A late night, another patient in distress or a tiff with the spouse—patients will never know the worries that weigh on their surgeon during an operation
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I operate with AirPods nestled in my ears, a conduit to the hushed anxieties of the ward and urgent whispers of the ICU. They also help me dispense advice to patients who might need it urgently without having to make them wait until the end of the day. It isn’t as distracting as one might assume; it’s the equivalent of talking to your assistant about his weekend while opening up someone’s head, which is what we do when we have a brain tumour surgery on a Monday morning. Having said that, however, I often silence my phone during critical crescendos of an operation so that there are no inadvertent interruptions.
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I realise that telling people you can talk on the phone while operating might unnerve some. Once, after boarding a plane, as the captain introduced himself, I recognised his name and voice and was quick to realise he was a friend. I sent him a message on his phone saying I was on the flight. He was so excited that he kept returning my messages as we were on the runway and about to take off. I finally stopped replying to calm my own nerves and be sure he’d focus.
On one such regular surgical morning as I was performing a craniotomy—the removal of a part of the skull to access the brain for a complex aneurysm of the internal carotid artery—a call from the ICU pierced through the sterile air. Siri read out the name of the person who was calling in her sultry, robotic voice in my ear. “Answer?” she asked. As I was burring a hole into the skull, I confirmed: “Yes.”
“Good morning, sir. The lady you operated upon yesterday for a pituitary tumour compressing her optic nerve has a problem,” the doctor on the other end told me. “What do you mean she has a problem?” I questioned almost angrily, because I had seen her an hour before starting surgery, and her face had been alight with the joy of returning vision. Before surgery, she was barely able to perceive light, and when I checked up on her this morning, she could count my fingers at a distance of 10 feet. “She says she can’t see anything now,” he clarified, his voice laced with concern. “She feels like a black curtain has fallen over her eyes. She’s also breathing heavily and looks pale and scared.”
My heart sank as I continued to drill, bone dust swirling into thin air. The only plausible explanation would be that she might have bled inside the brain. But a CT scan done earlier in the morning had been clean. I thought for a bit as I got the bone off, staring at a pulsating brain in front of me. “Repeat a CT scan, and if that’s normal, get an MRI and ask the radiologist to call me with the findings,” I ordered. “Yes, sir,” came the military-like response from the other end. “Also ask the ophthalmologist to rule out a retinal detachment,” I added, thinking of a rare possibility.
I sat on my chair, had the microscope brought in, and began dissecting the gossamer strands separating the frontal and temporal lobes to expose the carotid artery, the main blood vessel that supplies blood to half the brain. While I did that, a parallel movie of the other patient being wheeled into the CT scan room played in another corner of my head. The weight of it pressed down on me. I pondered the possibility of returning to a patient barely a day removed from the operating table, all the while keeping watch on an aneurysm pulsing before me, knowing it could rupture at any moment and potentially cause an on-table death. It demanded an insane amount of equanimity to deal with the duality, this dance between creation and destruction.
Patients will always be unaware of the circumstances under which they are operated. No surgeon will confess to a late night of revelry, a tempestuous argument with their spouse before leaving the house, the gnawing anxiety of a looming debt, if they are jetlagged, or even the simple human frailty of fatigue or distress. No patient will ever know that their surgeon’s previous patient may be dying in the ICU on the same floor while they’re being operated upon only a few metres away.
I had once scheduled a patient’s major spine surgery for a Thursday morning. “But isn’t your brother coming down from the US in the wee hours of the same day?” the Parsi lady sitting in front of me asked, clearly having conducted a thorough background check on me. “Yes, he is. So?” I asked, a little surprised. “If you go to the airport to fetch him in the middle of the night, will you be fresh for my operation the next morning?” she continued. “I’ve operated in more dire situations,” I told her, giving her a kiss on the head to assure her that she’d be fine.
The radiologist called to say that the CT scan was clear and there was no bleeding inside the brain. “We are doing an MRI to check if there is any vascular insult to the optic nerves,” he updated. With steady hands, I navigated the treacherous landscape in front of me, carefully dissecting the neck of the aneurysm. Within its delicate walls, blood swirled like daredevil motorcyclists defying gravity in a metal sphere. Two parallel patients were looping vertically and horizontally inside my head. I asked for a 6-mm curved clip and placed it across the neck of the aneurysm, seeing the ball of the aneurysm shrivel in front of me as if the bikers had run out of fuel.
The radiologist called back. “The MRI is also normal.” “Then why the hell can’t she see?” I muttered aloud. My colleague offered to close up the case so that I could go check on her.
Just as I walked into the ICU, I was informed by the team that her vision had returned to normal after learning that the MRI was clear and showed complete removal of the tumour. “She probably had a psychogenic panic attack after she overheard relatives of the patient in the next bed talking about someone losing their vision after surgery,” the doctor told me. “What the…?” I controlled myself. “You have no idea what a surgeon endures on the other end of that phone when you deliver news like that,” I said, my voice tinged with the weariness of the morning. Yet, I knew that in their defence, they had followed protocol. The situation could have easily spiralled into catastrophe.
I went to the patient and put up three fingers from a distance of 10 feet. She could see clearly. She was beaming. “What happened?” I asked. “I think I got very scared hearing that news [of someone losing their vision] and just blanked out,” she confessed. “But now I’m happier than I have ever been,” she added, thanking me. Just then, I saw the other patient, the one with the aneurysm, being wheeled into the ICU, giving me a thumbs up. I realised I was helping patients live longer, but aging twice as fast myself.
That night, while I lay in bed with my kids telling them about my rollercoaster of a day, I told them the story of how I was able to restore vision in someone who came in blind, and the mammoth smile she gave me at the end when she realised she could see. My 10-year-old elder daughter goofily asked, “Was the smile bigger than her face?” While that isn’t possible anatomically, I knew that physiologically and emotionally, it surely had transcended boundaries.
The Parsi lady who had the spine surgery and was discharged jubilantly a few days later, called one afternoon, in the middle of another operation of mine, to ask how soon she could start drinking. “At least wait until the evening!” I told her.
The writer is practising 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
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