The Surgical Banter

Why it’s important for a doctor to be part of a team whose decisions are constantly questioned, and healthy dialogue is the order of the day.

“Why can’t we have some surgeon-friendly anaesthetists?” I questioned my anaesthetist, who had bellowed back at me for asking her to hurry up amidst her getting my patient ready for surgery. “I need to secure an extra intravenous line, and an arterial line since we are turning him prone,” she started explaining, ending with “…why can’t we have more anaesthetist-friendly surgeons instead!” rolling her eyeballs almost up to the ceiling. I could see condensed air emanating from the sides of her mask, the silent gestural interpretation of having to put up with a surgeon’s low IQ. To infuriate her even more, I retorted, “It’s just a simple cervical laminectomy!”

“There’s no such thing as just a ‘simple’ surgery… you know this better than I do!” she exclaimed, reminding me of my own neurotic obsession to fuss about the tiniest and most frivolous detail in every single operation. “He has a bad heart; you know that, right? We’ve even taken a DOT consent. “What’s DOT?” I asked, not being a fan of abbreviations. “Death. On. Table!” she said, with a short, emphatic pause after each word. This time, my eyes reached the ceiling and came rolling back. “You surgeons don’t see anything apart from the organ you’re operating on, right?” she went on, putting the final taping to secure all her paraphernalia. “Of course we do,” admitting to myself quietly that we often don’t. “We’ve even got fitness for surgery from the cardiologist,” explaining my diligence. “Fitness for surgery is a meaningless term. Anyone who can lie down is fit for surgery. Fitness for anaesthesia is what’s needed,” she retorted, having used that line umpteen times before, borrowing from something she had once read somewhere.

In today’s age, every specialist looks at a patient from their point of view. I have to make sure I can surgically relieve him of his pain. The cardiologist has to ensure that his heart is optimized to withstand the operation. The physician checks that his blood sugars and blood pressure are stable. The anaesthetist has the ultimate responsibility of navigating the ship through the storm if something were to happen, and hence the excruciating emphasis on safety. “The cause for multi-organ failure is single-organ doctors,” one of my teachers used to say, emphasizing the need for being holistically involved in treating a patient.

I remember once operating on a patient’s lower back because he could hardly walk a few steps, having been debilitated by pain for years. He had severe lumbar canal stenosis. The operation relieved his pain completely, and in his newfound freedom and excitement, he started walking several kilometres a day until he had a heart attack. The heart was not conditioned to withstand such a drastic change in such a short span. Luckily, this was not a classic case of ‘the surgery was successful, but the patient died’; this man was okay with one stent placed in time.

After we were given permission to advance with the current case at hand, we flipped the patient nervously on his belly and continued to proceed with the cleaning and draping of the patient in the usual fashion, but this time, the corner of one eye was constantly on the monitor, checking for any fluctuation of heart rate or blood pressure. “If his heart stops, we’re not going to be able to resuscitate him in this position, with him lying on his stomach and his head fixed rigidly on a clamp,” were her soothing words just before I sliced into the back of his neck. To keep up with her wit, I stated mid-way through surgery, “We are losing a lot of blood, hope you’re okay there!” In reality, we were in control; I simply wanted to make sure she was glued to the right screen. We removed the compression meticulously, ensuring the spinal cord was pulsating gently. We were done before the anaesthetist could say anything else to us. But I was wrong; she wasn’t finished.

“Why did you book the case for 6 hours if you could finish it in 2?” she said, smiling behind her mask. “I included the time you would take to get the patient in and out of anaesthesia,” I teased, dismantling my gloves in the heroic fashion surgeons do when they finish a successful operation.

Doctors tend to view patients from different perspectives. Two surgeons viewing the same problem may have a completely different outlook because of context and relativity. A famous spine surgeon once said, “Anyone with a spine problem can be managed without surgery and anyone can be operated; there are very few absolutes.” It is for this reason that the more opinions a patient takes, the more confused they end up being. Medicine is an ambiguous science, leaving those dealing with patients’ lives in a constantly elusive quest of what is the right thing to do.

Two senior physicians may argue on whether a patent is optimized for surgery based on sound reasoning from the information at hand and may yet arrive at varying conclusions. Neither is right or wrong; the knowing is always in the doing, or sometimes, in not doing. On occasion, doing something has a price to pay, but so does not doing it. The best – and worst – part is, we always have a choice. Recently, we were reluctant to operate on someone for a spine issue without optimizing him because we felt the risk from his compromised heart function was too high. The patient was operated immediately elsewhere – successfully.

I’m fortunate to be part of a team where my decisions are constantly questioned. Where patient safety is a prime concern but there is still a willingness to push the envelope. Where we have to perpetually engage in dialogue – sometimes gentle, sometime harsh. Where we have to explain why we want to do what we need to. It’s strange that we are all fighting for a common goal, which is the good of the patient, and yet, everyone has a different perspective of what ‘good’ is.

After all, as the famous saying goes, “No one sees what you see, even if they see it too.”



32 Comments on “The Surgical Banter
  • Anil Karapurkar says:

    A joy reading your writing. Do continue.
    Everyone of us has similar experiences but we don’t have the skill or perspicacity to write. I wonder what the take of lay readers would be

  • Khyati says:

    “There are few absolutes”.. aptly said..well written..truly medicine is ambiguous so better to have complete surrender to the doctor you trust and let somethings be in hands of the ultimate power ALMIGHTY ..

    Keep writing.

  • Natwar says:

    Team work always give better result.

  • Dr Vineeta goel Radiation oncologist says:

    Dr mazda

    Many congratulations for a fabulous write up. I am
    Not a surgeon but can relate so well
    With everything you write and always look forward and enjoy reading whatever you writes

  • Clera Menezes says:

    I feel proud to read your excellent writting ,Because what ever you have written in your artical is absultly correct and agree with you.I really admire your humbleness and down to earth nature while you answer each one either it is Anesthetist or cardiologist .
    You always try to do best for your patients .Proud that you are working with us.

  • Dhanraj Chandriani says:

    It’s an art to narrate such serious matters, sometimes of life an death, in such a simple and often witty manner.
    Keep writing Mazda as it is a pleasure to read your articles

  • Zee Pasta says:

    *The Surgical Carol*

    (Can be sung along the lines of
    Rudolph the Red Nosed Reindeer)

    🌲We know Dermadoc and Dentist and Procto and Virologist

    Chiro and Onco and Gastro and Radiologist

    But we’ll ever fondly recall

    The most famous doctor of all …

    🌲Mazda – big-eared Neuro-Writer dear

    In fame and stature how he rose!

    And if you ever met him

    You’d aver he truly glows

    🌲Oft perhaps an anaesthetist

    Rolled her eyes and called him names

    She chided witty cachinating Mazda

    Underlining his neurotic nitpicker perfectionist games

    🌲And through foggy mists of memory

    He heard his teacher say

    💥Multi-organ failure’s such a blight

    With single-organ docs’ myopic sight! 💥

    🌲Oh how we truly love him

    This abbreviation abhorrer, holistic healer cheery

    Mazda – big-eared NeuroWriter dear

    You’ll go down in history!


    With love light n gratitude for another radiant gem to light up this serene Sabbath!!!

    Not-so-gentle nudge n reminder :

    Publish Publish Publish

  • Dr Sudhir Phadke says:

    Being an Anesthetist I have seen situations like this and been a part of similar discussions.Very well put with a message about holistic approach to the patient.

  • Atman Daftary says:

    Enjoyed reading sir! Pl continue d same. It’s becoming a Sunday habit of reading ur write ups

  • Dr. Chirag Desai, Maxillofacial Surgeon says:

    It’s always an absolute pleasure reading your articles…

  • Benita says:

    Nicely written. Especially the interaction with the anesthetist! 🙂

  • Anil Thakur says:

    – Another Surgeon could have done it with an anterior approach.
    – Another surgeon – male or female – may not have indulged in so much banter.
    – How senior was the Anaesthetist ? Haven’t seen this issue since my young days when President of RCS Edinburgh ( Paddy Boulter ) asked the anaesthetist ‘ when do you think we can start ?’ That was in Guildford Surrey. I was then his SHO.
    Anyhow, the banter was entertaining. Thanks.

    Anil Thakur. Australia.

  • Burzin Panthaki says:

    Fantastic!! Such a serious matter written with so much of wit.
    Carry on Doc. Mazda.
    You write up are very interesting. Always look forward to ii.

  • Pinky Mistry says:

    Fabulous attitude – baiting the anaesthetist! And an even super fab article.

  • Rita singh says:

    A very interesting piece of banter right from the O.T. Such a vivid description feels as though I were present there.Best doctor in ur field and a gifted writer.

  • Mahashweta Biswas says:

    Wow such a well written article full of wit & humour. Wit has been passed on to our kuchi

    Loved the sparring humour.


  • Srinagesh Simha says:

    Well said and very true. More relevant in the era of litigation

  • Dinaz S says:

    Every time I read your posts it’s like being physically present in the OT with you. I am glad you have a good rapport with all present in OT for the sake of the patient
    You are truly amazing not only as a doctor but also as a human being. We need more humans in doctors in today’s world. Keep up the good work and God bless you

  • Anuradha karnik says:

    Dear Mazda

    Your healthy banter and gentle teasing must be excellent stress busters for your team and you. Keep up this spirit always.
    Look forward to more from your desk

  • Rustom says:

    ThankQ Dr. Mazda for the insight. A patient usually looks up to the surgeon for success without realizing the checks n balances that the OT tream provides. I always wondered why a surgeon has a preferred anesthetics. It is now clear to me


    splendid.. now I know, when I go under the knife of the wonderful surgeon (You, Sahebji) and be knocked out for an hour or so, I shall still be unconsciously part to some wonderful humour and great exchange.. and I do hope that while i shall be ‘prone’ too, I won’t be the butt of the jokes in the OR.. wait, in India we call it the OT, ja? 🤣

    I know am a wee bit scared, but like my friend Mr. P.C in his inimitable style said: BC, agar kuch bhi ‘katwaane’ ka hai tere backside mein (Dr. I hope u remember it’s my “back” and not my backside) toe Dr. Turel ke alawa kissiko haath lagane diya toe maiii tere ko hospital mein aake maarega” 🤣

  • Shaleen Kumar says:

    The description of the ‘banter’ is so vivid that it had me riveted till the end.
    I will certainly, henceforth, read your weekly write ups, although not a neuro-surgeon.
    Thank you

  • Anjali Patki says:

    You’ve bought out the true aspect of the special relationship of the surgeon and anaesthetist, and we both know that one is quite incomplete without the other. An excellent piece written with your wonderful sense of humour, yet conveying the seriousness of your skilled speciality niche work.

  • Dr. Vishnu Mulchandani says:

    Pain has to be taken care of – surgery should be earned by the patient Family physician cardiologist have to give fitness Final say is Anasthetist ….patient should have no complications from anaesthesia / surgery ….Good selection of patient is important ..

  • Quinee Patel says:

    Once again Mazda, you brought to light in your inimitable way the need to be holistically involved in treating a patient with the ultimate responsibility lying the hands of the anaesthetist who has to navigate the storm if the waters get testy…..what warmed my heart was that each specialist looking at the patient from their own lens, still had the focal point zeroed in on the same horizon…..”patient safety is the prime concern”, Mazda, with your wit, humour and pen you educate us lay readers in the art and science of healing.

    Zee, I loved your surgical carol tribut to Mazda….it was brilliant!

  • Manoj MALKAN says:

    Mazda, as lucid as ever. This argument between surgeon and anesthetist will never end . But it is good for the patient. A good surgeon is ” ONE WHO KNOWS WHEN NOT TO OPERATE”

  • George Koshy says:

    Mazda..loved it..have heard these Surgeon-Anesthesiologist exchanges from 1998 onwards..😂🤣..the Anesthesiologist has to navigate the ship through the storm..going to share this with Sunitha..loved the “Rudolf” comment by Mr Zee Pasta..please keep writing..👍👍

  • Dr Monica Rajpal says:

    Too good. Thats an excellent write up. You must keep writing.

  • Dr Shivkumar V Dalvi says:

    How a patient is seen by doctors of different fields is very nicely n humourously explained in his inimitable style by Dr Turel.Team leader should not feel complacent n should be kept on his toes is the lesson nicely brought out here.

  • Upma Jaiswal says:

    Enjoyed reading the article as always. Your meticulous ways are heart rendering plus you always write in a way that any surgeon including me who 8s a gynaecologist can put myself in your shoes and enjoy your epiphanies.

  • Anant Joshi says:

    Loved your style of writing.

  • Di says:

    You are one witty fellow with a good sense of humor… nice reading about the banter between u and the anaesthetist like i witnessed it myself… its good to be questioned sometimes and healthy discussions between team members can be beneficial… u all have a common goal to do whats best for the patients… so very true everyone has a different perspective… really liked the last line of the article, the famous saying


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