The Surgical Finale

Because even endings, like patients, have a way of resuscitating themselves.

Endings are peculiar things. They arrive quietly after long journeys, like a house guest picking up his bag. Or they rush in without warning, like a sudden monsoon downpour that drenches you before you can run for shelter. As a surgeon, I have lived through most kinds. Endings that felt inevitable. Endings that felt unfair. And endings that surprised us by not being endings at all.

One of the earliest patients I thought I had lost was a middle-aged man who came to the emergency room after a road accident. By the time he reached us, he was unconscious, his breathing was shallow, and the monitors around him were making the kind of sounds that make doctors sprint instead of walk. His family had gathered in a corner of the waiting area, hands twisting prayer beads. When we opened his skull, his brain looked like it had fought a cyclone and lost. We worked through the night in a silence only operating rooms understand. When dawn arrived, he still had a pulse, but I had already prepared myself for the call I would have to make to his family.

Except, he refused to die. He clawed back with the stubbornness of someone who had unfinished business. A week later, he squeezed my hand. Two weeks later, he opened his eyes. Three months later, he walked into my clinic wearing a bright shirt and announced, “Doctor, I am here for a second life.” Some endings need a sense of humour.

There was another man in his seventies, a teacher who had lived his whole life by the clock. He came in with a massive subdural haemorrhage and went into cardiac arrest on the table. We performed CPR long enough for two residents to whisper that perhaps we should stop. But something in me refused. I kept going, partly out of instinct and partly because he reminded me of my own schoolteacher who had once told me, “Keep going even when you think you cannot.” He survived. When he came for a follow up, he told me, “You gave me extra time. I promise to spend it wisely.” I wished I could tell him that it was he who had given me extra courage.

And then there was a woman in her sixties who had a tumour in a location so deep and so complicated that even the MRI seemed to sigh. In the middle of surgery, there came a point when the bleeding would not stop. For a moment, the room froze. A nurse looked at me like Adele as if to ask, “Is this the end?” But something shifted. I prayed, and almost poetically, the bleed tapered, as if the tumour had given up its fight. She woke up, looked at her daughter, and said, “Did I miss something?” That day, I believed in small miracles.

We are trained to expect the worst. But the longer I practise, the more I believe that recovery has a personality of its own. It sulks, hesitates, throws tantrums, and then, when it feels like it, springs up and says, “Fine, I will come along.”

These patients taught me what every ending teaches us when we pay attention. We think endings are full stops, but they are usually commas. One chapter closes because another awaits. I have learnt that we can also survive hard endings because there is no such thing as a perfect ending, only honest ones. Atul Gawande (American surgeon, writer, and public health researcher) taught us that medicine is not just about saving lives but helping people live with purpose. Siddhartha Mukherjee (Indian physician, biologist, and author) reminded us that biology is not destiny but a story constantly rewriting itself. And the Stoics (ancient Greek and Roman philosophers), with their maddening calmness, insisted that every ending is simply a transformation muted by perspective.

Endings in surgery are sharper. They stare at you through monitors. They beep, they flatline, they turn blue, they turn back to pink. They teach you humility in a way no philosophy textbook can. But they also teach you delight when someone you thought you could have lost walks back into your clinic with a grin and a box of sweets. Like Brené Brown says, “If we own the story then we can write the ending.”

And now, dear reader, we arrive at another ending. This is my final Sunday Mid-day column. When I wrote the first one 6 years and 155 articles ago, I did not imagine I would write so many. I’ve written them in taxis, on flights, between surgeries, and once while sitting on the floor outside an airport washroom because that was the only place with a charging point. I’ve written about tumours and tenderness, aneurysms and affection, fractures and forgiveness, inflammation and intimacy, and the strange ways in which illness often sits beside emotion on the same hospital bed. I’ve written about the people we save and the ones who save us – about my successes, but more about my failures.

I need to profusely thank Tinaz Nooshian, the former Editor in Chief of Mid-day, for onboarding me and whose vision this was – to humanize and enthuse the common man with medical stories of grit, gumption, and grace. I did not imagine the unexpected and delightful consequences of doing so: strangers (mostly elderly women) who would stop me in elevators to say, “Doctor, I cried reading your piece,” or those who would bump into me at movies, restaurants, and flea markets to say, “Doctor, my mother loves your articles,” or the ever-welcome “Doctor, you make our Sundays smile.” I did not imagine I would come to look forward to the world (or a tiny portion of it) sitting quietly with my thoughts ever so often. I also have my dear friend Dalzeen to thank, who lovingly edited every single one of these articles before allowing me to send them out. She’s probably the only one who’s read them all.

But endings are necessary. They make space for beginnings. Something has to close for something else to open. A wound must heal before a scar can form. A chapter must finish before the next one can surprise you. The operation must end for the patient to awaken.

This ending, however, is only on this page in print. The writing will continue. The stories will continue. The patients will certainly continue. If you wish to keep reading them, they will live on at mazdaturel.com. And if you prefer them delivered more personally, you can reach out to me on +91 9930174567, and I will send them to you fortnightly on WhatsApp like a slightly overqualified newspaper boy.

Before we part, I want to tell you one last story. A young man once asked me in my clinic, “Doctor, do surgeries always have happy endings?” I told him the truth: “Only if you get them done in Thailand.” The serious answer, however, is “No!” And just as with surgery, life, too, does not always offer happy endings. But it offers endings with meaning. Endings with grace. Endings with humour. And sometimes, if we are lucky, endings with the kind of happiness that does not need a disclaimer bracketed next to it. Thank you for reading. Thank you for staying. Thank you for allowing me into your Sunday mornings.

A very happy New Year to you and your families. May your beginnings be bright. And may your endings, whenever they come, be gentle.

(www.mazdaturel.com – Click to Read More Articles…. )

(+91 9930174567 – Click to Save My Number and Message me..)