The strains of George Gershwin’s Summertime float down the busy corridors of King’s College Hospital in London as violinist Dagmar Turner delivers a near-perfect performance.
For a follow-up medical review, it’s rather unorthodox. But consultant neurosurgeon Professor Keyoumars Ashkan listens with rapt attention and delight.
The last time he heard Dagmar play this aria was four weeks ago. Both agree it wasn’t a patch on today’s encore. Scratchy, halting and a little out of tune, it was far from virtuoso.
‘I hit quite a few bum notes,’ says 53-year-old Dagmar laughingly, putting down her bow with a flourish. ‘It wasn’t my best performance, but perhaps my most famous.’
Dagmar Turner had a 8cm by 4cm brain tumour removed in January and was woken up during the procedure to play her violin so doctors could ensure they weren’t destroying her talent
You can say that again. Who hasn’t seen the video of Dagmar bringing a whole new meaning to the term ‘musical theatre’?
Woken up during delicate surgery to remove an aggressive tumour from her right frontal lobe, she played for three hours while Professor Ashkan, 52, literally fiddled with her brain.
Given that her head was clamped into place and part of her skull removed while the surgeon used an electrical probe on her grey matter, who could blame Dagmar for the occasional duff note?
Indeed, since footage emerged just over a week ago of the amateur musician from the Isle of Wight segueing from Gershwin to Gustav Mahler’s Symphony No 5 — via scales, random melodies and Julio Iglesias’s Besame Mucho — Dagmar has become an overnight sensation.
Her recovery has been so rapid, she is already rehearsing for a sellout concert in two weeks’ time with the Isle of Wight Symphony Orchestra.
Recalling the moment she was roused in mid-surgery, she says: ‘I said, “No, no, leave me alone. Let me sleep”. It was so noisy and bright in the theatre. I didn’t like it but they kept saying, “Play, Dagmar, play”, so I closed my eyes and tried to remember all the melodies I’d learned as a child.’
The violinist and the surgeon who operated on her, Professor Keyoumars Ashkan, have now reunited with Dagmar playing music as part of her follow up appointment
At one point in the video, one of the medical team cries, ‘Amazing!’ and urges her to continue.
‘I wasn’t frightened,’ she says, ‘but it was very uncomfortable being stuck in one position for hours, trying not to poke Professor Ashkan in the eye with my bow.’
She was playing to help the surgeon identify the parts of her brain that control the finest movements of her fingers, so he could be careful not to damage them. And although it was stressful playing non-stop in a supine position, unable to move her head a millimetre but fully conscious, Dagmar felt no pain at all.
She only knew Professor Ashkan was touching a vital part of her brain when her playing faltered, stopped or they all heard a wrong note.
‘I can’t say it was enjoyable but it was fascinating,’ she says.
Dagmar, pictured with her husband Mat, said she ‘hit quite a few bum notes’ while playing the violin during the surgery but wasn’t ‘frightened’ by being awake on the operating table
Professor Ashkan explains: ‘Although a patient can feel pain in other parts of the body through messages to the brain, the brain has no sense of itself because there are no nerve-endings. So when I do this kind of surgery the patient feels nothing.’
This is the first time Dagmar and the professor — head of the King’s Brain Tumour Service — have met since the six-hour procedure to remove her 8cm by 4cm tumour on January 31.
Two of his 12-strong team that day, consultant anaesthetist Holly Jones, 46, and neurosurgical registrar Mathew Gallagher, 35, have also popped in to enjoy Dagmar’s repeat performance.
‘I’ve woken up a tailor during an operation to check he could still sew. But this was our first violinist,’ says Holly, thrilled at seeing Dagmar as fit as her fiddle.
As for Dagmar, she is remarkably matter-of-fact about her ordeal and looks unscathed, her long blonde hair masking the scars and staples where the skin over her skull was restitched after surgery.
‘I am so grateful to the team because, for me, this operation wasn’t just about surviving but quality of life,’ she says. ‘I may not be a concert violinist but music means everything to me.’
Two of Professor Ashkan’s 12-strong team from the surgery, consultant anaesthetist Holly Jones, 46, and neurosurgical registrar Mathew Gallagher, 35, also popped in to enjoy Dagmar’s repeat performance in the follow up appointment (all pictured together)
Dagmar (pictured playing her violin after brain surgery) first suffered a seizure while practising a Mendelssohn overture during a rehearsal one evening in 2013
Iranian-born Professor Ashkan — who also has a music degree and is an accomplished pianist — insists he was just doing his job.
‘The technical aspect of the operation is fascinating but what really matters for me is not how I did it but why,’ says the professor, who has worked in neurosurgery for a quarter of a century since graduating from Cardiff University School of Medicine.
‘The ability to play the violin was critical to Dagmar, and it is a doctor’s role to listen when a patient tells you what they need, rather than say, “No, no, no, we can’t do that”.
‘The stakes were a bit higher with this operation. But I delivered, so I am happy and she doesn’t need to thank me.’
Born in Germany, Dagmar moved to the UK in 1997 as managing director of a mail-order fashion company and met husband Mat, 47, an engineer, in Nottingham, where he lived next door. They were married in 2003 and their son Felix was born four years later.
The daughter of an amateur pianist, Dagmar had played violin from the age of ten. Music was central to her life, and in 2010 she joined the Isle of Wight Symphony Orchestra.
It was during a rehearsal one evening in 2013 that she suffered a seizure while practising a Mendelssohn overture.
‘Luckily, we had quite a few retired doctors playing with us and I came round to find one of them shining a light in my eyes,’ she says.
Dagmar (pictured with her husband) put on a brave face, hiding the effects of the radiotherapy — which caused crushing fatigue — from her son Felix and continuing to play the violin
Referred for an MRI scan in Southampton, Dagmar says it felt like ‘a punch to the stomach’ to be told she had a large slow-growing tumour. Because of its size and location, surgery was considered too risky.
Instead, Dagmar had a six-week course of intensive radiotherapy to shrink the tumour, which, she says, gave her no further trouble for the next seven years.
‘Our son was only seven years old when I was diagnosed and we decided not to tell him because we felt he was too young. We didn’t want him to worry,’ says Dagmar.
‘It’s a huge shock to be told you have an uninvited guest in your brain. But I’ve always been a very resilient person, so I decided to embrace the tumour and make it my friend.
‘I thought, “OK, I didn’t want you to move in, but now you’re here I am going to live with you as best I can.”
She put on a brave face, hiding the effects of the radiotherapy — which caused crushing fatigue — from her son and continuing to play the violin.
Every three months, then every six months, she had an MRI scan to monitor the tumour, which did not change until last November, when it showed signs of aggressive growth.
Dagmar was told surgery was now the only option to prevent the life-threatening tumour gradually robbing her of her faculties.
Although her first priority was to live as long as possible for her adored family, the thought of surviving without the joy of playing the violin was hard to contemplate.
She heard about Professor Ashkan through a friend at the Brains Trust charity. He was renowned for his surgical expertise and also for his empathy and musical sensibilities.
Dagmar was told surgery was now the only option to prevent the life-threatening tumour gradually robbing her of her faculties and she heard about Professor Ashkan through a friend at the Brains Trust charity
Professor Ashkan says: ‘The first time I met Dagmar, she told me playing the violin was critical to her.
‘She said to me, “If you cannot preserve this function, I would rather the tumour was not removed and I will take my chances”.
‘For some patients it is good enough to be able to still move their arm to hold a cup, but Dagmar needed dexterity.’
Dagmar researched ‘awake craniotomy’, watching videos of other brain tumour patients who had undergone the procedure. She was the one who suggested it to Professor Ashkan, offering to play the violin during surgery.
‘I told Dagmar: “This is rather unusual, but let me go away and have a think.” I can’t always give patients what they want or match results to their expectations. But what kind of surgeon, when set a challenge like this, would say no?’
Professor Ashkan performs some 300 operations a year, of which about 50 are ‘awake craniotomy’.
‘When I started in neurosurgery, such an operation would have been unthinkable,’ he says. ‘But medical advances and new technology mean we can now do the most amazing things.
‘Waking a patient up during surgery means a surgeon can work on the brain and, depending on where the tumour is, preserve their speech or motor skills.’
The success of the operation relied on meticulous planning, including Dagmar’s position — lying down with her head slightly raised and turned to the left.
Mrs Turner explained to her surgeon Professor Ashkan – who holds a degree in music and is an accomplished pianist – how she was worried she’s lose her skill if she had surgery
‘We needed her to be able to play the minute she woke up, without moving her,’ the professor says. ‘We also had to take into account the movement of the bow, because if it nudged me the results could be disastrous.’
Before surgery, doctors carried out transcranial magnetic mapping. This involved passing a strong magnet over Dagmar’s head while she played the violin, to interrupt brain function harmlessly and reveal which specific areas controlled her fingers.
Dagmar says: ‘When I knew the surgery was going ahead, we finally explained to Felix what was happening. He was upset that he hadn’t been told sooner but understood why. On the day of surgery, Mat took him to the Science Museum to take his mind off it.’
That morning, however, there was a last-minute drama when Dagmar discovered she had left her violin at home. After some frantic phone calls to friends in London, another was conjured up for the surgery.
Following that slight hiccup, it all went like clockwork.
‘Everything is rehearsed in advance,’ says Professor Ashkan. ‘Nothing is left to chance.’
The team included two trainee neurosurgeons, two anaesthetists, a neuropsychologist, a physiotherapist and various scrub nurses, helpers and runners.
Dagmar was put under general anaesthetic for the painful part of the procedure, to cut the skin and saw open a section of skull to expose the brain.
Two hours into the operation, she was roused and asked to play the violin while Professor Ashkan used a device called an intra-operative neurostimulator probe to confirm which areas of her brain around the margins of the tumour affected her fingers.
‘Often during surgery I will listen to Classic FM but we didn’t have it on that day,’ says Professor Ashkan. ‘When I have a patient playing music, I am listening out for every note played wrong.
‘If Dagmar didn’t play or missed a note, I knew I was touching the wrong part of the brain. Some of the music she was playing I knew well — but although I love Mahler I don’t know it, which was a slight worry.
‘But one of the benefits of having a large team is the amount of knowledge in the room, and luckily one of the people in the theatre knew Mahler very well.’
But wasn’t he worried that Dagmar might unexpectedly panic or suffer an attack of stage fright, waking up in such a vulnerable state?
‘No, because this is more like elective than emergency surgery. The patient knows exactly what to expect because they have been involved in the planning and are surrounded by people they have already met,’ he says.
By being woken up during the delicate procedure, surgeons were able to identify and therefore avoid the areas of the brain that are activated while she plays
Dagmar now hopes she will be able to play at the Royal Albert Hall to raise money for brain cancer charities, with an orchestra of doctors and cancer survivors
‘They have to be fully conscious to give me accurate feedback when I use the probe.
‘The most difficult part for me is the 20 minutes it takes for the patient to fully wake up when you are standing around waiting to get to work.’
Dagmar adds: ‘I wasn’t frightened at all, but I was very relieved when, after I’d been playing for almost three hours, someone said, “Dagmar, we’ve removed 90 per cent of the tumour!” before putting me back to sleep.’
Although 10 per cent of the tumour remains, all the aggressive cancer cells were removed thanks to the revolutionary so-called ‘pink drink’ ( 5-Aminolevulinic Acid), which only became available throughout the NHS last year.
Before surgery, patients drink the fluid, which makes aggressive cancer cells glow bright pink under blue filtered light, so they are easier to identify and remove.
Now under the care of an oncologist, Dagmar has yet to find out if she will need further radiotherapy. Even if the tumour eventually grows back, she feels it has all been worth it just to be able to continue playing the violin.
As she picks up her instrument again, Dagmar looks serene. Her ambition now is to play at the Royal Albert Hall to raise money for brain cancer charities, with an orchestra of doctors and cancer survivors.
Perhaps Professor Ashkan would oblige at the piano.