15 minute interview: The neurosurgeon who separates Siamese twins
Professor Keith Goh qualified from the National University of Singapore Medical School in 1985. After completing his basic surgical training, he moved to Prince of Wales Hospital in Hong Kong in 1992 to specialise in neurosurgery. He later took up a clinical training fellowship at the Beth Israel Institute of Neurology and Neurosurgery in New York, where he specialised in paediatric neurosurgery. Keith Goh and his wife returned home to Singapore in 1999, and two years later headed the first of three operations to separate conjoined twins. The second of these was unprecedented in that it involved an adult pair. Laleh and Ladan Bijani were 29 at the time, and their story captured the imagination not just of Singaporeans but of the whole world.1 Unfortunately, they died during the operation. Professor Goh is currently working in Hong Kong.
What led you to train as a surgeon?
I began my surgical career late, compared with most people. I ad a lot of fun in medical school. I got by my exams but didn’t really excel. I began searching for which path to take as a doctor, and that’s when I tried family medicine for a while, radiology, all kinds of things, even military medicine. I was thinking of a career in military medicine until I dislocated my shoulder; then that was over. But once I started surgery, I knew that was what I wanted. It’s good to have experience in other areas, because it makes you more certain in your mind that that is the life for you.
Did the technicalities come naturally?
I’m naturally quite good with my hands. That’s one of the requisites to be a good surgeon. I found that that helped me a lot.
Why brain surgery?
I tried my hand at plastic surgery, cardiac surgery, and neurosurgery, and the most interesting to me was neurosurgery.Each case was different. You had to thinkcarefully and make so many considered decisions. It was a challenge. I wanted something that would keep me interested for the rest of my career.
Did you feel apprehensive before the first separation you supervised?
We were faced with a very complicated high risk case, and everyone was watching us. I was terrified. We had a whole team of specialists, but we were all worried about what would happen if there was a poor outcome.
What is it like performing an operation that takes so long?
The first operation that I did on the Nepalese twins took about 100 hours. I didn’t go home for five days and four nights. For the second separation surgery, my wife brought pillows to the hospital and moved in. It’s impossible to sleep. Most of the time you get through the hours by focusing your mind and concentrating on your surgery. When you can, you take rest moments and try to gather your thoughts, but it’s very exhausting.
What made you decide to go ahead with the second separation?
We had new surgical techniques to recreate venous drainage channels, which we thought would be the solution, because the success of the separation hinged on recreating two independent venous drainage systems from the fused venous sinus. We decided to proceed with this surgery because we were able to formulate a plan that could have worked, although we couldn’t guarantee 100% success. If you are faced with a situation where your patients are suffering and cry out for help, and you have a plan that may work, is it ethical then to deny them their chance, especially when they are fully aware of the risks and are willing to take them? I was in that situation, and I felt that if we laid the foundations correctly it would be reasonable to proceed. You see, when you become specialist, you are the end point in the patient’s care. You must decide which cases you accept for treatment and which you reject. As the end point in his care, you cannot refer him or her on to anyone else. This dilemma bothered me for a long time.
How did you feel beforehand?
Before the surgery, all the surgeons felt very upbeat. We all felt we could do it. Although no surgery goes completely smoothly, in this case we managed to surmount most of the problems and reached the 50-odd hour stage before the final catastrophe happened.
How were the days after this?
After the twins died there were a lot of things to do. The hospital was swarming with journalists and relatives. Everyone wanted to know what happened. I was numb. I just went through the motions of what needed to be done, without allowing my emotions out. The morning after, I remember waking up in bed, and my wife and I just cried. We had come to know the twins very well. We had a memorial service for them, and many people in Singapore came to pay their last respects. I had conflicting emotions initially. There were many things that I thought could have been done better. It’s only now that I’m able to look back and reflect more objectively. You sometimes need to take a step back to look at the big picture. Being caught in the middle of a tense situation, you don’t really have a sense of perspective.
Any words of advice for junior doctors and medical students?
Look for the things which turn you on. What are the things you are passionate about? What are the things that can give you joy for a lifetime? If you end up doing something which becomes a drudgery and there is no joy in going to work, it’s meaningless. This is the key to building your career. Get your principles right. Get your thought processes correct. Listen to your heart. And then just go for it.
Sadat Edroos, final year medical student, Warwick Medical School
Email: sadat@edroos.co.uk
studentBMJ 2004;12:349-392 October ISSN 0966-6494
- Davis J. Till death do us part. www.wired.com/wired/archive/11.10/twins_pr.html (accessed 4 Sep 2004).
