Category: Now Writing

Not every tumour in the brain is cancerous; not every cyst, a death call. Welcome to the bewitching world of ventricles where colloid cysts pop up in 3 people per million

“Hey, Mazda!” a senior ophthalmologist in the city called me in the middle of a bustling OPD. “I need you to see a patient for me today,” she insisted. I never say no to seeing a patient, no matter how busy I am, but out of curiosity, I asked what the urgency was. “This 35-year-old boy came to me yesterday to change his glasses,” she began. I later learned that she’d called him a boy because she’d known him since he was one. “He said he felt his number needed a correction because he couldn’t see clearly. When I examined him, his eyes were fine, but when I looked inside with my fundoscope, the optic nerves looked swollen – almost like they were on fire!” she exclaimed. She was describing a condition where raised pressure inside the brain transmits on to the eye nerves, converting a pale off-white nerve into a scarlet haze. This appearance is because of the tiny haemorrhages within the miniscule vessels inside the nerve head that rupture from the raised pressure.

“Did you get an MRI of the brain?” I asked the next most logical question. “I sure did,” she said with glee, having discovered the source of his raised intracranial pressure. Oftentimes, the source of an eye problem is in the brain, and it requires an astute ophthalmologist to decipher it. “There is a 2 cm colloid cyst within the third ventricle blocking the CSF pathway and causing hydrocephalus,” she read from the report. CSF is cerebrospinal fluid, responsible for providing nourishment and protection to the brain. “Send him over,” I requested, and within a couple of hours, he was sitting in front of me in my clinic with his father.

Rehan was a gentle-mannered boy, dressed in a simple striped shirt with baggy white trousers that made him look a little older than he was. His father sat stoically next to him, silently awaiting my verdict. “I have a lot of headaches, but I’ve been ignoring them. I thought it was because of my blurry vision,” he spoke, his forlorn look forbearing his folly. “He even fainted once for a few seconds, but we thought it was because he hadn’t eaten anything,” his father interjected.

After examining him, I plugged in his MRI and switched on the white light of the X-ray box to show him a cyst sitting in the centre of his brain. “This cyst is filled with colloid material,” I explained. “Colloid is gel or toothpaste-like material within this cyst that is blocking the normal fluid channels of the brain and causing the pressure in the brain to build up. This is why you have the headache and hazy vision,” I explained. “What’s colloid?” he asked. “Milk is a colloid. Blood is a colloid. Whipped cream, mayo, butter, gelatin, and jelly are colloids,” I gave him the gist. “All we have to do is puncture the cyst and remove it completely to restore the normal fluid pathways,” I explained to the father, the son, and the Holy Spirit that was hopefully guiding us to make the correct decision.

“Is this a brain tumour?” Rehan asked. I explained that it was behaving like a tumour, but a non-cancerous one. “Any complications that one can expect if I don’t have surgery?” he asked. “Some people have been reported to die from the sudden build-up of pressure inside the brain, and if that doesn’t happen, you could lose your vision and memory over time,” I stated matter-of-factly. I didn’t want to scare him but simply express the truth. “And what are the complications if I do opt for surgery?” he asked. Realistically, I knew that there was a very small risk to life, and that the complications ranged from bleeding inside the brain or damage to structures that control memory or even consciousness, but I tempered it with, “Not to worry, you’ll be fine.”

This kind of a situation is a semi-emergency, so we scheduled surgery soon, in a few days. In the operation theatre, after general anaesthesia, we fixed his head with a clamp so that it wouldn’t move. During surgery, we used robotic navigation to guide us to the exact point 8 cm deep inside the epicentre of the brain. Once we removed a piece of bone and opened the dura, the covering of the brain, we found the brain to be extremely tense. To soften it, we tapped into the ventricle, releasing CSF to soften the brain. Once the brain was lax, we gently slid between the two hemispheres, separating the spider-like webs that traverse between the two and splaying the two main anterior cerebral arteries apart. The surgeon’s heart rate is usually double that of the patient during this manoeuvre, lest a vessel snaps. We then made an incision in the corpus callosum, the glistening band of white fibres that connects the two halves of the brain and allows for them to communicate with each other. Too small an incision and you won’t reach your target; too big of an incision and you can disconnect one part of the brain from the other and Rehan will be transformed into Rahim or even Rihanna.

Once we made that incision, we were inside the ventricle of the brain where CSF was flowing like mountain springs. Ventricles are cave-like spaces inside the brain that have the most spellbinding interiors. Tiny veins and arteries traverse its walls, while the fluffy choroid plexus, which secrets the CSF, lines its corridors like snowflakes atop a hillock. It is so beautiful that one could potentially get lost, and that’s why we have navigation to guide us. As we traversed a little deeper, we saw the cyst splaying apart the regular foramen that’s supposed to be there, distorting the fornices that arch and land on it, the pillars responsible for memory.

As intended, we punctured the cyst and thick and sticky yellowish white mucoid fluid emanated from it, deflating a robust cyst down to its defeated self. “I wonder how this gets lodged here,” my assistant asked at the oddity of an ugly cyst in such a pristine environment. “The human body is a gigantic liquid crystal; anything can happen anywhere,” I poeticized. I grasped the wall of the cyst and separated it from all its attachments, snipping away at the tiny strands holding it down. We disconnected it, circumferentially preserving the important veins in the area, and removed it completely, opening up the pathways it was blocking. We gently retracted our instruments out of the great depths of danger, ensuring everything was just as clean as it was when we entered.

Rehan woke up a few hours later and made excellent recovery. When I saw him the next morning, I asked him how he was. “My vision is so much brighter, and the heaviness in my head has gone,” he said. “But I don’t remember having had surgery,” he confessed with intrigue. “I don’t even remember what I ate for breakfast a few hours ago,” he added. I was slightly unnerved and started wondering if I had knocked off the fornix, which is believed to play a key role in cognition and episodic memory recall. After such a perfect operation, how could I have left a young man bereft of his memory, I asked myself. I hoped that this was temporary.

“Relax, doctor, I’m just joking. I remember everything!” he teased, laughing at my ashen face.

After all he was just a boy.

 

A gentleman who proclaimed that he lived to eat shaved off 10 kg and a tumour.
Are we really what we eat?

“Good evening, doctor saab!” Jayesh bhai walked in with his wife to meet me. The couple were in their mid-fifties and seemed pretty jovial. He had a round face that sat atop an even rounder torso. The buttons of his bright yellow shirt were struggling to keep its two halves together. Through two of those buttons, his navel looked like his third eye, staring me in the face. Sensing my unwavering gaze from his centre of mystical enlightenment, his wife remarked, “He loves to eat,” which I acknowledged, because I do too. “And I love to cook for him,” she continued dotingly.

It was of little concern to them that Jayesh bhai had a brain tumour. “I was having headaches and my GP asked me to do an MRI. He said he had heard a lecture of yours where you mentioned that people with headaches should get an MRI,” he explained. I peered through the scan to note it was a craniopharyngioma – a benign tumour with a malignant pronunciation. It was arising from the pituitary stalk and pressing against his hypothalamus – the control centre for hunger and satiety besides a myriad of other functions such as regulating hormones, body temperature, heart rate, blood pressure, thirst, mood, sleep and sex drive. He had no issues with any of the other functions, he clarified, and his wife confirmed. The weight he was putting on had simply been attributed to his love for food. I explained to them that not everyone who lives to eat has a brain tumour, but subtle shifts of patterns should not be neglected. He had put on over 20 kg in the past 6 months.

“Can I continue to eat dhokla, khandvi, and undhiyu before surgery?” he questioned, listing out his favourite food items. “Of course,” I said without hesitation, “but we will need to check your hormone and sugar levels,” I cautioned. I detailed a battery of blood investigations and booked an appointment with our endocrinologist, who helped manage such patients perioperatively. Before leaving, he asked, “Is it true that you become hot tempered if you consume too much spicy food?” He smiled at his wife, who shook her head, denying the allegation. “It’s possible,” I said, having read this in a publication. “I’m telling her to eat more sweets but she’s just not listening,” he said, as both of them left the room laughing.

He came back really upset a few days later. “The endo doctor you sent me to has stopped all my desserts! No chocolate, no cake, no jalebi, no gulaab jamun, not even aam ras! Season is about to be finished. What does one eat?” He questioned, disapproving of medical nutrition. “One day, science will show that sugar is really good for us and the whole medical community will have to eat its words,” he muttered, disgruntled. “As long as we are eating only words, we won’t put on any physical weight,” I punned, only later realizing that the emotional burden of eating one’s own words is even heavier. “Let us quickly get over with the surgery, so that I don’t have to deal with all these dietary restrictions,” he told me. I agreed, adding, “It’s also possible that you might not want to eat as much after surgery relieves the pressure on your hypothalamus,” and I watched his face shrink with dismay.

Patients often ask what foods to avoid after brain or spine surgery, and unless they have a specific medical condition, my answer is always peppered with the sagacity of ancient wisdom: Everything in moderation is okay. I advise them on eating fresh fruits and vegetables and to go easy on the carbs and avoid red meat. People wonder if certain foods will affect wound healing or cause a tumour to grow back. They wonder even more if eating too many pizzas, dosas, or spring rolls might have caused the tumour in the first place. I also often get asked what foods are good for the brain, and the answer is berries, nuts, green leafy vegetables, avocado, fish, and eggs. And, if you’re Parsi, eggs on top of eggs. The foods we eat should bring us both health and happiness.

We operated on Jayesh bhai a few days later. The tumour had a large cyst with golden fluid within it, resembling the crystalline oil his jalebis were fried in. We peeled it off the hypothalamus and the pituitary stalk in the hope of restoring his internal balance. “Your hospital food is very tasty,” he proclaimed, sipping on cream of tomato soup, but with his eyes fixated on the pudding next to it. “Can I eat pav bhaji at home?” he asked, before getting discharged. I nodded. “And a small drink once in a while is okay?” he winked. I granted permission with a big smile.

According to a lot of data, research, and science, we are what we eat. But we are also the five people we spend most of our time with. We are the culmination of the experiences of our several lifetimes. We are the ratio of the suffering we caused and the suffering we endured. We are the failures we were unable to fathom or the success we were able to surpass. We are the hopes we racked up and the sorrows we shared. We are the strings we pulled and the ropes we hung on to. We are how stoically we portray ourselves and also how vulnerable we might choose to be. We are the questions that quench and the answers that ask more questions. We are the ships we sailed in and we are also the ships we saluted from the shore. We are our insight and intuition. We are our hunger and our cravings, our weight gain and our weight loss. We are the stories we tell ourselves. We are all. We are one.

Jayesh bhai came back three months after surgery for a follow up. He had lost ten kilos. Now he was Jayesh bhai Jordar. His shirt fit well. The third eye had closed. “Doctor saab!” he greeted me in his trademark fashion handing me a box of chocolates. “Can I eat sweet and sour pickles that may sometimes be spicy also?” I don’t know if there was any item on the menu that he hadn’t cross-checked with me in our time together. “Besides human beings, you can eat whatever you want,” I professed with folded hands.

 

What health boxes should a prospective life partner tick before you decide to marry? And is there a cure for a disease called incompatibility?

She came to me with her father. They sat in front of me in my office for a consultation, looking at me a little tentatively. She looked like she was in her late twenties, hair parted somewhere between the centre and side, distinct enough for me to notice. Her dress had a valley of yellow flowers that resembled the golden fields of the South of France. “This might seem like a strange consultation, but we wanted your opinion on the matter,” she said, looking sideways towards her father, who gave her a supportive smile. “I’m looking to get married and have received a proposal from a boy,” she said, clearing her throat. I wasn’t sure what exactly was so embarrassing for them to treat the subject so gingerly. “He’s very nice. Has a good job. Earns well. Handsome also,” she pulled out a photo on her phone as if I were Sima aunty from Indian Matchmaking. “So wherein lies the conundrum?” I asked. They leaned forward, I’m guessing for me to repeat myself. “What is the confusion?” I simplified. “He told us that his father has Parkinson’s. We want to know if Parkinson’s is hereditary and if the boy can get affected in the future,” they asked, speaking frankly. And I’m guessing, if it was, they would reject the proposal.

I started by explaining to them that Parkinson’s was a degenerative condition of the brain, where dopamine, an important chemical, gets depleted, resulting in tremors and slowness of movement and some tightness in the limbs. “It’s very often controlled well with medication, and sometimes, we can even offer an operation called deep brain stimulation if the tremors get out of control,” I laid out the basics. In the midst of my explanation, I remembered an elderly couple who had once confided in me not to over-treat the husband’s Parkinson’s because their sex life was marginally better because of it. But it was not my place to get into this in the current conversation, and, dear reader, I request that you refrain from doing the same in your head.

“It’s almost never hereditary,” I explained to them, alleviating their anxiety. “And in the extremely rare cases that it is, it shows up early on in life. So, you have nothing to worry about if he’s not shaking by this age,” I said with a gentle smile. “Any other questions?” I asked. “His uncle died of a brain tumour, he told us. Anything to be concerned about that?” the father added. “Certain brain tumours have a strong genetic predisposition,” I cautioned, “but it’s mostly for direct lineage, as in parent to child, so you should be fine,” I said, seeing the relief on their faces.

“How may boxes will you check before you get married?” I asked, intrigued by the thought process of seeking a partner to spend the rest of one’s life with. I believe you can be only one of two things in a marriage: lucky or unlucky. We can check as many boxes as we want, but we keep forgetting that they may all be Pandora’s boxes. As Cheryl Strayed says, “You don’t have a right to the cards you believe you should have been dealt with. You have an obligation to play the hell out of the ones you’re holding.”

“Any ailment in your side of the family?” I asked, mostly out of curiosity. “No,” she said instantly, until her dad reminded her that her mother had breast cancer several years ago and underwent surgery, radiation, and chemotherapy. “But she’s fully cured now, so nothing to worry about, right?” she assumed. “Breast cancer has a pretty strong genetic disposition, especially if your mom had it when she was less than 40,” I said, and they concurred that she did. “I don’t mean to get you worked up; all you need to do is get screened regularly,” I advised. “Is there any way to prevent it?” she asked. “Regular screening and early detection is the key,” I guided. “Some people remove their breasts if they are positive for a certain mutation, but that might be too much,” I opined. “We now have whole body genome sequencing for checking our predilection for thousands of diseases, but again, none of these are foolproof,” I said, lamenting that despite all the advances made by medicine, we continue to remain so far behind in providing certainty. Nothing is in our control, and yet, we’re busy checking boxes.

“So, will you tell him that your mother had breast cancer?” I asked upfront, even though it was none of my business. “I think I must,” she said, owning up to her end of the deal, and my heart was warmed.

“If you really want to discuss ailments, discuss mental health history in the family,” I stated, referring to its under-diagnosed nature. “If you’re getting married to a Parsi, there’s nothing you can do about it,” I joked, “but assuming you aren’t, it might be worthwhile discussing,” I mourned my wife’s plight. “Also discuss bills and money, credit and debt, parenting styles, and what beliefs you’d like to instil in your children. Discuss how you’d deal with the extended family and what are your financial and sexual expectations. Talk about childhood traumas and check if they’ve been resolved. Speak about your careers and how you’d like them to take shape. Describe your bucket list, your dream home, and your political views,” I listed out, my Sima aunty suddenly resurfacing. “And if you really want to go the distance, then cognitive neuroscience allows you a detailed testing of your personality and can identify the exact points of confrontation between the two of you. Knowing those in advance will help you understand each other better and divert the obstacle course ahead with ease,” I finished.

“We came here with such a simple question, but we’re leaving so much more informed,” she confessed with a big smile.

“May you live happily ever after,” I wished them the myth.

Six months later, they got married. Then, she brought her husband to me with back pain, which I treated with ease. Back pain in recently married couples has a specific diagnosis (excessive use of the front) but I gave him some exercises and told him he’d be okay.

“So, how’s everything?” I asked at the end of the consult. “Parkinson’s and breast cancer are the least of our worries, doctor,” they both said smiling. I understood. “Marriage is just two people trying to stay together without saying the words ‘I hate you,’” I reminded them of what Jerry Seinfeld once said, and we all laughed together.

A couple unable to imagine their lives away from each other challenge death and destiny 

He brought his wife to the hospital in a deep coma. They were both in their late sixties. I was called to see them in the ICU. “She was absolutely fine when she went to work in the morning,” Sarosh uncle told me with a dazed look on his face. “But when she got home for lunch, which she does every day, her speech was a little slurred and she was talking gibberish, which is very unlike her. She complained of a terrible headache in her temple and couldn’t complete the conversation we were having and collapsed,” he narrated. “I immediately rushed to find her completely unconscious. Our family physician and my two sisters got her here,” he said, limping from a bad arthritis of the hip that he’d been ignoring for years. He told me that she had been a breast cancer survivor for 18 years. We had noted her blood pressure to be 240/110.

“Did she smoke?” I asked. “That was her only vice,” he revealed. “About 15-20 cigarettes a day for the last 35-40 years. “Otherwise, she was the life of every party: vibrant and full of vivacious energy. We’ve been married for over 30 years and there has never been a dull moment,” he volunteered information. “But she never smoked in front of me,” he interjected. “She knew I didn’t like it, so she would only smoke in the kitchen, or if we went on a dinner date, she would excuse herself,” he told me with a look in his eyes as if they were still in college.

I examined her to note that she was completely paralyzed on the right side. She didn’t open her eyes even to deep pain. No sound from her either. The CT scan showed an 8 cm haemorrhage in the left temporal lobe, the area responsible for speech, language, and memory. “We have two options,” I tried to explain. “Either we don’t do anything and let her pass peacefully, or we remove the hematoma and see to what extent she recovers, knowing that she’ll never be normal again,” I said softly, bluntly but lovingly. “Oh my God,” he replied, unable to fathom the gravity of the situation, several thoughts probably coursing through his mind.

“Being an editor myself, I’m an avid reader of all your columns, and you’ve saved so many people who were almost dead,” he said, searching my face. “We always try our best,” I put my arm around his shoulder, “and sometimes we win, but sometimes we don’t,” I replied, feeling almost like a fraud for not being able to deliver for someone who had come to me with such hope. Over the next hour, we went through the entire spectrum of possibilities, from death to a persistent vegetative state to assisted living to the uncertainty of predicting to what extent she would recover. I was ambiguous about whether her speech would recover or if she would remember anything. “We have so many things we still want to do together,” he told me. “I would be completely devastated if anything were to happen to her. We are all we have,” he lamented. I asked him about his children, and he said that he hadn’t wanted kids and she was ambivalent. “I had often asked Ketayun who would look after us when we are old, and she used to say that we’d always have each other,” he said, a solitary tear running down his face.

“Can I accompany you inside the operation theatre?” he requested, explaining, “I would not like to leave her side. I’ll sit in a corner and won’t be in your way. I just want to sit and pray while you’re doing the operation,” he kept adding sentences, hoping I’d agree. I convinced him it would be best for him to wait right outside, and that we would be done in a couple of hours. We finally operated on her and removed the large thick blood clot that was compressing the vital structures of her brain. The tense brain was soft again. As we wheeled her back to the ICU, I told him I was happy with the surgery and the nature of the brain at the end of it. “We’ll have to take one day at a time,” I told him as I signed off.

He secured special permission from the hospital management to sit next to her 24/7. When I went for my rounds the next day, he was praying over her. I was so deeply moved by this man’s love for his wife. “Why don’t you get some rest, Sarosh uncle; this is going to be a long haul and it might wear you out. You have to be fresh and fit so you can look after her,” I tried to explain. “In fact, I was going to request you for something,” he said to me. “Can you please arrange for me to have a shower in the hospital? Because when I went home yesterday to change and shave, I was stricken with a profound grief of having left Ketayun’s side for a few hours,” he shared, wearing his heart on his sleeve.

We arranged for him to be comfortable around her in whatever way he wanted. Over the next few days, we were able to get her off the ventilator and she began opening her eyes. She could not speak because she had a tracheostomy tube in her windpipe, but she was beginning to move her right leg. Every time I walked into the room to see her, she would break out into an enormous smile, which thrilled Sarosh uncle to bits. “She’s making great progress,” I told him, as he adjusted the speaker that played healing sounds in her ears.

“Do you know, she’s taken such good care of me,” he told me on one of my daily rounds. “I often have these dizzy spells, so she used to constantly remind me to drink water. And if she knew who I was with, she would remind our friends to make sure I was drinking enough water,” he said with gleaming eyes. “‘I live for you,’ she used to tell me. ‘And you are my life,’ I used to reply.”

I went home that day and told my wife I loved her. She probably wondered what was wrong with me. I narrated this story to her. “They seem like a special couple. I would love to meet them,” she said. She met Sarosh uncle and Ketayun a few days later, when we had arranged a special musical evening for patients and their relatives in the hospital cafeteria so that they could forget about their worries for a moment. “I must have done something phenomenal to deserve a wife like Ketayun,” he told her then. “I also must have done something to deserve my wife,” I told him, leaving out the ‘phenomenal’ bit, as all of us laughed a little after three weeks of rigor.

As Sarosh uncle and his beautiful wife Ketayun left our hospital to continue further rehabilitation and physiotherapy elsewhere, I couldn’t help but remember the famous Russian poet Sergei Yesenin, who said, “In this world you can search for everything, except love and death. They find you when the time comes.”

Should you call a surgeon on his private number after work hours? Should s/he feel compelled to respond to your Whatsapp? Here’s looking at phone etiquette in matters of life and death

“There is some fleshy stuff coming out of his nose,” Vicky’s doctor called to say, backing it up with a very tentative, “I think it’s tumour, but I’m not sure.” Probably because no one would expect something so freaky, I thought.

“Send him over, I’ll take a look,” I said instantly, because almost nothing surprises me anymore. Vicky was 30 years old. He came from an unheard-of town in the interiors of Uttar Pradesh. He had some on and off bleeding from the nose, for which the village doctor kept prescribing medication until it started to get out of hand. “My nose is completely blocked,” he told me, dabbing his scarlet handkerchief. “And the headache is driving me mad,” he said in Hindi, breathing from his mouth. “His left eye seems to be bulging out more than normal too,” his sister, sitting next to me, pointed. I shone a torch into his nostril and saw that his nose was full of ‘stuff’. He could not smell and had very poor vision in his left eye.

I immediately shunted him off to the radiology department to image his entire head, and, like I said, I wasn’t surprised. There was an 8 cm ghoulish tumour occupying the entire nose that had eroded the wall of the left orbit and gone into the eye. No only that, like a rodent, it had corroded the base of the skull and gotten into the brain, opening up into both frontal lobes like an umbrella. It had no respect for boundaries. The normal protective layers of the brain – the dura and the bone – had been breached by this monstrosity. “We’ll have to remove this,” I told the doctor who had sent him to us, confirming his diagnosis with, “You were right, it is tumour.” “Is this cancer?” his sister asked; its the most common follow-up question. “We’ll know for sure once we send it for testing, but it sure does look like it,” I said to their disbelief.


A few days later, my ENT colleague and I decided to excise this together, as the tumour had destroyed all boundaries of where the nose ends and brain begins. While she went from below, emptying the nose, I went from above, opening up the head simultaneously. While she gobbled up tumour with a debrider, I meticulously separated it from the overlying frontal lobe and all the important arteries it was attached to and then removed it completely, until both our instruments shook hands with each other from inside the head. There was a 3 cm hole from where I could see into the nose and she could see up into the brain. We spent the next hour repairing the defect from both above and below to ensure that brain fluid doesn’t leak out from the nose – a nightmare for both the patient and surgeon.

Over the next few days, Vicky made great progress. He could breathe comfortably from the nose after we removed his nasal pack, although he didn’t regain his smell; the tumour was a carcinoma arising from the nerves that control olfaction. His vision had been restored and his eye regained its normal position. The postoperative scan showed a large black hole, the size of a cricket ball, instead of the previously seen white tumour. He was discharged a week later, having healed beautifully. I gave the family detailed instructions on every single aspect of care for the next week until they were supposed to return to remove the stitches on the head.

But yet, when the patient went home, the relatives kept calling a few times every day. If he had a slight headache, I would get called. If the nose was a little dry, they’d buzz. They checked with me daily on whether the medication they were administering was correct. They messaged pictures of nasal secretions to ask if they were of any significance. I thought to myself that not only had the tumour not respected any boundaries, even the relatives were not. But it was also I who had told them to call if they had any concerns. Thankfully, my patience keeps irritability away. I caringly replied to every question of theirs until they returned for suture removal a week later. The wound was dry and clean. “You can have a head bath now and shampoo it daily,” I instructed and gave them a spray to keep the nose moist.

Doctors constantly discuss among themselves if they should share their personal number with patients. While most patients are discerning enough to use it sparingly, there are some who will call even if a pimple erupts on the forehead. My daughter doesn’t want to become a doctor because her father gets too many phone calls. My wife is constantly irritated because every time we’re having a deep meaningful conversation, it’s interrupted by a patient asking weeks after surgery if they can eat meat on Thursdays. The problem is that I have to answer every call because most often the number is unknown, and until I take the call, I wouldn’t know if someone is dying or just in the mood for non-veg.

A surgeon friend from the US, who was visiting me for a week to learn the nuances of endoscopic brain surgery, was aghast to see me talking to patients at odd hours of the day and night. He was stunned to note that I replied to queries on WhatsApp all day long. “In America, we don’t give our number to any patient. If there is an emergency, they come to the ER, or if it can wait, they take an appointment with the office and come at the next available slot. There must be a balance, or else patients will walk all over you,” he told me.

“Don’t you have any boundaries?” he sternly questioned. I understood what he meant. Boundaries are important. As one of my favourite authors, Cheryl Strayed, says, “Boundaries teach people how to treat you and they teach you how to respect yourself.”

“But Indians are emotional people,” I explained to him. “We have to deal with the heart more, even though we’re operating inside the head,” I reasoned. “They simply need to know that someone is there for them, that’s all,” I put my arm around his shoulder. “And plus, when you love what you do, your focus is never on boundaries, it’s only on the sixer,” I told him, hitting the ball out of the park.

 

Redoing what you thought you did perfectly can be an invitation for ego wear and tear and gossip . Here’s why this should not apply to reopening up wounds and other wisdom from the OT 

“The dressing is not completely dry,” the doctor in charge of the floor informed me about Mary’s wound while I was on my morning rounds. We had operated on her back three days ago to relieve severe nerve compression. She also had significant spinal instability, which we had to fix by inserting some screws and rods. “I was going to discharge you today,” I told her, “but your wound doesn’t look great.” I peeled off the dressing to notice a yellowish soakage on it mixed with a tinge of blood.

“But I feel perfect!” she interjected. “On the outside,” I warned her. “We don’t know what’s going on inside.” I pondered at the deeply philosophical statement I had just made – and I wasn’t even a mental health professional. Oftentimes, we may seem unperturbed externally but there is a tsunami going on internally. I wondered if surgical wounds and human emotions had a similar modus operandi.

“It’ll settle down, won’t it?” she tried to convince me, eager to get back home. “Let’s dress it again and take a look in the evening,” I offered instead, because I don’t discharge patients if their wound isn’t dry. We took a swab from the wound and sent it for culture, starting her on antibiotics.

Very rarely do patients have some discharge from a surgical wound. This discharge is often superficial, originating from a little fat degenerating in the subcutaneous tissue, and it settles down on its own. Sometimes, if it’s infected, it could be pus, which is what one needs to be wary about, but that also often subsides with a course of antibiotics if it is depthless. It is the deep-seated ones we need to be cautious about. And like emotional wounds, we can’t tell the difference until it’s too late.

When I returned in the evening, the dressing was soaked a little more. It also had a slightly offensive smell to it, I realized, as I pulled the gauze off the wound and brought it to my nose to take a sniff, much to the disgust of the nurses and interns around me. “If it’s your mess, you must be ready to get your hands dirty. Only then will you be able to clean it up,” I gave them some insight, as the creases on their nauseated faces eased out. I pressed on the edges of the wound and the discharge was purulent.

“We have two options,” I told Mary. “Either we give you intravenous antibiotics and hope that it subsides, or we take you back to the operating room first thing tomorrow morning, wash it out, and then administer antibiotics.” Mary finally realized that this was getting serious. “What would you like to do?” she threw the ball in my court. “I don’t like not knowing what’s going on,” I said categorically. “Instead of allowing it to fester, it’s better to open it up, drain the pus, and clean it up,” I opined. “Infected wounds are like bottled up emotions,” I told her, doubling up as her shrink. “If you don’t make space for it, it’s going to blow up sooner or later, and that has a larger price to pay.”

Taking patients back to the operating room, especially in private practice, is considered taboo. It means acknowledging that something has gone wrong, which we need to fix. In the world of mental health, it is considered a step in the right direction, but in the surgical world, people – patients, relatives, colleagues, or administrators – will often scoff at you. It dents your reputation (as if that was ever a real thing) and everyone gossips about it (but it’ll never fall on your ears) that you didn’t do it right the first time around.

I’m very aggressive as far as opening up wounds is concerned. Especially if they belong to others. Especially if I’ve inflicted them. My theory is simple: If you’re going to war every day, you will have to take a few bullets. But with time and experience you get better at dodging those bullets. It’s not that they won’t strike you; they hit spots where it’ll hurt less.

The next day, we took Mary back into the operating room, flipped her on her tummy and made an incision into the previous wound. Frank pus, the kind that results from an acute inflammatory reaction, came out under pressure. We cleaned the cavity with a bunch of solutions and washed everything out for it to look anew again. “I wonder where this came from,” my colleague asked while we were closing her back up. “However much you audit it, sometimes you’ll never know,” I replied. Just like our feelings, I thought to myself.

When she came for a follow up the next week, we removed her stitches. The wound was clean and dry. It had healed cleanly, with a small footprint of us having been there. “Scars are actually beautiful things,” Mary told me. “The hurt is over, the wound is healed,” she crossed her heart. “Amen,” I went along in the name of God. I’m glad we did the right thing. Over the past decade, I’ve taken several patients back to the operating room, and I promise you, it’s not because I’m a bad surgeon. Never have I regretted the decision.

Mary was the last patient I saw that day. And like most evenings before I leave, I put my feet up on my desk and cross them over to ponder for a few minutes on the day gone by. The first thought to strike – Why do I treat my own wounds so differently from those of my patients? What pain or doubt or fear am I concealing? Would I be okay ripping into my own wounds with that much ease, tearing them apart to examine them closer?

PS: I only speak metaphorically, of course, in case there are some kind hearted aunties out there wondering, “Beta, are you okay?”

I’m fine.

 

 

 

A spur-of-the-moment decision becomes a night to remember and leads me to turning into a Swiftie dad

“Ay, dadda, we want see a Taylor Swift concert!” my Swift-obsessed Swifties said in unison one day when I returned from work. They are 8 and 9.5 years old. Their bedroom walls have handmade posters of the star, they’ve painted T-shirts with her quotes on it, they weave bracelets with names of her songs, and listen to her music all day long. Apart from every single song from every single album, they know where she was born in 1989, what her birthweight was, how many boyfriends she’s had, and at what temperature she soaks her almonds. I don’t remember being this bewitched by any celebrity in my childhood as these girls are. I’ve been a fan of The Beatles, Elvis, and Michael Jackson all my life but with none of this madness.

“Let’s see when she’s coming to India,” I told them, as I settled onto the couch with both of them atop me, searching for concert dates. “152 shows in 54 cities… and not a single one in India,” I said, looking at their sulking faces. “But,” I added, “the closest concerts to us are in Singapore… in two weeks!” We’d been planning to holiday there for the longest time, and the dates of the show coincided with their spring break in the first week of March. I clicked on the link to buy tickets, and to my surprise, everything was sold out. She had 6 shows over 8 days in Singapore alone, in a stadium with the capacity to seat 60,000 people, and all of them were sold out. And all the tickets for all her shows for the rest of the year across the world were sold out. Either this is some sort of scam or this girl really is famous, I thought to myself. I happened to find out later that it was the latter.

“Let’s go to Singapore,” I told my girls. “Yeah!” they jumped at the thought. “We’ll stand outside the stadium and ask for extra tickets; someone might sell them in black,” I reminisced. They stuck out their tongues, knowing that this wouldn’t happen, but I fully remember buying tickets in black for DDLJ and so many other movies. The 90s were so much fun. I later found out there were some sites selling resale Taylor Swift tickets and managed to source them out through a friend. We booked our tickets, packed our bags, and got onto a plane 2 weeks later to the cleanest country in the world – where a few days into the trip, my elder daughter dropped an ice cream cone on the floor but instantly picked it up and started lapping it up.

“These few miles of road can be immediately converted into an emergency landing for airplanes,” the taxi driver told us as we zipped off from the airport into the city on a runway. “Everything is booked in the city because of Taylor Swift,” he said, pointing to the National Stadium in the distance where she was performing the first of her six shows that week. I later heard – and, of course, much of this is hearsay – that she was paid an additional 3 million dollars a show to exclusively perform in Singapore out of all the South East Asian countries. We checked into a hotel on the bustling Orchard Road, whose lobby was filled with Asians who were a combination of over and underdressed returning from one of the concerts. “How was it?” I asked some of them. “Oh my god… it was soooo good la!” they screamed. This is going to be fun, I thought to myself.

We spent the first two days doing touristy things like visiting Sentosa Island and Universal Studios, where my younger one almost got run over by Kung Fu Panda. On the day of the show, the two of them spent the afternoon making more bracelets with her song names beaded into them. People exchange these at the concert and it’s a big deal. To skip the madness of the lines, we decided we’d miss the opening act, so just before Taylor was about to perform, we sauntered into the stadium amidst the loudest roar I’ve ever heard in a sports arena – and I was present at Wankhede when India won the World Cup in 2011! When she walked onto that stage to the beat of a countdown timer going from 10 to 0, the crowd went berserk. Not only teenage girls but grown men – uncles like me – who were adorned in bracelets from wrist to elbow, were weeping with joy on seeing this 34-year-old look in their direction from half a mile away.

And when she started to sing, it was one hell of a party. The crowd went ballistic, waving their arms, their wrist bands changing colour – every fluorescent hue – at every song. Over the next 3 hours and 15 minutes, she sang 45 songs with over a dozen costume changes. I knew only four songs, but I was in awe. She played the piano, strummed the guitar, sang every song live, and danced her butt off to an eclectic array of sounds and lights and a production that was stellar. The agility of the background dancers, the quality of the set design, and the magnitude of the production was something only dreams are made of. My girls were thrilled to bits dancing to every song they knew, with their idol grooving in the same room. At the end, 60,000 people exited the stadium in bliss and dispersed into oblivion amidst a sudden downpour of torrential rain.

We spent a few more days walking around the city, visiting the zoo, and going on a night safari. We had lunch atop Marina Bay Sands and stimulated our other senses at the art and science museum next door. We ate our last meal of the trip with a bunch of friends at the famous Lau Pa Sat open-air food court, where we bumped into some other friends from Mumbai who were also there to see the concert. It turns out we weren’t the only crazy ones.

We returned to Mumbai and saw three and half hours of The Eras Tour concert film on Disney+ Hotstar, which is the recording of the entire concert up close and free. The little one then had a Taylor Swift-themed birthday party at home, where the cake had all the Taylor Swift album covers on it. We’ve unofficially adopted Taylor Swift. When I was young, it was aapro Freddy. Now, it’s aapri Tehmina.

One of India’s trendiest, most popular spiritual leaders has the golden chance to raise awareness around SDH and timely medical intervention. Will he?

It was when I saw in the news that Sadhguru had undergone brain surgery that I realised his full name is Jaggi Vasudev. He apparently had a chronic subdural hematoma, abbreviated as SDH in neurosurgical parlance. It occurs when tiny bridging veins between the surface of the brain to its covering, the dura, snap. The rupture can either be spontaneous or be precipitated by even minimal trauma. It often happens in the elderly, who don’t even realize they might have bumped their head somewhere. It is also more common in this age group, as with age, the brain tends to shrink a little and there is a potential space between the brain and the dura. In young adults, the brain has more ego and hence is fuller, disallowing for this potential space.

Over time, blood accumulates in this void, and when full, the liquefied blood causes physical pressure on the brain, which brings on symptoms such as headache, vomiting and occasional weakness of the opposite arm and leg – as the right side of the brain controls the left side of the body. If left untreated, this can rapidly progress to confusion, altered sensorium, and even a quick slip into becoming comatose. Allegedly – and I must confess that this is all hearsay – Sadhguru worked through several days of ignoring his headaches, performing rituals, giving sermons, and attending conclaves until his condition deteriorated to a point where it required an emergency operation to make a hole in the head and drain the blood that had collected.

The surgery itself is one of the most gratifying operations in our field, where a person can be pulled back, quite literally, from the jaws of death. You drill a hole in the skull and nick the dura with a knife, and a fountain of blood will spurt out, causing a comatose patient to instantly start talking if the surgery is performed under local anaesthesia. Sadhguru’s surgery was performed under general anaesthesia, and once he was alert enough to record a video for his well-wishers, he joked about how doctors couldn’t find anything inside his brain. I’m surprised he isn’t Parsi. I’m also happy to note that he doesn’t take himself too seriously. No one should.

What struck me instantly was to see a man always adorned in grandiosely flashy turbans and flowing shawls reduced to wearing a hospital gown, almost looking like a miniature version of the one we see in the media. The bike bouncing, soil saving, river rallying, inner engineering man was no different from the hundreds of Muthuswamys or Annamalais I had treated for an SDH. I have often maintained that medical illness is a great leveller.

But what I found even more amusing was that neurosurgical WhatsApp groups were rife with doctors who were irate that the medical community was not being acknowledged for the role it had played in saving Sadhguru’s life. They pulled out old posts of his where he spoke about why “one should not hand over your health to your doctor,” probably in a completely different context. How one’s “brain need not deteriorate with age; with simple yogic practices, you can keep enhancing it.” His own treating physicians released a press statement which mentioned that “Sadhguru is healing himself, apart from the medical measures instituted by us.”

It is probably true that if he hadn’t had surgery, we would have lost him. But we’ll never know if that is how he had chosen to go. I’m told that truly spiritual people can choose their time and mode of exit, although I wonder if anyone would choose a SDH to do so.

I wouldn’t have blamed Sadhguru for not opting for surgery either, because the treatment of chronic subdural hematoma has also undergone a paradigm shift in the recent past – although I doubt he might have known the full extent of it. Smaller amounts of blood can now be resolved with a course of steroids, and newer medication, which works by blocking the breakdown of blood clots to prevent bleeding, has also helped some people avoid surgery. In some cases, we can even embolize the blood vessel that is partly responsible for the bleeding by injecting glue through the groin. Perhaps Sadhguru was on some kind of medication to see if the condition might reverse itself, and hence, we shouldn’t pass judgement calls on his seemingly irresponsible attitude of not opting for surgery immediately, although a lot of doctors did. When he gave his surgeons the go-ahead to perform the procedure, it was apparently because he was losing function of his left leg.

This brings us to another interesting question posed by a friend: Does the constant evolution of science make you lose faith in its accuracy? The treatment we offered for certain medical conditions a few decades ago are considered barbaric today. It is highly possible that what we consider state-of-the-art practices today will be scoffed at very soon. There are innumerable instances of people having healed themselves with unconventional and alternate techniques. But for the rest of us, for now, we have to make do with what science has to offer us today, because science is a self-correcting process where new evidence, discoveries, and insights lead to revisions and refinements of existing knowledge. This process is what drives scientific progress and allows our understanding of the world to become increasingly accurate over time.

Through the work of various spiritual foundations across the country, what is also evolving is the ability of people to explore their inner selves and transcend limitations to live a more conscious and fulfilling life. Thanks to people like Sadhguru, individuals are able to explore and enhance their inner dimensions, leading to greater peace, joy, and fulfilment in life. While he heads the non-profit Isha Foundation, most of my profits are nullified when my wife orders their products home.

I am relieved to learn that Sadhguru has recovered completely and is doing well. The neurosurgical community wishes him great health to continue his humanitarian work. He has a global following and his teachings are imbibed by all generations. I’d like him to tell his devotees that while it is paramount to take responsibility of their own health, it is equally important that they pay heed to their doctors too. I hope he uses his rich baritone to

spread awareness of this condition and enlighten people on why a headache should not be ignored. After all, he is now SDHguru.

 

The best surgeons in the world lose to the universe sometimes. And they don’t know why. This story is about mysterious deaths doctors cannot explain

“Hey, Maaz,” a friend of mine randomly called up. She’s the kind of friend you don’t talk to often but feel connected to the moment you have a conversation. We all have these friends. There is no compulsion to make small talk or exchange pleasantries, asking about families and discussing other trivia before getting to the meat of the discussion, even if you’ve picked up the phone after months or,at times, years.

“I’m calling about my second cousin, who’s 20 years old,” she gave me the brief. “Last night, she was out at a family function where she was perfectly fine. She doesn’t have diabetes,blood pressure issues, or heart problems. No drinking or smoking,” she categorically emphasized like an astute narrator, as these are the questions doctors ask first. “This morning, she woke up and walked to her parents’ bedroom, saying that her right arm was feeling funny. As she was describing the problem to her father, it stopped moving. She started weeping profusely, not understanding what was going on, as she was suddenly not able to lift the hand,” she tried to narrate the sequence of events as accurately as possible. “Then the right leg went numb within the next few minutes and was completely paralyzed,” she explained. “It was as if she had had a stroke where one half of the body couldn’t move,” she gave her interpretation. I listened intently; all this was unusual for a young girl.

“They planned to rush her to a hospital in the suburbs close to their home, but within the next few minutes, she collapsed and stopped breathing. Her sister, who was also at home, had received some paramedical training at her workplace for emergencies. She felt her pulse, realised it was absent, and started giving her CPR, which revived her transiently. They put her in a car and took her to a hospital 15 minutes away. When they reached, the doctors recorded no pulse or blood pressure but nonetheless tried to resuscitate her. After several attempts and after the heart having stopped on multiple occasions, they were able to get her back to life,” she described as best as she could.

“But an MRI done after stabilizing her has shown severe damage owing to a lack of blood supply to the deep parts of the brain, and the doctors are unable to clearly say if the issue is in the heart or the brain or the blood vessels that connect the two,” she sounded exasperated. “They’ve said that her survival looks unlikely, but it’s been only 24 hours since all this began!” she exclaimed rhetorically, as if to ask how someone could make such a declaration within a day.”

“What would you like from me?” I asked,as I wasn’t the treating doctor nor was she in my hospital. “Can such a thing happen to a 20-year-old?” she asked in utter disbelief. “Obviously, it’s extremely rare, and whatever has happened seems freaky, but I’ll talk to the neurologist there, who is a friend of mine, and get a more technical picture,” I offered.

“She’s brain dead,” the neurologist told me. “Her pupils are not reacting, the brainstem reflexes are absent, and there is no response to any sort of deep pain. The MRI shows extensive infarcts in the brainstem, but the blood vessels and heart are okay, so we really don’t know where this has come from,” he confessed a truth that we deal with daily – that we know so little. “We can only postulate multiple possibilities,” he went on to list all the causes of strokes in the young. I conveyed the message to my friend to pass on the information to the family. Her father asked if he could speak with me, and I agreed.

It was 9 PM in the evening. I had just finished seeing my patients and was about to leave for the day when the father called. He narrated the entire story of what had happened the previous day and told me that the doctors were trying everything but had declared her brain dead. “I want you to come and see her once,” he pleaded. “She was laughing and dancing the previous evening, the life of the party, and today I’m being told she’s not going to make it,” he said with such profound grief that I had tears running down my eyes. I seldom cry; the last time I did was when I lost a patient 2 years ago after making multiple attempts to salvage her over a month. “I’m unlikely to tell you anything different from what the doctors there have told you,” I said. “Come as a friend, don’t come as a doctor,” I could hear him sob. “I cannot let my baby die,” he said in a muffled voice. I couldn’t refuse. “I’ll be there around 11 PM,” I confirmed. I requested the neurologist to allow me to see her. He willingly obliged.

After the phone call, I sat in my office with my feet up on the table, and in the eerie silence of the floor, couldn’t help but wonder what I’d do if this were my child. What would I want from the universe? We have all heard about the brutality of a life coming to an unexpected end, but when that happens to someone in the effervescence of their youth, it is even more shocking. The truth is that unless it is our own blood, we can never fathom the depth of that grief. It is a bottomless pit. And however hard we try, there will be no answers. Closure is often a myth.

I reached their hospital close to midnight, where the entire family and several friends waited for someone to tell them something different. I examined her and peered through the scans in detail. I could only reinforce what the doctors had told them. I had nothing more to offer. “Is there no way to reverse this?” the father asked with an ashen face, as the mother stood next to him, lifeless herself. I shook my head sideways. “Is there any way to know why this happened?” they wanted some clarity. “A postmortem might give us some clue,” I said, but I later realized how cruel that must have sounded. “You can consider donating her organs; that way, she lives on,” I tried to propose an alternative, but that didn’t go down well either. “We’ll try whatever we can for a miracle to happen,” they told me. I knew that I, as a man of science, would probably do the same if this were my child. At some point, the acceptance must come, but these journeys are extremely personal, and a doctor should never impose their belief beyond providing an honest heartfelt opinion. I left the hospital feeling helpless and hopeless. We have made so much progress in our field, and yet, at times like these, it feels like so little.

She passed way two weeks later.

A visit to the temple town of Tirupati gives this doctor an intimate look at the grandeur of religion and the power of faith.

“Have you heard of Tirupati?” I asked my daughters, after my wife and I returned from a visit to the holy town. “It’s that place from where everyone comes back bald, na?” they answered in unison. I was very impressed at the association. “Why didn’t you go bald?” the older one asked. “He has very little to offer in that department,” the younger one retorted, tapping the vertex of my head.

“You cannot come to Tirupati and not visit the Venkateswara temple in Tirumala, the abode of Lord Balaji,” a swami patient of mine told me when he heard of my plans to visit the city. “I can’t stand in line, Swamiji,” I pleaded, trying my hardest to not sound South Bombay-ish. “Don’t worry, doctor ji: with the blessings of the almighty, everything will be arranged for you,” he assured. “Please keep yourself free on the first half of Saturday morning,” he signed off.

A car picked us up from the ashram we were residing in and drove us 30 minutes to the bottom of the hill. “Most famous temple in the world this is!” the driver told us in ‘Teluguan’ English. “Why is it so famous?” I asked. “Whatever you wish for comes true,” he told us. “One lakh people take darshan here every day,” he added. That’s the world population of the entire Parsi community, I thought to myself. “And two crore rupees is donated to the temple daily,” he said proudly. My uncle, who was travelling with us, told me that his boss used to take suitcases of money to donate. “Lord Balaji was a 10% legal partner in his firm!” he said.

“Do you know anyone as famous as this Lord?” I asked my daughters. “Of course,” they chimed in eagerly, in sync. “Taylor Swift! She has more than 500 million followers on Instagram, and she makes 1 million dollars a day,” they rattled off facts whose validity I could not check. That’s about Rs. 8.5 crores a day; four times wealthier than the Lord on a daily basis, I pondered. “And she makes wishes come true,” they added. “Maybe she should have a temple,” I suggested. “Arizona’s Swift City is like a place of worship for all Swifties, dadda,” they educated me.

We met Swamiji at the bottom of the hill on which the temple is situated and he whisked us through a VIP drive-through. After a scenic winding route laden with pretty flowers, we reached the temple city of Tirumala, a fortress in its own right. Men in unform armed with guns paraded each of the entrance gates. We were driven straight to one of the residence quarters. “There are four families of head priests,” Swamiji said, as he introduced us to one of them. “He is the one who dresses up the deity every day,” he proudly announced, as they were related. The priest placed a red tilak on our foreheads and we were served traditional breakfast in the dining hall. We kept our mobile phones away, removed our socks, adorned our dhotis, and made the march with the sun darting its rays on the tar.

“There are several queuing systems that don’t allow for one to understand the magnitude of the crowds, but IIT Madras is responsible for these smooth passageways to greet the almighty,” Swamiji gave us some trivia. We were sitting in a room that was screening a live puja going on in another part of the temple ground, where they marry the Lord Balaji and his wife, Padmavathi (an incarnation of Goddess Lakshmi), on a daily basis. “Bhagwaan ko bhi itna torture karte hai?” I asked Swamiji, who insisted that I should come again at the age of 60 to get remarried. “To the same woman or a different one?” I asked with a poker face, while Swamiji turned his head to my wife for confirmation. Luckily, it was time to change rooms and get into a fast-moving line that meandered from one part of the complex to another, until we entered the four walls of the main temple precinct with a gold-plated tower atop it.

Loud chants of Govinda, Govinda, Govinda – which, I found out later, was another name for the Lord – kept the line moving, as security guards made sure no one loitered around. The loud emphasis on the first syllable of the name made me wonder if it was just a strategic chant to keep people go, go, going on. We got a glimpse of the idol decorated in jewels in a dark room faintly illuminated by a few diyas that added to the mysticism. The head priest whisked us into the sanctum sanctorum where we were allowed to wait a few minutes before being ensconced in chants of Go, Go, Govinda once again, which took us back into the line. We were done in an hour. “Why are the Lord’s eyes always covered?” I asked, referring to the white mark over the idol’s forehead that covered his eyes. “Devotees cannot look directly into the eyes of the Lord, as he radiates cosmic energy, which mortals cannot handle,” Swamiji explained. Some others say that he doesn’t want to discriminate who he is granting his wishes to; he grants them unconditionally. We were offered delicious lunch and expressed our gratitude for this experience.

We drove down the hill to meet Padmavathi, the Lord’s wife. Why they have different temples a few miles apart is confusing. If gods cannot live together as a married couple, how can one blame us mortals? We paid our respects there too, as this is required to be done to complete the circuit. We ended the evening with filter coffee at a local jaunt outside the mandir and strolled along shops selling temple paraphernalia.

“Someday, we’ll see all the places of worship in the world,” I told my kids. “We’ll start with Swift City in America!” they said unanimously. “We’ll start with Udwada,” I gave them a stern look. “We haven’t been this year and it’s time to go!” I reminded them.

This Navroze, may whatever you wish for be yours. As long as someone else isn’t wishing for the exact same thing – because then, you’ll have to share it. May the gods you believe in grant you serenity, wisdom, courage, and compassion. May you always be healthy and mostly be happy.