The JOY and AGONY of battling to save young lives

Every parent dreads their child being rushed to hospital — but what’s it like for the one trusted to help them? In a compelling new book, a leading brain surgeon lays bare...

MY REGISTRAR took the call and ran straight to my office. ‘We’ve got a four-year- old girl coming in, unconscious. Initial assessments show bleeding in the middle of the brain,’ he panted. ‘Have we got the scans?’ I ask. ‘On their way. But there’s another thing. One pupil dilating.’

Oh god. a single pupil enlarging is a really bad sign. When a doctor shines a light into your pupil, they’re monitoring brain function. Pupils are meant to shrink with light. If they don’t, there’s a real risk of death.

according to dispatch, the ambulance was less than 20 minutes away from me, at John radcliffe Hospital in Oxford, where I’m a consultant paediatric neurosurgeon.

The scans arrived and confirmed a massive haemorrhage from an arteriovenous malformation — where a change to the way blood vessels develop results in high-pressure blood flowing straight into small arteries, which can potentially rupture.

The resulting blood clot was in the middle of the little girl’s brain, blocking the brain fluid’s path. It looked severe. But the clot wasn’t the immediate risk. It was the raised pressure from the blocked fluid. If we didn’t get a drainage tube in, the little girl was looking at devastating brain damage — if she lived.

With every minute’s wait, the prospects of survival were looking less positive.

What would normally happen — scary as it is — is this. anaesthetists would have everything ready. The moment the ambulance gurney came flying through the double doors, the girl would be lifted on to the bed.

all checks completed, anaesthetists would wheel the patient 30 ft into theatre where we’d position her carefully on the table. We would put a safety drape over her head to ensure it’s all clean, and give her antibiotics. Double- check the scans. everything clean, safe, correct. We would begin full anaesthesia, precise incisions, peeling back the skin. So many things we would do if we had time. BUT from the second the ambulance guys burst in, I realised that was precisely what we didn’t have.

‘Pretty sure she’s coning,’ one of the paramedics calls out. Damn.

‘Coning’ is shorthand for the clot piling up so much pressure the heart rate drops.

‘Heart rate?’ I ask. ‘Thirty-five and dropping.’ He checks again. ‘Thirty-four.’

a normal four-year-old would have a heart rate of between 80 and 120 beats per minute. I’m worried the time and movement needed to get her on to the operating table will finish this poor girl off.

‘We don’t have time for theatre,’ I tell my registrar. ‘get everyone here.’

Suddenly, it’s a circus. The trolley crashes into the anaesthetic room. The anaesthetists are trying to keep the girl stabilised.

Tim, my senior trainee, and I are splashing antiseptic on our hands, all over the girl’s head. I’m in my hospital blues, not my surgical uniform. The room isn’t sterile, there are people who have literally run in off the street. But none of this will matter to this little girl if we don’t get going.

The anaesthetic room is tiny. Now my nurse is here, too, dragging in the most essential equipment. But it doesn’t matter where we are. I’m still looking at a human head. This is all the room I need.

There are two ways to open a person’s head. Usually, I shave the hair, nick the skin with a scalpel, then apply an electrocautery device to burn down the tissue to bone level. It’s slow, precise and leaves almost no scarring. But it takes time.

So the second I get the all-clear, I make a stab incision at the top of her head, on the right, to the front. It’s the less dominant side and doesn’t tend to influence speech — the child is less likely to suffer lasting damage from an invasion. There’s no point in saving a child’s life if she has no life worth living afterwards. The clock, however, is still ticking.

I make a drill hole through the skull and pass a rubber tube into the brain. We don’t have scans in front of us. I’m doing it by memory. Mess this up and it’s game over.

‘We’re in,’ I say, feeling the tell-tale change in resistance as the tube goes in from the ‘school blancmange’ bit of the brain into the water of the ventricle (the central cavity).

‘Heart rate rising,’ the anaesthetist confirms, ‘blood pressure dropping.’ His face is as elated as mine.

Then smiles fade. Our crash-bang-wallop-style procedure has saved her life — for now.

Once she became stronger, we would have to look at the ongoing cause behind this crisis.

But that was for another day. ‘Now,’ I say, ‘it’s time to meet the parents.’

I’ve saved hundreds of children with the exact same symptoms [and appeared on the BBC fly-on-the-wall documentary Brain Doctors]. But sometimes the parents of a sick child don’t ask for my Cv or past success rates. They stare at my hands.

I get it. I’m going to be putting my fingers inside their baby’s skull. Touching their brain, most likely. They want assurances that I’m worthy, I’m not shaking, I’m clean. The reality is that, by 9.30am, I’ve probably already scrubbed my hands 20 times. and we wear gloves for all procedures.

But it’s all about appearances.

Where desperate parents are concerned, they count for more than you think.

Mentally, I’d given the little girl a 50/50 chance of survival following the first procedure. Not only could she then still have succumbed to the pressure she’d already endured, but she could have re-bled.

I couldn’t stop worrying about her that first night. It always takes me time to switch off after a traumatic evening, but the 40-minute drive home helps. That car is my decompression chamber.

When I step through the front door, I’m almost ready to face being a husband and dad again.

Twenty years on, according to my wife, I’m indistinguishable from the job I do. She says I am completely ‘The Job’. everything — her, my children, my hobbies, my health — they all fit around the job. But I’d say it’s because I’m a father that I am as obsessed as I am. The same thing goes through my mind every time I have a new case: ‘What if it was one of my own children who needed treatment?’

Thankfully, the little girl wakes up from her operation after nine agonising days — and when this news hits my beeper, my grin is the widest it can be. What a relief.

eventually, she makes a full recovery. To listen to Mum and Dad afterwards, I was somewhere between Santa Claus and god. (In reality, I’m somewhere between Mr greedy and Mr grumpy.)

But rather than higher powers, my job can be fuelled by adrenaline; speed can be of the essence. Just as the father of a four-year- old boy found when he went to wake him