Pressure, Patience, Prayer and some Lennon

“Mazda, they need your help in the next operating room.” It was the unmistakable voice of the panicky nurse who had run in as I was suturing the scalp of an old lady with a brain tumour way past midnight. I usually sign my initials (MT) on the head of every patient I operate on; reflecting on what’s left inside it after I’m done with surgery, but this time I handed over the winding up to my assistant and paced across to the other side to see two of my colleagues operating on a 30-year-old alcoholic with a severe head injury; both their hands saturated with the hues of red on their gloves.


They were religiously following the three P’s of how to control torrential bleeding from a large ruptured blood vessel in the brain: Pressure, Patience and Prayer. Sometimes the best P is Prevention, but we were way past that one here. In a series of quick manoeuvres, working well as a team, we brought the situation under control. The patient made a complete recovery, which, I must admit, is not always the case.


The myriad emotions, stresses and anxieties that a brain surgeon goes through when there’s copious haemorrhage are rarely explainable. If you’re an adventurist, it’s like bungee jumping for an hour at a stretch. If you’re a cricket fan, it’s like facing Wasim Akram, Courtney Walsh and Dennis Lillee all at the same time. But once you’ve successfully stopped the bleeding, the feeling you get is similar to the one you get at the end of a Zubin Mehta symphony — mystical relief!


It’s surprising how different surgeons react to blood in diverse ways in the operating room. I suppose it’s similar to how individuals react to cockroaches. There are some surgeons who will chase every red blood cell they see to keep their operative field spotless, while there are some who can do a perfect job amidst brisk gushes. There are some who shout at the top of their voices and panic, and then there are those who display composed aggression. “First control yourself, then control the bleeding,” I used to hear my father tell his students when, as a child, I made trips to the operating room with him.


It is in these few moments on an operating table that your true self is tested and your real character emerges. Years of hard work, relentless practice, a temperament of steel and immense courage all boil down to these precious minutes, when everything is a matter of life and death — or a little more than that. It’s quite similar to preparing for some of life’s big occasions, where you have no option but to succeed after being down and almost out or at other times you fail even after you have kissed the face of success.


Like Andy Murray finally giving England something to cheer about with his Wimbledon glory after the nation’s 77 year heartache. Or then, like Milkha Singh at the 1960s Olympics Games who mysteriously turned back toward the end of the race after having been in the lead for most of it, and as a result came in at 4th place. Unlike these superstars, however, we run our big races and play our greatest matches on a daily basis. Not only doubling our victories, but also our failures.


Giving in to a certain preoccupation with my occupation, I wonder if there exists a stereotypical surgeon’s persona? Focused and organized or arrogant and non-communicative or perhaps a combination of all of the above.The truth is we are as apt to harm as we are to heal and this realization is what keeps most of us duly balanced.


We are often taught in our training years, which in our case happens to be life-long; that skill is only a fraction of what makes a good surgeon. Atul Gawande, an Indian American surgeon and journalist says, “No one looks at your hands to see how much they shake when you are interviewed to be a surgeon. The physical skills required are no greater than for writing cursive script. If an operation requires so much skill only a few surgeons can do it, you modify the operation to make it simpler.”

To make things simple – for ourselves at the operating table and for our patients and their loved ones in times of crisis is what makes the good surgeon in my opinion. But at the same time….simple is hard. Really hard!



Human beings use various methods to deal with the complexities of life. Some resort to prayer, some to astrology; they change the direction in which they sleep while sometimes also making their goldfish do the same. Some immerse themselves in the arts, while some in commerce.  Each of these quirks defines us.


I’m reminded of a story of how a young boy went to the wise man of his village to challenge his wisdom. With a bird in his hand, he mockingly asked the sage whether he knew if the bird was dead or alive. The enlightened man saw the arrogant boy’s fingers encircling the bird’s neck, and knew that if he replied that it was alive, the boy could easily squeeze its neck and let it die. If he said otherwise, the boy could let the bird go and allow it to fly away. After a pause, the old man made an astute reply, “The answer, my son, lies in your hands.”


So it is, too, in the operating room. When we’re faced with grave challenges, the answer often lies in our hands. Sometimes it’s our skill, courage and attitude that guide us, but often it’s the last big P that sees us through. Prayer. ‘Science without religion is lame. Religion without science is blind.’ Albert Einstein said so.


On a lighter note, what we also occasionally do in demanding times is rely on some music to give us some direction. While anaesthetists usually listen to Comfortably Numb by Pink Floyd to put their patients to sleep, when we are faced with a crisis we customarily turn the volume up on How, a song by John Lennon, which sums up every single human being’s state of mind at some point in their life:


Lennon asked, echoing oftentimes, our state of mind at the Operating table.

“How can I go forward when I don’t know which way I’m facing?

How can I go forward when I don’t know which way to turn?

How can I go forward into something I’m not sure of?

Oh no, oh no.”