The surgical tunnel

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My right hand hurts like hell," Josephine told me as she settled into the chair, supinating her palm. She showed me with the finger of the other hand where and how the pain radiated: around the wrist and into the first few fingers. "I have to shake the pain off my hand sometimes, mainly at night," she demonstrated, replicating the gesture of air drying a wet hand. "It's a combination of burning and tingling, numbness and heaviness," she tried to explain, wincing. She was a company secretary in her 60s, and wore a dress whose scarlet hue reflected as a rose tint in her glasses. Her 97-year-old mother sat next to her, upright and vigilant to every word of the discussion. "I can't do any work around the house and Mummy needs to chip in; it's just the two of us."

Mummy piped in, "That's what keeps me young and fit." The only time she has been to a hospital is to accompany people younger than her, she joked, poking her daughter with her walking stick. "What's your secret to a long life?" I asked. She strained her neck to hear me. "Getting a little deaf," she apologised. I wondered if that was her answer or she wanted me to repeat the question, but she followed it up with, "People talk nonsense, so the less you hear, the longer you'll live!" Mummy shed a few pearls of wisdom.

"Do you have a pain in the neck or arm?" I asked Josephine, since sometimes, pain in the hand can arise from a pinched nerve in the neck. But her symptoms were typical of a condition called carpal tunnel syndrome, where the nerve in the wrist gets strained by the overgrowth of the soft tissue around it. "Are you diabetic?" I questioned, as it is more common in people with elevated sugar levels, thyroid problems, arthritis, and those who are plump. "I find it hard to open bottle caps, turn door knobs, and even cook."

"The carpal tunnel is a space that sits between your wrist bones. It's like a shaft cut through a mountainside, but instead of making room in the rock for cars to drive through, this passageway lets tendons, ligaments, and nerves pass through to reach your hand. The nerve is getting pinched here," I said, tapping on her wrist with my fingers, making the pain shoot to her fingers. "This is called Tinel's sign, which confirms my diagnosis," I demonstrated.

Josephine said that her job involved sitting at the computer all day, although she did take breaks and rest her hands as often as she could, following some good advice she had been given. "Repetitive movements of the wrist are a reason why some people suffer from this condition. Also, women are three times more likely to suffer from it than men," I gave her some trivia. "Chefs, waiters, bartenders, dishwashers, and people who use machine guns are also prone to it." Her face registered mild scepticism. "I have operated on a few army men with the problem," I explained, in case she thought I was joking about the machine gun.

Josephine told me that another doctor, who had suggested a nerve conduction test to confirm the diagnosis, had recommended a splint to ease the repetitive movements of the wrist, but that hadn't helped. Someone else had asked for an ultrasound and tried a steroid injection around the nerve, but after temporary relief, the pain returned. "I am your only hope now," I grandiosely pacified her, as Mummy lent her outstretched hand for me to hold. I had operated on another family member of theirs a year ago for a colossal brain tumour, so they were familiar with my jest. They had come mentally prepared for surgery, which a few others had recommended.

"This is not as big an operation as we had for Francis, correct?" they tried to gain some perspective. "Not as big, but just as important," I mentioned. "I don't consider any surgery simple or small, but you'll be able to do everything from the next day onwards," I reassured her.

I could have discharged her that evening itself, but she'd have to stay the night to avail of insurance. "Mummy will stay with me," she said. That's not necessary, I clarified. "Do mothers ever listen?" she said, smiling at her fondly.

A couple of days later at their arrival in hospital, the nurse walked up to Mummy to put the patient wrist band on, and was redirected to the correct patient. It's funny how our mind is programmed to believe that the older person must be the sicker one. These stereotypes permeate through life - women don't drive well, thin people are fitter, older people cannot manage technology, or that the French are arrogant - and are especially true in the medical field, where people believe that the younger doctor must be less skilled or that all hospitals are here to fleece patients. And my favourite: All neurosurgeons are dashing.

We wheeled Josephine to the operating room the next day as the anaesthetist skilfully knocked her out. We infiltrated local anaesthesia around the wrist and made a 2 cm incision to extend the lifeline on her hand and take it all the way up to the crease of the wrist. "This is the only surgical procedure that can astrologically extend your life," I joked with my assistant. "Now she's sure to live as happily as Mummy," he quipped.

We separated the fat until we saw the thick band of tissue we were supposed to cut. We nicked it to slide the instrument under it, and cut along its entire length so that the nerve below could be fully freed from the tension it created. "Such severe compression!" my colleague and I enunciated simultaneously, imagining Josephine's plight.

We closed the skin meticulously and wrapped a comfortable bandage around the wrist. Mummy was delighted to see Josephine when she returned to the room. "My pain is gone," were the first words she said. "My hand that was asleep and pricking is alive and kicking!" she rhymed. "Amen," I said, as Mummy beamed.

The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals.