The surgical awakening

How do we feel when we lose our sense of self? Sometimes, a slice of the scalpel leads to a personality reset

She came in wearing a Sabyasachi silk sari the colour of pomegranate peel, her salt-and-pepper hair twisted into an efficient bun, and carrying a Bottega handbag that probably cost more than my last holiday. “I’m not mad,” she announced before I could say a word. “I just forget things I don’t like,” said 70-year-old Mrs. Gandhi.

Her daughter accompanied her. Far less flamboyant and living up to her last name in a khadi kurta that was more Fab India than haute couture, she did most of the talking. “She’s been acting odd for a few months. Forgetting appointments, asking the cook if he’s single, putting her keys in the fridge… I know they’re small things, but it isn’t like her,” she declared, glancing at her mother, who looked like she’d just walked out of an art auction. “And I’ve been baking too much cake,” her mother added with visible irritation. “Apparently, that’s a symptom now.”

She was a feisty lady, single-handedly managing the family business up to a year ago until the kids decided to step in and take over. They had already been to a psychologist and a psychiatrist. Both had offered the same diagnosis of early-onset dementia, which, for someone in their seventies, is neither early nor a diagnosis anyone wants to hear. They had even started joint therapy — the new South Bombay substitute for family dinners.

“She needs help,” the daughter said gently. “She’s changed.”

“And you,” the mother interjected, “need a less boring therapist.”

There was something off. But not in the way I’m used to seeing with dementia. She didn’t have that blankness behind the eyes. There was sparkle. There was mischief. She remembered the name of her school principal but couldn’t recall why she had tried to bathe the cat in coconut oil last week; I guess she wasn’t named Velvet for nothing. I checked on her smell and vision and both seemed fine. So, I did what I often do when things don’t add up: I scanned her.

The MRI showed a 5-centimetre tumour sitting smugly on the base of the brain, nudging her frontal lobes upward like a snob in a sea-facing duplex. Frontal lobe tumours are curious things. They don’t always announce themselves with seizures, strokes, or headaches. They slip in quietly, altering personality, judgment, and behaviour with the subtlety of bad politics. People become more impulsive, disinhibited, indifferent – just like regular politicians. They make promises they can’t keep and tell neighbours what they really think of their children. They sleep in meetings. They laugh at funerals. They start baking (the country) obsessively.

When I showed her the scan, she examined it like a Sotheby’s catalogue. “So that’s the little fellow causing all the trouble?” “It’s not little,” I said. “And it’s not trouble. It’s pressing on parts of your brain that control personality, planning, and memory.” She looked at her daughter. “That explains your father,” she rued. I guess every South Bombay family is dealing with the same problems – chic on the outside and chaotic within. Where the saris are Sabyasachi but the souls are slightly scrambled. Where the bags are Bottega but the baggage, bhaari.

“These tumours are typically benign — polite in nature, even if disruptive in behaviour. But they’re often vascular and can be tightly adherent to the surrounding structures. The key is to debulk them from within, cauterize the blood supply, and peel the capsule away without harming the brain or the nerves. It’s like scooping malai off the surface of chai without disturbing the rim of the cup,” I explained. They decided to go ahead with surgery.

We made an incision hidden within the hairline and reflected the scalp forward. I drilled two burr holes and fashioned a frontal craniotomy, lifting the bone flap with care. Once we opened the dura, the frontal lobe came into view — pale, glistening, gently pulsating. We placed cotton patties and started the slow process of brain retraction; more than a forceful act, it was a conversation with the anatomy, with gravity doing most of the work. The tumour revealed itself. Yellowish-white, slightly lobulated, mildly vascular. I buzzed the base and began removing it. It felt soft, almost apologetic, like it knew it had overstayed its welcome. The ultrasonic aspirator hummed away as we cored out the central mass, shrinking the tumour from within. As it collapsed, the capsule started peeling off like the rind of an overripe fruit.

We removed it cleanly. No brain contusions. No bleeding. The dissection felt like a polite negotiation, not a battle. The frontal lobe relaxed back into place, grateful, as if someone has lifted an invisible burden. The microscope lights glistened off a clean, dry surgical cavity.

She left the table warm, stable, and intact, and it was as though we had pressed a reset button on her personality. She woke up from anaesthesia already halfway into a joke about the ICU nurse’s eyebrows. Over the next few days, the transformation was nothing short of cinematic. Her memory sharpened, her language regained nuance, and her sarcasm returned to its pre-morbid potency. By day four, she was giving unsolicited life advice to the junior doctors and correcting their Hindi grammar. By day six, she asked if she could run my clinic reception. “Clearly, your current staff can’t spell ‘meningioma’ correctly!”

I saw her two weeks later, in yet another silk sari but with none of the earlier confusion. She handed me a chocolate cake. “Only three layers this time. I’ve calmed down.” The final biopsy had confirmed what we had expected — a benign meningioma. No radiation needed, just annual scans to ensure it doesn’t return. “Doctor,” she asked, pausing as she got up to leave, “do you think I should go back to therapy?” “Only if your therapist asks to see you instead.” She laughed. “I’ll take that as a no.”