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When neurosurgeon Prof Keyoumars Ashkan was asked to remove a brain tumour from a professional violinist, he knew there was only one way to protect her fine motor skills during the operation. She would have to play the violin while he performed the brain surgery.
“The young lady told me: ‘If I end up being unable to play, I don’t want to have the surgery, I’d rather die’,” says Prof Ashkan, an NHS consultant at King’s College Hospital in London. He was awarded an MBE for services to neurosurgery last year. “So we agreed she would play the violin while I operated.”
This was the best way to preserve her dexterity as a violinist. “I’d touch the brain with a probe, known as a neurostimulator, and if she stopped playing the violin, I would know I shouldn’t be removing that bit.”
At the end of the surgery, which was filmed and shared on social media, she was still playing the violin. “Two weeks later, she was doing a concert,” says Prof Ashkan.
He also recently performed surgery on a patient with Parkinson’s disease while she was awake and playing the clarinet, and managed to improve her finger movement to such an extent that she was able to play in her orchestra again.
Having the opportunity to perform such ground-breaking, life-changing work is one of the things Prof Ashkan loves about his job as a brain surgeon.
Another is the sense of fulfilment he gets from treating his patients, improving their quality of life and, in many cases, extending their lifespan.
“One of the most important factors that gets me out of bed each day is that I know I can help patients and have a really major impact on their lives. Neurosurgery deals with probably the most critical illnesses and conditions that patients can suffer from. Being able to treat those is immensely important – and immensely gratifying.”
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‘It’s emotionally demanding’
There’s a public perception that brain surgeons are arrogant, he says. But this isn’t true. Instead, he feels “hugely privileged” to be entrusted with someone’s brain: “If you touch a patient’s brain, you touch their soul.”
One of the most difficult aspects of his job is telling patients that they have an incurable brain tumour. But even this gives Prof Ashkan a sense of job satisfaction, because that is one of the moments when his patients need his expertise and empathy the most.
“I don’t enjoy that conversation – but being able to have it, even if I cannot do very much for them, I think is important,” he adds.
Whenever he manages to offer comfort to a patient during a difficult conversation, he feels a sense of achievement that he has “the skills to talk them through it”. “Over the years, you learn to do it better,” he says. “Even if there is somebody we cannot operate on, we can still relieve their pain or anxiety.
“Seeing patients leaving the room more comfortable – that’s the best indication that I’ve done well.”
Communicating with patients is an important part of the job, but he says, if you’re not dexterous with your hands and you don’t have stamina, “you will probably never make it” as a neurosurgeon. Some operations can take more than 15 hours.
Prof Ashkan also thinks you need to be very clever, decisive and good at working in a team to succeed in a career as a brain surgeon, which he describes as “emotionally demanding”. “I think there are only about 400 neurosurgeons in the entire UK.”
After initially flirting with the idea of becoming a vet, he decided to become a doctor when he was six or seven years old, and emigrated to the UK from Iran when he was 15.
While attending medical school at Cardiff University, he studied part-time for a BA in music at the Open University, just for fun. “That’s why all the musicians come to me, because I am a musician myself.”
Working three roles at once
He is now 57 and became a consultant neurosurgeon for the NHS 22 years ago, after undertaking 17 years of medical training, including eight years of highly specialised neurosurgical training. “The NHS consultant annual salary ranges from £110,000 to £140,000 based on seniority,” he says. “You start on a basic salary, and every year, it goes up – until you reach the top.”
Prof Ashkan was appointed professor of neurosurgery at King’s College Hospital 13 years ago and was also made a professor of biomedical engineering seven years ago. He took on both roles alongside his work as a consultant neurosurgeon at the hospital.
The academic positions involve teaching students and carrying out cutting-edge neurosurgical research, as well as publishing his findings, but he doesn’t get paid any extra for this work. “The NHS just gives you one salary,” he says. “My salary didn’t go up even by one penny when I became a professor.”
Prof Ashkan is typically in the hospital every weekday from 7am to 7pm, so he tends to do his academic work after he returns home and on weekends, when he is also sometimes on call for emergency cases.
To date, he has written more than 900 academic publications. “I always say I don’t do neurosurgery; I live neurosurgery. It is not my job; it is who I am ... when I’m not working, I’m sleeping.”
He never stops trying to improve his knowledge, his skills and his performance for one simple reason: “Every single movement of my hand in theatre can have potentially life-terminating or severely disabling consequences for my patients. So I have to make sure that I am as good as I can be.”
Since there is no longer a set age when surgeons must retire from the NHS, he plans to keep going for as long as he – and his peers – judge that he can. “Many of my friends in their 70s are still operating.”
Although he thinks his own career is sustainable until he retires, he predicts a lot of what neurosurgeons do will one day be replaced by machines. “I think eventually robotics matched with AI will be able to do most things that neurosurgeons can do – I think that applies to pretty much every career in medicine and beyond medicine as well. I think AI is a major threat.”
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