The Tenth Nerve: a brain surgeon's stories of the patients who changed him

Public

From another person, also available on 'Apple Books as well which I prefer as sharing with "family" is easy.'

I have already read this book, enjoyed it and recommend it.

We belong to a couples book club that expands our usual reading list. This month the Book was 10th Nerve by Chris Honey, that was introduced on doclounge a few months back. We are the only medical people in the group, which was started 30+ years ago by teachers with their wives. Now there are 3 proficient artists and a retired business man as well. Everyone really enjoyed the book, rating it the best in a long while, but would not have read it unless introduced to it.

A diagram of the brain seen from below with Cranial Nerves numbered and a list of their names & functions helped discussion.

Starting, out of chronological order, with the chapter in Liberia and its’ all too human conclusion, ensured that everyone was hooked to the end of the book. Everyone mentioned chapter1, followed by impressions of the first patients treated for 10th nerve compression and ended with the soccer field.

I was curious that nobody discussed Nadia, the penultimate patient. Perhaps it was too technical or, never having experienced the pseudo-3D of rolling through serial CT “cuts”, their mind may not have generated the image of a brain CT with a dreaded white blob that I pictured. The author referred to it as a miracle, serendipity was my takeaway. Not the least part was recognizing the upside for future study on dental pain.

For me, Nadia brought up a memory from 50 years ago in Scotland. Another woman, who after a couple of weeks in coma, hit her head… and suddenly woke up. She was able to leave the hospital, with her husband, walking without any aids within a week. Oh, for today’s imaging tools to have helped us comprehend the disaster turned “miracle”.

*CT scan theory had been documented ~ 1900, and around the time of this woman’s “event”, there was a research prototype in London UK. It would be 25 years before CAT scanners, as they were initially called, were appearing outside universities. These were slow both in acquiring the images and in crunching the numbers afterwards to make visual images available. Breakdowns were so frequent initially that one technician was stationed in Kamloops to look after the scanner there plus the one in Vernon.

Great Read.

* https://en.wikipedia.org/wiki/History_of_computed_tomography

This gave me to investigate CT scanning again.

Wikipedia:  "The mathematical theory behind computed tomographic reconstruction dates back to 1917 with the invention of the Radon transform[1][2] by Austrian mathematician Johann Radon, who showed mathematically that a function could be reconstructed from an infinite set of its projections.[15] In 1937, Polish mathematician Stefan Kaczmarz developed a method to find an approximate solution to a large system of linear algebraic equations.[16][17] This, along with Allan McLeod Cormack's theoretical and experimental work,[18][19] laid the foundation for the algebraic reconstruction technique, which was adapted by Godfrey Hounsfield as the image reconstruction mechanism in his first commercial CT scanner"  "The first commercially viable CT scanner was invented by Sir Godfrey Hounsfield in Hayes, United Kingdom, at EMI Central Research Laboratories using X-rays. Hounsfield conceived his idea in 1967.[14] The first EMI-Scanner was installed in Atkinson Morley Hospital in Wimbledon, England, and the first patient brain-scan was done on 1 October 1971.[29] It was publicly announced in 1972."  (Yes, this was the same EMI company that produced music albums from a somewhat noisy band called "the Beatles")

The first CT scanner at the Royal Columbian Hospital - purchased largely by donated funds, including a chunk from the Medical staff, came in 1980.

It was pretty crude but much improved over the EMI original.

A young Dr. Ken Kaan was hired away from the VGH as the CT consultant - about that time the RCH Radiology department developed a policy of ensuring each new partner brought in new skills to the department and they subsequently developed exceptional skills in ultrasound, MRI, interventional radiology, and other sub-specialties.  This was a "non - academic" department in Dr. Naismith's term.  They looked at images one at a time on the oscilloscope:  part of the expertiese of the CT technologist  was to know what images to print onto film.    Scans today can include up to a thousand images so the computer - and multiple high resolution monitors - have become a necessity.

NIH Have an interesting article on the CT history 1. Their block diagram of timeline appealed to me 2. I checked for CT Installation dates across BC & ran across this 3 which appears to miss most before 1990. It did however confirm my memory of Vernon in early 90s. I suspect 1993 was the start rather than switch on date.

1 https://pmc.ncbi.nlm.nih.gov/articles/PMC10644676/

2 https://pmc.ncbi.nlm.nih.gov/articles/PMC10644676/figure/F1/

3 https://www.cda-amc.ca/sites/default/files/pdf/ct_report_01.pdf