How Sickness Happens

At this workshop on November 15, 2012, Dr. Gabor Maté presented an in-depth analysis of vicarious trauma – including definitions, myths, and realities of trauma and vicarious trauma, as well as the sources and triggers for stress, its physiology, and how to release it. Dr. Maté integrated meditation, music, and excerpts from two of his books, into lively and interactive sessions, with all participants engaged in learning from each other and Dr. Maté.

On hygiene, intellectual and otherwise

Medical science had an irrefutable argument against it: sterilization of surgical cutlery would have no beneficial effect at all because, if it had, the practice would have been introduced a long time ago. After all, boiling water was already available at the time of Hippocrates.

.. Medical research was a little bit more tolerant in the sense that they admitted that, yes, perhaps some of such hygienic practices could be allowed in the case of novice surgeons, whose work was anyhow confined to toy operations. Research, however, would not pursue it since it was ridiculous to believe that the sterilization of their cutlery would enable surgeons to cure all diseases.

.. imposing such artificial disciplines in the operating rooms would stifle the surgical creativity of its members, and, secondly, that, if sterilization of the knife really helped, everybody would be able to operate and that would be totally intolerable. Furthermore, what was then known as operational research had shown that the proposed sterilization procedures would be much too complicated for the average nurse.

.. Emotional protest came from the nurses themselves, who loved to take care of the very sick and whose devotion rose in those days to unfathomed heights each time a young patient died in their arms. The spectre of routine operations was a threat to their job satisfaction, greater than they could endure.

.. Eventually, emotions ran so high that the Church could not remain silent any longer. It settled the matter on moral grounds: since it is Man’s predicament to die, it would be immoral even to try to reduce the natural mortality rate of the surgical wards by such unnatural and counterintuitive acts as boiling a pair of scissors: the sole purposes for which God had created hot water were

  • the cooking of food and
  • the boiling of heretics

such as the practitioners of greater hygiene, be it surgical or otherwise.

Comments: Hacker News

A Neurosurgeon Reflects On The ‘Awe And Mystery’ Of The Brain

But given that the tumor looks like the brain, and if you’re operating near what we call eloquent brain – that is brain where, if it’s damaged, the patient suffers serious troubles such as paralysis or inability to speak – something like that – it’s very – it can be very helpful to have the patient awake, talking or moving the relevant limbs as you remove the tumor to make sure you’re not doing any harm.

And I was one of the first people to do this in this country many years ago. And it was considered rather eccentric at the time. But, in fact, it’s now the standard way of operating on these tumors and is practiced everywhere.

.. But it is one of the various themes of the book, which is this extraordinary fact which is very hard to come to terms with. It is a fact for all people who work with the brain that thinking and feeling is a physical process. It doesn’t feel like it. You know, my thoughts don’t feel like electric chemistry. But that is what they are. And I find it quite a consoling thought that our modern scientific view of the world which has explained so much – we can’t even begin to explain how consciousness, how sensation arises out of electric chemistry. But the fact of the matter – it does.

.. So does the work that you do as a neurosurgeon increase or diminish your sense of the mystery of consciousness?

MARSH: It increases it.

.. But you’re very nervous, as you describe it, during this procedure because you just recently performed surgery removing a tumor…

MARSH: Which had gone very badly, yes.

GROSS: Yes, from the cervical spine – cervical spinal cord of a woman. And she was left paralyzed on one side of her body.


GROSS: You fear that you removed too much of the tumor, and that’s what damaged her spinal cord. And you confess to several times when you felt responsible for a spinal or brain damage as a result of a surgery. And I’m interested in why you wanted to share that. You’ve even given a lecture called, like, the 10 worst mistakes I’ve ever made.

MARSH: Well, something like that. I’m a great believer that doctors and patients should, in a sense, be equals, I mean, especially as we give advice. I’ve always hated sort of paternalistic, condescending doctors. And I’m all for patients making demands and patient’s rights. But it’s a two-way process. And I think patients in the modern world where – certainly in England, you can’t open the newspapers without reading about the latest medical scandal and incompetent doctors. Now its incompetent nurses.

The public need to understand that medicine, actually, is often a very uncertain process.

.. I think, on the whole, if you – as a patient, if you go and see a doctor, and you could only choose one quality, I think most of us would go for honesty (laughter) because if you see an honest doctor, if he knows what should be done, he’ll tell you. If he thinks somebody else can do it better than he can, he can tell you. And I think honesty is, in a sense, a more important quality than steady hands or nerves of steel or heart of a lion – all the old cliched ideas of what surgeons should be like.