When senior citizens forget, we attribute it to old age. When they miss a step repeatedly, it’s what else, but wasting bones! In medicine, assumptions can be counter productive
“I have come all the way from the suburbs for him,” Mahrukh aunty told me, pointing to her husband who was being manoeuvred by an attendant into my office on a wheelchair. She wore a floral scarf on her head knotted under her chin and a simple beige dress. He wore a big smile, typifying an oblivion of why he was here. For having lived to more than 80 years, he was robustly built: broad shoulders, steel frame, firm handshake. He was 5 feet 11 inches tall and weighed 110 kg.
“He’s forgetting everything,” his wife started. “Can’t remember what he’s eaten for breakfast, can’t remember the names of relatives who come to visit, and now he’s even forgetting things of the past such as the name of his school, college, or where he worked,” she gave a detailed description of his memory impairment. “Do you remember your wife’s birthday?” I asked Rustom uncle, trying to engage him. There was a silence. He stared at me blankly for a few seconds and burst out laughing. She gently stroked his forehead trying to calm him down. I can guarantee that no other wife in the universe would have had that reaction. “This is his behaviour to most questions,” Mahrukh aunty informed me of his plight. “Doctors tell me that this is Alzheimer’s and that he has to live with it,” she lamented.
“Why is he in a wheelchair?” I asked, not convinced about the Alzheimer’s diagnosis. “He cannot walk for more than a few steps; he tends to keep falling and needs two people to support him,” she explained. “I used to walk 2 kilometres a day until one year ago,” he interjected following the conversation, not completely out of it. “What about passing urine?” I asked. “No control,” his wife stated. “He’s been on a diaper for the past 9 months,” she added. I made a detailed examination and concluded that before we could call this Alzheimer’s, we needed to rule out other treatable causes. “We should get an MRI of the brain done,” I insisted. “Doctor, please admit him and do whatever you want to because I’m 75 myself and can’t manage him at home,” she said exasperated.
The MRI done the next day showed what I had expected. The ventricles – the cavities that produce and contain cerebrospinal fluid or CSF were distended beyond the normal, pushing against the delicate leg and bladder fibres of the brain, resulting in his imbalance and urinary dysfunction. Normally, ventricles look like two slender bananas backing each other. Dilated ventricles look like the bananas put on a Mickey Mouse hat. I explained the findings to the wife. “This looks like an entity called normal pressure hydrocephalus or NPH,” I got technical. “The pressure in the brain isn’t raised, but because the ventricles are distended or dilated, he has these symptoms,” I reasoned.
I explained that the logical thing to do was to drain some spinal fluid via the lower back, which communicated with the brain, and if there was an improvement in his symptoms, we could consider inserting a tube in the brain that would permanently drain CSF in a regulated fashion into the abdomen. We also tested for any vitamin B12 deficiency and thyroid dysfunction, which are the commonest causes of forgetfulness. His results were clear. “Is there a need to do all this at this age?” his wife asked. “Only so that he can remember your birthday,” I replied, putting my arm around her shoulder. “If he doesn’t get better after draining CSF via a lumbar puncture, we won’t do anything else for him,” I promised. She consented.
The next day, we stuck in a needle in his spine and drained about 40 cc of crystal-clear fluid from his spine. A few hours later, when we made him walk, his gait was remarkably better. He could walk longer distances simply with the support of one person. “How do you think he is?” I asked his wife. “He’s so much chirpier today than I’ve seen him in the past one year!” she said, beaming. I looked at Rustom uncle. “When is your wedding anniversary?” I asked. He gave me a blank stare. His wife looked away dejected. And then, three seconds later, he said, “12th March 1975!” His wife turned around in disbelief. With a smile like Julia Roberts’, she kissed him all over his bald head and face. “So, shall we go ahead with the shunt operation?” I asked with a smile. “Of course!” she said without any deliberation.
When elderly people start forgetting things, the general tendency is to attribute it to old age or label it as the wearing out of faculties. When they have some imbalance while walking, it is mostly attributed to the withering of joints, muscles, and bones. When they have trouble peeing, it is most probably a prostate dysfunction. But we need to look deeper and identify if we can find something that is reversible. And when I’ve looked, I’ve found brain tumours, excess fluid, collections of blood pressing against the brain… all of which can cause the exact same symptoms. That’s why I always insist on an MRI in anyone who’s unreasonably forgetful.
The next day, we made a tiny hole in Rustom uncle’s skull and tapped his dilated ventricle. The tube was attached to a valve that would regulate the pressure at which the fluid was drained. We then tunnelled the tube under his skin and inserted it into the abdomen, performing a sophisticated plumbing job. Now, all the excess fluid that was produced by the ventricles would drain into the abdomen and get absorbed by nature’s magnanimity. The day after surgery, he was sitting up and eating alone – something he hadn’t done in months. Two days later, he indicated an urge to pass urine and walked to the washroom on his own.
“Now I have no work left to do; otherwise, I was changing three diapers a day!” his wife joked. She also told me the story of how, when she was in hospital and diagnosed with breast cancer a few years ago, he was there to take care of her round the clock. When they got discharged, the hospital staff cut a cake with the words “Best husband ever” iced on it. The next day, we decided to get another cake with the date 30th July inscribed on it. When he was told to cut it, he instantly recognized the date to be his wife’s birthday. She was delighted beyond measure. Tears rolled down her wrinkled cheeks. Memory allows us to have a meaningful life.
“I feel like eating French fries from McDonald’s,” Rustom uncle told me. “Will you help me smuggle them into the hospital?” he winked. “French fries are for 8-year-olds, not 80-year-olds,” I chided.
“Just get rid of the zero after the eight. I’m enjoying my second childhood,” he reminded me, paraphrasing Shakespeare, followed by a bellow of laughter from his belly.
23 thoughts on “The surgical memory”
This is a superb account of your great work Doc. Keep up the good work and miracles to transform the lives of such needy and grateful human beings. You surely much more than you are getting.
That is such a sweet recounting of an interesting encounter. Max, you almost make the reader forget that the encounter is taking place in a hospital, such is the beauty of your narration. It is human, it is compassionate, it is spell-binding!!
Apologies Maz. It’s the silly autocorrect!!
Age is just a number..if u have kiddos n parents u know what I mean..!A lady can b so delighted to get love even in her oldies..btw the Julia Robert’s smile was cheering !!
“Memory allows us to have a meaningful life”
Your medical expertise in your awe inspiring field coupled with your genuine concern for your patients and their emotions is what makes this article interesting. Keep up the good work
The greatest gift is to restore human dignity at the tail end of one’s life when it is needed the mos, is a gift that is priceless.
,
It can only be given by a surgeon who thinks like The great William Osler And operates like a wizard.
Great story and hats off to you Mazda
Doc Mazda, thanks for a glimpse into humanity as it’s meant to be lived…..with humility from yourself oozing to your patients and their families. Let alone us who share your joys and their joys from a safe distance. May you remain blessed
No words to appreciate your skill and expertise.
May God bless 🙌 u with long life to enable u to cure tbe patients.
Best wishes & cheers, Dr.
-Bipin Dani.
International cricket 🏏 reporter.
Nice story with a beautiful ending. Happy his problems were sorted out. Getting old isn’t easy.
Thanks doc for an eye opener. MRI should be made mandatory perhaps before an Alzheimer’s diagnosis.
Hats off to you and the MRI tool.
Dearest Dr Mazda Sir ….
Believe it or not sir the Amount of Blessings you will receive from Maharukh mai & Rustom ji is beyond your imagination……🌹
Lord All mighty will surely give you super strength in your hands ( & Brain too ) to use for surgery & writing ❤️
Your typical Parsee witty short sentences are very very touchy & powerful 🥰
Dearest Dr Mazda Sir …..
Believe it or not Sir the amount of Blessings you will receive from Maharukh Mai & Rustom ji is beyond your imagination 🌹
May All Mighty Give Super Strength in Your Solid Hands ( & Brain too) for continuing Surgery & Writing with same Passion ❤️
Keep on updating with Finest Anecdotes with knowledge & Humorous approach with PARSEE touch 🥰
I think it’s the same thing happens to me it’s in less form, I would gladly do whatever Dr Mazda would tell me to do. He is definitely a wonderful doctor but a good human being.
I think 🤔 you are a wonderful doctor, but a better human being.
Dear doctor Mazda,how can one express their appreciation .Every time we learn about one of ur marvellous diagnosis and treatment we r wonder struck by ur clearity of mind and sincerity for each of ur cases.God bless you.
That was inspirational Dr. Mazda. Such an important thing for old age, Memory and ability to look after one’s self.
Superb.. 😊👍💐.. 🙏
“You are so brave for facing this head-on. I admire your determination, and I believe wholeheartedly that you will come through this surgery stronger than ever. I’ll be keeping you in my thoughts and prayers.”
Lovely story with a happy ending.
May you carry on God’s work for a long, long time.
Memory allows us to have a meaningful life.
Great job doc
Keep it up
Returning human dignity. V humbling
Keep it up