The Surgical Chatter

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.

 

34 Comments on “The Surgical Chatter
  • Chaitaniya A Karnik says:

    Would be great to see something on what the brain does when ones actions out of responsibility and care seem to have misfired, if only for a few moments.
    Keep up the good work! And great writing Doc!

    Reply
  • Chanda says:

    Whew. What a journey you’ve made us go through Doc. Was literally on tenterhooks following the procedure. It was like I was part of your operating team. It’s not just reading your article, its actually performing the operation along with you, including sharing all the emotions you’ve experienced. Brilliant!!
    Hat’s off to you Dr. Mazda

    Reply
  • MEGHA S UPPIN says:

    Your writing and expression is just wonderful. While I read the story, it automatically unfolds in front of my eyes as if I am watching a live play. This is an extreme talent of a writer and very few have it in them. You are truly a gifted writer and I am sure you must be a very wise surgeon. Keep it up.

    Reply
  • Supriya Correa says:

    Wake up, Liz!! We are no longer the readers, we are transported into the OT, the ICU and out of it, with you.

    Brilliant,Mazda!! Brilliant work, awesome post. In a span of a reading minute, we feel your terror, hopelessness and vulnerability which finally gives way to deep calm and peace. You keep getting better and better, both surgery and writing.

    One of your best!! Love it!!

    Reply
  • Freny says:

    Throughout the article was on tenterhooks. Look forward & love reading your articles. Please keep sharing your experiences Dr Mazda.

    Reply
  • Freny says:

    Throughout the article was on tenterhooks Dr. Look forward & love reading your articles. Please keep sharing your experiences Dr Mazda.

    Reply
  • Freny says:

    Had goose bumps reading your so descriptive case. Look forward & love reading your articles. Please keep sharing your experiences Dr Mazda.

    Reply
  • Hiten dadia says:

    Too good sir keep it up
    Thanks
    Happy Sunday.

    Reply
  • Sumit Singh says:

    Before too long into the article, couldn’t help but root for Liz.

    Reply
  • Shruti says:

    Just brilliant. And so insightful as you took me along this journey with you!
    And the honesty, just so rare.
    Your best piece of writing yet!

    Reply
  • Mrs sunaina N Saraf says:

    Hello sir
    Theres always to learn something from ur articles
    Be it from the small incidents or quotes
    Self introspection is the key to success which u did
    Loved every bit of it
    Regards
    Mrs sunaina N Saraf

    Reply
  • Annuradha Rakesh says:

    Dr Turel, such brutal honesty makes you an amazing writer and definitely a great Surgeon.

    Reply
  • Dinesh Shikotra says:

    Awesome, you kept us gripped and shared your worries too. Loved your confidence and patience. Brilliant write up. You are amazing Dr. Mazda. God bless you for giving new life to your patients !!!

    Reply
  • Dhanraj Chandriani says:

    Great work doc. Food for thought for sure
    Dhanraj Chandriani

    Reply
  • Dr.Pritraj Ranjan(PT) says:

    Not every one analysis themselves ,its because not every one follows Chinese proverb also. It’s really great and courageous to write the introspection , not every surgeon does. Aneurysm cliping is not at all a game, I being physio has seen my previous neuro surgeon doing cliping, how much precision it requires. Hats off sir, it great to read the conflict which was going in your mind. Immense Respect..

    Reply
  • Dr. Shubha Thatte says:

    A great read as usual ! Your analysis of the situation is really noteworthy & your description is so vivid that I felt as if I was standing by you tense & worried when Elizabeth isgoing to open her eyes . All is well that ends well.
    Love & I wish there were more medical professionals like you who care so much for the patient & express it as well.

    Reply
  • Anuradha karnik says:

    Brilliant! Those few minutes dragging into hours have been perfectly captured by you in your article. The brain is an awe inspiring organ. Through your writings I have learned to respect it and not take it for granted. I imagine an interesting camaraderie between doctor, patient and the brain! What a journey! Loads of good luck and success in your endeavours Mazda.

    Reply
  • Indira says:

    Like to hear more.Is there any book regarding this

    Reply
  • Avinash Karnik says:

    While reading through your article, I felt that I was reading a suspense story or awaiting a decision of a third umpire taking his own time for his verdict while keeping us on the edge. The thoughts that must have crossed your mind while watching your patient must have been very stressful. However, at the end, your expertise and the genuine effort to save a life has and will succeed most of the time. Well done and very well narrated. Take a bow

    Reply
  • Jasmin Lord says:

    Bravo Mazda! Another one brilliantly written. I’m sure as I was praying throughout for her to awaken, so were your other readers. We cannot fathom what surgeons, doctors, nurses, anaesthetists and every other health care professional goes through every day. Well done to you and your team for seeing her home in the pink of health. 👏 👏👏

    Reply
  • Dr Ram Dama says:

    Good work sir as usual keep it up 👍👍 while reading your post I felt that now what next its amazing thank you for sharing

    Reply
  • Gladys Y K Kokorwe says:

    Shuuu😳 Goose bumps. What a story. I couldn’t stop reading to see what happened at last. Happy to see the good ending. May God continue to help you and your team in your good work.

    Reply
  • Gladys Y K Kokorwe says:

    Shuuu😳 Goose bumps. What a story. I couldn’t stop reading to see what happened at last. Happy to see the good ending. May God continue to help you and your team in your good work. When I read this story I think Elizabeth could mean Gladys. I remember hearing those loud voices… Wake up Gladys …. we are done. Your surgery has been successful. Wake up. Thank God, I did.

    Reply
  • Marzin R Shroff says:

    Brilliantly articulated as always.
    We’re often stuck in many places on our journey and the voice inside is often the only way to seek an answer. But one really needs to learn how to activate this voice. It’s not easy because often, it’s our need that crops up as our voice. And it’s also often the “first right answer”. Seeking the “second right answer” often helps me when I’m stuck. Of course, I often have the luxury of time. In your case the patient would be dead by then
    The “third person theory” also helps a lot. I’ve found that withdrawing yourself from the situation and looking at it as a third person gives an “outside in” perspective (again if you have the luxury of time)
    Thank you for this amazingly written piece. I’m now going on my Kindle and immediately ordering Ethan Kross’s book.
    Look forward to your stories every weekend
    Cheers to you Doc

    Reply
  • Kamalrukh says:

    So well written. Rarely do we know what doctors feel. We are always hearing from the patients point of view. Showing your vulnerability and being so candid is endearing and almost a relief….it gives others too the courage to be vulnerable. Bravo for your courage in talking about your doubtsxand fears so openly. We need to normalize this. Your mum sends me your articles to read and I always enjoy reading them. Looking forward to next sunday! All the very best doc!

    Reply
  • T George Koshy says:

    You have put your emotions into words very well Dr Mazda..this story must be true..thank God it had a happy ending

    Reply
  • Vipul Shah says:

    Dear Dr Mazda………

    Honest enough to admit & introspection
    On situation of Elizabeth………

    Feel like watching edge of seat thriller on Sunday afternoon…….

    Very well explained what’s going inside the Brain of Surgeon post operation…….

    Of course humor was missing being serious subject……..

    Repeating suggestion of Compiling in book ……

    Congratulations & keep on writing Sir …

    Reply
  • Dr Jayant Apte says:

    A wonderful introspective narration . I can imagine your thought processes swinging from despair to high flights . Some queries remain unanswered even after the hopeful outcome .

    Reply
  • Arun Pushkarna says:

    All has been said already. Your mastery over the narrative is simply sublime! As so many have said before, you actually take your readers with you in the operating room and what they see is a truly humane, caring, empathetic and kind human being who explains what the gifted surgeon is doing in the theatre. The fact that these two characters are one and the same is truly awe inspiring.
    I really cannot decide what I admire most – your awesome surgical skill, your adorable humane self-effacing self or your fabulous mastery at bringing words to life!
    Truly you’re a treasure!

    Reply
  • Dr Rajesh M Shah says:

    This time, for a change, a serious case discretion…. But let me tell you… It was not less than a thriller…. You are really an amazing writer and ofcourse exceptionally excellent surgeon as well…. A rare combination…. Loved your articles.

    Reply
  • Gool Kotwal says:

    You carried your readers with you on your journey through the operation room & ICU, with all emotions which you experienced during that period.
    The true worth of a good writer is weighed by the measure of emotions he evokes in his writing.
    You have passed this test with aplomb

    Reply
  • Dr Shivkumar V Dalvi says:

    Extremely gripping n full of suspense.This kind of introspection is what our Sages must be practising when sitting for finding solutions to the worldly n cosmic affairs.Congrats on sincerity in discussing likely causes of such delayed post-anaesthesia post surgery awakening.

    Reply
  • Monica says:

    Mazda, a riveting, spellbinding journey across the landscape of hazardous, vulnerable human emotions.
    Upgrade to the ‘novel’. Go for it. Blessings.

    Reply
  • Rita Singh says:

    This was a very gripping piece of of write up.We were sitting on edge until it’s happy ending.U really have a gifted flair for expression.

    Reply

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