The heart is where the head is

In 2005, I made my transition from GMC to CMC—Grant Medical College to Christian Medical College. After fortuitously having completed my MBBS at the 150-year-old hospital, fondly called JJ Hospital, I packed my bags and immeasurable memories and moved to another institution that also happened to be over a century old. My love for the archaic definitely had something do with the fact that I was Parsi. Being old-fashioned myself, I entered Vellore like one enters a great love affair: with no exit plan.

As an unsure 24-year-old aspiring to learn brain and spinal cord surgery, I worked in the neurosurgical intensive care for two years before securing a residency spot in 2007. Only after completing a pre-residency programme does one have a chance of getting into an actual training programme in the subject of one’s choice, as it is in this nascent yet effervescent period that most aspirants eventually end up deciding against the pursuit of the field.

 

The work hours are horrendous and there is no time to sort out your confusions and make them clearer. By the time you’re done pondering, someone will be dead. I was overwhelmed with how much people around me knew, and without much ado, I was thrown into the deep end, struggling to stay afloat for the next several years.

 

The trick of survival, I soon realised, was in being able to convert the struggle into a joyride, the challenges into golden opportunities of learning. I rapidly had to create my own support system. So, I got myself a local guardian; expeditiously mastered my Neuro-tamil; hurriedly adjusted to the ‘mess’ food (no pun intended); instantly made all the ‘sisters and brothers’ in this Christian institution my friends; and began interacting with professors from various departments, so that if my neurosurgical patient had a problem with another organ, I didn’t reach a roadblock with his treatment. And in all these interactions, when I told them I’m Parsi, I found almost all of them being curious to know what was the latest on how we dispose off our dead. It’s actually a great icebreaker!

 

The city of Vellore is quaint and charming with no tourist attractions but a 200-year-old fort—and, like in every Indian city, a 100-metre stretch of road called Mahatma Gandhi Road, where all of life’s basic necessities can be fulfilled. Over the years, the city took shape around the hospital campus. The hospital is Vellore city’s ‘downtown’. The place is a maze with 75 wards, 120 departments and 5,000 daily outpatient visitors. There is a certain charm to the chaos. As you negotiate your way through the narrow corridors, you see walls lined with quotes from the Bible, and soft ‘praise the lord’ Christian jazz peacefully permeates through doors and windows. With small golden lamps artistically arranged in the chapel that is located in the centre of the hospital, the place looks ethereal, making me believe that God was with us on a mission here.

 

The neurosurgery residency was difficult. Sometimes you go 36–48 hours without catching even a wink of sleep. It is at these times that out-of-body experiences don’t seem like a rarity at all. You’re walking six inches above the ground swaying from side to side, making it difficult for a bystander to tell the patient from the doctor! If there’s one thing the residency teaches you, it is that the days you are most uncomfortable are the days on which you learn most about yourself. Some might object to this sort of existence but the program is structured such that there are several people at different levels taking care of one particular patient, and there is no negligence in any form of management, however ‘spaced out’ you may be.

 

The fantastic thing about the training is that you are always supervised. Right from the time you examine a patient to the time you operate on them. Then, to complete the cycle, you do the supervising once you’ve become competent. Your training begins with learning to make a simple stitch to performing complex surgeries; from conducting rounds and teaching students to presenting your complications and being grilled for them; from learning on whom to operate and, more importantly, on whom not to operate. The training includes dealing with an array of emotions ranging from fear, anger and frustration to empathy, despair and grief, right up to confidence, ecstasy and exaltation—all in a state of equanimity. After all, each of these emotions is related to a human life, God’s most sacred vessel.

 

In 2012, I completed my residency, and this brought me to another turning point, as my mind was further bombarded with questions of what I must do next. Should one consider setting up an independent practice at 31 years of age, seeing that colleagues in other fields of finance and business were already making retirement plans? But neurosurgery doesn’t work like that, and thanks to the support of my family, I decided to stay on—having already completed seven golden years in Vellore—to train still further. Just when you think you have completed the most complex period of your life, the next one awaits. Now, as a consultant, the stakes are higher, the responsibilities manifold and the expectations exponential. Not only are you responsible for your own mistakes but also for those of the others. Over the years, the number of patients increased, we got more complex cases, and dealt with even more rare and unseen complications.

 

In such situations, when chaos burns like wild fire around you, all you can do is fall in love with the warmth. In the last two of my nine years at Vellore, I was finally able to put into effect mostly everything that I had learned and been trained in. All my energies had been channelized and consolidated into a field that has given me so much in terms of skill, art, passion and emotion.

 

But now, my bags are packed and I’m ready to go. As I see the bluish-grey hospital engulfed in a purple haze one last time, I pay homage to the white light of the cross that is a symbol of hope to the millions who seek its shelter. The time has finally come for me to move to another place in search of the next best thing for my family, my patients and myself. But, as my wife told me in one of the several discussions we had about this transition, you never really leave a place until it has taught you everything you need to learn from it. For me, a part my heart will always be in a place where I learnt everything about the head.

 

Mazda K. Turel

 

 

Figure

 

  1. An unedited unphotoshoped CT scan of a patient’s head showing a heart within it. The heart is where the head is.
  2. A file photo of CMC
  3. A landscape photo of CMC
  4. One of the buildings in the campus at twilight
  5. A patient’s relative praying at the chapel.
  6. A birds eye view of the city of Vellore from atop one of CMC’s buildings
  7. The CMC chapel from within
  8. The Vellore fort with patients relatives taking a boat ride.