I visited were out of a nightmare.
    We had arrived in Kiev early in the morning on the overnight train from Moscow. The line crosses one of the long bridges