The Surgical Laugh

While laughter is said to be the best medicine, a recurring one, without rhyme or reason, might just be a cause for concern

I GOT a little worried when he started laughing at his brother’s funeral two weeks ago,” said a concerned wife, as Rusi, her 55-year-old husband, sat in front of me shaking his crossed legs with his hands clasped on his belly. He wore a chequered shirt with a grey pant that complemented his pepper hair, and a confused look for why everyone was so perturbed about a few laughs.

“The other day, our cat had diarrhoea and defiled our expensive Persian carpet, and all he did was sit on the couch and laugh.” “Not only has it been ruined, it doesn’t smell as good anymore either!” Rusi added with a huge grin followed by a cachinnating guffaw.

“See, isn’t this ludicrous,” she pointed, almost instructing me to fire him for having switched from being a caring and loving man to a callous embarrassment. “He chuckles at old people being unable to cross the road. He laughed so much, he snorted when I mentioned to him that our son and his wife got COVID-19. He has started behaving like that man from the movie Joker.”

“Not the Raj Kapoor one!” Rusi interjected as I burst out into a bit of a giggle myself. “Yes, the actor whose name no one can pronounce properly,” his wife concluded with exasperation, as she pulled out an MRI scan of the brain that their family physician had ordered.

“So, he’s laughing at all the wrong things,” I said, summarising her woes as I plugged in the MRI into the luminance of the X-ray box, “and this is why.” With the back of my pen, I went on to circle a 3.5-cm tumour arising from the trigeminal nerve and pressing onto the brainstem. “A tumour in this location is  known in extremely rare cases to produce pathological laughter,” I explained, as they looked at me befuddled. “We’ll remove it and he’ll be fine,” my confidence coming from seeing a similar outcome in my training days of this common tumour with an arcane presentation.

A couple of days later, we tucked under his right temporal lobe, drilling into a little quadrant of bone obscuring our vision. Neurosurgeons take a look into the glistening opalescence of the brain every day, but the view is a tad different on each day. The brain is a variant shade of beige-pink, the nerves a diverse spectrum from white to yellow, and the corridors to access these tumours keep changing, making it a wondrous journey into enthralling nooks and crannies. There is a new treasure to be excavated every day. “Can I cut this?” is the commonest question I voice aloud to the amusement of the team watching the surgery on the big screen. Most often, you know what you’re about to cut, but on occasion, you end up nipping something you can’t identify in the hope it’s a part of nature’s abundance.

We peeled the tumour off the nerve it originated from, and when we removed it completely, the dent it had made on the brain stem gently ballooned back to take its original form. “You think he’ll stop laughing after surgery?” I indulged my assistant as we closed, a time of the operation where we resort to prosaic yet philosophical questions of life. “I think he has a great sense of humour; your surgery is only going to ruin it for him!” came the reply.

The morning after surgery, when neurosurgical patients are fully awake and alert, we check if they are oriented to time, place, and person, and do a thorough neurological examination to check for motor or sensory impairment, seeing if things had become better or worse. In Rusi’s case, we needed to say or do something strange to see if he laughed. “We’ll leave that for his wife to assess, after she spends the whole day with him,” I decreed as we wrote orders to transfer him out of the ICU and into the ward, which deemed everything was perfect.

Two days later, we got a call from the emergency department about a 67-year-old lady who began crying violently and inconsolably for two hours after a glass of water slipped from her hand and smashed to the floor. On checking further, we realised that she wasn’t hurt nor did the glass have any emotional value for her. The psychiatrist who was called in to opine was also confused. Our astute neurologist ordered an urgent MRI that showed a stroke in the left thalamus. She was administered a clot-busting drug and we could see her tears dry up as the last few drops of medication emptied into her veins.

Pathological laughter and crying are uncommon manifestations of common neurological conditions. They don’t have a motivating stimulus nor are they triggered by an impulse that would not have otherwise led to this reaction. Scientists term this as “emotional incontinence” and it is often seen in patients with amyotrophic lateral sclerosis, a form of motor neuron disease. We have also seen this in patients with multiple sclerosis, Parkinson’s, and in some brain tumours.

We went to check on Rusi on the day of his discharge. I could hear a roar as I knocked on the door. “We haven’t cured him, have we?” I turned to my colleague. “Hi Doc,” he smiled as the door opened. “Is he still laughing at stuff he’s not supposed to?” I turned to his wife. “Nothing crazy so far,” she said, her hands folded in gratitude. “Then what was he laughing at when we walked in?” I asked, my curiosity piqued. “Someone sent him a neurosurgeon joke!” “Let’s hear it,” I said, preparing myself to be embarrassed.

“How many neurosurgeons does it take to change a light bulb?” he asked, and then followed up with the answer after a sly grin from me. “Just one: he holds the bulb and the world revolves around him.” I smiled, shaking my head at the comical impression people have of us, but appreciating the humour nonetheless.

The next time you see someone laughing nonsensically, don’t hesitate to get a scan on him. If the scan is normal, you can safely diagnose him to be Parsi.

28 Comments on “The Surgical Laugh
  • Vipul shah says:

    Dearest Dr Mazda………..

    Your every piece brings so much enlightenment
    to common persons………

    You make complicated surgery so easy in your easy & lucid style of writing……
    I was not knowing laughing & crying need surgery..😂🤣

    Reply
  • Anjali Patki says:

    Dr Mazda, your article on pathological laughter brings a smile to one’s lips..thanks to your brilliant sense of humour and timing, and yet at the same time throws light on an intriguing condition which I’m sure a lot of non medicos would be unaware about. Interesting, entertaining and as always…. educational.

    Reply
  • Supriya Correa says:

    Wow, Mazda!! Amazingly written. Another Sunday, another chapter in neurosurgery. A front row seat to all things rare and unimaginable…brilliant work by you as usual

    Reply
  • Jasmin Lord says:

    Haha that last sentence had me in splits Mazda 🤣 very informative and very well written. Thanks 🙏

    Reply
  • Mahashweta Biswas says:

    Excellent Mazda. You narrated your experience so beautifully. Now everytime I see someone laughing too much I
    Will remember this article

    Cheers
    Mahashweta Biswas

    Reply
  • Khushroo says:

    Very well written and educational
    Continued Medical Education in its finest form
    K

    Reply
  • Chanda says:

    Oh Dr. Mazda, You’ve done it a again. What a wonderful way to begin a lazy Sunday. Reading your article has become a pleasant routine. Usually, repetition becomes monotonous BUT in your case it is welcomed with open arms 😉. You are genuine and generous in distributing smiles.

    Reply
  • Chaitaniya A Karnik says:

    Agree but in the most lovely way!

    Reply
  • Chaitaniya A Karnik says:

    It’s another world! And Glad to see the humour on this side of the table. Keep up!

    Reply
  • Avinash Karnik says:

    Dear Dr. Mazda
    This article unfolds slowly just like you cut into a layer by layer of the brain and suddenly you see the culprit.
    Well written as always. Keep up the writing as it helps people like us to make sometime of the day worthwhile otherwise it becomes senseless during this lockdown.

    Reply
  • Connie says:

    Hey Doc. Need I check out my goggles😳😳😳Could they be silly and needing a snip😂😂

    Reflections of a Joker🤷‍♀️🤷‍♀️🤷‍♀️

    Reply
  • Kermeen Bose says:

    Mazda Turel, You bring out emotions from me every Sunday- perhaps I need an MRI ??? Well written as usual. You always right interesting pieces, that spice up my Sunday!!

    Reply
  • Dr Jayant Apte says:

    Dr Mazda has work as an epitome ,
    Wonderful article with positive outcome ;
    Diagnosis and therapy of high class ,
    Admire your style with narrative class ;
    Enjoy your your success with a glass .

    Reply
  • Jonathan Juma says:

    A brilliant piece of work which will no doubt add to education, bring relief and joy to many. Keep the flag flying, Dr Mazda

    Reply
  • Rita Singh says:

    Great and entertaining and educational at the same time.Thank u for keeping us informed and entertained in these difficult times even.

    Reply
  • Vandana Uday Kamat says:

    Dr Mazda
    Reading your article for the first time.
    Excellent article imparting important knowledge _ unfolding like a story and humar/ joke in the end.
    Looking forward for more articles.

    Reply
  • Anuradha karnik says:

    Dear Mazda

    An amazing article. Unravelling the magical power of the brain to heal almost any affliction. Respects to the human brain and the master magician who knows how to delve into its mysteries with the right keys! Congratulations! An excellent read!

    Reply
  • Mercy says:

    Fantastic writing , Mazda. Loved it .
    I wonder if I need a scan!!!

    Reply
  • Martha says:

    Thank you very much Dr Turel. The first time I’m reading on “the Surgical laugh “
    You are a genius.
    May God bless you with more of His wisdom, Amen

    Reply
  • Sandeep Shah says:

    Dear Dr Turel, your every article reminds me of ‘Life’s Like That’ ! You always end on positivity while where you begin is life threatening and uncertain outcome.
    Love reading your every piece of article.

    Reply
  • Havovi says:

    Mazda there’s no doubt you are a great story teller. Your writing is laced with suspense n humour. Most enjoyable article.

    Reply
  • Zubin Bhesadia says:

    A Super Sunday Dose packed with Narration, Knowledge & Humour. Leave it to Mazda to add the condiments & spices of anecdotes, punches & lingo to flavour up the article…& my what a blending he does!

    Got to hand it to you Mazda – you surely make the most complex surgical procedures & neurosciences-related experiential escapades sound like book review sessions
    …or better yet, blockbuster movies that goes into flashback & return to the present where the scenes unfold with a concoction of suspense, thrills, laughter, at times sentimental & in majority, have an “all is well” ending.

    This is the reason why people from all walks of life love your articles & blogs. You could have easily written them all in medico terms, but then, you have an undying spirit of disseminating knowledge & promoting experiential learning catering to both – the medical & non-medical fraternities.

    I’m sure that your contributions not only in the field of neurosciences, but also, in the field of knowledge-sharing will go a long way. Kudos to your efforts that you put into authoring such wonderful articles albeit the long durations in the OT & consulting! Stay shining, keep winning.

    Looking forward to more such fantastic & mystic reads from you. Best wishes.

    Reply
  • Di says:

    As always well written… the article is interesting, funny and informative… learnt laughing and crying for no reason, get a scan done.. haha lol diagnose him to be parsi

    Reply
  • Vinod Ahuja says:

    Excellent article. Well written and a delight to read. Thanks.

    Reply
  • Dr Chintan Desai says:

    I’m laughing my guts out at the last line.

    I’m not Parsi but the laugh is probably just as loud and nonsensical.

    Sometimes gujjus can be crazy too.

    Love it! Keep it up.

    Dr. Chintan Desai

    Reply
  • Lucky Yashvant Singh says:

    Amazing article sir,
    one can easly imagine a actuall situation by reading only
    Thank uh

    Reply
  • Prof. Ekkehard M Kasper says:

    Dear Mazda,
    There are many talented surgeons out there in our communities and beyond and some are gifted academic scholars, – but only very few have the talent to tell a complex medical story to the world in simple terms that are understood by the layman. Even fewer can attract attention and curiosity through enlightening insight with good stories that allow the reader to look into this world of wonders with simplicity and beauty! This, my friend, is a blessing that only the greats possess. Your writing reminds me of stories told by Oliver Sacks ….
    Terrific ! Please share more of your talent with the world.
    Best,
    Ekk

    Reply
  • George Koshy says:

    As usual u have a way with words and descriptions..very well written

    Reply

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