The Surgical Mother

All of us have a protective mother that nestles inside us. This Mother’s Day, we salute her resilience and valour.

“We have a 50-year-old man with a large haemorrhage inside his brain and he is unconscious,” came the call from the emergency room. I ran down to the casualty and made an entrance (Hindi movie style) to speak to the family. Sometimes, doctors like to do that, pretend they are important. We push hard on doors, we ring the bell twice, and we take the steps instead of waiting for the elevator. We believe that by doing this, perhaps we can salvage the calamity at hand – and my gosh, how wrong we are sometimes.

“He was watching television when he complained of a severe headache. Before I thought of getting him a paracetamol, he fell to the ground and collapsed,” said his wife, looking nervous amidst the heightened activity around him. I shone a torch in his eye and noticed that both pupils were reacting, but that the right one was larger, a sign that we needed to rush him into the operating room. After I checked that he wasn’t obeying any of the simple commands – a straightforward way to assess consciousness – I dug my fist into his chest in a way to check his response to deep pain and he brought his hands to stop me from doing it, an indicator that he wasn’t completely stuporous.

I scrolled ardently through each slice of the CT scan to discern if there was an underlying pathology for the bleed and suspected it to be the rupture of a right frontal arterio-venous malformation. “We don’t have time to do an angiogram, so let’s see what we find when we open,” I instructed for a swift transfer to the operating room. Within the hour, we had made a large incision on his head shaped liked a question mark. We call it the question mark flap because we often don’t know what we might find inside. We removed the bone flap in a set of quickly mechanized moves, with my assistant and me making the best use of four hands working simultaneously. Surgery is like ballroom dancing; it’s romantic no matter who your partner is.

The dura, which covers the brain and is often crumpled and leathery, was stretched thin to the point of rupture. Usually opaque, it distended such that its silvery white hue had turned transparent, enough for us to see the underlying brain that gnawed angrily at us the moment we cut into it. The brain was under so much pressure that it jumped up a few centimetres and seemed to settle only once we zealously and expeditiously removed a large chunk of the clot. We circumferentially coagulated all the arterial feeders supplying the malformation and finally the abnormal vein that entered the dural venous sinus. The brain looked so much nicer at the end of surgery as compared to before we started. The dura breathed gently as it lay over the now soft and pulsating brain. We kept the bone out in sterile storage; to place it back over the brain a few weeks later, when the brain regained normalcy and the patient was better.

The dura mater, Latin for tough mother is a thick durable membrane that covers the brain. The dura mater is the mother of the brain: mater, rooted in the universal maa, means mother. The primary function of the dura, akin to that of a mother towards its child, is to protect the brain – and what a fabulous job it does of that. Like a mother for her family, the dura guards the brain’s internal environment.

When there is an impact to the head, the dura takes the first brunt, shielding the underlying brain no matter what its age. Over certain parts of the brain, the dura folds over itself to add an additional layer of protection. When certain tumours grow within the folds of the dura and reach ginormous sizes, it almost never gives way by thinning itself out, ensuring that the baby within is not hurt.

The current wave of COVID has unleashed a deadly fungal infection: Mucormycosis. This fungus is seen a few weeks after patients have received steroids to treat their COVID associated pneumonia. It travels up from the nose and decimates the nasal structures, often infiltrating the eye. Were it not for the defensive barrier that the dura provides, almost each such patient would have been dead by brain infiltration from this ghoulish adversary. Like most mothers, however, the dura also has an endurance threshold: at some point, it needs to give way for the child to realize what it is capable of. While it is an extraordinary saviour, it is also a tough teacher.

The dura has venous lakes and channels (sinuses), which carry blood from the brain to the heart. This covering extends all the way down to the spinal cord. It holds cerebrospinal fluid, or CSF, with sanctity. If there is a spontaneous tear in the spinal dura, the CSF can leak out leading to severe headaches, as it is this fluid that maintains the buoyancy of the brain. This kind of headache gets better only on repairing the leak, but some say even after lying down or, strangely, after drinking coffee.

A few weeks later, once the gentleman had made an excellent recovery, we brought him back in to replace the bone. The dura had refashioned itself healing beautifully, a sign of resilience and inner fortitude, just like the mothers we know. We put the bone back as if to say thank you, because those who constantly defend us sometimes need to be shielded too.

So, this Mother’s Day, I wish my mother, the mother of my children, and every mother in the world a happy and awakened Mother’s Day. Whether you are a literal mother or a metaphorical one, the mother of a child or an adult, a pet or a zoo, a home or an organization, you need to be aware that you are our protection and our nourishment. If you are intact, we are safe. Stay strong, stay superb!

31 Comments on “The Surgical Mother
  • Supriya Correa says:

    And to you who have been both mother and father to patients, friends and family…Happy Mother’s Day to you, Mazda!

    Reply
  • Dr Nishchal Vyas says:

    Happy Mother’s Day to you too Dear Doc 🙏❤️🙏

    Reply
  • Marzin R Shroff says:

    Love your conclusion.
    Just awesome.
    So, this Mother’s Day, I wish my mother, the mother of my children, and every mother in the world a happy and awakened Mother’s Day. Whether you are a literal mother or a metaphorical one, the mother of a child or an adult, a pet or a zoo, a home or an organization, you need to be aware that you are our protection and our nourishment. If you are intact, we are safe. Stay strong, stay superb!

    Reply
  • Mahashweta Biswas says:

    Firstly thanks for the Mother’s Day wishes. Superbly written article with a bit of humour.

    Thanks

    Reply
  • Rita singh says:

    Thanx for giving us mothers so much value.U r such gem of a person n doctor one cannot but help loving n admiring.Keep up ur superb work.

    Reply
  • Dr Rajesh M Shah says:

    Always love to read your article, it’s a learning process for me…. Thank you so much for sharing it…. 👍👍🙏🙏

    Reply
  • Vipul Shah says:

    Dear Dr Mazda

    Fantastic way of explaining conditions of Unconscious patient to Change back to normalcy……
    How nicely covered MOTHER into your piece ….

    Please write a compilation of all your articles in a book & Dedicate to Your MOTHER who is the BEST in the world…..

    Reply
  • Avinash Karnik says:

    The comparison of dura to mothers is never heard of.
    Just like your thinking that brings the readers of your article to feel as if we are watching a silent movie in which you are performing a brain surgery.
    You have a heart of gold yet soft with full of affection.
    Another great article. Congratulations

    Reply
  • Azmin Vania says:

    Dear dear dear Mazda,

    Only a person with your compassion and warmth can create such metaphors! This article is so vividly described that it feels like I was part of the surgery, witnessing this majestic surgery you just described!

    Thank you and Happy Mother’s Day to you, for being that protector for so many already and so many more to come!

    To the soldier in all of us!!

    Lots of love,
    Azmin

    Reply
  • Anaheeta Mehta says:

    Womderful Mazda , mother of all , keep u safe and healthy

    Reply
  • Pragnesh Bhatt says:

    Excellent analogy and so timely 👌👌👌

    Reply
  • Donna Reen says:

    It was so amazing to hear of Dura Mater. What an appropriate name and so appropriately used for this article.

    Reply
  • Sunaina N Saraf says:

    Happy mother’s day 🙏to everyone not necessarily being a biological mom but anyone is a mother who has a beautiful & generous heart ❣
    Sir respect u more for your seem less effort & efficiency 🙏

    Reply
  • Dr.Syed Moeed Zafer says:

    Excellent write up Dr.Mazda

    Reply
  • Farhanaz Irani says:

    Excellent comparison with mothers care

    Reply
  • Chanda says:

    Dear Pied Piper Doc,
    Couldn’t help but shed a ‘happy tear’ ( whatever that may mean) on going through yet another mesmerizing article. Just as the Pied Piper led one and all to follow him, so do you. We wait to follow your article every fortnight. Need I say why? To summarize, the article touched my heart ❤. It sure is a tribute to ‘Mother’

    Reply
  • Anjali Patki says:

    Had absolutely no idea that dura mater had this meaning. Kudos to your research, writing skills and surgical skills too. And kudos to all the tough mother’s out there.

    Reply
  • Anuradha karnik says:

    Dear Dr Mazda

    The baby in your article, the brain, is nurtured and protected by two mothers. The dura mater and yourself. Precious article, very compelling and one which transforms a serious surgical procedure into a human interest story. Thank you for this article on Mother’s Day.

    Reply
  • Vinod Ahuja says:

    I will sum up in one word Peerless. Thanks for the excellent article.

    Reply
  • Pravina Mecklai says:

    That is so beautiful. Thank you Mazda. God bless and much love. Also happy birthday for the 12th and always. Xx

    Reply
  • N H Tandon says:

    Brilliant collation
    Protection synonymous with Mother
    Nothing could be more truthful than that

    Reply
  • L g says:

    Your reverance and love for your wonderful mother is writ large throughout this article. Through this dura mater, you name and laud so many qualities in a mother which even the mothers themselves may not be aware of!- only a loving son like you can feel and express them.
    On this mothers day, your article takes all your readers to a new path of knowledge both on dura mater and mothers. Looking forward to your next.

    Reply
  • Benifer says:

    Chaabook article.
    Mommies Day Mubarak !!!

    Reply
  • Dr Ipe V George says:

    Nice one .. apt for Mother’s day. Good writing Mazda 🙏

    Reply
  • Amita Jadhav says:

    Loved the analogy doc. Such a profound message on Mother’s Day.
    More power to your healing knife and to your pen.

    Reply
  • Leah G says:

    A beautiful article written by a beautiful human being with a beautiful heart! Thank you ever so much for your ubuntu or botho Dr Mazda!

    Reply
  • CHANDAN Sanjana says:

    What a lovely article you have written Mazda. We are all so very proud and fond of you. You truly are a wonderful person full of affection and so compassionate in your way of dealing with everybody. God bless you abundantly with your wonderful family at your side. Very very proud of your skills as a Neuro Surgeon.🙏👍🏼

    Reply
  • Dr. B.S. Bhesania ( Phd. Law. ) says:

    Simplification of a serious and complex surgery is the forte of Dr. Mazda Turel and the idea to link it up to Mother,s Day a brilliant move.
    Dr Mazda’s weekly articles serve to remove the natural anxiety of the patient and the relatives of the hitherto unknown subject.
    Thanks Dr. Mazda and keep writing.

    Reply
  • Rustam says:

    Dear Dr. Mazda. You are a brilliant surgeon. I enjoy all your articles so thoughtfully and brililantly written . You area bundle of talent. Every article is so informative and interesting. I always look forward to the next one. Thanks for taking the time to write and to share your knowledge and insight with others.

    Reply
  • Firuzi Mehta says:

    Your blog posts are a joy to read… thank you for who you are and what you do.

    Reply
  • T George Koshy says:

    Beautifully written Dr Mazda

    Reply

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