Room for a view: Neurosurgical depression

He wakes up soaked in sweat at 3:30 am, rescued by consciousness from a string of nightmares. The first was about a new reality show on television in which all of the male contestants agreed to have their penises cut off if they didn't win. The victims seemed to tolerate the insult with equanimity. He rolls out of bed, panting with panic. There is no point in trying to sleep a little longer. It doesn't take a brain surgeon to understand that this man has feelings of inadequacy and insecurity and is tormented by demons. He gets dressed, fumbling with his shirt buttons and the knot in his tie. It's an awkward process: the end of his dominant thumb is split from the dry winter air and he doesn't want to reopen it and bloody his clothes. He tries to get downstairs quietly, to avoid waking his wife and daughters, but his chocolate Labrador emerges from nowhere and trips him up in the dark. Body and briefcase go sprawling. His older dog, a big yellow lab, pads down the hall to check things out; she licks his head, sticking her tongue up his nose. This is his laugh for the day. He pulls himself up, resigned to the blond dog hair now clinging to his meticulously kept clothes. He stumbles downstairs and throws on his coat. The air is frigid; he feels his way in the dark to the car. The engine won't be warm until he pulls into the parking lot at the hospital. For three hours he answers emails, dictates discharge summaries, listens to jazz on the radio, and works on revisions of a manuscript that he is so proud of and that three journals have rejected so far. He goes downstairs to the coffee bar and gets a large regular coffee, his only meal of the day. The hospital still has an early, empty feeling: there's no one else in line. At 7:45 a.m. he goes to the operating room. His first patient needs to be delayed; she has had a sore throat since yesterday and has started to wheeze. Her elective back surgery was booked a month ago. He chats with the anesthesiologist, who suggests they start with one of his two other cases — both young, both requiring removal of a brain tumour. The OR nurses, his second family, curse under their breath because they already had the room set up for the lumbar discectomy and have to rearrange it. He gets through the two tumour surgeries and the sweet little lady with the back problem is deemed fit for surgery after inhaling from some puffers. So he gets all three cases done. Much of the surgical day is spent fussing over residents and fellows to do the surgery as well as he would but in twice the time it would take him. And one of the really good OR nurses is in a manic phase and is exhausting to be with; he's usually the only manic one in the OR. At the end of the day he makes quick rounds with the residents to make sure all is well: another day of doctors triumphing over disease. He ought to feel exhilarated. All of the surgeries have gone well, but he knows that the second patient will not graduate from college in two years; her cancerous brain tumour will have claimed her by then. He stumbles back to his office at 6:00 p.m. to do paperwork and gets home at 8:30. His dogs greet him enthusiastically; his wife and daughters less so. His wife smiles wryly and tosses a meaningful glance toward the girls. Another family supper missed. He summons a loud “Hi” for each of his daughters; they reply with garbled grunts. He makes a gin and tonic and after gulping it in 20 seconds pours a glass of red wine to lubricate the rapid downing of his first meal in 24 hours. He has a bath and pours a scotch and takes it with a tall glass of water to his study, where he turns on the computer to check emails. He writes a tormented piece like this one and falls asleep watching television, trying to dream about fishing or being a monster jazz saxophonist. He loves his family and they love him, but everyone's struggling with the same thing he is. At 3:30 a.m. he wakes up and does it again. He's a little depressed, pal. But has he figured it out yet? The next evening he gets a phone call from one of his daughters, who is out on the town with friends. She sounds so grown-up, yet so dear and tender — the youngest of three precious daughters, who was born with a large birth-mark on her upper lip that eventually faded, who had a few febrile seizures as a baby that scared him and his wife shitless, and who is struggling with the things teenagers struggle with. Before he hangs up he tells her how much he loves her. Then he sits on the side of the bed and sobs like a baby. He's a really depressed man. What is he going to do about it? Mark Bernstein Neurosurgeon Toronto Western Hospital Toronto, Ont.

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