The right to die with eyes wide open

The Weekend Australian - Review - - Books - Norman Swan

WLife in his Hands By Susan Wyn­d­ham Pi­cador, 293pp, $ 32.95

HAT comes into your mind when you think of the word heroic? Kokoda? The self­less acts of courage we reg­u­larly hear about in ev­ery­day life? To a doc­tor, the word heroic gen­er­ates an un­pleas­ant sen­sa­tion in their spine akin to the fight or flight re­sponse. No word could have such dif­fer­ent mean­ings, de­pend­ing on where you’re com­ing from.

The tightly bound feel­ings in many doc­tors’ minds are of fu­til­ity and per­haps even stu­pid­ity: surgery taken on when hope has gone; where the risks are as huge as the op­er­a­tion is rad­i­cal and where fail­ure amid mu­ti­la­tion is the al­most in­evitable con­se­quence. That’s heroic and it’s one of the most bit­ter, most ironic twists on a word that you can imag­ine. It’s deeply embed­ded in the med­i­cal psy­che.

Courage is res­o­lute­ness in the face of per­sonal risk and suf­fer­ing, yet no doc­tor risks bod­ily harm to them­selves un­less an an­gry rel­a­tive comes af­ter them with a kitchen knife. The courage that sur­geons need is when things haven’t turned out as planned and they have to face the pa­tient ( if still alive), their col­leagues and, above all, them­selves in the wee, small and lonely hours.

Life in his Hands by Susan Wyn­d­ham is about a pa­tient and sur­geon who are flawed, com­plex, coura­geous he­roes who both have life in their hands. Aaron McMil­lan was a young, tal­ented con­cert pi­anist with al­most un­bri­dled self­be­lief, di­ag­nosed with a huge, rare and dan­ger­ous brain tu­mour. Charles Teo is a neu­ro­sur­geon who, ac­cord­ing to his col­leagues, does heroic brain surgery. Some of Teo’s col­leagues dis­like his flam­boy­ance and, yes, un­bri­dled self- be­lief and what they see as need­less risk- tak­ing by op­er­at­ing on what they think are in­op­er­a­ble brain tu­mours. Teo, though, can line up pa­tients still alive who were con­demned to death by other sur­geons and thinks that with care and plan­ning, us­ing the small­est pos­si­ble in­ci­sions and op­er­at­ing fields, you can get life- pro­long­ing re­sults with less dis­abil­ity than was once thought.

Teo is part of a long line of sur­geons who have pushed the en­ve­lope and re­ceived the same praise and op­pro­brium. Pro­ce­dures that to­day are com­mon­place and life sav­ing have re­lied on courage and hero­ism, al­though much more on the part of pa­tients than sur­geons.

Many op­er­a­tions in the sur­gi­cal reper­toire are built on dis­fig­ure­ment, dis­able­ment or death in their de­vel­op­ment. The his­tory of open heart surgery is an in­cred­i­ble tale of death and in­jury. The early heart sur­geons hooked up chil­dren with heart de­fects to dogs’ lungs and even to pris­on­ers ( usu­ally black) on a ta­ble across the op­er­at­ing theatre to al­low time to open up the heart. Some lives were saved and many were lost. The level of hos­til­ity from med­i­cal col­leagues was at times enor­mous. They felt the sur­geons were feed­ing their egos rather than ad­vanc­ing hu­mankind.

For pa­tients and fam­i­lies, though, it was of­ten dif­fer­ent. Even when they were prop­erly in­formed of the risks of the un­proven op­er­a­tions, they were pre­pared to have them, given the al­ter­na­tive was cer­tain death. If it were not for their courage and hero­ism, we wouldn’t have safe surgery to­day. When the chips are down and hope is of­fered, many peo­ple will choose life over death, re­gard­less of risk.

McMil­lan made his de­ci­sion to have high- risk surgery with barely a blink. To some ex­tent he was a guinea pig, but seemed hap­pily so.

Two par­al­lel lives in­ter­sect in this book: Teo knew noth­ing about classical mu­sic and McMil­lan was an un­worldly artist with es­tranged par­ents and no money. Thanks to an op­er­a­tion that at times looked dis­as­trous, McMil­lan was given a dis­abil­ity- free re­prieve for a while, again prov­ing Teo’s view that neu­ro­sur­geons should learn new ways of do­ing brain op­er­a­tions and se­lect­ing pa­tients for them.

Out­side the hospi­tal, McMil­lan in­tro­duces Teo to the world of the arts, all in the spot­light of na­tional television as the ABC’s Aus­tralian Story fol­lows them.

The can­cer re­turns and Wyn­d­ham, com­mit­ted to both her char­ac­ters, del­i­cately shows how Teo, like many sur­geons, has trou­ble deal­ing with im­po­tence and what’s seen as fail­ure. It oc­ca­sion­ally dis­tances him from McMil­lan.

This is a beau­ti­fully writ­ten, emo­tional, al­most nov­el­is­tic ac­count of what to some may seem blind courage on the part of both pa­tient and doc­tor.

It tells, how­ever, of a big­ger story that af­fects us all: the right to live and die the way we choose, as long as our eyes are open and noone else is harmed. Norman Swan hosts The Health Re­port for ABC Ra­dio Na­tional.

Push­ing the med­i­cal en­ve­lope: Neu­ro­sur­geon Charles Teo

Coura­geous: Aaron McMil­lan

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