The Surgical Closure

While doctors are told to detach from their patients, they are never really trained or prepared for it. 

“It’s a really huge tumour encasing the major arteries of the brain and circling both optic nerves,” I said to the family sitting in front of me. This is after I’ve been intently and repeatedly scrolling back and forth through the MRI images loaded on the computer in front of me. The growth was arising from the pituitary gland but had invaded into the nose below and brain above, chewing up the bone at the base of the skull. 

Betty, who had come in with her mother, was 48 and rapidly losing vision. She was finding it difficult to look after her five-year-old daughter not only because of her deteriorating vision but also her decision making and executive functioning. “It’s probably due to the tumour pressing on the frontal lobe, which is responsible for these functions,” I said. “We’ll have to operate on this through the nose and by opening up the head simultaneously. It’s going to be a major deal.”

“Will she be okay?” her mother asked. “Of course,” I said, following it up with a laundry list of possible complications. Our interpretation of how any operation will shape up is often filtered through the lens of our own experience. 

A few days later, two teams operated on her synchronously. The ENT surgeon put in an endoscope from below and then prepared the passage through the nose. The tumour looked right back at us – quite pale and deceptively well-behaved. But the moment we bit at it, it bled like a pig. The only way to control the bleeding in such cases is to briskly remove the tumour and we proceeded to do just that. We then opened up the head and removed the monstrosity from above, gently separating it from the arteries it was encasing and freeing up the optic nerves till we encountered the cavity in the nose. 

Once we removed it completely, we could see right through from the brain into the nose and right up the nose into the brain, and with the radiant light of the endoscope shining directly onto the brain through the nose in a dark lit room, the skull looked like an art installation. The ENT surgeons then repaired the defect in the base of the skull to isolate the two compartments. This closure is the most crucial part of the operation. 

The next day, Betty was alert and awake, could see better, and looked really happy despite being connected to tubes and pipes in the ICU, which we got rid of over time. Her mother was thrilled that she was ready for discharge within a week, but just the day prior to that, I noticed two drops of water trickling down the nose. It was no ordinary water leaking out but cerebrospinal fluid or CSF from the brain. My heart sank into that elusive pit in the stomach where it makes knots when disaster is around the corner. 

“We have to repair this urgently by sealing the leak,” I said with certainness. “Another operation?” her mother questioned. I nodded; the longer we take, the higher a chance of getting an infection, and I wasn’t about to waste any time. We went back in and redid the closure, tracing a gentle stream of CSF meandering from the brain into the nose. But she developed an infection with fever – no ordinary infection but full-blown meningitis. She became drowsy, irritable, and almost comatose, but with the appropriate antibiotics over 3 weeks, we got her back in shape and she was discharged in pristine condition. Every day of those three weeks, we fought for her survival even when her family was convinced she wasn’t going to make it. She went home with a new vision – literally and philosophically. She was back to taking care of her daughter with gusto. 

A month later, she landed up in the emergency department with severe headache and vomiting. The CT scan showed that her ventricles had blown up – a condition we call hydrocephalus – and worse, they were full of air, air that was seeping in from the nose into the head. More sophisticated testing confirmed it. The year 2021 was bad for nearly everyone, but for this family, it was just getting worse. 

“We have to go back in and fix the problem,” I proclaimed, albeit a little helplessly. Why this had happened after such a meticulous closure was hard to fathom. Was there another area of the bone destroyed by the tumour that was sucking in the air? Was it the pressure of the hydrocephalus that was not allowing the seal to heal? Whatever needed to be done had to be done now, before it became too late. We took her back to the OT and put in an emergency tube to drain the fluid, re-repairing the leak even though we didn’t find the spot it was leaking from. But she wasn’t improving. 

I was razed to the bone of my resilience; yet, I told them I wasn’t going to give up. “We’ll fight this thing together,” I told her forlorn family. I saw her four times a day, checked on her an additional eight times. After doing a few small operations to change the external tube, we did another operation to internalize the shunt tube and then another to set its pressure right. 

After another month, the CT scans looked perfect and so did she. She started talking, eating alone, and walking with support. She asked about her child and gave instructions on how she should be managed at home. We cut a cake for her a day prior to discharge. The family was effused with affection. For our grit and her grace. 

And the next day, she had a seizure; her head was full of air again. She was unconscious. We got another senior ENT surgeon to repair it but that closure didn’t work either. We tried once more a few days later. Three months and ten operations later, she was gone. And I still can’t get over it. It’s like the laceration of a heart that barely feels bearable. 

Often in medicine, we are told to detach. But no one teaches you how. She was an appendage of my mind and body and it is impossible to forget her. The popular mode of thinking is, if you work hard enough and follow certain steps, we’re able to get over our losses. That might be true for most, but some losses don’t follow such models, and it was famous psychologist Pauline Boss who cautioned us on the nature of such loss: “Its ending is never perfect, even in the best of times.” 

Patients sometimes leave, but how they leave always stays. And often, the illusion of closure is exactly what it is – simply a myth.


This article first appeared in the Sunday Mid-Day on 9th January 2022


27 Comments on “The Surgical Closure
  • Mrs sunaina saraf says:

    Hello sir

    Its so touching but u had put in ur best thats commendable
    Ur last bit patients always leave but how they leave its imp
    Its so true with each of us
    Sunaina Saraf

  • George Koshy says:

    You r right ..”closure” is a myth..

  • Supriya Correa says:

    My heart goes out to you, Mazda and Betty’s family. Thank you for being so empathic that you grieve for your patients as much as their families do.

  • Avinash Karnik says:

    After reading this article, I also felt very sad for the loss of life and you couldn’t save her in spite of so much effort. We are taught by elders that every moment is governed by the almighty. And our job is to do our best in given circumstances. You have sone your best and it must be have been very difficult for you to face such a calamity. After so much effort by you and your team, it was left to the hand of God to decide the final result. However your grit to save her has to be appreciated.

  • Chanda says:

    Thank you dear Doc. Bless you!

  • Anaita says:

    So tough on you guys too. Thanks for your service and sacrifice ❤️

  • Navzer Irani says:

    Words are difficult to find to recommend a comment to such a moving and difficult situation……. And u and ur team must be regularly going through. Man proposes God disposes. Stay strong and may HE always guide u.

  • Shyam Babhulkar says:

    Excellent from the true heart narration. The pain of pt aswell closers is so intensely felt, as we are present there. This feeling is quite frquent in our field especially in our earlier days.. Your expression & language is just superb.

  • Gladys T K Kokorwe says:

    Ah This is truly touching. You guys tried your bestest (if there’s any word like that) to safe her life. At times if it’s time for one to leave this world there’s nothing anyone can do.
    You Dr Turel and your team are so gifted.

  • Rita singh says:

    I feel for ur sorrow.But what can u do ? Be consoled in the thought that u gave ur best under all complications. God had planned only that many days for her on this plane. Om Shanti Shanti.

  • Mehroo Mistry Turel says:

    You write beautifully Mazda. Felt like I was with you and Betty for those three months. You are a gifted neurosurgeon and an amazing human being.

  • Bikram Shakya says:

    The battle to win goes on…

  • Freny says:

    Beautifully penned to every detail of each surgery Dr. You n your team of Drs did your best. Whatever happens is not in our hands. It was her destiny.

  • Marzin R Shroff says:

    Honestly, I was expecting the end of the article to mention that Betty was back with her kid taking care of him / her. However, life is not always like that.
    I am deeply impressed by your resilience and the fact that you are a Human Being first, and a Doctor second.
    When you do what you do 24×7, it either makes you or breaks you. In your case, I’m sure that it has made you into a stronger, Better Human being and Doctor
    Three Cheers to you Mazda. May your tribe live increase

  • Hiten dadia says:

    Very touchy & tough for us as our professional life & emotions try to get over with such events in our life…..

  • Bapsy Bengali says:

    This article was very sad and touching. However, Dr. Mazda you had done your very best. May God always bless you 🙏

  • Mahashweta Biswas says:

    Bless you Mazda & your team for not giving up & continuing very hard to safe Betty’s life.
    This was a very touching experience you shared with all of us. You put your best foot forward, rest was upto The almighty. Heartfelt condolences to you & her family.

    God bless

  • Sameer Futane says:

    Dear Mazda,

    Very poignant. The article released many ghosts from the proverbial cemetery that lies in every Neurosurgeon’s heart. You are a gifted writer!

  • Vipul shah says:

    Dear Dr Mazda

    In spite of your Marathon efforts along with your team to take steps after steps we all must realize that final outcome is in the hands of All mighty ..

    This is taught to us in Gita ji emphatically that your job is to do Good Karmas with positive intentions without expectation of fruits…..

    Your sadness will reduce considerably if you follow principles laid down in Gita ji …

    Good Luck for your kind efforts in subsequent Surgeries to follow

  • Dr Shivkumar V Dalvi says:

    It was a real superhuman effort that you made for this lady and one certainly feels sad that she could not be saved for her sake as well for her little daughter’s sake.Yes, doctors are also human beings and cant stop getting involved emotionally.No guilt should be felt under such situations.You tried your best n never gave up is most important.

  • Dr Anil Sant says:

    Nicely narrated.We doctors do go through such situations, and it is not easy to remain detached or compartmentalize our emotions. Nevertheless one must keep in mind that we are not godplayers (even though people might think so) .
    One must not feel guilty after you do your duty.

  • Di says:

    Well written as always… Such a touching article… while reading emotions going high and low… felt happy to read Betty wud get discharged then sad that she needed to be operated again.. hats off to u and the team working so hard and diligently… never gave up n kept fighting to save her life… u all did ur best, rest is in God’s hand.. must be extremely difficult for u to detach from patients who u have connected with.. may Betty’s soul rest in peace.. God bless you

  • Anjali Patki says:

    A very touching narrative, sensitively written. The ups and downs in a patient’s life and their struggles so truely are shared by the doctor too. Keep up the good work dr Mazda.

  • Burzin Panthaki says:

    So sad that inspite of your best efforts Betty could not be saved. Dr Mazda you a great human being.
    Reading the article brought a lump in my throat, it brought back flashes of my brothers fight with cancer.

  • Chandan Sanjana says:

    Mazda this for me was very difficult to read. What your patient and her family went through, besides you and your team who grew so close to the patient and in the end she had to ‘go’. Hard on her family and for you too to loose a young patient. But this is part of your profession to do your best and in the end it is HIS will that will be done. 🙏🙏

  • Katrin says:

    Thank you for sharing! Quiet a humbling experience that reminds us no matter how good one is at his/her profession, some unexplained circumstances can take the journey to a different destination. “Have no regrets when you give your best”. You are amazing and much appreciated!

  • Katrin says:

    Thank you for sharing! Quite a humbling experience that reminds us no matter how good one is at his/her profession, some unexplained circumstances can take the journey to a different destination. “Have no regrets when you give your best”. You are amazing and much appreciated!


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