I’ve got your back

The story of a 90-year-old who arrived with a compression fracture in his vertebrae is a good example of how doctors shouldn’t sell surgery, even if in their favour, but get patients to buy it.

“My father has not been able to get out of bed for over 2 months,” lamented Jagdish Sanghvi, as his 90-year-old dad lay helplessly on a stretcher that jutted obliquely into my consulting room. In his tenth decade of life, the old man had a full mop of dishevelled silver hair and a perfectly curated face that wrinkled every time he winced in pain at attempts to adjust his recumbent posture. “He had a fall 8 weeks ago and has been unable to walk since then,” continued Jagdish amidst short ragged breadths and heaving sobs. I let him talk, handing him pieces of tissue and placing a glass of cool water on the table.

I have never been uncomfortable watching men cry in front of me. I, too, have cried when the occasion demands it. It’s a basic expression of grief across all ages and sexes. Why should stoic men be exempt from expressing it? Jagdish must have been in his mid-60s and was unable to comprehend how his completely independent father, while remaining cognitively crisp, was reduced to frail dependency within a few weeks, physically worn out from the pain in his mid-back. I gently got him on his side and started pressing his back lightly, eventually reaching a point where it unleashed such an intense scream from the injured man that it got a few nurses running into my room. The area I had palpated corresponded to a compression fracture of the tenth thoracic vertebrae that was lit against the luminance of the X-ray box into which I had plugged in the film.

“There it is – that’s the cause of his problems, ”I told the son excitedly, pointing to a slightly collapsed triangular vertebra compared to the healthy and nicely squared others. I completed the examination noting the strength in the patient’s legs, which was good. He wasn’t moving only due to the pain. “The family doctor said to just keep him comfortable, that no surgery should be attempted at this age, so we’ve kept him home, but this is only getting worse and hence we came to see you. The medication or physiotherapy is not helping at all,” he finished in a fresh burst of uncontrollable weeping.

Both father and son had lost their wives and were each other’s only pillars of support. The son bolstered the father physically and the father was his son’s emotional strength; even through his own pain, he had a sympathetic smile on his face, silently conveying to me that it was his son who really needed to be taken care of and not he.

I explained to them vociferously that surgery was a very good option in his case. All we needed to do was inject some cement into the collapsed vertebra and fortify it; the heat generated from the cement would then numb the nerve endings in the bone that generated the pain. “We can do this under local anaesthesia,” I implored, setting to rest a gnawing concern of theirs. There were apprehensions about his age, him being able to lie awake on his belly for the entire duration of the procedure, management of his high blood pressure and diabetes… I navigated all their copious questions and got them to finally agree on surgery.

“You must never sell an operation to a patient,” I remember a professor once telling me, “you must get them to buy it.” And more often than not, this is a philosophy I adopt, simply laying down the pros and cons and allowing the family to decide. But sometimes, when you have a cogent solution that will almost certainly relieve your patient of their malady, the only reasonable thing to do is to be unreasonable about it and goad them into making the right decision. The elderly are an extremely valuable asset to our community. They bring with them a grit and grace, a courage and compassion that comes with the wisdom of living a long life. There is a lot to learn from them. It is our moral obligation to care for them to the best of our ability.

The next morning, Mr. Sanghvi lay prone on bolsters, shivering in a freezing operating room. We armed him with a warmer that soothed him a little. After cleaning and draping him in the usual fashion while our anaesthetist kept him preoccupied with the latest in the stock market, and after giving him some local anaesthesia to numb the area, I directed the needle to our target using intraoperative X-rays and injected 5 ml of toothpaste-like cement into the vertebral body. Live images showed the cement seeping into cracks and crevices augmenting the injured area. Very rarely, the cement can extravasate into the bloodstream and enter the lungs, causing a sudden collapse, but knock on wood – we were okay. I withdrew the needle and sealed the entry point with a stitch.

We flipped him over and asked him to wiggle his toes and bend his legs, the first thing we do after every spine operation to ensure we haven’t caused any harm. He did so effortlessly, without even a wince. A few hours later, I went and saw him in the ward. He lay in bed smiling, chatting with his son. “Would you like to try and walk?” I interjected. They gawked in disbelief. I put the side rails down and extended my hand for him to get a grip as he seated himself at the edge of the bed gingerly for the first time in 2 months. Then, he reluctantly planted both feet on the ground and stood up, taking his first step. For his son, it was like watching Neil Armstrong take his first step on the moon; he once again wept vehemently. Tears are a most confusing body fluid: they express themselves the same way even in diametrically opposite extremes of emotion.

The next morning, Mr. Sanghvi had taken a shower on his own, had oiled and neatly partitioned his dishevelled silver mop, completed a walk around the corridor, and then sat upright in his bed reading the newspaper. “How do you feel this morning?” I asked. “Younger than my son,” he quipped, and his perfectly curated face wrinkled again – not with pain but with a hearty laugh.

27 Comments on “I’ve got your back
  • Vishnu Mulchandani says:

    The art of counselling convincing for surgery resulting in pain free situation because the surgeon knows his job from his dedicated experience…..moreover A good surgeon is the one who knows when not to operate ……Regards God bless 🙏

    Reply
  • Poonam Nowzadick says:

    Thanks for sharing..keep it up.
    I m proud of you Doctor
    As usual always be here to help and care for your patient.
    God blessed you and gives you lots of courage n success in your career life

    Reply
  • Cashmira says:

    Your diagnosis was so accurate…. bravo
    I absolutely love the way you write your expirence

    Reply
  • Supriya Correa says:

    And you, Mazda, put the spring back into his step! How easy you make a surgery look…Another chance for father and son to put their best foot forward, thanks to you. Such talent – well done!!

    Reply
  • Dr Ram Dama says:

    Really appreciate Dr turel good case with proper treatment and smile on the face of patient is really a reward of a doctor.thank you for sharing a nice case.

    Reply
  • Avinash karnik says:

    Dear Mazda,
    Your expertise in the operating theatre laced with superb command on picking the right words at the appropriate places mingle so easily with each other that the reading becomes a happy moment. Keep up the good work to help the patients and also the readers with a hope of good life even after nasty injuries to their head & spine.
    Avinash

    Reply
  • Dr Indu Bansal says:

    Such a beautiful description of surgery in simple words and its soothing effect on patients and caregivers misery. The way you tell your stories is truly magical and captivating. Keep on doing the excellent work.

    Reply
  • Daisy Jesia says:

    A superbly written article by an absolutely wonderful doctor, who, above all else is a fabulous human being!
    I so look forward to your articles!

    Reply
  • Vineeta Rao says:

    Your patient will be eternally grateful.Knowledge,skill,compassion,genuine concern in the right doses can work wonders and release a flood of joy!

    Reply
  • Anuradha karnik says:

    An excellent narrative showing the doctor patient connect, the gamut of raw emotions which suddenly spill over. The firm yet assuring grip of the doctor’s hand when an important life threatening decision is made and finally the joy and gratitude at the eureka moment. Sums up to what an excellent surgeon and good human being you are Dr Mazda Turel. Blessings

    Reply
  • Sunaina Naresh Saraf says:

    Bravo Sir
    Continue the good work & be ur original self always

    Reply
  • Marzin says:

    You’re not just a neurosurgeon, but also a psychiatrist (getting him to buy the operation). You sure know how to handle a patient mentally. I guess the body responds to the mind as much as the mind responds to the body
    Great job, Mazda

    Reply
  • Vipul Shah says:

    Dear Dr Mazda

    Very well explained the procedure for 90 years young patient……..

    Bravo….

    You virtually took us in OT…….

    Keep on writing exciting Experience

    God bless

    Reply
  • Dr. Jibril A. A. says:

    This is so heart warming and professionally satisfying for Dr. Mazda and indeed all doctors globally.
    MK Turel, may your days be prolonged in service to humanity and may you train as many younger Neurosurgeons as possible to continue with this wonderful service long after you might, inevitably, have left to the great beyond.

    Reply
  • Hutoxi Doodhwala says:

    Another superb experience that you have shared making the whole process sound so easy peasy . You have God’s gift of healing people. Well done son!
    Keep up the good work.
    Cheers!

    Reply
  • Rita singh says:

    Very encouraging article for seniors.who most of the time r discouraged from seourjery by family n doctors both.Salute to ur dedication for all.

    Reply
  • Farokh P Bharucha says:

    Dear Dr. Mazda Turel reading your article the way you put your pen to paper is really amazing & worth reading it many a times without getting bored, the way you explain the whole process in your wrire up gets very interesting to read word by word & sentence to sentence.
    God Bless you & may you go on gaining success in your profession throughout your life.

    Reply
  • Gloria Msampha says:

    Good ending for the old man. We tend to think that because a person is old, their bones can’t be fixed. To convince a man his age to go for surgery is a miracle. My mother or father would not have agreed to do any surgery. Glad the old man was able to smile again.

    Reply
  • T George Koshy says:

    As usual Mazda..ur descriptions and choice of metaphor and simile make the whole scene come alive in our “mind’s eye”..all the best for all ur future surgeries..may they always have happy endings and PLEASE NEVER EVER STOP WRITING ..like I have mentioned often earlier make it a best seller collection of short stories or a block buster tv serial..”tears are the most confusing body fluid”..☺️

    Reply
  • Cyrus Desai says:

    Excellent!!!!’ Down to earth in its simplicity!! Your observation on expression of emotions very touching. Keep the narratives coming. The Jame Jamshed no longer has its earlier content. The only article of interest are your articles which are worth reading.

    Reply
  • Cyrus Tampal says:

    Doc you are a GENIUS.

    Reply
  • Capt. Rumi Engineer says:

    Your penmanship as well as your medical expertise is an absolute treat, Doctor.
    Please continue your wonderful work and may the Good Lord give you more power to your hands.

    Reply
  • Chanda says:

    Dear Dr. Mazda,
    You are one unique doctor under whose scalpel and care one would wish to be, if ever the occasion arose. As mentioned before ( I’m sure by a great many ) your experiences need to be compiled and presented as a hard copy which could enlighten countless of being humane – as you are.
    Yes, truly, please do continue penning jists of your wonderful and noble contribution to humanity. Look forward eagerly…to many more such experiences.
    Thank you and God Bless you!

    Reply
  • Dr Sangita Jain says:

    Great work and article

    Reply
  • Dr Shivkumar Dalvi says:

    Extremely well written.Opening like a detective case n then taking to its successful happy ending but on the way unravelling all the details in a simple n easy to understand language.Grt going…

    Reply
  • Jyoti Verma says:

    I just love reading your articles the passion and love for your profession and the compassion that you have for them is extraordinary…

    Reply
  • Dr Kaizer Barpt says:

    I was reading your article. I was very much impressed by the way you treat your patient, and the personal interst you take in treating every patient. Though it is said that neourosurgery is a thankless job. I congratulate you Sir and continue doing the good work. May God bless you in your work and give you success.

    Reply

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