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Brendan O'Connor on our TV Radio One.

A lot of reaction there to Natasha Mortimer. What I'm going to do is I'll come back to her in a little while, if that's OK, because I want to move on for the moment. Listen, if you think you have pressure at work, right, this will stop you moaning because I'm going to talk no to a brain surgeon. And in fact, she's Ireland's first female consultant neurosurgeon, Caitlin Moran.

Good morning. Good morning, Brendan. I'm so Katrin, you took up your position at the National Neurosurgical Centre in Beaumont last October. And I know you're joining a team of 12 there. But I think that you come to you with a particular speciality which was kind of missing from our offering in this country. Yes.

So and for each one of us kind of sub in a different area of neurosurgery. And what I specialise in specifically is a deep brain stimulation or functional neurosurgery.

And for patients with movement disorders or Parkinson's disease, mostly, OK.

Could you explain to us how it works so deep?

Brain stimulation is basically inserting electrodes or wires and deep into the brain nucleus, and that kind of augments the abnormal motor circuits that you get in Parkinson's disease. So about 10 percent of people with Parkinson's disease, they get good response from their medication. But over a few years it kind of wanes and they start getting real trouble walking, moving. And then the deep brain stimulator can be used to basically bring you back to walking normally and for at kind of much longer during the day.

It can it helps with tremor. And it's basically it's a life changing procedure for patients, especially with Parkinson's. Over the last 20 years, we've had our patients have gone to the UK for treatment, which kind of is a barrier for them because you have to travel a lot. I did my fellowship training in Bristol and with Professor Steve Gill, who did a lot of who treated a lot of the Irish patients over the years. And when I treated people, they would maybe come for maybe six times over and back to the UK, which is obviously especially difficult when you have severe Parkinson's disease.

And so listen to the operation itself. Now you have to do so. Do you have to actually. Drill into someone's head, so to speak. Yes, yes. So basically, you a lot of it is accuracy. These this nuclear nucleus that you're targeting is deep within the brain. It's about the size of a Tic-Tac. And you need to get the electrode right at a specific spot of that nucleus to have a good effect of the of the basically you're putting a little current or electricity into the brain so that you have two wires that go into two holes the in the frontal bone of your skull, and then they're tunnelled underneath your scalp into a battery that goes into the chest wall.

And then you can augment that kind of electrical signal to to that particular patient's movement problems. And so you can kind of and you programme it in a way.

And I'm already thinking and presumably I know Nottingham's probably routine in brain surgery, but this is kind of an elective enough procedure.

It's not done for crisis or anything. So presumably it's regarded as being at the less dramatic end of the spectrum.

But presumably you make one slight error there and presumably the results can be catastrophic.

Like it must be a huge responsibility, isn't it?

Yeah, well, I think all of neurosurgery is is like that. And the brain is robust in some ways.

And but then when you know, if there's if you get a vessel or, you know, you need to be very accurate and for you to have good results, especially when it's an elective surgery.

Look, I probably read too much Henry Marsh, but the way he presented is that's like at times you are almost like it is almost like playing God in a way. But also the unexpected can happen when you're in there and you need to make these decisions about, you know, life or death or life changing stuff that if I do this, I could possibly save the person, but I could have this other knock on effect. Is that. Yeah, yes.

And that's kind of a lot of the if you have a complication in neurosurgery, the the consequences can be different for the outcomes can be different for different patients in terms of what the what the if a complication arises, is the person left, you know, are they do they have weakness? And, you know, is their mentality changed?

You know, the neurosurgery when you're operating on the brain and it's a it is high stakes stuff. Yeah.

And are you able are you able to prepare and kind of go through in your head each operation or is the question.

I don't you have to take it. Yeah. A lot of our surgeries are, especially with deep brain stimulation. A lot of the planning is before the surgery is maybe especially with deep brain stimulation, can take as long as the surgery itself.

And so DBS is kind of it's a there's a lot of technology involved in terms of the planning software that we use and to locate this nucleus really accurately. We also use robotics to help guide the electrode to exactly where it needs to be. And so but a lot of it is planned before the day.

And how do you deal with the pressure?

And I think good friends and family. Yeah, and good colleagues. I mean, you do work in a in a team. And so there is always know twelve heads if you want to ask questions, you know, we work together, we discuss things and it's a small community. If you like neurosurgery. There's thirteen neurosurgeons now in Dublin and four in Cork. So we've all worked with each other for four years. So yes. Your your colleagues are.

Yeah. They're really important. Yeah.

Because they're the only people who really understand what you go through. A passion. Is it something that takes over your whole life. I mean I presume you can't just like clock in, do the job and go home. Forget about it.

No. Yeah, you do. Definitely go home and still you see, you're still thinking about maybe what you're going to do tomorrow or what happened that day. And you're calling in to make sure everything is OK. You're going in at the weekends to make sure, you know, your post-operative patients are doing well. And so it is hard to clock out. But it's I think you get over time, you get a bit better at it.

You kind of have to at some stage and to, you know, function well and kind of, you know, keep optimistic and keep fresh.

Yeah, I bet you mentioned airable calling into the patients then as well and checking in on them. So presumably. You have to have some kind of I know a lot of people who never see their surgeon before or after an operation sometimes, but presumably you have to have some kind of relationship with this person or meet them are definitely.

Yes. Yeah. Especially, you know, it's you know, people can they've probably heard of patients having, you know, a hip procedure or their appendix. But when it comes to the brain, there's a lot of explaining to do. And I think, you know, once people understand what's going to happen and just in terms of timelines and what to expect after surgery, that that's really important. And yes, so I would you know, we would definitely be all of our patients and go through everything as much as we can to try and scare them, but to try and get them in the picture and, you know, show them diagrams, show the patients, the actual electrodes that's going to go in and the battery and what to expect.

Because once they have an idea of what's going to happen afterwards, everything is a little less daunting.

Yeah, because got people must be very scared at the idea of someone going into to their brain.

It must be kind of draining for you that presumably you're dealing with people as well sometimes who are in a like fairly catastrophic situations or maybe somebody who whose life has been altered after procedure. And everything that must be tricky is. Yes.

So a lot of our work, about 70 percent of what we do is kind of urgent or emergency work in terms of brain trauma or brain haemorrhages or tumours. And and, you know, you really need to kind of and again, spend time with them and spend time with their families. And, you know, sometimes you have to, you know, try and make a, you know, recovery plans with them and. We have really good backup and we work closely with the Giuliani rehabilitation and centre, but a lot of neurosurgery as well is and some of it for us is quite routine.

And so you kind of you're trying to explain that as well, that this is obviously when someone's getting a craniotomy to have a tumour removed for them. You know, it's it's not routine, but for us, it's it's what we do every day.

Am I right in thinking some people are awake for some brain procedures?

Yes. So traditionally, actually, people were operated on awake for deep brain stimulation.

And but we're kind of changing that. So because that people didn't want to go go ahead with it if they were going to be awake.

I don't blame them. Yeah. So some centres still do it awake, but we have basically with the software we're using and the preoperative kind of MRI imaging has improved so much over the last 20 years that we're able to do it and asleep or under anaesthetic.

And Wake Forest was sorry, cut the wakefulness was so that you could check. How you doing? Test reactions and stuff. Exactly.

Yeah. Yeah. But we still do some tumours, so parts of your brain we call eloquent.

So, you know, you have frontal lobes and temporal lobes and particular parts of those lobes can be and even taking a small piece of that brain away can have a much bigger effect than if you're a little bit more forward. And so doing away craniotomies for tumours in those eloquent areas and we still do well.

OK, but then you take all that and most people are thinking, I neither want to be on the giving or the receiving end of any of that. I believe you're at your happiest when you are in tears or are operating. Yes.

Yeah, I think I think most surgeons, you know, that's their kind of favourite part of the day or favourite part of the week is when you're you're just it's actually it's it is stressful. But the actual when you're actually doing the surgery itself and you're quite Zen, you're just concentrating on what's in front of you, you know, and it's where you want to be. So definitely at your happiest when you're when you're operating. So you're operating space.

Yeah. Yeah.

You're like you're in your flow almost when you're in there. Yeah. So we're almost not thinking, but obviously thinking very, very fast as well.

When did you decide you wanted to be a brain surgeon? Like what's the draw to such a, as you say, a high stakes kind of thing?

Well, I started so I we didn't have much I didn't have much exposure to neurosurgery because as a kind of an undergrad and but it was I loved learning and I loved I loved reading any of the neuroanatomy or any neurophysiology books.

They were what kind of would keep me up at night, just going through them. And and it was kind of something that you never stop learning about. So I knew that in 20 years time, you'd still be there's still so much more to know about the brain that you would it would keep you going for a whole career, which is which is true. And then I loved surgery. So what I was training and I, you know, standing if you were holding a retractor, kind of assisting in a surgery, even though you just kind of stand there, you wouldn't be doing much just holding a retractor.

But four hours. And that was exactly where I wanted to be. So I put the two together and went for neurosurgery and never looked back.

And this will be reassuring for people. Does it take it takes 20 years training really to to get there, does it?

Yeah. So that's when you kind of do your medical training in medical school and then you go on to kind of general surgery training and then you go into neurosurgery, special speciality training for about six, seven years, and then you do kind of fellowship training in whatever subspecialty you're going to do. So I specialise in spine and deep brain stimulation. So, yeah, 20 years I you were around the world a lot and everything.

Did you always want to come back? Because I suppose the impression we have that people who are operating at that high level like you can make a fortune, say, in America compared to here or whatever.

And I always did want to yeah, I always wanted to come back and work in Ireland.

I think the health system, you know, it gets a lot of slack all the time, but it's it's a great place to work. I mean, the the colleagues I work with in Beaumont were second to none.

And you are like, I don't know how relevant it is in one way, but it's very relevant in another way that you're Ireland's first female consultant neurosurgeon. Is that a surprise?

Are there not many women in neurosurgery in general?

And. There is about so in the UK, there's about three hundred and something neurosurgeon's, about 10 percent of them are women and so it's it's growing slowly. I guess it wasn't something that was in the forefront of my mind while I was training. And it's I guess when you get the position, you're like, OK, right. I'm the first. And I'd like to kind of promote and I think when people see somebody in a position, you know, a woman in that position, that you can people it more normalises it and people just kind of go into it quicker.

Did you have role models, female role models when you were coming up? Yeah. So especially one particular surgeon I worked with before I started in Beaumont.

I spent a few weeks in Harvard and she was you know, I went to house for dinner and, you know, she just took me around and I was thinking about training there. But I wanted to come home and train in Dublin and just kind of having a woman who was, you know, friendly and normal and chatting and, you know, giving her what the day to day is like.

And that was important. And then I've had other colleagues in the UK when I worked there who were certainly role models and maybe not totally consciously, but subconsciously.

Yeah, yeah.

And listen, I'm going to be very careful how I say this now. I'm not saying they should think this, but do people often expect the neurosurgeon to be a man?

They do sometimes. I mean, not always and certainly not the majority. But I think, you know, you live you know, you live in society. You know you know, people have various attitudes and, you know, different generations think differently. And I think and, you know, once once they kind of get it in their head, it's fine. But it just takes a little bit of time. But it's it's something that changes. Yeah.

And listen, before we finish up, I know that the deep brain stimulation is very, very expensive. And Beaumont is currently fundraising, isn't it, for the for the service?

Is is that something that seems unusual to do you like presumably out in America? Do they have to go with the begging bowl for hospitals and stuff?

For what we're we're getting is we're getting very good support from the Hajazi and from Beaumont for kind of capital expenditure. But just going forward, it's a it's a tech heavy and expensive service in terms of just the the you know, the actual system itself. And but I get you know, I worked in the UK, I think most hospitals would would do fundraising just for extra equipment that makes things and that makes that our lives better and it makes the patient treatment kind of easier.

But I think what we are getting good support from from the Hajazi, they're kind of they've been planning on bringing this to Ireland for some years and we're getting there. We have the other are the neurology side of the team is in the matter and they're up and running. There's a team of eight and the neurologist there, Richard Walsh and Tim Lynch, who's been working to getting this back to Ireland for for a number of years. So we're getting good support.

But it is it is expensive and it's going to be expensive to keep going.

OK, well, Catherine Moore, I think I speak for all of us, judging by the texture, when you say we're very glad you came home to Ireland and people delighted to have you on board and you are. That's extraordinary staff. You're an extraordinary person. Thank you very much. Thank you. Bye. Catherine Mawn, let's take a break.

Text five one five five one. Brendan O'Connor on our TV, radio one.