The Surgical Age

Performing a complicated surgery on a nonagenarian is usually avoidable, but should you give up without giving them a fighting chance?

I was clipping a ruptured aneurysm in the angry brain of a 35-year-old girl at 9 PM on a Thursday evening, when a nurse walked into the operating theatre with a message from the ER that she’d been asked to deliver: “There is a 95-year-old man with a large hematoma (blood clot) in the brain. He’s drowsy and paralysed in the right arm and leg.” Without seeing the scan or asking for any more details, deeply engrossed in the critical part of my ongoing surgery as I peered through the microscope, I responded crassly, “He’s 95; let him go in peace.” I could see the nurse nod her head through the corner of my eye, saying, “Okay, sir” as she exited. I dissected around the aneurysm and placed a clip perfectly on its neck, securing it from further rupture. I was ready to call it a day.

The nurse returned a few minutes later. “The family too doesn’t want surgery or any form of aggressive treatment but wants to admit him under you for comfort care till he passes,” she ended. “Sure,” I replied briefly, while inspecting the precision of my clip placement and ensuring that no arteries were incorrectly stuck within. I sprinkled the now soft and peaceful-looking brain with saline, sutured the dura, and put back the bone. While we closed the head, I asked my colleague, the surgeon assisting me, “If that was your grandfather, would you operate on him?” “I wouldn’t do anything even if he was 75,” he replied, confident in his knowledge and experience that the elderly don’t recover well after surgery for a massive blood clot. “You finish closing, and I’ll go see the old man in the ICU and talk to the family,” I told him, removing my gloves, feeling the exhaustion of two 4-hour operations in the day.

Mr. Gupta lay on the first bed as I entered the ICU. My first impression was that he didn’t look 95. His son-in-law stood next to him as the nurse placed a blanket over him to keep him warm. His eyes were closed but he opened them after my third try of calling out his name and shaking him a little. “Show me your tongue,” I said, raising my voice after learning that he didn’t have his hearing aids on. He gently pulled out his parched tongue. “He’s a bit dehydrated,” I told the nurse and asked them to run some intravenous fluid. “He’s not had anything for the past 12 hours,” his son-in-law mentioned. He raised his left arm and leg on my command but couldn’t move his right. On further questioning, he seemed confused about where he was and even which century we were in. He could barely utter a few words.

I plugged the CT scan films into the viewing box and, as informed to me, there was a large subdural hematoma compressing the left half of his brain responsible for his right-sided weakness. But this was a chronic subdural hematoma, which has a very different prognosis from an acute one. The former entity often occurs in the elderly with or without minor trauma, and a simple small hole made in the skull to drain the waterlike blood results in good recovery. When the clot is acute, the blood is thicker and it requires a bigger operation and has a poorer outcome. My stance changed in an instant. I explained my intention to do an operation and to do it now. The son-in-law was befuddled; he had just conveyed to the rest of the family who was out of the country that they were going to let him pass in peace.

They put me on a conference call with his two sons, one in Dubai and the other in the United States, and I explained why I had changed my mind. “If he was completely independent prior to this recent affliction and as he has no other medical co-morbidities, I would operate on him,” I explained. “He’s so old and he’s lived a full life. He’s just recovered from throat cancer and we don’t want him to suffer. Have you operated on a 95-year-old before?” they asked me. “No,” I said, “but I’ve operated on quite a few in their late eighties, and most of them have done well – but the final decision is yours.” I concluded by explaining all the risks and benefits of performing brain surgery on someone this old. They had a quick internal discussion and then said, “Go ahead.”

My colleague from the previous surgery walked up to me. “The aneurysm is extubated, she’s absolutely fine. I’m going home; it’s midnight.” I shook my head. “No, you’re not; we’re operating on this 95-year-old uncle right now.” I could almost hear his jaw drop. “We’ll do it under local anaesthesia,” I added. Within a few minutes, we had him in the operating theatre. We numbed his scalp and sliced into it, drilling a hole in the skull. I incised the dura and dark altered fluid gushed out under pressure. At that very instant, he started moving his right hand and leg under the drapes, and by the time we finished, he had even started talking coherently. We shifted him back into the ICU within the hour, and his son-in-law was shocked to see the transformation. His children, who had steeled themselves for his demise, cancelled their tickets.

The next morning, Mr. Gupta was as fresh as a daisy sprinkled with morning dew. He told me the story of how he had been diagnosed with throat cancer 8 months ago and that the oncologist had told him that they couldn’t treat a 95-year-old. He then sourced out immune therapy medication after seeking a second opinion and was now in complete remission.

In medicine, we often generalise, and more often than not, it is correct not to be aggressive when the patient is at such an age. But we must make room for the exception that will defy all odds and we must have the courage to follow one’s gut instinct. It is said that there is an exception to every rule. The exception was in front of me: I watched an old man chatting away, seeming young again.

“I have a four-bedroom apartment on Altamount Road, but I live all alone. Both my children are abroad. I bought the house for Rs. 4 lakh in 1975, and now it is over 15 crore,” he beamed with pride. “Uncle, don’t forget to write my name in your will!” I said in jest, and everyone in the ICU along with a nearby patient burst out in a laugh.



45 Comments on “The Surgical Age
  • Taizoon Khorakiwala says:

    What a happy outcome… did you feature in his will

  • Chanda says:

    Now I’m positive that Angel’s in disguise do exist.

  • Anjali Patki says:

    Excellent narrative. So true, it seems retrospectively a superb decision. Imagine if you’d have let him go. Age is a matter of perception. At one time 50 was old, now that I’m there, i think 90 is old…hehe

  • Dr. Pradip Kumar Tiwari says:

    Absolutely brilliant write up. Sometimes when the whole world seems to be at the end there is a spark which brightens everything. Even I had a case who was totally bed ridden with an abscess in the temporal region following chronic suppurative otitis media and after operating him he could walk. His happiness was beyond imagination. Same happened with a guy who had a knife crossing the midline of the skull base and next day after operation he was walking all alone. Life do gives you a chance, just that you need to take that call.

  • Dr. Shilpa Tatake says:

    Amazing article Dr. Mazda…as you rightly did mention we have a tendency of generalization and how conveniently we use it….!!!

  • Natwar Panchal says:

    Great Dr. 👍

  • Navzer Irani says:

    Wonderful you did what you are trained for and leave the rest in HIS hand. A perfect storey for Easter.

  • Vipul Shah says:

    Dearest Mazda sir

    Fantastic & Daring Decision
    Your Gut feeling gave you super power

    Many congrats for bold decision

    I am expert in drafting WILL

    Send him to me & I will take care of your all wishful Thought process 🤣

  • Avinash Karnik says:

    Once again your genuine thinking of helping all your patients is peeping through the hole you just drilled in to his skull. You have just extended few more healthy years of Mr. Gupta. Here you are thinking exceptionally about an exceptional patient.
    We all are proud of you. Please take a bow.

  • Shirsat Neelam says:

    Great decision. At his age many give up without much consideration

  • Neelam Shirsat says:

    Great decision. At his age many give up without much consideration

  • Jangoo B. Mistry says:

    Thank you Dr. Mazda, from all humanity.


    You truly are an angel 😇


    Brilliant Dr. Mazda Turel.

    Shows the fallacy of “generalizing” EVERYTIME on EVERYTHING!

    Congratulations on your Bold Moves !!!

  • Lucy Mhlanga says:

    A brilliant piece of writing with a wonderful outcome Dr. Your expertise and care for your patients shines through your rich and vivid narrative

  • Dr Naresh Jani says:


  • Mrs Nergish Antia says:

    Dr. TUREL, U r truly an angel. Keep up the good work.

  • Dr Gurudas Pundpal says:

    Excellent narrative Dr Mazda. I remeber he was so happy to see you post op in ICU and invited u for his 100th Birthday party. Keep up the good work…

  • Asppi Turel says:

    Reminds me of an incident few many years ago an ambitious Resident Neurosurgeon in a Municipal Hospital was retiring for the day peeped into an OT where a senior NS had just wrapped up a case as nothing more could be done. This young NS ventured if something could be done. The surgery was successful and the patient recovered to the astonishment of all. The next day this young NS was severely reprimanded for interfering in senior Surgeon’s case. You guessed right who that young NS was !

  • Marzin R Shroff says:

    That’s a really ballsy decision to take. Most Doctors would worry that they unblemished records would suffer. But not you. Congratulations on being a humanitarian first and a Doctor second.
    May your tribe increase.
    God Bless

  • Zee Pasta says:

    🪂🌈And lo and behold..
    He hath risen!!! 🪂🌈

    Wondrous heartwarming Easter Tale from that Wonder to beat all Wonders… Dr Mahvallouzda !!!

  • Burzin Panthaki says:

    Lovely take. What a happy outcome. We need many more such Dr. Mazdas’

  • Dr Rajinder Singh says:

    Brilliant article… Age is just a number

  • Mahashweta Biswas says:

    Wow Mazda. Once again you have excelled in your gut instinct about this patient & went ahead to give Mr Gupta a few more years to live. Beautifully expressed article

    Lots of love

  • Marazban Dalal says:

    well done Doctor, after God on earth any one can save man from Death it is a Doctor who doesnt give up

  • Rita singh says:

    Dear doctor ur writing brings hope to ur elderly readers. I hope God creates more of ur kind. The episode was so interesting I read it almost in one breath. Mr.Gupta is a blessed soul. Hope he goes well beyond the century Mark.loved both of you God bless.

  • Aspi Aibara... says:

    Please tell me …Are other Doctors do the same thing as u have done??..
    I doubt….

  • Bapsy Bengali says:

    Congrats Dr Mazda for your great decision n successful surgery..may God always bless u..

  • Anuradha says:

    Your connect with the aged is amazing! The decision to operate on him was your gut instinct about his ability to bounce back and how he did! Great job doctor!

  • Harsha Bhadra says:

    Congratulations !!
    It must be the most memorable cases of yours, appreciate your gut feeling ,great surgical skills ,stay blessed.

  • Lois Juma says:

    Another beautiful piece. God bless you

  • Dinesh Shikotra says:

    Dear Dr Mazda, A very well narrated success. Not only shows your commitment and love but reflects how compassionate you are! You always go above and beyond and work tirelessly towards a healthy outcome. We feel blessed and safe knowing an angel like you!!!

  • Altaf Ladak says:

    A lesson we all need to learn… don’t let age be a defining factor while judging people.. whether it is wearing the color red or giving them a fighting chance to live..Excellent narrative as always..Thanks for such a brilliant story Doctor

  • Dr Shivaji Kalel says:

    Really Dr are in form of God. You’re work is really great like God. Devotion to our professional is our life. Really service to man is service to God.

  • Minnie Erach Avari says:

    Congratulations Dr. I recollect an incident. Around
    THE year 1965 my father aged 57 was diagnised
    Having a brain tumor. He had lost his speech and
    Dr. Gajendra Singh advised us to get him operated.
    We took the decision. Everything went well. He was
    Normal. After a year his health gave way. But
    At least for a year he was OK. We really thank you
    All the doctors who are angels who give hope to their
    Patients. Hats off to you all.

  • Nergish Maloo says:

    Dear Dr.Mazda,once again your exemplary
    subject narrative is par excellence, and being your erstwhile patient ( now completely cured) it has further cemented my firm belief that you surely are blessed with “AHURAMAZDA’S” Choicest and Devine Powers to perform such miracles !!
    Wishing you all the success in your very noble endeavours !!!!

  • Anita says:

    Enjoyed reading this endearing piece. God bless Dr Mazda 🙏

  • Nergish Maloo says:

    Dear Dr.Mazda,once again your exemplary subject narrative is par excellence and being your erstwhile patient ( now completely cured) it has further cemented my firm belief that you surely are blessed with “AHURAMAZDA’S “Choicest and Devine Powers to perform such miracles
    Wishing you all the success in your very noble endeavours!!!

  • Vijayakumar Kotteri says:

    Unfortunately, the common perception is one is “trapped” when one enters a hospital with a loved member of the family in a critical state. There are so many recommendations and never-ending array of tests. It takes a rare doctor to look beyond the apparent and offer an advice that is outside convention and does not smell of a larger bill. Yes, there is no point in extending the agony in the final stages. Yet, if there is a good chance of giving someone an opportunity to share some more smiles and love, why not? The challenge is to spot such rare surgeons, who can think right with their heart and write even better.

  • Monica says:

    DR MAZDA !

    You are gifted with divine vision and power in the

    Bless you.

  • Sameer says:

    Your narration is so full of joy and the love of doing your work. Very inspiring!!

  • T George Koshy says:

    Loved reading that..fills the reader with a lot of positive vibes..keep operating and keep writing..God bless u..”fresh as a daisy sprinkled with morning dew”

  • Zarin Bahmani says:

    How do you manage to make us laugh and smile with your expressive articles? Keep on enthralling us with such positive, descriptive stories…love you dear Dr Mazda. God bless you.

  • Benaifer Wykes says:

    Forget the Will , You would have won a Booker , with this brilliant a narrative skill !!! What are you doing in the medical field ? The literary world will welcome you with open arms !! But on second thoughts medicine will get poor with one great Doctor lost ! May your tribe increase Doc !

  • Di says:

    A heart warming article and what a wonderful outcome… yes most of us tend to generalize which we shouldn’t… and yes, loved ones don’t want an aggressive treatment option for the old family members… but thank God you made a swift correct decision… lol when i read about his altamount road house, i was wishing i was his granddaughter haha


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