To take on a case where death or paralysis is a given, and life, a freak chance, takes courage and confidence in expertise. But also, YouTubing, Whatsapping and faith in music
“No one in the entire continent is willing to operate on him,” said Jonathan, on arriving from Africa with his younger brother Jude. I glanced at the MRI films and wasn’t surprised. “Gosh,” I thought, projecting composed confidence, as the two waited to hear the next words from me.
Jude was a 16-year-old pleasant kid. He had started having headaches a few years ago but had got an brain MRI done only recently, when he began to lose vision. The MRI showed a colossal 10-cm tumour within the ventricles of his brain, occupying 80 per cent of it.
Ventricles are cave-like cavities filled with cerebrospinal fluid that give buoyancy to the brain. They are the reason why you can carry 1.5 kg of it without feeling the weight, even if you are pig-headed. An obstruction in this normal pathway of fluid by a tumour within the ventricle results in raised intracranial pressure, which manifests as headache, vomiting, and problems with vision.
“This is a very complex and high-risk operation,” I explained, after examining Jude and noticing that his right arm and leg were slowly losing mobility. There was a greater-than-usual chance of complications since the tumour was in a precarious location, straddling the centres of consciousness. It was enormous in size, and had voluminous vascularity. We went on to discuss the chances of death, paralysis, and even a vegetative state—all the possibilities that could arise despite the best of doctors taking on the case. “Whatever happens, don’t let him die,” Jonathan said quietly, pressing my forearm. I wanted to say, we won’t but stuck to, “We’ll do our best.” I left the hospital that day with the image of that beast of a tumour in my head.
For the next two days, I studied Jude’s scans from all angles, reading up about his specific kind of tumour, and watching surgical videos. It might be scary for a patient to learn that the surgeon YouTubed the technicalities of the operation the night before surgery, but if one sticks to credible sources, I find this mode of research extremely useful and one that offers clarity.
I also WhatsApped the scans to my senior colleagues to check what approach they’d take. I received replies accompanied by the eye roll emoji, most likely at the monstrosity of the tumour.
The next morning, I was inside Jude’s brain. The snowy spotless walls of the ventricle soon disappeared from sight as we saw the tumour rearing its ugly head in the form of a red ball of fire. Some tumours allow you to go around them but this one, we had to get into. From the moment we touched it, it started bleeding. The magnification of the microscope makes trickles of blood seem like roaring rivers. What seemed like a calm start instantly turned into a battlefield; it was like watching an episode of Man vs. Wild. The tumour had pearly lobules, and each of them, burst despite delicate handling, flooding the field of vision.
“Get another suction in here,” I ordered to improve visibility. The nurses scrambled, sensing the tension building up. The monitors started beeping, suggesting a drop in blood pressure. The anaesthesiologists muttered in a whisper among themselves on how to tackle the situation. They ordered more blood and administered medication to keep the blood pressure stable.
Just when we thought we were in control, another tumour lobule exploded. The the blood pressure shooting up this time owing to an autonomic dysfunction. “Control the damn BP!” I barked.
Mature anaesthesiologists never shout back at the surgeon, knowing well the duress s/he is in. They also don’t make it known if there is a problem at their end, even when things are out of control, unless they need us to stop. They efficiently go about pressing buttons, turning down the volume of alarms, connecting bottles of blood, and injecting drugs, like clockwork. The communication with the surgeon is constant, brief, and firm. Unfortunately, they don’t get enough credit for their competence. Often, lives are saved by them, not us.
A famous surgeon once said, there are four degrees of intraoperative haemorrhage. One: “Why did I get involved with this operation?” Two: “Why did I become a surgeon?” Three: “Why did I study to become a doctor?” Four: “Why was I born?”
In this case, I surged directly from stage one to four.
The only way to control the bleeding from an aggressively vascular tumour is to remove it completely and briskly. This took around six hours and six units of blood. I think I also aged six years in that time. Once we had removed it, the ventricles finally reappeared in all their glory and the cerebrospinal fluid flowed uninterrupted like an immaculate waterfall. The brain was soft and pulsating tenderly as we closed. Jude woke up the next morning as we got him off the ventilator. He was paralyzed on the right side but movement improved dramatically over the next few days. By the end of the week, he was prancing, not realising we had almost lost him. His chirpy disposition helped him recover faster.
“Surgery is not an art, it’s a personality disorder; that’s why we do what we do repeatedly!” I told his brother, quoting a line I had once read.
“How did you pull off such a miracle, doc!” he asked, hugging me.
“We had the Beatles playing in the background,” I said.
And we made the lyrics come true: Hey Jude, don’t make it bad / Take a sad song and make it better…
40 thoughts on “The surgical cliffhanger”
Wow Mazda ! Another feather in your cap. You are clever and brave. You did your best and you were deservedly rewarded. Ahuramazda’s many blessings on you . When reading this article I felt I was in the OT with you .
As usual Phoenix rose from Ashes.
As my mentor told me it always pays to be lucky as we all know rhe steps but the end result counts.
Great job. Surgery always keeps us humble
Excellent work, great skills..keep up the good work!!
Miraculous. You make it sound easy!
There are so many phrases from this piece that has stuck in my brain (will be coming to you soon if it leads to malfunction)
1. ‘You don’t feel the weight of it even if you are pig-headed’ 😁
2. ‘The four stages of inoperative haemorrhage’
3. ‘Surgery is a personality disorder’
Dr Mazda you are truly multi talented
I am not a surgeon but I do treat brain tumours.
Tears rolled down my cheeks after reading this.
Mixed emotions…riveted to the write up… and could place myself in the boots of the brother and was left wondering what you may have gone though.
I salute your persona.
Extremely Amazing , I being Anesthesiologist understand gravity of situation, heart beat missing operation for every one. Thank you for being so passionate . Let God give your more strength to keep it up
Absolute gem!!!
What a blessing to have been saved this way!
U were born to b a blessing to humanity. Ur an asset to all those who know u..even for once!
The calm n composure u ooze is amazing. Ur write ups r a Sunday morning bliss!
Awesome…!!!!….the palpable tension in the long drawn silence of a NeuroOT… interrupted occasionally by the beeps of monitors…needs to be seen ,to be believed…..
Really very well described 🙏🙏
And being a anaesthesiologist myself feels nice to be appreciated 🙏🙏🙏🙏..
Best wishes 👍🏻👍🏻…
Beautifully written Mazda. Keep on doing great work…
I feel so inspired by your ‘never give up ‘ attitude. 👍👌🏿👏🏽
Having been born and raised in Africa I am aware of the lack of expertise in this field; Jude is lucky to have come to you. Well done, Sir 👏🏽
Dear Dr. Mazda
I wanted to take a moment to commend you on your article. Your writing is not only informative but also engaging and eloquent. The way you presented the topic showed a deep understanding and a talent for conveying complex ideas in a clear and captivating manner. Your thoughtful insights make the piece stand out.
Excellent doc, people like u make life worth living. U have treaded where the sun doesn’t shine,where no one would have dared to put his foot(hand) in.
It’s a pleasure to know docs like u.
God bless and continue your godly work.
Wonderful doctor, ur a wizard of the medical field of spine and brain. God bless you.
What a masterful skill you poses as a surgeon! Hats off to you doc. Wonderful narrative!
What a wonderful description of a heart stopping difficult operation.
Kudos to You Mazda for the surgical expertise and your precise description for the layman
You nearly jumped off the cliff during surgery 😳 😂
Congrats first to accept such high risk surgery and then to complete the job successfully without any aftereffects. This needs GUTS and CONFIDENCE.
It really was a magical surgery u pulled on successfully. God bless you .
You have this knack of relaying the most serious story with the correct touch of humour and such fantastic comparisons and descriptions that it’s easy to actually visualise the situation. Lovely read as usual. You really make a sad song…I mean sad situation , better!!!
Wow Dr Mazda!
You truly are a miracle worker!
God bless your beautiful brain and steady hands.
You definitely have a disorder to be able to function under such stress.
What a heart warming, gripping & certainly Godly Mazda! Doc, stay blessed…. Miracles are possible specially in the hands of devoted caring surgeons & doctors. And chirpy positive patients!!!!
Dr Mazda, stay blessed🙏
Hey Doctor ! You are miracle doctor!!
Salute to you.
You are a marvelous surgeon who puts disorderly brain parts in order.
It’s a Wow!
You are God in shape of a human being!!
Stay blessed
Dr Mazda Turel is a gifted a writer as he is as a surgeon. When he talks to you he oozes confidence in you👍.
Brilliant article. Was so stressed out reading it. But Doc what about the times when surgeries are not successful? Do you write those articles too?
Wow! Doc, you are a genius. A miracle maker. God bless you.
Ufff! My Bp was high while reading!! 😅😅
Anyways, I know you are a good doctor, that’s why me and my husband promised each others, anything happens to us, first we will contact you , 😊😊,
Very impressive surgery indeed. God bless you, u make even the impossible cases successfull by ur dedication. Hats off to you doctor!
Fabulous Blog
Such emergency situation shows the correct and quick decision of surgeon his courage and competence.
Wow. Great. Proud of you.
Great Dr. Mazda. You are great.👍
U are absolutely great sir .not only u care for your patients but for your surgical staff and anesthesiologists efforts too.
Greats .
Dearest Dr Mazda Sir ……..
It was absolutely amazing to read & feel the Live experience of having inside OT with you……..
Can literally feel the missing Heartbeats even while reading & can imagine the situation inside the feelings of your Team members, so tense & pressure…….
Would like to pat on your back & Hug you tightly for graciousness by acknowledging the Fact that you are giving good credit to your support colleagues in OT……..
Please please keep on repeating & Sharing the Amazing experiences from inside & outside of OT and enlightening your Readers with your Rich Knowledge of Medical & non medical skills sir …..
God Bless & Live Long with Super Health sir 🥰
You don’t seize to amaze us, when one thinks how did Dr. Mazda achieve these miraculous surgery comes another milestone and your writing skills has us hooked …
God bless you.
You make impossible, possible in all your cases your luck is also on your side, but the effort you put in your surgery is mind bogling. O M G.
Jude is blessed as are you Dr. St Jude Thaddeus is the Apostle of the Impossible.
Dear Dr.Mazda
Kudoes for your meticulously planned and executed surgery.
I admire the courage and skill of your anaesthesia team.
It took me into the memory of managing difficult cases with Dr Keki Turel at JJH.
May you succeed in such difficult cases in future
Hi mazda, right from the beginning I knew that you would energe a winner over that beast of a tumour. What a toorud time u must have had thru the surgery and kudos to the anaesthesia team they did a super job keeping the BP in control. The suspense was truly Hitchkockian.
O
Now we know why you were named MAZDA for all the good that you do in the name of Ahura Mazda.
May you live long to continue giving life to others. Msy your hands be blessed always.