given differing interpretations of whether they are getting closer to agreeing a post—brexit trade deal. eu officials say they are close to overcoming one of the key obstacles — an agreement on fishing rights. but the british side has denied this. president trump's personal lawyer, rudy giuliani, is reported to be in hospital after testing positive for the coronavirus. mr giuliani is understood to be receiving treatment in the georgetown university medical facility in washington. earlier, the president tweeted that mr giuliani had tested positive for covid—19. a top uk health official has warned that the distribution of coronavirus vaccines will be a "marathon, not a sprint". professor stephen powis said the roll—out is the "beginning of the end" of the epidemic in the uk. dozens of hospitals have been chosen to serve for administering the innoculation.

now on bbc news, it's hardtalk with stephen sackur. welcome to hardtalk, i'm stephen sackur. brain surgery carries with it an awesome burden of responsibility, and within neurosurgery there are particular challenges that take the physical and ethical pressure to an extreme. imagine doing complex brain surgery on small children, then imagine trying to split twin babiesjoined at the head. that is the specialism of my guest today, neurosurgeon owasejeelani, whose work has made headlines in the uk and right around the world. how does he deal with the extreme stress of life and death decision—making?

owase jeelani, welcome to hardtalk. thank you. i think it is fair to say that there's a little bit of a mystique around people like you, around brain surgeons. i'm delighted we've persuaded you out of the hospital, into the tv studio. do you think it is useful to talk about the work you do and maybe undo some of that mystique? absolutely. i don't quite understand why the mystique is there, but i think it's really useful to talk about it. maybe it's because we're a little bit frightened of the thought of surgeons delving deep inside our heads. i do understand that. let's talk it through. yeah. so when you decided to specialise in this

particular form of surgery, what was it that attracted you to it? well, when i decided that i was going to be a brain surgeon, i knew nothing about brain surgery. i was quite young. it was one of those things that sounded interesting. erm... and i have an uncle who's a trauma surgeon and i recall him saying on a number of occasions that you can fix various parts of the body, but when you injure your head, then you're pretty much done for, and that sparked an interest as a kid. it just seemed that we needed to do something more in terms of understanding the brain and learning how to fix it. and that's how the interest in brain surgery started. clearly, i had no idea what it entailed. so the next 30 years were spent trying to understand what i was trying to do. now that you know so much more about it, i wonder whether you still feel that the brain is perhaps the last frontier unexplored by science. some scientists have said we know more about the cosmos than we know about the workings of this incredible organ inside our skulls.

indeed, indeed. i think that's a fair, er, fair, fair comment. are you trying to push the frontiers? erm, as brain surgeons, to a small degree. i think we should really be talking to the neuroscientists that are really pushing the frontiers on that front. as brain surgeons, our work is not that complicated. it sounds complicated and, as you've mentioned, there's mystique around it, but to do brain surgery, there's really... ..all you need to do is address the facts and your relationship to the facts is what matters. you make it sound so matter—of—fact. but let us talk about the case which brought you to worldwide attention, a case which involved two babies. i have to describe them as babies, safa and marwa, two little girls fused at the head and whose case came to your attention back, i believe, in 2017, soon after they'd been born, when a neurosurgeon in pakistan called you and said, "look, "can you do anything to help me for these two little girls? "

what was your initial response? indeed. so, yes, the call came through early in 2017. the girls were a few months of age and the first... as a doctor, the first response was, of course, you know, very happy to try and help. the next question is, let's look at the facts of the case. can we help? that's the first question. and so we went through the whole process of getting the various scans, imaging, video consultations with the kids within our multidisciplinary team at great 0rmond street. and at the end of that detailed assessment, we came to the conclusion that technically it was possible to separate the two girls with acceptable risks. there clearly were risks with the surgery, but we felt, on balance, the risks were acceptable. we then had to take that challenge of, how do we make it happen in the uk? and the whole process of trying to get the funding togetherfor... so, you know, this is extraordinarily complex surgery. i believe in this case there were three major operations and plenty of other

minor procedures as well. correct. and we're talking about an overall bill to the nhs of well over a million pounds. er, it was, it was, but the bill was not to the nhs, it was private funded. so these cases, if they come from overseas, will not come within the nhs umbrella. they will have to be funded separately by a charity or a foundation. so not only did you have to be the neurosurgeon taking responsibility for this case, you had to be the fundraiser, too. i did, and that was very challenging. i did not enjoy that one bit. it was my first experience of trying to raise some money and it's not a fun exercise. i'd much rather stick to brain surgery. well, we might come back to future funding for projects like this in the course of the interview, but we need now to talk very specifically about the case because it raises fascinating and very troubling ethical challenges for any doctor, because as is often the case, i think, with conjoined twins,

one was noticeably stronger going into surgery than the other. i believe safa was stronger than marwa. sure. but in the course of surgery, particularly the second major operation, you had to make some profoundly difficult decisions, particularly about blood vessels, blood supply to the two brains from the fused skulls. sure. how do you go about making those decisions? a lot of that decision—making is done before the actual surgery. and this, the scenario of having asymmetric twins is quite common. so typically the way it happens is you have blood that flows from one twin to the other and back, but there's a net flow in one direction. so the twin that's pumping blood to the other twin generally tends to be the weaker, the smaller twin and the twin that's not doing a lot of work or getting some of the work done for them tends to thrive and grow bigger. so the imbalance creates pressures on the two cardiovascular systems and the renal systems in the two kids.

and what we know about the natural history of conjoined twins is a lot of them don't survive beyond a certain age. and we... our knowledge base at the moment is that it's primarily the asymmetric loads on the cardiac status and the renal status is what leads to their demise eventually. in a scenario where the blood flow is equally matched between the two, i think those are potentially the cases that could survive in the long term if they weren't separated. and talking about this particular case, some people sometimes talk of surgeons having to play god. did you feel you were, to a certain extent, having to play god, decide on, you know, very literally decisions of potential life and death with these two? because you did put some blood vessels, er, toward, if i can put it this way, marwa's brain... sure. ..and therefore disadvantaged safa. now, we now know, in the aftermath, safa,

who'd gone in stronger, ended up having a stroke. sure. and to this very day, sadly, safa's condition is significantly worse and weaker than her sister. now that you know all of that, do you second—guess some of the medical decisions you took? erm... this, erm... the concept of playing god, i've never really understood that. and the reason i say that is because all of your decision—making has to be based on facts and how you handle the facts, how you look at them, how you use them in your decision—making algorithm. so in this particular set, as in our previous sets as well, when you have two girls, one is clearly stronger, one is weaker. certain parts of their shared anatomy are set in a way that they will have to go to one twin and that decision is made simplyjust by the very nature of how they're put together. no choice. but there are some decisions that you do have to make

and you know that, for example, if this one particular vessel is taken away from marwa, she's very unlikely to survive. whereas if this one vessel is taken away from safa, she is likely to survive but may take a hit. so when those, you know, when you look at those facts in that fashion, when you put them into the algorithm, the net benefit to the two girls, so what you go for is the optimal outcome. erm, and... well... i'm sorry to interrupt, but there's so many fascinating questions here. for example, if you had a case of conjoined twins, and they are rare... he coughs. excuse me. they are rare, i believe there are perhaps a few dozen in the world every year. sure. but if you had a case where to operate, you pretty much knew that you could save the life and lead to a thriving life for one twin, but the other would die, would you undertake that operation on the basis that at least one life would therefore be much improved even if the other had to be sacrificed? yeah, they're very, very

difficult decisions, and i don't think we could make that call if... ..certainly if the two girls were thriving in the sense that, erm... so in a scenario where you have two girls, two kids conjoined, one is the weaker twin, the other one's the stronger twin, i don't think you could make the call of sacrificing one for the sake of the other. but, doctor, why not? because in this case, these two little girls are joined at the top of the head. there is no way on earth that without surgery that either of them can have a very positive, thriving life. yes. they can't walk, they can't sit up. they are condemned to forever lie together without even seeing each other. i understand. sure. i understand, i understand the question very well, stephen. the issue is that you cannot compromise one life for the sake of another. you can't do it. ever. in my opinion, no. now, where things may be different is if you know that without separation,

both kids are likely to die. now, that's a different scenario where you would then take that to the ethical board, ethics board in the hospital, so on and so forth, and take that through. but if the end result is you'll have two kids that are going... likely going to live in the long term, i don't think you can make the call of sacrificing one for the sake of the other. i think this conversation is already making plain that you live on the very extreme edge of surgery. you know, these are extraordinarily difficult cases and decisions that you are having to make. i just wonder on a personal level whether this case and other cases of conjoined twins that you've had to work on have ever pushed you personally to an emotional edge, that has actually been difficult for you to cope with? of course. of course, the stereotypical image of the steely surgeon who's technically gifted but emotionally quite detached is... in my opinion, it's a fallacy.

i mean, you know, perhaps some surgeons might be able to perform like that. but i think if that's your modus operandi, you're really compromising what you're able to offer to the patients and in turn compromising yourself. 0ur... you know, clearly the way you do this work is you stick to the facts and address the facts of the case, but then you need to bring in your emotional side. that has to be a part of your decision—making. does it? you definitely engage personally and emotionally with your patients? absolutely. because i know in the past some surgeons have literally gone to the extent of covering the face of a patient they are working on with a cloth so that they do not see theirface. they want this to be as close to — if you don't mind me using the phrase — a piece of meat that they're operating on as possible, because, for them, that works. you're very much not like that. very much not like that. so i understand. i understand what, you know, what those surgeons may say. but for me, i think the emotional element of a human, a surgeon,

it's in many ways much more powerful than our cognitive, our cerebral drivers. now, the key is the emotional input can both distort and empower your decision—making process, and that is what you need to be really clear about, and that's where i refer to the earlier comment i made, sticking to the facts. what are the facts of the case? why are we here? why are we doing this? and in that decision—making process, if you put the child right at the centre of the decision—making process, is this in the benefit of the child? are we doing this for the right reasons? then your decision—making, you know, it's easier to progress along that. i get the sense in which you're saying emotions can actually aid your work rather than hinder it, but i'm just wondering whether there's a danger of keeping your emotions involved in a case even after it's done. for example, i know such was the high profile of the case of safa and marwa, and it became a tv documentary, it made

headlines around the world. i happened... and you've stayed in touch with the family since the operation, because we're talking now some months since it was completed. is that sometimes dangerous? because, you know, as i've already indicated, safa in particular has had a real struggle since that operation. and maybe it's not good for you to see that struggle. erm... by the nature of what we do, stephen, i mean, safa and marwa is one case, but certainly a lot of cases that we undertake when we operate on children, for example, if you were to take a brain tumour out from a child's head or other reconstructive operations that i do, by the very nature of the kind of work we do, you do follow those kids up. so it's quite normal for us to then see those kids on an annual basis until they're 18, when we hand them over to our adult colleagues who would then carry on looking after them or keeping an eye on them. so it's not unusual that these particular girls have stayed in touch.

for me, this takes me back to something that a senior surgeon, one of my mentors, said a long time ago that's always stayed at the forefront of my decision—making — so to be a surgeon, you need to do your best. that's the first thing. speak the truth. that's the second part. and then go fishing. and you have to do it in that order. from my perspective, if you're not able to do the second part of it, then in some ways you're really compromising what you're able to offer your patients in the future and almost certainly what other surgeons might be able to offer their patients. so the second part of it, to speak the truth, is a key element, because the closest analogy that i can draw here is if we look at machine learning, if we look at self—driving cars, we don't teach those cars how to drive. the way they work is they have a decision—making algorithm. they try certain combinations. they come across an error. they change their

track and move on. and in this iterative process, they learn how to drive. and hopefully we'll see lots of self—driving cars driving very safely, much safer than how we drive them. surgery is a very, very similar process. but the key element is the feedback has to be fact—based and accurate, so our biases which distort the feedback for us and how we get feedback from others, that's what we need to really be careful about. but you're not a computer. you are a human being. 0ur brains work like computers. 0ur brains are organs of prediction. and what our brains do is precisely what we now understand from our machine—learning experiences. so typically when we have to do a complex operation, the way we would go about it is you walk through the various steps in your mind on a sequential basis, so for a case like safa and marwa, for weeks on end, i would sleep on the problem, wake up early hours of the morning with a thought, write it down and run that again and again. then you are working within the setting of a team,

you get feedback — from your colleagues, computer engineers, engineers, other surgeons, nurses, paediatricians — and you just add to that algorithm until you build a full picture of how this could be done from start to finish. it's a very interesting and very collective effort you're describing. but i'm mindful of a brain surgeon we had in this studio a few years ago called henry marsh. i know him well. he wrote an amazing book, do no harm, telling the inside story of his career and some of the cases he'd had to deal with. he's a deal older than you and maybe that is significant because henry marsh said that in the course of his long career, he'd come to realise that what he could do for patients was both, in his words, wonderful and terrible. and he was very honest about some of the mistakes he had made. and he talked about one particular operation on a very complex tumour in a patient where he'd got most of it out. it was a success, but there was a little trace of tumour left and he went the extra, extra, well, millimetre or so in this case and he made a slip and he caused terrible

damage, blood loss and haemorrhage, and the net result was that the patient never recovered beyond a vegetative state and he lived with that for the rest of his career and he said it changed his attitude to risk. what's your attitude to risk? so the experience that henry described that you've just told me about, it's not unique to henry. u nfortu nately, most surgeons i know have experiences like that. have you? of course. of course, any surgeon who's not had an experience like that has not operated enough. that's the reality that of the world we live in. but the point i'm trying to make is, having made that error, what henry's done really well and what i advocate is, the honesty part is absolute key, not simply for your own education, but also to educate the future generation of surgeons to try and prevent the same mistakes being repeated again and again. the second part of the... do your best — that's great.

speak the truth. and for me, if you're not able to do the second element of it, then in some ways, you're really compromising, you know, your surgical career and pretty much anybody who's in a position of authority needs to be able to do that. no, i understand that. but i'm very... right now, i'm thinking a little bit of what we've learn from covid as well, and particularly the race to find a vaccine, because in developing new vaccines and trialling and testing and experimenting to make sure they're safe and they work, there is, of course, a big element of risk at the very beginning of the process. you don't know, because this is a new frontier. you also have to push frontiers of what the brain surgeon can achieve, what he can do. are you honest with patients when you say perhaps sometimes, "i've never done this before, but i believe it might or could or probably will work," are you honest about risk? my style of working is, yes. i think, for me, it's really key that i feel i've been as candid as possible with the patient.

and i know some patients can find that troubling, or rather, some parents can find that troubling. but the reality is that at the end of the day, we're all human and we all make mistakes and it's easier to deal with things when they go wrong if you have that start of trust. trust is key in what we do and the honesty element is a key part of building that trust. i want to talk aboutjust one other element of covid, because i think people around the world will share my feeling that it has preoccupied so many health services around the world. it has been a focus for everybody in terms of public health care over the last nine months. for somebody like you, a specialist in paediatric neurosurgery, has the focus of resources, time, expertise and hospital space on covid—19, has it affected the way you've been able to work? erm... my work, i mean, clearly, covid's put a big strain on the nhs.

we know that. that's pretty obvious. but my work as a neurosurgeon, a lot of it is emergency work, critical, time—critical work. and that hasn't really... we've carried on doing. so in my department, for example, ican categorically say that no child's come to harm because of us having to deal with covid. cases have been managed in a timely fashion. and so, you know, ifeel very proud, very fortunate to work in a set—up where we've managed to do that. there is an enormous strain on the health service right now, but there is enormous strain day after day after day on people like you. i believe i'm right in saying you get up, particularly on surgery days, at something like 4:30 in the morning so that you're truly prepared for a full day in the operating theatre. and we've talked about some of the ethical challenges. and there are physical challenges, too, in what you do. i think i'm right in saying you're in your mid to late 405. iam. is there going to be a point when you burn out? er...

yes, i expect, you know. you may call it burn—out, it may be a fizzle rather than a burn—out as such. but there will come a time when i would not want to be dealing with... dealing with the mental and physical stress of being a paediatric neurosurgeon. and it's just being aware of when that time happens and then moving on to other pastures. but right now, i know obviously the safa and marwa case is done, but you are still working on conjoined twins and other highly complex cases involving very young children. absolutely. so, you know, within the nhs, we are extremely fortunate in terms of the set—up that we have at great 0rmond street and other hospitals in the country. safa and marwa were one high—profile case, but we undertake over 1,000 complex cases every year, so that's daily life. and then a case like safa and marwa, which is perhaps a bit more complicated than our other cases,

you deal with those and then you carry on. but a case like safa and marwa, what it really does for a hospital such as ours or any hospital is... for safa and marwa, what we needed to do was pull in expertise from a whole host of fields, not just surgeons and paediatricians and nurses, but also virtual reality, cgi work, computer specialists, biomedical engineers. all these ingredients are present in great 0rmond street and around in london. the ingredients were all there, so we just needed to pull the team together in such a way to deliver something that was thought to be not possible, or the odds were truly against us. so to do something like that, the analogy i would draw is when man first went to moon, itjust made global travel so much easier. and that's the effect that a case like safa and marwa has, where all the other super, super complex operations we do, the whole team feels much more upbeat about doing these difficult cases that we do on a weekly basis. we've sadly run out of time, but it's a real pleasure

to have you in the studio. 0wase jeelani, thank you very much. thank you very much, stephen. thank you. well, frosty and quite foggy for some of us out there again at the moment, certainly the south east of england, into east anglia as well. some of this fog could persist right through the morning and into the afternoon, a bit like on sunday, so it's going to feel pretty raw in these areas. now at the moment, we're sort of between weather systems, one in central parts of europe there, more clouds out in the atlantic. we're kind of stuck in the middle where the skies have been clear. it's a really tricky area to forecast because you have

areas of cloud, mist and fog floating around. you can see we've sort of been wrapped around by this dip in thejet stream where the cold air is sitting, so that fog reforms at night and we get the patchy frost across the uk as well. so this is what it looks like through the early hours of monday morning. the frost will again be in the south east and parts of east anglia, but not exclusively. these are the city centre temperatures. in rural spots, it will be colder than that at 6am in the morning on monday. so the frost and the fog possibly persisting into the afternoon in some southern areas. but there's a lot of sunshine in the forecast as well. certainly western coastal areas here will have the best of the weather. liverpool, belfast and glasgow, too, in for some sunshine, but it's going to be nippy. now, here's monday evening into tuesday, rain moving in off the north sea. that'll sweep into the north of england, but particularly scotland. there will probably be some mountain snow here as well. and that's a low pressure which will park itself across northern parts of the uk on tuesday. it's not going to drift

anywhere else, it'lljust sort of sit there during the course of tuesday until it rains itself out. so, not a pretty day at all across scotland, northern ireland and the north of england on tuesday. on top of that, we've got gale—force winds. it'll feel cold, raw in places like belfast and glasgow, even though the temperatures will be around 7 or 8 degrees. it's that strength of the wind that will make it feel pretty cold. now, wednesday actually doesn't look too bad across the uk. see that little blob of rain there? that's the remnants of the low pressure that we will have had on tuesday, so by wednesday, it should be gone. now there's just a hint that temperatures will be picking up a little bit towards the end of the week, so rather than chilly, well, it's going to be less cold towards the end of the week. bye— bye.

this is bbc news — i'm aaron safir with the latest headlines for viewers in the uk and around the world. donald trump says his personal lawyer rudy giuliani has tested positive for coronavirus. a day of last—ditch talks between the uk and the eu but still no breakthrough in a possible trade deal. firefighters in australia tell people to leave a popular holiday island as bushfires burn out of control. as batches of the coronavirus vaccine arrive in hospitals in england, one official calls it the beginning of the end of the pandemic.