DO NO HARM

That brain surgery is fraught with disaster and complications should come as no surprise. However, we rarely hear about that side of this field. That is, until the wonderful confessional book Do No Harm by the British neurosurgeon Henry Marsh pictured above.

Marsh's book recounts his experiences operating on brains and spinal cords for over forty years in England and elsewhere. Unlike most medical books that focus on the heroic, this book also highlights how harrowing the experience of brain surgery can be to both the patient and the surgeon.

Mistakes in medicine are inevitable. Yet, there is no organ less forgiving of mistakes than the brain. Certainly, there are portions of the brain that when traumatized do not lead to permanent damage. Then, there is the rest - what Marsh calls "eloquent brain" - that whose damage leads to significant disability. Unfortunately, very terrible diseases often lurk in or near eloquent brain - tumors, aneurysms, strokes. While the latter is the domain of the neurologist, the former two are the domains - and perhaps cemeteries - of brain surgeons.

How does one venture into these territories day in and day out? It takes more than hubris. It takes courage and the conviction that the benefits of intervention outweigh the risks. Marsh acknowledges that it is heroic to take on challenging cases that others might pass on. However, he clearly reminds the reader that thoughtfulness and cautiousness must also be considered if we are to truly operate under the principle of "first, do not harm" -  a first principle of Medicine that is laid out in the Hippocratic Oath that all doctors take at some point in his/her training.

I often think of this Oath and this principle of avoiding interventions when harming the patient seems much more certain that helping him. Oncology is not brain surgery, but certain parts of the body, like the nerves or bone marrow, do not forgive or forget the poisons to which they are exposed. Because of this, I do have an abiding belief that it is much worse to harm a patient with an intervention than to withhold a toxic, unsafe therapy that has the potential to improve longevity by a few months.

My patients often disagree with this approach. This is because, although there are risks with dangerous treatments like chemotherapy, the risk of a poor outcome without no treatment is a certainty.

It is within this context that life and death medial decisions are made every day. Marsh reminds the practitioner and patient alike of the gravity of Medicine and our choices. Let us remember his words when making these shared decision, and let us first do no harm!

LITERARY MORTALITY

I recently finished reading Our Souls at Night, the latest novel by Kent Haruf. I enjoyed the book thoroughly. However, it was only after I completed it that I realized that Mr. Haruf had passed away recently and that this would be his final book. This revelation made me quite sad.

I first came across this author more than fifteen years ago when my book club from residency read his novel Plainsong. Like Souls, Plainsong takes place in the fictional small town of Holt, Colorado. Both books capture moments of pettiness and grace in this small town and remind one just how similar we all are. The prose is simple, much like the setting of Mr. Haruf's novels. However, the simplicity of the writing is what makes the stories so beautiful, and I am sad that I will not be able to read another of his stories.

Mr. Haruf's death is a reminder of how ephemeral life is, and how writers and artists are mortal just like everyone else. While Souls may be Mr. Haruf's last book, his works will live on well beyond his death. Let us appreciate the beauty in everyday life and in art and literature before it is too late for us, too! Rest in peace, Mr. Haruf.

PROMOTION/DEMOTION

Nicholas' soccer coach asked to meet with us last week to review his progress over the summer season. I was not quite sure what to expect when I received the email, but I had an idea.

The soccer club Nicholas plays for has four levels, and Nicholas was playing on the black team, the third of the four tiers. The coach said that he enjoyed having Nicholas on the black team, but he thought that Nicholas was better suited for the lower team. This decision was mainly based on Nicholas' lack of aggressiveness and inability to make quick decisions in attack. I had witnessed exactly what the coach was describing on multiple occasions and told the coach that I agreed with the decision. 

After our conversation, the coach invited Nicholas in and shared the news with him. The coach was very thoughtful and used the right mix of motivation and compassion when breaking the news to Nicholas, who was visibly upset. As Nicholas took in this information, I could see him choke up and fight back tears of embarrassment. The coach told him that this move was not permanent and that it was up to Nicholas to work his way back up to the third team. The coach also said that he thought Nicholas was a wonderful young man and cleared loved the game.

As a parent, this was heartbreaking to watch. My little guy who eats, breathes, and sleeps soccer was being demoted, and there was nothing that I could do about it. 

Later that night, we talked after reading bedtime stories. I told Nicholas that his experience that night is not unlike what many of us face each day. One has to work hard and earn one's place - whether it be in the workplace, at school, or on the pitch. He expressed understanding, but it was at this time that he began to tear up. 

I wiped away his tears and gave him a big hug. I shared my own stories of not making countless sports teams growing up, and I also reminded him that several of his friends had been too afraid of failure to even try out for the soccer team. Finally, I helped him remember that he plays quite aggressively whenever we go to the park to play soccer with Cate. Nicholas perked up and said he knew that he could do better.

I look forward to watching Nicholas no matter what color team he plays on, and I would not bet against this kid making his way back up the pecking order!

THE BEAUTIFUL GAME

This week, we have been enjoying vacation near Banff National Park in Alberta. Of course, we brought along a soccer ball, and we quickly found a pitch nearby in town with absolutely breathtaking views of the Rockies.

We went there earlier this week to run around and blow off some steam. The kids and other adults went to the playground area. However, I headed for the pitch. I started to practice free kicks, which was a little tough. This was because there was no net in the goal and because so many of my kicks sailed over the bar. :(

An Asian gentleman saw me, and he stationed himself behind the goal. He then proceeded to shag my kicks and return them to me. He also provided some encouraging words along the way. 

After I was done practicing, I proposed a kids versus parents game, and our families and his family joined in this spontaneous kick about. 

The game was competitive, especially with Cate and Nicholas on the opposite side. However, the parents might just have prevailed due to some special play from yours truly and the Asian dad who had started the evening by shagging my free kicks.  It turned out that he was an orthopedic surgeon who was visiting from Beijing, and that he too loved football and Messi. What a small world!

They say that a soccer ball can help break down barriers and bring people of different creeds, nationalities, and political affiliations together. I do not know about all that, but it was clear to me that night that soccer is a beautiful, beautiful game appreciated the world over - from the USA to China by way of Canada!

STORYBOOK ENDING

Yesterday, Barca played the UEFA Super Cup Championship match in Tbilisi, Georgia against its domestic rival Sevilla. A lot was on the line in this match. This is because, Barca had won all three of the trophies available to the club last year. A win in Georgia would have put them one step closer to their goal of a clean sweep of all six possible trophies in this calendar year.

The game started off with a Sevilla goal from a free kick. Not to be undone, Messi equalled with a splendid free kick of his own. He followed this with another free kick goal, and Rafinha and Luis Suarez added one more goal each. Barca led 4-1 at half. However, the game was far from over.

Sevilla fought back and tied the game in the closing minutes. This sent the game to added extra time. In the first period, no goal was to be found. However, more fireworks were to come.

Pedro Rodriguez, a Barca youth prospect, was substituted late in the game, and he had an extra bit of determination. This was not only because he wanted to win another trophy. Rather, it was because he has been strongly linked with a move away from Barca to another club due to lack of playing time. The game in Tbilisi might actually have been his last match in a Barca shirt.

In the second added time period, Messi was fouled outside the box. He blasted a free kick in, but it was blocked by the hand of a Sevilla player. Messi played on and fired in the rebound that the keeper could only parry. Guess who was there to pick up the pieces and put the goal away? If you guessed Pedro, you would be right!

Barca went on to prevail 5-4, and they lifted their fourth trophy of the year.

One could not write a better ending than what we witnessed! We thank you Pedro for your years of service and devotion to this team. If this was indeed your last game, you go out a hero to all cules. Visca Barca!

A FINAL TO REMEMBER

The United States National Team won its third World Cup final recently, and we were very lucky to witness it in person!

The US team started the tournament slowly, and many feared that the US would not make it out of its group stage, labelled the "Group of Death." This was because the US' play early in the tournament was quite lackluster due to a combination of nerves and poor player selections and tactics by Coach Jill Ellis.

These mistakes were corrected as the tournament went on, and the solid US defense that only conceded one goal in five matches kept the American's dreams of a third title alive.

It was fitting that the US' opponent in the final was Japan - the team the US had beaten in the 2012 Olympics, the last major international final, but who had defeated the Americans in the last World Cup final in 2011. 

Japan had played uninspiring, robotic football for the entire tournament, but they did enough to win each of their five games. Most predicted that Japan would bring their A game to the final and that the Americans would face a tough test. 

Those observers were wrong. Because within three minutes, the US was up 1-0 on a Carli Lloyd set piece goal. Two minutes later, Lloyd scored again. Lauren Holliday added a third within the first quarter hour. At twenty minutes, Carli Lloyd scored her third, a beautiful shot from midfield that caught the Japanese keeper off her line.

We and the overwhelmingly partisan US crowd went wild, but there was more excitement to come. Japan scored, and added one more in the second half. However, Tobin Heath from the US quickly responded to make it 5-2, which would be the final score.

I have never been more proud of an American sports team, and I am thrilled that we were able to witness such a remarkable match. Here's to our national team. U-S-A! U-S-A!

ALL THE LIGHT WE CANNOT SEE

Good books make one think. Great books, on the other hand hand, make one reflect on one's place in this world. By that metric, All the Light We Cannot See is a fantastic book.

The novel by the American Anthony Doerr is set in wartime Europe and tells the story of two young people - one a blind French girl named Marie-Laure and another a German boy named Werner. The book alternates between their perspectives and tells their war stories, which are seemingly unconnected. However, there is a connection between these characters, and the book is a deep study in empathy and the ties that bind us despite our different nationalities and ideologies.

The book has clear shortcomings. The prose is often pretentious. One of the German characters is really more of a caricature, and Werner's character is not fully developed. Despite this, All the Light We Cannot See manages to move and inspire.

It does so by telling a heartbreaking story from the perspective of two lost souls struggling to survive and maintain their dignity in one of Europe's bleakest times. Pick up the book. You will not be able to put it down. Afterwards, you will appreciate all the light around you that you might not have seen before.