The right to die with eyes wide open
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