Real life stories from leading neurosurgeon Chris Honey

For most people, neurosurgery is a mysterious, high-stakes profession—but that’s part of the reason I was drawn to it as a curious child and, eventually, as a medical intern and PhD student.

And while surgeons are trained to be detached and rational, some patients have left an indelible mark on my soul. Here are the stories of two who profoundly changed my understanding of both medicine and myself—and of what it means to be human.

In the fall of 1986, I was an intern at St Michael’s Hospital in Toronto, having just finished medical school and begun a one-year clinical rotation to complete my qualifications. My internship was designed to provide exposure to a variety of specialties. I had spent two months each in emergency, obstetrics, paediatrics, internal medicine and psychiatry. I was now trying the field of surgery.

As a naive 10-year-old, I had found neurosurgery appealing, but now, as an intern at age 25, I was learning its realities. I was on call for the first time, working all night and the next day. I began to question if it was right for me.

That doubt was allayed one night in the ER when a patient named Jeff arrived by ambulance. Jeff was a 19-year-old construction worker who had fallen 20 feet from scaffolding while installing windows in a new hotel. The paramedics had found him on his back, unconscious but breathing, and had transported him to hospital on a spine board with a neck collar.

My pager beeped and I headed for the trauma bay. The physician in charge was Grant Drysdale*, an emergency doctor in his early fifties, short, lean, with grey frizzled hair. Wearing a white lab coat, its pockets filled with instruments, he was being briefed by a paramedic.

“No medical history. Vitals stable. Glasgow score was three at the scene but 14 in the ambulance.” The Glasgow Coma Scale is a numeric representation of the level of consciousness: from three (deeply comatose) to 15 (fully alert). Our patient was a 14, meaning alert but confused.

In obvious pain and moaning loudly through clenched teeth, he fought with everyone. His eyes were squeezed shut from the pain. The board he lay on and the white cervical collar around his neck were to keep his spine immobilised. He was moving all four limbs, suggesting he did not have an obvious spinal cord injury.

I stood behind Dr Drysdale, waiting to be told what to do.

The orderly ran large, orange-handled scissors up one pant leg and a moment later Jeff’s shirt was open. Two nurses, one on each side, pushed intravenous (IV) lines into his arms. Then they stuck electrocardiogram leads on his chest and put a small white pulse oximeter on his finger. The monitor began to beep with each heartbeat at a pitch proportional to the amount of oxygen in his blood. The beep had a reassuringly high pitch.

A blood pressure cuff was wrapped around his upper right arm; the reading, 105/55, was lower than it should be, but not alarming. His heart rate was 130 and his respiratory rate was 26—both higher than normal but not surprising for a patient in pain.

Drysdale assessed the victim’s airway, breathing and circulation. Everything was okay. He spoke to him, “Can you tell me your name?”

The patient spoke through his clenched teeth, “Jeff ...”

“Jeff, where does it hurt?”

“My back, my back ... my f*****g back.”

The words were muffled, but it was clear to everyone where the pain was and how much he had.

“I’m going to examine you to make sure you don’t have any broken bones,” Drysdale said. He moved quickly through Jeff’s scalp, face, jaw, chest and abdomen, before methodically squeezing up and down each arm and leg.

“We need to roll him,” he announced, and all the players took their positions. Everyone stood on Jeff ’s right side except Drysdale. One nurse held the head, another reached across his chest to hold his left arm, the orderly reached across his legs to hold his left thigh, and I stood motionless not knowing what to do.

Drysdale looked at me and said, “Grab his legs.” I moved beside the orderly and held Jeff’s ankles. Drysdale counted, “On three. Ready, one…two…three.” Everyone rolled Jeff toward them so Drysdale could see his back while keeping the spine straight.

After palpating Jeff’s back, from below the collar to his tailbone, Drysdale said, “Wait a second. What’s that?” He was looking at Jeff’s back. “There’s a one-inch cut between the ribs on the left.” Reaching into the thin wound, he found a piece of glass and started pulling it out as Jeff moaned louder. It was out, and Drysdale stood up and held up the bloodied shard. It was as long as a steak knife and slightly wider.

“Roll him back, and call thoracics!” he yelled out to the charting nurse. The volume of his voice underlined the urgency of his request for the thoracic surgery team, who dealt with serious chest injuries.

We slowly rolled Jeff back. The moment he lay flat on his back, he went limp and stopped moaning. His arms fell to his sides. I was still holding his ankles, but now his feet, which had been pointing straight up, were flopped open.

“What’s his pressure?” barked Drysdale. The nurse inflated the cuff and, after what seemed like an eternity, said, “I’ve got nothing.”

Drysdale demanded two litres of saline and four units of O-negative blood, the blood type that can be given to anyone. It arrived in the hands of a breathless orderly and soon was flowing into Jeff’s left arm.

Drysdale was visibly shaken. The patient was in trouble, and there were only about five minutes to figure out the problem before he would die. Jeff was deeply unconscious, motionless and unresponsive. Drysdale, standing on the patient’s left side, grabbed his shoulder, squeezed it and yelled at him, “Jeff, open your eyes!”

There was no response. He grabbed Jeff’s left nipple, squeezed and turned it, and yelled again, “Does that hurt?” Nothing. Without any blood pressure to perfuse it, Jeff’s brain had stopped working. “We’ll tube him,” Drysdale told the nurse.

Drysdale was going to intubate the patient because in an unconscious person the tongue can relax into the throat and cut off air to the lungs. He opened Jeff’s mouth with a metal-bladed laryngoscope and slid an endotracheal tube down his throat. Then the tube was connected to a ventilator to breathe for him. Four minutes left.

Drysdale listened to Jeff’s chest with his stethoscope. With each pump of the ventila tor, he could hear air filling both lungs. There was no airway problem. Circulation, however, was catastrophically impaired. “What’s his pressure?”

“Nothing,” the nurse responded. I stepped away from the foot of the bed to stay out of the way but be ready to help when told what to do. This was no longer a learning moment where a mentor would stop to teach you some important point. A life was slipping away and only Drysdale could save him. We were his extra pairs of hands, not his partners.

Three minutes.

“Why’s he got no pressure?” Drysdale said aloud. He glanced up at the electrocardiogram (ECG), seeing what looked like a flat line from where he was standing.

“Start compressions,” he commanded, and the team immediately moved to begin CPR—cardiopulmonary resuscitation. The bed was lowered and the nurse on Jeff’s right side stood up on a footstool and leaned down on the patient’s chest with both her arms straight, hands on top of one another with her fingers clasped. She leaned the heel of her hands hard into the middle of Jeff’s chest and counted, “One and two and three and four, and five and six and seven and eight…”

Each compression pushed Jeff’s chest down against his spine and squeezed his heart, mimicking a heartbeat. The compressions forced whatever blood was in his heart to move out into the aorta and around his body, thanks to the heart’s one-way valve system.

After 15 compressions, the respiratory therapist squeezed the ventilation bag and pushed two large breaths into the patient’s lungs. The endotracheal tube had been disconnected from the ventilator and attached to a bag of oxygen so the breaths could be coordinated with the chest compressions. After 30 compressions, another two breaths.

“Hold compressions.” Drysdale reached for Jeff’s neck. He tried to find the carotid pulse to see if his heart was working and moved his fingers around above the neck collar in several places. Drysdale looked up at the ECG rhythm and saw a flat line. No heart activity.

Two minutes.

“Restart compressions.” He still could not find a pulse. “Give me a shot of ‘epi’ and be prepared to shock him.” The nurse injected into the IV one milligram of epinephrine—the injectable form of adrenalin, the powerful hormone that gives the heart a boost of energy. The defibrillator was brought in, but Drysdale knew that someone with no heart activity (“asystole”) would not respond to its shock. He wanted it ready in case the rhythm changed to something shockable.

The nurse pushed down on Jeff’s chest and the respiratory therapist squeezed air into his lungs. Drysdale held Jeff’s wrists to measure the degree of pulsation in his radial artery. “Deeper compressions,” Drysdale commanded. The nurse put the full weight of her shoulders into the compressions, but the doctor could not feel much pulsation.

“Deeper!” Drysdale was not pleased, but the nurse was maxing out her effort.

“Chris! Take over compression.” He flashed a glance at me. I moved next to the nurse, ready to crush Jeff’s chest. My own adrenalin had charged my muscles. I began, counting aloud up to 15 and then a pause for the two breaths. I was standing on the footstool and staring straight ahead at the ECG monitor only a few feet in front of me.

After a few cycles Drysdale said, “Hold compressions!” and we froze in position. I stared at the monitor and saw a faint tracing of a pulse. It had the characteristic shape of an ECG tracing, but the amplitude was reduced almost to a flat line.

“Asystole,” Drysdale called out. “Resume compressions.”

“No!” I shouted. “He has a rhythm.”

“What?” Drysdale was as surprised that I would contradict him as he was that I thought there was a rhythm. The room was silent. The protocol does not allow for discussion or dissent. Everyone was staring at me, but I just looked at Drysdale and spoke directly to him.

“There’s a rhythm, I can see it,” I assured him.

Drysdale hadn’t been able to see it because the monitor was above his head and his bifocals showed him only the details below his nose. Now, he moved right up to the monitor, lifted his glasses and tilted his head way back.

“Agree,” he announced. He was calmer than I was and emotionless in his tone. There was no “Congratulations!” or “How dare you?” It was just the right answer and now the protocol changed.

“EMD!” Drysdale called out. “Another shot of epi.”

Electromechanical dissociation occurs when there is electrical activity in the heart but no coordinated pulsation to push any blood. The chance of survival is 20 per cent.

One minute.

“Resume compressions,” Drysdale ordered, and I leaned down hard on Jeff’s chest. We had begun another cycle when the doctor yelled “Stop!” In a flash of intuition, Drysdale had suddenly understood exactly what was happening to Jeff. He pulled open the stiff cervical collar around the patient’s neck.

Jeff’s neck veins were engorged with blood, standing out like ropes under his skin. Drysdale looked at me over the top of his glasses and said, “Cardiac tamponade!”

The diagnosis explained everything and, more importantly, it had a treatment. The heart is surrounded by an empty sac called the pericardium, which allows it to beat without rubbing against anything else. If the sac fills with blood, however, the heart is squeezed smaller. It can still beat but it cannot fill with much blood between each beat. The output of the heart, its pulse, gets weaker and weaker until the heart cannot fill at all. The glass shard had cut into Jeff’s heart like a dagger but had plugged its own hole. When the shard was removed, the ruptured heart began squirting blood into the pericardial sac, choking the muscle closed. The cure was to relieve the pressure around the heart by draining the fluid in the pericardial sac.

“Cardiocentesis needle,” Drysdale ordered, and the nurse flew to the shelves at the back of the trauma bay and returned with a small rectangular box wrapped in sterile green cloth.

Drysdale looked at me and said, “Sterile gloves. Prep the belly.” He opened the tray and put it between Jeff’s legs as I gloved and rubbed his lower chest and abdomen with brown iodine, which pooled in his belly button. I wondered why Drysdale was asking me to be involved at this crucial stage. Perhaps it was a small reward for seeing the rhythm.

Drysdale connected the cardiocentesis syringe to a needle that was at least a foot long. He attached one of the ECG wires to the needle with an alligator clip and then turned to me. “Stand here. Enter here. Aim for his right shoulder.” Drysdale was pointing to a spot just below Jeff’s lowest left rib.

I was stunned that he wanted me to do this but immediately walked around to Jeff ’s left side, took hold of the mother of all needles, then pushed the tip in exactly where Drysdale had pointed. The skin puckered inwards, then gave way as the needle plunged through. I was aiming for Jeff’s shoulder, and his heart was somewhere along the way.

“When you feel the heart, stop and suck back.” Drysdale’s instructions were simple, but I had no idea what the heart would feel like at the end of a long needle.

“If the ECG fires, you’re in too deep,” he added. That made sense because the needle would cause the heart to fire, and the ECG wire connected to the needle would detect that electrical impulse.

Unexpectedly, I did feel the needle push on the pericardial sac and then pop through. “I think I got it,” I said and started to pull back on the plunger. Everyone in the room was silent and staring at the syringe. I pulled harder on the plunger. It stuck momentarily and then gave way and glided back. Dark red blood flowed easily into the barrel. After 30cc, the plunger stopped.It was sucking against something and no more blood came.

Jeff sat bolt upright.

The needle was still six inches into his chest. I let go of the blood-filled syringe and jumped back, lifting my arms like a criminal at gunpoint. Jeff reached up to the endotracheal tube in his mouth and ripped it out.

“I’m Jeff Sageman* and my back is killing me!” he yelled. No one moved. We were dumbfounded and frozen in disbelief.

Only Drysdale remained calm and knew what to do.

“Okay, Jeff, just lie down and we’ll take care of you,” he said, as he put his hand on Jeff’s chest and pushed him to lie flat. I was still standing with my arms up in surrender when the senior resident in thoracics arrived and announced himself.

“Hi. Mike Phoenix*. Thoracics. What’s up?” he asked Drysdale.

Drysdale summarized the case succinctly. Phoenix looked at the needle with the blood-filled syringe still in Jeff’s chest. “I’ll call the OR,” was all he said, and started to walk backwards towards the phone, still looking at Jeff.

Then Jeff fainted again. Drysdale felt for his pulse at the neck. Nothing.

“Chris. Once more,” he looked at me.

I pulled on the syringe, but no more blood came. I moved the needle in and out, still pulling, but nothing came. Phoenix was suddenly beside me, pushing me away. He pulled the needle right out of Jeff and squirted all the blood onto the blankets between his legs, then pushed the needle back through his upper abdomen but it banged up against his lowest rib. Then he angled the needle downwards and slipped it under the rib, pushing the needle to its hilt. A foot of metal pierced Jeff’s chest. Keeping suction on the syringe, he pulled the needle back slowly. No blood squirted into the barrel.

Without hesitating, he pierced Jeff again. Nothing.

“Open the thoracotomy tray,” he said, and the nurse rushed to the shelf. The rarely used tray was at the bottom.

“We have to crack the chest,” he told Drysdale. “He won’t make it to the OR.” Drysdale moved to the head of the gurney and Phoenix moved to the left side. While Phoenix put on gloves and poured iodine on Jeff’s chest, Drysdale intubated him again.

Then Phoenix took a scalpel and cut deeply between Jeff’s left fifth and sixth ribs; the incision curved around his chest from below his nipple towards his side. He shoved his hand in between the ribs and inserted a rib spreader—two flat metal blades with a crank that allows them to be ratcheted apart.

Phoenix then pushed Jeff’s lung away with his left hand. There was no way to see inside the deep hole in Jeff’s chest, so Phoenix used his fingertips to feel for the heart. When he found it, he reached for the scalpel with his right hand and it completely disappeared into the hole. Phoenix cut a window in the pericardium to relieve the tamponade on the heart.

“Okay,” he said as if the problem was solved, but Jeff remained motionless.

“No pulse,” Drysdale said with his fingers on Jeff’s neck.

“Let the heart fill,” Phoenix responded.

“No pulse,” Drysdale returned, not waiting very long. Jeff was dying again.

Phoenix reached back into Jeff’s chest and held his heart in his left hand. He squeezed his fingers towards his palm and rhythmically squished Jeff’s heart. Open cardiac massage—I had never before seen this done.

“I need to call the OR,” said Phoenix and looked at me. “Squeeze his heart.”

I moved behind Dr Phoenix and waited for his instructions. He just pulled his hand out and walked away. No instructions.

I pushed my gloved left hand through the tight space between Jeff’s ribs and it popped inside. His ribs squeezed my forearm and I could feel his heart like a chicken breast. I reached around it and pressed it against my palm. It refilled as I let go. I squeezed again and it refilled. This was working.

“Good compressions,” Drysdale reported, his finger on Jeff’s carotid artery. Emboldened, I squeezed harder. Each time, Jeff’s heart refilled with blood and swelled larger, moving more blood forwards through his aorta and around his body. Suddenly, I had a horrible thought—what if I put my fingers through his heart? I squeezed more gently and looked up at Drysdale.

He nodded reassuringly. “Good compressions.” I think he knew what I was thinking. Then I felt Jeff’s heart start to beat in my hand. I held still and felt it move with a twisting power, beating on its own. I had flushed enough oxygenated blood through to get it started.

I left my hand in place, scared any movement would undo things. I looked at Drysdale and said, “I’ve stopped, but he’s going,” and waited for instruction.

He said, “Out.” I pulled my hand out.

Drysdale said, “Good pulse,” and covered the gaping wound.

Phoenix returned and said, “The OR is ready. We’re taking him.” With that the orderlies wheeled Jeff away to the operating room, surrounded by nurses scuttling sideways with the stretcher and a respiratory therapist squeezing the bag blowing air into his lungs.

I looked at Phoenix and called out to him, “Will he be okay?”

Phoenix looked at me and changed my life forever. “Yeah, he just has a hole in his heart.” The surgeons would suture the hole in Jeff’s heart, and he would leave hospital 11 days later. Problem solved.

There was no team debrief. The charge nurse simply handed me another chart. I have no idea who that next patient was or what their problem was. All I could think about was getting home and telling my wife, Karla, about the drama of my day. The brief surgery that allowed me to massage Jeff’s heart was the most exhilarating thing I had ever experienced, the most rewarding hour of my life. This man had died twice, and lived.

This was how I wanted to spend my life. Surgery was the right path for me.

By 2014, I’d been a neurosurgeon for 25 years. No patient of mine had died after an elective operation, and I was proud of my winning streak. I saw my goal as operating without complication, not necessarily improving a patient’s life. But a baby boy in Africa taught me to see purpose in helping the patient yet losing to the disease. To see that medical learning and discovery is not just a science—it’s also an art.

In the spring of 2014, I landed in Monrovia, Liberia’s capital, as part of an international aid mission that would perform the first neurosurgical operations in the West African country.

The Korle-Bu Neuroscience Foundation was supporting this effort. A group of nurses and physicians, initially from where I worked, Vancouver General Hospital, had helped set up and equip a neurosurgery service in nearby Ghana. Now the foundation’s director wanted to put a satellite clinic in Liberia.

The foundation had sent an African neurosurgeon from Nigeria to the Jackson F Doe hospital a month earlier to see patients and identify some for surgery. The hospital, in Tappita, a six-hour drive east of the capital, had Liberia’s only CT scanner. At least a dozen people were now waiting for neurosurgery if conditions were right for me to proceed. This would be their only chance for the surgery they needed.

The hospital was a white, square two-storey structure with a red tile roof and a paved courtyard at its centre. It was hot and humid; there was air conditioning in the operating rooms and the staff lounge, but not on the wards. At the back of the compound was a large locked shed humming with two diesel generators that provided the hospital with electricity. They ran one at a time, 12 hours each.

Among the cases we would operate on were two infant boys with massively enlarged heads characteristic of hydrocephalus. That’s a condition where the flow of cerebro-spinal fluid (CSF) through the brain is blocked and the fluid builds up. CSF is a clear, water-like fluid produced within the ventricles (cavities) of the brain, and flows around the organ, allowing it to float inside the skull. If there is a blockage en route, fluid builds up and the ventricles dilate, crushing the brain against the skull.

A baby’s skull is made of separate bones that, to allow the brain to grow, do not fuse for several years. The gaps between these bones, called fontanelles, feel like the soft spot on the top of any baby’s head. If hydrocephalus begins before their skull has fused, the infant’s head will balloon in size. Before the 1950s, the condition and its treatment were often lethal.

But the two babies had very different prognoses. A CT scan of Joshua, nine months old, showed enlarged ventricles that were pushing outwards and enlarging his skull. He would benefit from a ventricular-peritoneal shunt, which regulates the flow of CSF, and I had brought one. He seemed otherwise healthy and happy.

The second baby, Saika, was far worse off. Also nine months old, he could not lift his enlarged head off the crib. The brown skin of his scalp was stretched paper thin, and every vein was visible beneath its translucent surface. His young mother lived in a small village with no running water about three days’ walk from the hospital.

A nurse told me that Saika had been treated by the local healer. When his head began to grow, the healer wrapped it in a plaster of mud, manure and straw. The mixture turned rock-hard in the sun, and the helmet limited skull growth. But the pressure inside Saika’s head eventually broke the plaster. It must have been excruciatingly painful. I knew, as an outsider, that I held Western biases and should not judge, but when I heard this story and imagined the child’s unnecessary suffering, I could not regard the traditional healer with equanimity.

Saika’s CT head scan was so abnormal that it was difficult to pick out the normal structures. Most of his brain was compressed by a grapefruit-sized cyst of fluid on the right side. All the ventricles were enlarged, and pushed into the left side of the head. There was a small ribbon of abnormal brain surrounding everything, and the combination of the cyst fluid and enlarged ventricles had pushed the skull bones open, causing the massive head. He could not be saved.

When we met to choose which of the boys would be operated on next, it was clear: Joshua. His surgery went well, and we were done by lunchtime. The follow-up CT scan showed the  shunt was in an ideal location and had begun to decompress his ventricles. Joshua could go home in a few days.

Our team met that evening to discuss our plans for the next day. To my surprise, the Nigerian neurosurgeon suggested we operate on Saika.

I outlined why this would be futile. Saika had a serious infection and we had no way of culturing the pathogen to choose the correct antibiotic. The infection probably came from the manure that had been wrapped around his head, the bacteria having entered through his thin scalp. We didn’t have strong enough antibiotics to handle an infection from bowel bacteria. Even if we did, we couldn’t provide a long-enough course.

A closer look at the images of his brain showed multiple smaller abscesses, and we had no way to drain them all. The infection would have already damaged his brain, and it was highly unlikely he would survive in his village. I was categorical in my conclusion. We were not going to operate on Saika. This child was going to die and there was nothing we could do about it.

My Nigerian colleague patiently explained why it was important to try: “We can fail. Africans are used to medicine failing. There is no cure for Ebola, for instance. But the village needs to know we thought it was a medical problem. If we stand back, they will think we believed there was something else wrong with him. They will cast the mother out of the village. They will think the boy has been possessed and that there is some evil in his mother for her to have a child like this. Even she will believe she has done something wrong.”

Everyone in the room was nodding as he spoke. I was dumbstruck. I had never formulated a treatment around how society felt about a patient and his mother. They looked at me. All I could say was, “Wow. I’d never thought about it like that.” I agreed that we should try to help this boy. The details of how we would do so, however, were unclear. It was medically unsound.

I looked at Saika’s CT scan again, and eventually concocted a far-fetched but plausible plan. “We could try to drain the main fluid collection on the right side of the brain,” I said. “He might get relief and we would be more certain of the diagnosis. If it is an abscess, we will know the prognosis is lethal.”

Saika arrived at nine the next morning, washed and changed by his mother and the nurse. Too weak to cry, he was laid on his back on a small table covered in green towels.

I explained the plan to everyone in the room. First, we’d put some anaesthetic in his scalp; he was too weak for a general anaesthetic. “Then I will push a large needle into the part of his skull where I think the abnormal fluid is,” I said. “Then I’ll withdraw the syringe plunger to pull out whatever fluid is there.” The brain doesn’t feel pain when it is touched. Saika would not suffer.

I took a number of measurements off the CT and marked the spot on Saika’s head where I thought we should go through his scalp. I studied the images again to understand the depth and direction of the needle and how the fluid would then distort the brain after I began to remove it. Brain shift, with a needle deep inside the skull, could be disastrous.

When we were ready to begin, I gently washed Saika’s scalp with warm water and soap. The skin looked very fragile, so I did not scrub hard. Then I applied dark-brown iodine solution, and after it dried, I put a small amount of local anaesthetic underneath the skin with a tiny syringe. Saika did not cry. A nurse handed me a syringe attached to a thick, two-inch-long needle. I bent over the baby, resting the back of my left hand on his head and holding the syringe in both hands.

“Okay, here we go,” I announced, and started to advance the needle’s sharp tip towards Saika’s skin.

That’s when the lights went out, submerging us in darkness. It was early morning, but the operating room had no windows.

“What the hell?” the anesthesiologist blurted. I pulled back. I had not yet pierced Saika’s head. All the monitors started to beep as they switched over to battery power. The noise was deafening, particularly in the dark.

Four or five minutes later, the lights came back on. Shortly after, someone in dirt-stained overalls peered around the doorway of the operating room and said, “Don’t worry. We just switched over the generator.” The alarm on each monitor was eventually turned off, and gradually the operating room returned to normal. Saika continued to breathe, oblivious to the near disaster.

I leaned over Saika again. The needle pierced his skin and penetrated deep into his brain. At the one-inch mark, I paused and pulled back the plunger. The syringe filled with a thick green fluid. It was easy to get 50cc. I twisted the syringe off the needle and emptied the fluid into a kidney basin. It was definitely an abscess.

I reconnected the syringe and pulled out another 50cc. Then another 50, and another. I had estimated that the volume of the cyst before surgery was at least half a litre (500cc). Saika’s head began to collapse. The next pull of the syringe had resistance—something was blocking the flow of pus into the needle, probably the brain collapsing into the evacuated space. I repositioned the needle further backwards and deeper, pulled out another 50cc and then stopped. I did not want a huge brain shift, which could tear some of the blood vessels.

I put a small bandage on Saika’s scalp where the needle had been. We would let the infant recover and then reimage his brain. He was swaddled and bundled off to the recovery room and was back in his mother’s arms a few hours later.

That evening I went with the medical team to see how Saika was doing. His mother burst into tears of delight when she saw us. Saika was much brighter and more active since the surgery, she told me. He could cry with strength, and his cry sounded more like it did when he could lift his head.

Everyone on our team was beaming and the mood was joyous. Everyone except me was truly happy. I knew Saika would die in a few weeks.

I spoke to his mother through a nurse who translated. “We are proud of how strong Saika is and how well he did during surgery,” I began. “An infection made his head grow. I’ve removed some of the infection, but it’s strong and he is very young.” Her eyes pierced mine when she asked, “Can you do more?”

“No,” I replied.

She bowed her head and turned away. She sat down in a chair beside the crib and looked at Saika and then up at me. “Thank you,” came the translation. She did not cry. She picked up her son and held him, rocking him back and forth in her arms. She understood.

Saika and his mother were welcomed back to their village a few days later. The nurses covered my small bandage with a very, very large dressing that wrapped around his head like a turban. It was clear to everyone that he had had a medical procedure—a brain operation.

Normally I get to see my patients after surgery in follow-up and learn how they did. But Saika was a three-day walk away—I would not hear anything further about him.

Back at home, I thought about Saika a lot. His brief time in this world was painful, but he would surely die in his mother’s arms, surrounded by members of his village who no longer believed he was possessed by evil spirits. Social progress was made. A life was saved: Saika’s mother’s life. My co-workers had made the right call.

I could not put into words why I felt I was a better doctor for having met him. I only knew it was so.

Excerpted from The Tenth Nerve by Dr Christ Honey. Copyright 2022, Dr Chris Honey. Published by Penguin Random House Canada Limited. Reproduced by arrangement with the publisher. All rights reserved.