11 January,2025 07:01 AM IST | Mumbai | Dr Mazda Turel
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There is a 16-year-old girl admitted with vomiting," the ward doctor called to inform. "She also had some stomach cramps, and the medicine guys worked her up for a gastro bug, food poisoning, and typhoid but found nothing," he added. "Could she be pregnant?" the curious cat in me inquired. "They ruled that out too with a test," he confirmed. "Since yesterday, she also started complaining of a severe headache and was unsteady on her feet, so the consultant in charge ordered a brain MRI and found a large tumour in her head. Hence, we are calling you," he gave me the gist.
When I went to see her, she was sitting with her hand in her head. This is not a good sign, I thought to myself. I peered into her eyes with a fundoscope, a device that allows you to see the optic nerve head. It was fuzzy and red as opposed to sharp and white, suggesting raised pressure inside the brain. She spoke coherently with a gentle smile even though she was in pain, respectfully doing her best to answer all my questions. I was pleasantly surprised; I don't expect anything civil or gracious from today's teenagers, even if they are unwell. "There is something wrong with the world today, I don't know what it is," a song that Aerosmith sang 30 years ago often plays in my head on loop when I see the kids of today.
The MRI showed a large heart-shaped tumour at the back of her head in the area called the cerebellum. I circled the tumour out to her father, a short bald guy, who stood there with hands folded but slightly apart as if to catch every word that came out of my mouth. "It's filling up the entire fourth ventricle and blocking the normal fluid outflow pathways," I explained the reason for the headache, showing him how the normal slit-like ventricles had ballooned up. "It is also pressing against the upper part of the spinal cord, which is why the imbalance," I gave a clear explanation.
"We'll have to remove this with an operation," I explained, detailing the need to do this at the earliest. "Can't we try some medication to see if it melts?" he asked; understandably, like most people, he wanted to avoid surgery for his daughter. "Not only do we need to do it, but we need to do it tomorrow," I pushed. When doctors press for surgery, relatives often have their antenna going up. They are only here to make money⦠they are scaring us⦠someone else we know got better without the operation that two other doctors insisted on⦠we must take another opinion⦠are all the thoughts I've heard screaming from inside heads without actually being articulated. "There is something wrong with our eyes, we're seeing things in a different way, and God knows it ain't his," the Aerosmith song continued to play in my head.
"At least shave her head to be on the safe side, in case we need to do something urgently," I instructed the ward doctor before I left for the evening to go for a friend's wedding anniversary dinner. "We'll get back to you in a day or two about our decision," the father told me. As I drove away, I didn't blame him because this is a pathology that could remain stable for a few days or even weeks or it could get worse anytime. As surgeons, we tend to act before the situation deteriorates because then we have a better chance at recovery. It's going to be a while before patients can universally trust a doctor's intuition. "There's something wrong with the world today, the light bulb's getting dim," Steven Tyler crooned in my ears.
I had a fabulous dinner. Walloped succulent lamb chops. Picked on peppered prawns. Munched on mutton. Nibbled on noodles. Hugged friends I hadn't seen in ages. Danced a lot, sweated a little. I drove back home with my windows down, a cool late December breeze blowing in my face. As I parked my car, I got a call from the hospital. "The barber came to shave her head, and she's not waking up," the ward doctor paused, not saying anything after. Neither did I, waiting for him to continue. "There is no response even to deep pain," he added, waiting for me to say something. I remained silent. "Her pulse and BP are okay," he added, to tell me she wasn't dead, but still waiting for me to respond.
"Living on the edge (You can't help yourself from falling), Living on the edge (You can't help yourself at all), Living on the edgeâ¦" blasted at full volume inside my head - the electric guitar, keyboard, percussion, everything. If you grew up in the '90s or are an Aerosmith fan or even a fan of Tyler's daughter, you'll know what that would sound like on full volume at 1 AM.
"Activate the entire team and shift her to the operation room now!" I commanded. "Don't wait for consent or clearance from the billing department," I warned, softly but very sternly. "If we don't do this now, she will die."
"Hey, Siri, play âLiving on the Edge' by Aerosmith," I instructed, as I turned right back out of my lane and reached the hospital in the six-and-a-half minutes that the song lasted. To my surprise, the patient was already on the operating table. I changed and scrubbed, and cleaned, draped, and bore a hole into the skull as bone dust swivelled into thin air. I took a tube and inserted it into the ventricle to drain some CSF, cerebrospinal fluid, releasing the pressure in the brain. Fluid gushed out at such high pressure that it sprayed my mask wet. She instantly opened her eyes. I connected the tube to a system to let it drain at a constant slow rate.
I told the anaesthetist to keep her ventilated overnight and told the father we would operate early in the morning to remove the tumour if he was willing. "I don't have a choice, do I?" I asked. "Not really," I replied. Eight hours later, we took her back to the OT, flipped her prone, and opened the back of her head. Pearly white tumour slurped into my suction, begging to be removed. We cleanly separated it from the cerebellum, and as the last bit came out, it unplugged the fourth ventricle with a clear egress of CSF, restoring balance in the brain. We closed in the usual fashion, and she woke up bright and crisp the next morning. All the tubes and pipes from her body were removed as she was discharged in perfect health a few days later - the MRI showing a complete removal.
"I don't even remember what happened to me," she confessed. "Just think of it as having taken a good night's sleep," I told her. "Thank you for saving my daughter's life," the father acknowledged with reverence, "And Happy New year." I couldn't help but think of the song of the moment again. "There's something right with the world today, and everybody knows it's wrong!"
The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazda.turel@mid-day.com