Discussion page

brain1Hello there, this is the discussion page for A Journey Round My Skull. I’ll be posting things I learn about the brain as the project continues – things learned from post-show discussions, from the people I meet and the articles I have read. I hope you find it interesting.

Thanks, Olivia


5 Comments

  1. In Autumn 2015 we toured A Journey… to venues in the South East through house. During the tour we enjoyed some lively post-show discussions and felt particularly humbled by the audience members who stayed afterwards to tell us about their experiences of brain surgery. One gent in particular showed me the scars from surgery by the eminent neurosurgeon Henry Marsh (see previous post). Perhaps it seems a little perverse to delight in seeing the marks of a life saving / changing operation but it’s not about the scars, it’s that the scar are the external markers for that person having undergone an extraordinary procedure. Their brain has been open to the world.

    Harry Webb reviewed the performance at Dorcehester Arts Centre. Appropriately rendered in sound. Thank you Harry. Have a listen here:

  2. Neurosurgeon extraordinaire talks with humour, humility and brutal bloody honesty about the brain and surgery. Have a listen, only 30 mins. Something to enjoy on a lunch break…
    The Life Scientific, Henry Marsh

  3. How has a patient responded to A Journey Round My Skull?

    Olivia: “Do you miss it”?
    Graham: “what, that grey glob of cells?…. No!”

    Perhaps it was an inappropriate question, but I had to ask. Perversely that’s what the show is about: is it possible to mourn something that might ultimately kill you?

    During the development of A Journey Round My Skull I met Graham Feeney who had had a pilocytic astrocytoma removed from the base of his brain near his cerebellum. Commonly it’s a slow growing tumour diagnosed in children and young adults which of course raised the question of how long had it been there! When I met Graham over dinner I told him about Karinthy’s book and the performance we were making, and asked if he’d join the post show discussion at Bristol Old Vic.

    Graham Feeney, in the middle

    During the post-show we talked about a whole range of things to do with the brain: how does surgery change the relationship to the people around you? Why simulate brain surgery? How did the production come to be? But it wasn’t until the performance in Birmingham, when a group of neurosurgeons asked the specific question that titles this entry that I realised I’d failed to ask Graham about what he made of the production. So when summer came we spoke on the phone and Graham’s short answer was “with curiosity”. But what I learned from our conversation was, of course, not what he thought of the show but more interestingly his experience of his diagnosis, treatment and recovery after surgery.

    Graham’s symptoms were not unlike Karinthy’s: poor balance, extreme headaches and nausea. His diagnosis too, was similarly frustrating: shuttled from doctors to specialists, never getting a satisfactory diagnosis and all the while his symptoms getting worse. I’ve since learned that an effective diagnostic tool can be ‘time’. This may well allow the disease to fully present itself but can also be painfully frustrating for a patient who doesn’t know what the hell is going on and if their condition might ultimately be fatal. As he waited Graham speculated about the underlying cause of his symptoms. Were the challenges of walking on rough ground caused by a bad back? Were the pins and needles in his leg the onset of multiple sclerosis? Might his head actually explode next time he coughed? It was only after an MRI scan that a positive diagnosis was reached and he was swiftly admitted to hospital the following day.

    The pioneering surgeons in the early twentieth century realised that patient survival rates increased by around 20% if patients were kept conscious during surgery. Nowadays it’s common to rouse patients during their operation to test brain function, particularly if the tumour is close to eloquent areas of the brain. Graham was kept sedated throughout his surgery and so remained unaware of the cutting, drilling and resecting going on inside his head. Though he did confess to watching explicit videos of craniotomies on YouTube and “felt fine with the idea of what would happen”.

    It’s the seemingly banal details either side of this unconscious blank that prove most striking: a rapid admission to hospital so quick that he didn’t have time to get his tooth brush or pyjamas; waiting to go into theatre and appreciating the significance of his only possession at that moment- his wedding ring, glasses and er… boxer shorts; the hug with his wife, a hug that was so intense it felt like it might be the last; the impatience of wanting to just get on with it like it was some minor inconvenience that was preventing him from getting on with his week; of the reassuring anaesthetist who he felt actually listened to him and gave him an opioid that wouldn’t make him sick. Then, oblivious to the events of the operation his relief at coming round to genuinely appreciate the “naff painted murals on the hospital walls”. In the recovery room he said he’d conducted his own brain tests by running through Patent Law and the difficult ringing pattern of Cambridge Surprise Minor– he’s a Patent Examiner and Bell Ringer.

    The real purpose of this personal check list is perhaps “does my brain still work and can I still remember?”. And there must be a peculiar moment when the immediate marker for realising you’ve not croaked it under the knife is coming round not to see a Hollywood style soft-focused crowd of family members around your bed but the “naff murals on the hospital walls” as you exit theatre. With the sigh of relief comes a moment of checking, like when you discover you’ve been burgled and whilst the TV, camera and foreign currency might have been grabbed the personal treasures and sentimental heirlooms that you’ve stored away in the safest place are indeed still there but that you might not have checked had they not been put at risk.

    So back to my crude question: “Do you miss it?” It’s not about missing the grey glob of cells but rather about the threat a brain tumour poses to our most precious faculties. Perhaps anything that jeopardises our very existence does that, a sort shake down forcing us to check through our list of priorities, and what we find at the top are perhaps the things we so often take for granted or just don’t take the time to notice.

    Like the process of making A Journey Round My Skull, this entry started out as one thing, has become something else and has taken me too long to write. Maybe I’ve not answered the question, but perhaps I’ve just started to ask another one…

    A Journey Round My Skull is out and about in theatres next Spring. Do come along and ask us some difficult questions.

    And here’s a quick blast of Cambridge Suprise Minor for the curious:

  4. A response from Andy Keen audience member who saw A Journey Round My Skull on Valentines Day 2014. With his permission I have posted it here for you to read.

    This highly creative piece of theatre had me utterly entranced throughout. Intense and absorbing, while also mischievous and funny at times, this was story-telling at its best. Olivia Winteringham plays the part of Julia, a neuro-surgeon who falls in love with a patient. It is based on a true story, of the brain surgery performed in 1936 on the Hungarian writer Frigyes Karinthy, to remove a tumour.

    From the start Julia speaks to us as if we are the patient, arriving for the appointment which is to change both lives and the relationship between us. The patient has experienced many symptoms such as aural hallucinations and erratic behaviour, including violent rage. Because our memory is also impaired, she reminds us of the medical history, giving a short lecture about the parts of the brain – playful and expressive, she makes the audience laugh. With the help of a Germanic accent and quick smile, she superbly balances the severity of a neuro-surgeon with a clear but controlled, tantalising hint of mischief and sensuality, the woman beneath the professional. She gives us the history interspersed with moments of intoxication on her part leading to much greater emotional involvement.

    She also gives us something of her tragic personal history, of the suicide of her parents along with the attempted murder of herself as a small child.

    Recovering from the painful memory of this, she invites us to experience brain surgery on ourselves. As she operates, we hear many sounds through the provided headphones; the aural hallucinations, the beautiful, soothing piano of ‘Liebestraume’ by Franz Liszt (Karinthy’s chosen piece), along with the sounds of drilling and sawing into the skull, the pulling back of bone flap, and the knife delving into soft tissue. We also hear her voice professionally checking with us regarding our cognitive integrity, interspersed with her increasingly intense reminders of the sexual intensity of what has passed between us (imagined or real), as she prepares to excise the tumour. …

    binaural craniotomy
    photo: Jonathan Blackford, Bristol Old Vic

    This climax of the performance builds to a profound level the sense of intimacy created by the telling of the history. All story telling is intimate when done well, but this ‘personalised’ aural experience adds a new dimension, combining our own fears and awareness of the terrifying yet prosaic use of drill, saw and scalpel with the ache, yearning and angst experienced by our doctor. How well Julia lays it out and draws us into it all – the tenderness and passion she feels and the hurt of loss, along with the professionalism and consummate skill required for the most delicate surgical procedure imaginable.

    Patient and doctor meet once more after a year. We are well now, perhaps boringly so, but she still yearns for the intensity of the affair. We spend some time together, but the patient is uncomfortable, checking his watch. We agree to go to the fair and the ghost train which she likes – perhaps we are feeling both guilt and gratitude – this woman has saved our life, but we are not in love with her. Now in his right mind, the patient wishes for the safety of the appropriate professional boundaries which have been so utterly transgressed. She makes one last attempt to kindle the passion described during the operation. The writer rejects her and leaves with a ‘thank you Doctor’.

    The pain of loss in adulthood can be appallingly amplified by deep childhood losses which are stirred and revived by the later experiences. In fulfilling her professional duty despite the vast emotional cost to her, Julia reminds me what love is about in its deepest sense. A wonderful and memorable Valentines Day celebration.

    Thank you KILN for the obvious hard work and commitment required to produce such a piece. I wish you success in the hope that many more are able to benefit from your creative talent.

    Andy Keen, member of the audience at Bristol Old Vic, February 2014

  5. mac birmingham on surgery and sound design
    Cafe Gerbeaud (Central)
    photo: David McAlpine, Cafe Central, Budapest

    2 weeks ago we performed on home turf at mac in leafy Cannon Hill park. Our largest venue to date on this current tour and we even attracted some neurosurgeons from the QEH up the road.

    Our collaborators Sound Designer Iain Armstrong and David McAlpine Professor of Auditory Neuroscience came and responded to questions from the audience in a post show discussion chaired by psychiatrist Guy Undrill. There were some meaty questions about the ‘3D’ sound design and about the production and our process of collaboration. But it’s two questions in particular that have stayed with me. One was about the nature of collaboration with the scientists: “Did the collaboration merely create content for the show or was it more than this?”

    In autumn last year I visited Splice a symposium that ‘examined the process, philosophy and products of collaborations between scientists, musicians and performing artists.’ A former lecturer was presenting at the event and has published a book about science on stage. During her presentation she discussed the works of Italian maker Luca Ronconci. She suggested that his site-specific project Infinities which deals with ‘hardcore maths’ it’s not a play about science or maths or the biographies of the learned folk working in these fields but about engaging in a process with that material to inform the making and content of the project. David McAlpine too discusses in his article about the creative and scientific process being similar, something that C.P Snow saw as a gulf:

    “This interaction of science and theatre permitted the expression of a desire to explore more deeply each other’s domain, and to do so without the fear of looking foolish…This speaks to a simple truth – science and theatre can learn from each other through their common goals of interpreting knowledge and ideas in new ways. A successful outcome will be that the audiences leave the (lecture) theatre with more questions than answers. It doesn’t get more scientific than that.”

    If I am truthful, A Journey Round My Skull is a production that uses science to tell a story, ostensibly its narrative follows that of an operation and that parallels a three Act play, albeit one performed in an hour:

    Act 1 – Pre-op consultation
    Act 2 – operation
    Act 3 – Post op / Recovery

    Certainly, our scientific collaborators informed the medical content of the script, but it would be inaccurate to suggest that our collaboration was merely about exploiting their knowledge or to produce a didactic play about the diagnosis and treatment of brain tumours. Like all scientific enquiry, this play started with a hypothesis ‘how can we simulate brain surgery for a collective audience?’ Our process in examining this question led to further questions and exploration with the creative and scientific team.

    Iain and I were very fortunate to meet and shadow the scientists at work: David’s office at UCL Ear Institute and surgical wards in Gloucester. We witnessed care in action, were coached on possible ways to simulate the sound of a drill boring through bone, and how best to capture field recording in a medical environment. On a visit to Budapest, David visited the café that Karinthy frequented and where he first experienced the auditory hallucinations of a tram. David sent me some photos and this short video of the café. Appropriately, you can hear the roar of a motor bike passing in the street. He later told me that his visit to Budapest was for a conference on tinnitus and he began his presentation with the example of Karinthy sitting in the café and experiencing the tram hallucination, explaining that this symptom could be categorized as extreme tinnitus.

    I’d hope our collaboration between artist and scientists has not been one way but has brought both parties attention to other forms of examining familiar and new material. I was told after the post show discussion that one of neurosurgeons had enthusiastically said they ‘never thought they would experience an awake craniotomy performed on stage’.

    The second question was asked by a neurosurgeon during the discussion: ‘how have patients responded to the operation. For this I’ve asked for the response of Graham Feeney who participated in the Bristol Old Vic post-show and who had undergone surgery last year. I’m due to speak to him on the phone and will be sure to share what I learn…

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