If the cortex is the city where thoughts are born, the white matter is the road network that carries them around. It’s what lets the brain’s neighbourhoods talk to each other. The motor area sends a memo to the spinal cord. The temporal lobe files a report to memory. The frontal lobe emails the cerebellum (sometimes forgetting to ‘cc’ logic). It’s a busy place. The white matter doesn’t sparkle under the microscope like the grey matter does, but it’s the reason we function as one coherent story instead of as a collection of confused committees.
A few months ago, I saw Ravi, a burly man in his late 50s who came in after a small stroke. He could move his limbs, remember his address, even crack jokes. But his wife noticed something odd. “Doctor,” she said, “he’s talking fine, but not connecting.” When I asked him to show me his left hand, he showed me his right. When I asked him to draw a clock, he placed all the numbers on one side. His brain was a city with working buildings but a collapsed bridge. The cortex was intact; the white matter had short-circuited.
On the MRI, a lesion sat in the deep white matter near the internal capsule – a small clot in a critical junction. The cortex was sending instructions; the body just wasn’t receiving them on time. I explained to his wife that the white matter is made up of fibre tracts, bundles of nerve fibres (axons) that carry messages between distant parts of the brain. When these cables fray, it’s like losing network coverage. “So, he’s in airplane mode?” she asked. “Exactly,” I said.
Under the microscope, white matter looks less like matter and more like meaning – gleaming fibres running in every direction, shimmering like silk threads. They’re coated in myelin, the brain’s version of insulation, helping signals travel fast. Every emotion, every gesture, every word that escapes our mouths depends on these fibres firing in synchrony. When they falter, people lose not just movement or speech, but connection. They become islands.
Ravi’s stroke was small, and with therapy, his words slowly began to find their roads again. Watching him recover was like watching a city rebuild its flyovers, one lane at a time. By the fourth week, his wife said, “He’s back to arguing, doctor!” That’s how I knew the white matter had reconnected.
The brain, like society, survives on connection. The cortex may create ideas, but it’s the white matter that carries them into the world. It’s the unsung middleman, the Mumbai local that makes the city function. When it breaks down, chaos ensues – both in the brain and on the tracks.
We surgeons are always navigating through these white matter tracts to reach deeper tumours or aneurysms. The challenge is to get where you need to without cutting the wrong cable. Each fibre bundle carries a different signal: movement, vision, speech, thought. It’s a daily exercise in restraint. Operating in the brain’s white matter feels a bit like rewiring an entire city during a power cut and hoping the lights come back on in the right homes.
I sometimes think our white matter is also a metaphor for how we live today: endlessly connected, rarely communicating. We have more networks than ever, but fewer true connections. The brain, at least, has the excuse of anatomy; we have only distraction.
One evening, Ravi came for a follow-up. He was sharper, laughing, even driving again. “I’m fine now,” he said, “but my wife still said I forgot her birthday!” “That’s not your white matter,” I said. “That’s a universal male deficit. No known cure.”
The white matter is not glamorous. It doesn’t think or dream or compose poetry. But it keeps everything that does in conversation. It is the quiet fabric that turns thought into motion, intention into speech, and chaos into coherence. When I look at it under the microscope, it reminds me that medicine is not just about fixing organs but restoring connections – between brain and body, and sometimes, between people.
We spend our lives trying to stay connected: to Wi-Fi, to work, to one another. But the most important connections are still inside our heads – unseen, silent, endlessly patient. And when they falter, all we can do is wait, hope, and try to rebuild the bridge. The next time your internet drops, be grateful it isn’t your white matter. One reconnects with a reboot; the other requires a miracle (or me).
37 thoughts on “The white matter”
Sir
Your thoughts and write up is osm keep it up Sir
Forever grateful to the brain Wi-Fi ,
The white matter .
Thank you Dr Mazda !
Your article is so insightful, especially for those of us with no medical background.
The analogy with networking and
Wi-Fi really hit home.
Thank you for all your succinct articles and your interaction with patients.
Superb explanation 👌
Complicated matter explained in a simple manner.
Thank you Dr Mazda for simplifying the brain for us,the layperson.
Sir, As in the saying your articles make my sunday.
Thank you sir.
So appropriate Doc to share and u nderstand these complex matters
Thank you
Any tips you can share to avoid these if possible would be greatly appreciated
Truly educational articles for us laymen. So well written n explained.
🙏🙏🙏
Beautiful weaving of words as always. Thank you for such wonderful writeups. Keep them coming
As I read your articles, they bring a smile to my face. Enjoy the wit with which you share your wisdom.
Personal touch is so much more important than social networking..
White matter is okay, what counts are the Brown connections!
Your love of the city is as obvious as your love for the brain. Mumbai is clearly central to you, as you constantly pay tribute to Maximum City in your articles drawing much inspiration from the metro and her people who regard you more as Demi God than neurosurgeon
White matter so wonderfully explained. Connections that we mostly take for granted are sometimes the most vital ones
Dear Maz,
I apologise for borrowing your wit, but what can I say? Not everyone is as gifted as our good doctor!
I thank you for staying connected. I pray no lesion interrupts this valuable connection!
Sundays become fundays thanks to the articles you so thoughtfully share!
Much love
Dear Dr Mazda,
I thoroughly enjoy reading your articles as you impart knowledge in a simple way which is an eye opener for a common person who does not understand much of medical terms. Your examples, explanation are fantastic. Keep up the good writing for all to benefit.
When it comes to building bridges, I’d trust you more than our “marvelous” city contractors—thanks for the laugh!
Earlier it was always about Grey matter but now I know the importance of white matter. Thanks for providing me with a plausible alibi – Universal Male Deficit also.
My kids accuse me of being ‘in airplane mode’ at dinner – not focusing on the discussion. Enjoyed Ravi’s plight and recovery ❤️🩹 and as usual, your tongue-in-cheek style!
As a student of Neuroscience I am amazed to see how skillfully you weave your vast knowledge of our miraculous brains with your literary skills, a product of our brains.
Superb articles doctor!
You write so beautifully doc. Such complicated information explained so simply. Thank you and keep these articles coming.
Thank u for letting us know about the white matter.Even we non medics can brag something about the mighty brain.After being connected to ur sunday articles i feel like a non practing neuro doctor.keep educating us by ur sunday writings.
Explained in a way …laypersons will follow…& So simplified ..
Wow Dr.. Ur blessed wth the gift of writing & surgical expertise..
Amazing Grace…
Dr. Turel, your writing is a masterclass in medical humanism. You have a rare gift for translating the intricate architecture of the brain into a language that breathes and moves, turning “fiber tracts” into the very fabric of human connection.
Nicely explained Dr. Mazda.
So well explained in a layman’s language.. always enjoy reading your article. Thank you
Enjoyed the read and the subtext of Mind over Matter!
Dear Mazda
Superb article!
Well Narrated Dr. Mazda.
Hope to learn many more knowledge from you.
Dibakar
‘Operating in the brain’s white matter feels a bit like rewiring an entire city during a power cut and hoping the lights come back on in the right homes.’
This brought back the image of MTNL guys of yore, squatting in front of that big box with exposed wires, trying to figure out which connects where and then after multiple cross connections finally getting it right 😅 … It used to be fun to listen in to somebody else’s conversations while waiting to connect to the intended person.
You are such a good communicator. Your writings make me want to know more about matters pertaining to the brain and spine. Thanks a ton.
Again a feel good piece to read. I eagerly wait for the diagnosis that’s about to come up every time. Keep going Sir😇
Thank you for a great read Dr. Turel. Truly insightful and engaging from start to finish. Gave us a vivid clarity on the subject and skillfully took us through the travails of the patient. Looking forward to your next one.
Dear Dr Mazda, your articles provide complex medical information in simple terms. To read them is fun and enjoyable. And the empathy and sensitivity you show towards patients spurs us to do likewise towards others encountered in our daily lives!
For me this White matter does not matter as long as Mazda can serve it on a platter.
No arguments just do it.
It’s amazing how you bring alive the inner workings of the brain and it’s different parts…we all know you are an amazing surgeon…aren’t we lucky that you are a fabulous writer too?