A late night, another patient in distress or a tiff with the spouse—patients will never know all the worries that weigh on the mind of their surgeon during an operation
I operate with AirPods nestled in my ears, a conduit to the hushed anxieties of the ward and urgent whispers of the ICU. They also help me dispense advice to patients who might need it urgently without having to make them wait until the end of the day. It isn’t as distracting as one might assume; it’s the equivalent of talking to your assistant about his weekend while opening up someone’s head, which is what we do when we have a brain tumour surgery on a Monday morning. Having said that, however, I often silence my phone during critical crescendos of an operation so that there are no inadvertent interruptions.
I realize that telling people you can talk on the phone while operating can seem unnerving to some. Once, after boarding a plane, as the captain introduced himself, I recognized his name and voice and was quick to realize he was a friend. I sent him a message on his phone saying I was on the flight. He was so excited that he kept returning my messages as we were on the runway and about to take off. I finally stopped replying to calm my own nerves and be sure he’d focus.
On one such regular surgical morning as I was performing a craniotomy – the removal of a part of the skull to access the brain for a complex aneurysm of the internal carotid artery – a call from the ICU pierced through the sterile air. Siri read out the name of the person who was calling in her sultry robotic voice in my ear. “Answer?” she asked. As I was burring a hole into the skull, I confirmed: “Yes.”
“Good morning, sir. The lady you operated upon yesterday for a pituitary tumour compressing her optic nerve has a problem,” the doctor on the other end told me. “What do you mean she has a problem?” I questioned almost angrily, because I had seen her an hour before starting surgery, and her face had been alight with the joy of returning vision. Before surgery, she was barely able to perceive light, and when I checked up on her this morning, she could count my fingers at a distance of 10 feet. “She says she can’t see anything now,” he clarified, his voice laced with concern. “She feels like a black curtain has fallen over her eyes. She’s also breathing heavily and looks pale and scared.” My heart sank as I continued to drill, bone dust swirling into thin air. The only plausible explanation would be that she might have bled inside the brain. But a CT scan done earlier in the morning had been clean. I thought for a bit as I got the bone off, staring at a pulsating brain in front of me. “Repeat a CT scan, and if that’s normal, get an MRI and ask the radiologist to call me with the findings,” I ordered. “Yes, sir,” came the military-like response from the other end. “Also ask the ophthalmologist to rule out a retinal detachment,” I added, thinking of a rare possibility.
I sat on my chair, had the microscope brought in, and began dissecting the gossamer strands separating the frontal and temporal lobes to expose the carotid artery, the main blood vessel that supplies blood to half the brain. While I did that, a parallel movie of the other patient being wheeled into the CT scan room played in another corner of my head. The weight of it pressed down on me. I pondered the possibility of returning to a patient barely a day removed from the operating table, all the while keeping watch on an aneurysm pulsing before me, knowing it could rupture at any moment and potentially cause an on- table death. It demanded an insane amount of equanimity to deal with the duality, this dance between creation and destruction.
Patients will always be unaware of the circumstances under which they are operated. No surgeon will confess to a late night of revelry, a tempestuous argument with their spouse before leaving the house, the gnawing anxiety of a looming debt, if they are jetlagged, or even the simple human frailty of fatigue or distress. No patient will ever know that their surgeon’s previous patient may be dying in the ICU on the same floor while they’re being operated upon only a few metres away.
I had once scheduled a patient’s major spine surgery for a Thursday morning. “But isn’t your brother coming down from the US in the wee hours of the same day?” the Parsi lady sitting in front of me asked, clearly having conducted a thorough background check on me. “Yes, he is, so?” I asked, a little surprised. “If you go to the airport to fetch him in the middle of the night, will you be fresh for my operation the next morning?” she continued. “I’ve operated in more dire situations,” I told her, giving her a kiss on the head to assure her that she’d be fine.
The radiologist called to say that the CT scan was clear and there was no bleeding inside the brain. “We are doing an MRI to check if there is any vascular insult to the optic nerves,” he updated. With steady hands, I navigated the treacherous landscape in front of me, carefully dissecting the neck of the aneurysm. Within its delicate walls, blood swirled like daredevil motorcyclists defying gravity in a metal sphere. Two parallel patients were looping vertically and horizontally inside my head. I asked for a 6 mm curved clip and placed it across the neck of the aneurysm, seeing the ball of the aneurysm shrivel in front of me as if the bikers had run out fuel.
The radiologist called back. “The MRI is also normal.” “Then why the hell can’t she see?” I muttered aloud. My colleague offered to close up the case so that I could go check on her.
Just as I walked into the ICU, I was informed by the team that her vision had returned to normal after knowing that the MRI was clear and showed complete removal of the tumour. “She probably had a psychogenic panic attack after she overheard relatives of the patient in the next bed talking about someone losing their vision after surgery,” the doctor told me. “What the…?” I controlled myself. “You have no idea what a surgeon endures on the other end of that phone when you deliver news like that,” I said, my voice tinged with the weariness of the morning. Yet, I knew that in their defence, they had followed protocol. The situation could have easily spiralled into catastrophe.
I went to her and put up three fingers from a distance of 10 feet. She could see clearly. She was beaming. “What happened?” I asked. “I think I got very scared hearing that news and just blanked out,” she confessed. “But now I’m happier than I have ever been,” she added, thanking me. Just then, I saw the other patient, the one with the aneurysm, being wheeled into the ICU, giving me a thumbs up. I realized I was helping patients live longer but aging twice as fast myself.
That night, while I lay in bed with my kids telling them about my rollercoaster of a day, I told them the story of how I was able to restore vision in someone who came in blind, and the mammoth smile she gave me at the end when she realized she could see. My 10 year-old elder daughter goofily asked, “Was the smile bigger than her face?” While that isn’t possible anatomically, I knew that physiologically and emotionally, it surely had transcended boundaries.
The Parsi lady who had the spine surgery and was discharged jubilantly a few days later, called one afternoon, in the middle of another operation of mine, to ask how soon she could start drinking. “At least wait until the evening!” I told her.
25 thoughts on “The Surgical Duality”
You are just great doc. That was a very enlightening episode though most of the terminology went over my head. But it surely lightened the day. Thanks for the post. Pls Keep them coming. Have a nice day.
Great one Mazda
Gosh- SUPERB!
I’m still spellbound-reeling with the impact your writeup has on me. I’ll comment when I’m out of this cocoon of the article. Lovely-lovely-lovely
You are great SIR.
I commend you for operating with AirPods. I never do. Never. And over the last years I have put my phone on silent when I operate. No calls. In the 5 odd years that I have done this I have had the registrar run up to OR twice, that I can remember. I will say that is infrequent. Am I getting more cantankerous with age? Surely not!!
Eu tiro o meu chapéu para si, Dr. Mazda!!!
O senhor tem feito milagres, graças a Deus. Eu digo que a Mão de Deus tem guiado as suas durante as cirurgias que tem levado a cabo com muito sucesso. É de louvar 🙏
Eu sou um produto desse sucesso!
Na verdade, os pacientes nem imaginam o que vai na mente do seu Cirurgião – antes, durante e depois da operação.
Continue assim, Dr. Mazda e que Deus o abençoe abundantemente 🙏
Votos de um excelente trabalho, SEMPRE!!!
Hirondina Morais
Superb and in sync with the turmoils of surgeon and surgery and ward and intraop and postop, all together ❤️
Excellent article Mazda so true of life we still have to perform no matter what is going on around us.
Reading this felt like being in the OT with you—intense, gripping, and filled with heart! The way you juggle life and surgery is nothing short of extraordinary. Here’s to more ‘smiles bigger than faces’ and fewer mid-op phone calls!
Keep up the good work.
Love reading your stories
You make us laugh and cry reading your blogs…such beautiful words ‘gossamer’ mammoth…Truly Dr Mazda you have the touch of a mastereo holding the scalpel or the pen!
I don’t know about neuro surgery but every fortnight my heart sops breathing for a spell as I anxiously read your accounts in the operating room.
In fairness, if the message doesn’t come through, my heart goes through worse!!
Love you Maz!! You really and truly take us on this amazing journey with you! Hats off to the wonderful surgeon, amazing writer and adorable human being !!!
This perfectly captures the tightrope walk of a surgeon – one moment saving a life, the next answering a Parsi patient’s most pressing post-op question: ‘When can I start drinking?’ I remember asking my my Doc the same question after my Chemo and I got a really stern look from him 🙃
But on a serious note, the duality is real.
Your stories always remind us that behind the precision of the scalpel lies a world of chaos and the occasional cardiac event induced by an ICU call. Brilliant as always
Excellent article mazda really a real rollercoster keep writing cheers
Great 👍
Beautifully described the excitement, terror and elation that a surgeon goes through on a certain given day. Fortunately such eventful days are infrequent though not rare.
“blood swirled like daredevil motorcyclists defying gravity in a metal sphere”
Verrry interesting read especially for a Vipassana practising psychologist!!
Just amazing.wonder how u can keep up the excellent surgeries under such a tug 0f war on two sides ,in and out the o.t.Great doctor and a greater human being.
My BP shot up while reading the adventures of ur OT!
Ur a master of ur brain n others too!!!
Dearest Dr Mazda sir ……
As usual extraordinary piece sir on riding two/ three horses together while operating thinking about patient in ICU & your music & your Accountant etc all together……..😳
You are multitasking personality my dear sir…….🌹
Enjoying every word of your superbly written blog filled with Emotion & Love ❤️
May God give you super strength in your hands for surgery with knife & Fingers for your Laptop 😎
Hiya Doc.., it has indeed been my observation… multi tasking is your forte !
However this kinda dilemma and the stress it causes is of another level…
We all have had to meet with deadlines at our workplace or/else there’d be consequences, sometimes dire… but nothing compares to life and death situation such as this one !
Your professionalism and unequivocal concerns for your patients is incomparable !
Doc, stay that way… you have our best wishes always 🤗
Dear Doc, Great analytical skills, great writing “…my heart sank as I continued to drill bone dust swirling into thin air.. as I was burying a hole into a skull…this being done between creation & distraction…”.
Brilliant perception.
Speaks of clarity,knowledge, professional pride.
Reminds of ancient verse of Kalidasa”…look well to this day for it is life for yesterday was a dream and tomorrow is a vision.A day well looked after makes yesterday a dream of happiness and tomorrow a vision of hope….”
The ancient verse seems to have augered well !
Thanks .
Doctor, you are Too Good…not only as Surgen but Writer as well.
Dr Mazda Turel is a wonderful and blessed surgeon
Dr Mazda Turel is a wonderful and blessed surgeon