When all’s not well, surgeons often rely on voices in their head, where ideas and uplifting thoughts are sometimes replaced with self-questioning
“Wake up, Elizabeth, your operation is over; everything went off very well. Now, open your eyes,” I heard the anaesthetist bellow as they went through their routine of reversing the anaesthesia to awaken the patient and remove the breathing tube.
It was an operation to clip an unruptured aneurysm arising from the bifurcation of the right internal carotid artery. I sat in one corner of the operating room writing down the post-op orders, feeling a kind of inner joy as I typed out my notes for having performed a masterful surgery. After I finished, I made a quick dash with my team to round on all our admitted patients, and an hour later, headed to the ICU to check on Elizabeth. I was brusquely informed that she hadn’t been shifted yet.
“That’s strange,” I said to myself, swiftly climbing the stairs that led to the operating room to hear four words from the anaesthetist that no surgeon wants to ever hear: “She’s not waking up.”
The anaesthetist peered right into my eyes. “The muscle relaxant has been reversed, blood gas analysis is fine, but she’s just not opening her eyes,” she finished, looked at me with the finality of not having a plausible explanation for this on her end. This was also her polite way of saying, you’ve done something wrong inside; now fix it.
I went through the steps of surgery in my mind, running my hands through my scanty hair. Could it be because we buzzed a surface vein? Have I taken a perforating artery supplying the hypothalamus in the clip? Did we retract the brain too much? Is the main artery kinked by the clip?
The self-introspection then made way for chatter. Should I have operated on her in the first place? I should have just asked the interventional radiologist to coil the dam aneurysm. She’s a mother of two, have I destroyed her family? Do I really think I have the skill to do these complex cases? Who am I trying to impress? And at whose expense? Better do something before it’s too late. Or is the damage already done? It’s a sickening feeling when someone you’ve operated on doesn’t wake up the way you expect them to. It is literally gut-wrenching; your intestines feel as though they are physically being squeezed.
I looked at the numbers on the monitor and then at the anaesthetist repeating the same words over and over: “Wake up, Elizabeth, wake up – your surgery is over.”
“Raise the blood pressure to 170-180,” I ordered, thinking that some crucial vessel might be in spasm. She transiently opened her eyes, but within a few seconds went back into a deep slumber. We got an urgent MRI done but that was clean; no area of ischemia or infarction. No blood clot as well. The clip was positioned perfectly, and we ruled out her having subclinical seizures too. We shifted her to the ICU on the breathing tube as my gaze vacillated between the monitor and her body lying motionless, when it should have been sitting up in bed and talking to me instead.
The chatter turned to a full-blown tirade. Am I missing something here? Should I call someone and ask for help? Should I just give this some time? What would I do if someone else operated on this patient and I was called to opine on how to proceed? I use this last analogy a lot when I’m in distress: I try and distance myself from the problem at hand and adopt the fly on the wall approach. It’s easier said than done, of course, but all you have to do is zoom out. I remember reading somewhere “The only people who see the whole picture, are the one’s who step out of the frame.”
There is a Chinese proverb that says, “He who blames others has a long way to go on his journey. He who blames himself is halfway there. He who blames no one has arrived.” I was halfway there. The countless permutations and combinations of the infinite possibilities of things that could have gone wrong kept buzzing in my head.
We all have a voice in our head. We tune into its incessant chatter to look for ideas, guidance, and wisdom. Sometimes, these conversations uplift us and sometimes they sink us into the deep, dark hole of despair. Ethan Kross, a renowned experimental psychologist and neuroscientist and one of the world’s leading experts on how to control the conscious mind, has written a book called Chatter: The Voice in Our Head, Why It Matters, and How to Harness. In that he states, “In recent years, a robust body of new research has demonstrated that when we experience distress, engaging in introspection often does more harm than good. It undermines our performance at work, interferes with our ability to make good decisions and negatively influences our relationships.” Instead, he reveals tools you need to harness that voice so that you can be happier, healthier, and more productive. “Chatter doesn’t simply hurt people in an emotional sense, it has physical implications for our body as well, from the way we experience physical pain all the way down to the way our genes operate in our cell,” he warns.
I hadn’t read the book at the time and my head was spinning with thoughts as I stood at the edge of her bed for 3 hours, waiting for her to move just a little. I was following the old age adage of ‘just give it time’ when dealing with this unsettling experience. And so I did – I gave it time. After a long, painful wait, Elizabeth moved a little. And then a lot. She opened her eyes and made chewing movements and brought her arms to the tube as if to denote she wanted it out. We took it out once she was fully awake and briskly obeying commands, indicating to us that she was conscious, alert, and aware.
I am still intrigued about why she took so long to wake up – Probably it was a tiny artery that went into spasm but opened up later. But the relief of shifting her out of the ICU the next morning and then home with the family in a few days was intense. Finally, there was no one to blame.
