It’s 2am on a Saturday morning. My fiancee is in bed; some of my friends will be out on the town dancing. I’m stood in a sterile, brightly lit operating theatre, wearing tatty scrubs and a stranger’s theatre shoes, holding the on-call neurosurgery phone, the single point of contact for all the local hospitals in a region covering millions of people. But I’m also dancing on the inside. I’ve been referred a patient for an emergency operation, and I’m desperate to do some drilling.

Drilling is what the game is all about for me right now. For the haggard, wearied, fatigued senior registrars, drilling has mostly lost its excitement. Not for newbies like me. I’m permanently trying to sniff out opportunities for hand-on-drill time; getting colleagues to text me what’s happening on the ward, checking the list of incoming admissions, reviewing the scheduled operation lists. Is there a patient going for a scan? Might his clot have expanded? Might he need another operation? Better stick around!

I don’t wish bad things to happen to patients, yet the reality is bad things do happen. And I need the exposure and the training to learn how to deal with these disasters. I go to work hoping for a golden trinity of circumstances: senior registrar on call (less interest in drilling, won’t need to call the consultant in); night time (fewer colleagues to compete with); and an acute but not complex pathology. If these stars align, the drill should get passed to me.

It’s a strange combination of feelings you experience, standing over an exposed bit of skull with a high-powered drill in your hand. I’m not fearful, not afraid. How can I be? Whatever happens during the operation, I’ll get to walk out of here. Those emotions are for use by relatives only. I’m not stressed at this moment. My boss has the weight of responsibility on his shoulders – responsible for my actions as well as his. Excited? Certainly. Lifting the bone flap, incising the protective membranes and exposing the brain is truly exhilarating.

The overwhelming emotion, though, is of being acutely self-conscious – it’s not called a theatre for nothing. Every movement I make is being scrutinised – this is my training arena. How did I hold the scalpel? Did I thank the scrub nurse? Have I told the anaesthetist I’m starting? Am I holding the blade parallel to the skin? On and on, a relentless inspection of my operative skills. I am always one step away from the boss having to step in and take over, one step away from a heavy sigh of disappointment from the scrub nurse as another swab falls on the floor.

For every gap in the rota we can fill, another two come up. We are getting stretched thinner and thinner

Operating with a registrar affords me a large and sturdy safety net – a pair of experienced hands ready to prevent me doing something stupid, catastrophic or both. I’ve not made any major mistakes in theatre yet – the safety net has been pulled too tight. Over time, and many hundreds of hours and operations, the net will slowly loosen, until I have no one to guide me.

My mother finds this situation rather alarming, still ringing to check I’m sleeping enough and getting my five a day. My brother is permanently incredulous that I’m in training to be a neurosurgeon. My father still doesn’t trust me to use a garden strimmer without steel toe-capped boots. Their memories are of me dropping plates, breaking glasses and snapping bones. But my transition from bone breaker to brain surgeon hasn’t happened overnight – it has taken years of schooling, lectures and ward work, with success, failures, mistakes, luck and everything in between. I always wanted to be a surgeon after I had some surgery myself as a child. Seeing the cerebellum exposed as an impressionable second-year medical student sealed it – it was infinitely cooler than removing a haemorrhoid.

I will certainly make mistakes. Some will be minor; some will be catastrophic. Flunking a cannula might leave a patient with a bruise, but the margins of error operating in the head are that much smaller. Henry Marsh talks about having a cemetery in his head. I’m not experienced enough to have a cemetery yet – although I am sure the stonemasons are sharpening their tools in preparation for building me one. I don’t know how this will come to affect me, how can I? I can’t prepare for the moment it all goes wrong in theatre followed by the slow walk to the relative’s room to break news I don’t want to give and they don’t want to hear. I cycle between being constantly aware of potential catastrophe yet deliberately forcing myself to be ignorant of it. What use would I be if I was so paralysed by fear I couldn’t make a decision? Who would choose the surgeon with shaking hands?

These stresses can take their toll, on myself and those around me. As do the night shifts, the disturbed sleep, the eating breakfast for dinner and dinner for breakfast. The current situation in the NHS is well documented. The pressure is growing. For every gap in the rota we can fill, another two come up. We are getting stretched thinner and thinner – at some point our chain of resistance will inevitably snap.

I can already feel myself becoming desensitised. Things that used to upset me no longer do. The child with a tumour, the father who was assaulted, the grandmother with cancer. Sad tales are filed away with the other countless tragedies that unfold each day. I don’t want to lose my compassion, but I can’t immerse myself in the emotions of every single case.

When I leave the hospital, I try to be a good person at home to my fiancee. Console and support her after she has had a bad day, as she does to me. But can I truly empathise if she cannot get her spreadsheet to balance? I worry that she’s starting to see through the communication skills I learned at medical school. She wants to go out for dinner, watch a film, see friends. I don’t. I need to conserve my energy – how else will I hold the drill straight?

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