The practice of medicine involves interesting contradictions. In the name of treatment, clinicians regularly inflict pain on people who are already suffering. Medicine promises to alleviate pain in the long-term through an intervention that exacerbates it. Such is the strength of humanity’s hope (collective and individual) for life without pain and suffering that we undergo experimental interventions with little or no documented success.
Gavin Francis describes an operation aimed at alleviating severe and intractable epilepsy, where a woman’s skull was opened and an area of her brain cut out. The decision of where to perform the excision was made by the patient speaking, while the neurosurgeon stimulated local areas of the brain surface. If the woman’s speech faltered with a stimulation, the surgeon labels this bit as not to be removed. The surgeon admits that removing the ‘epileptogenic’ part of the brain is a hit-and-miss operation, with no guarantee of reducing the frequency or severity of the woman’s seizures and a significant risk of worsening her situation.
The surgeon compares his work to ‘gardening’, emphasising the lack of precision or certainty involved. By contrast, the account of surgery for epilepsy that appears on Epilepsy Today’s website offers more reassurance that ‘epilepsy specialists’ can and will make precise and secure diagnosis of best treatment options.
A friend was offered surgery to control his seizures 20 years ago, when, presumably the techniques were even more experimental. At the consultation he mentioned that he was about to start studying for a doctorate. My friend remembers his physician saying ‘Oh well, best not opt for surgery then. If you were working on a check-out, it might be worth the risk.’ The outcome of this encounter was that the friend avoided the medical professional for the next decade and phased out his own anti-epileptic drugs. Only when his seizures became visible to colleagues and friends was he persuaded to return and re-start the process of finding a suitable drug combination.
Gavin Francis’s account of watching a semi-conscious woman’s brain being manipulated ends with her rueful regret at the resulting raggedy scalp scars. The implication is that this is a small price to pay for the reduction in seizure frequency. But in the ledger of costs and benefits for heroic surgical interventions, how should we account for the decade that my friend spent with uncontrolled seizures, resulting from his horror at the gung-ho attitude of his doctor?