The Surgical Mystery

Death like life is mysterious and sometimes, the struggle for a doctor is to accept that the end is near for their patients

“She was absolutely fine a minute before she collapsed in front of my eyes,” an agitated father said to me as he watched the ICU personnel hooking up his 26-year-old daughter to every possible tube and line that a comatose patient is wired to in order to keep her alive. An appalled mother could not fathom the thought that her daughter, who had been pottering around the house just a few hours ago, was now on a ventilator fighting for her life.

“She had a fever for about four days,” the father went on to narrate amidst all the chatter and clatter of a busy ICU past midnight. “She complained of a constant headache,” he continued, “but today there was no headache!” he rationalized in disbelief of how such mild symptoms could result in such a catastrophe. After about two days of the fever, they got a COVID-19 test done, which was negative, and their family physician correctly prescribed a host of other tests the next day, the results of which were still awaited.

“We did our evening meditation, listened to a discourse, had our dinner, and were just winding up for the day when she had a seizure. I saw her violently jerking her hands and legs and she fell suddenly to the ground. Her eyes rolled up and her mouth started frothing. We immediately rushed her to the hospital,” he said, emphasizing the promptness of their actions. I shone a bright torch into her eyes. The pupils, which normally constrict with a certain shyness of being exposed to the light, refused to budge in her case. They gawked back at me sending an unsaid yet stern message: large non-reacting pupils are a harbinger of brain death.

Her CT scan looked ghastly. The brain was terribly swollen. All over. There was thick blood layering the surface and splattered specks within. This could be some sort of an aggressive viral infection, the brain damage made worse by possible trauma to the head from the fall after the seizure, I reasoned with the family. “The only option we have is to take her to surgery, open up both sides of the skull, and allow the brain to expand out rather than keep the vital structures pressurized within. We’ll remove the blood clots on the surface and then see what happens,” I offered. “When the pupils don’t react, we often don’t operate, but since all this has happened within 2 hours and she’s so young, we should give it a shot,” I determined, justifying the plan in my head and in my heart. “Even if there is a 0.001% chance, you do it,” they said, paralyzed from reason, powerless from circumstance.

Within the hour, we cut into the scalp from ear to ear and exposed as much of the skull as was possible. We drilled holes into the cranium and cut out large pieces of skull on both the right and left as the smell of burning bone infused the operation theatre. As expected, the brain was extremely tense, and as we opened the dura – its leathery covering – it gnawed at us angrily. It was as if someone was pumping air into it, and with each inflation, it felt like that brain was distending closer to our faces. Both the temporal lobes appeared terribly inflamed, tiny vessels rupturing from its surface unannounced. We removed the blood clots and closed the scalp back briskly as the brain attempted to cheese out through the suture line.

“We’ve done what we intended to do, but the brain appears badly damaged – like it is being devoured by a flesh-eating organism. It’s extremely rare, but we call this haemorrhagic necrotizing encephalitis,” I concluded with dismay. Any viral infection could have caused this. Initially, we suspected that this could be due to dengue, as her platelet count had kept dropping, but those tests came back negative. The coronavirus – or, as a matter of fact, any influenza virus – has also been reported to cause this. In her case, the entire panel of tests for all tropical diseases came back as normal. We had no answers.

The next day, she lay motionless on the ICU bed. I could feel her brain directly under the scalp as we had removed all the bone. It was like concrete, with no pulsations. The rest of her brainstem reflexes were absent too. Her pupils were much larger, more rebellious, refusing to bow down to the light.

For the next few days, we spoke to the family for long hours to explain to them that we had lost the battle. They sought opinions from other neurologists and surgeons from the city, all of whom concurred. Every day, we spent time asking ourselves just one question: “Is there anything else we can do to reverse this?” The answer, unfortunately, didn’t change.

I spoke to the parents and told them that it might be best to accept that the end had come. I proposed that they allow her to undergo an apnea test, to certify and declare her to be brain dead. They shook their heads. “How will you understand what we are going through, doctor?” they asked me, refusing my suggestion. “This is our only daughter, the love of our life.”

I narrated the story to them of how my mother lost her sister, aged21, in the infelicitous Handloom House fire of 1982. She was working in the building when the fire broke out on a higher storey. She had been evacuated from the building when she realized she had forgotten something valuable and rushed backup in a quick attempt to retrieve it. A burning beam collapsed right onto her and she was bereft of life instantly. My grandparents dealt with this until they were bereft of their long lives.

Death is mysterious. There is no right time for a young person to go. No circumstance can justify their exit, and yet, more often than not, we need to accept it without having any answers. How they choose to go is equally mysterious, or whether there really is a choice. These are all esoteric questions. We have to survive these with an understanding that their purpose on earth has been fulfilled for this lifetime and that they have moved on to a different realm for a different reason. That unfolding, if it ever comes, will reveal itself to us only when we are ready.

These were my parting words to her parents as I hugged them.

25 Comments on “The Surgical Mystery
  • Dr. Neepa says:

    Well written mazda..really sad for the parents to lose their only daughter at such a young age..
    Life is a mystery..we really dont know what it unfolds..
    Hope god gives you more courage to deal with such situations and give closure to grieving relatives..

  • Mahashweta Biswas says:

    Doctors too are human n it must have been really hard to inform her parents she would not survive. But you knew it before you took her in for surgery but still did not give up trying to save her

    God bless her

  • Vispi Jokhi says:

    What is the right time to broach the question of organ donation in these circumstances?

  • Tozar Heerjee says:

    You tried your very best Doc and thats important.

  • Chanda says:

    Thank you for today’s ✍ writeup Doc. I’m reliving my sister’s traumatic end. One day alive and kicking, the next day, brain dead – it was all over. This is Life – live it, give it the best – while it lasts. Bless you!

  • Chandan sanjana says:

    Today’s article was very hard to read for me. I just went through my mind of everything that Rumi and I went through with our son. I can fully understand her parents wanting to have their daughter with them as her life was cut short. Hard to accept these losses!

  • Natwar Panchal says:

    Dr hard to accept such in life but as you mentioned it is life.

  • Dr Vineeta goel Radiation oncologist says:

    Hard read. Harsh reality

    When I loose patients who are young or when it’s an unexpected death – a bit of patient and family always remains in my memory and my heart

    It’s difficult to ever forget these circumstances and unexpected deaths

    I remember losing a patient on the morning of Diwali festival. It happened 10 years back but I still remember crying faces of his children

    As doctors we mourn and cry alone….

  • Anuradha karnik says:

    Death comes in most uncertain ways and at most unexpected times. Mazda, the way you presented the truth to the girl’s grieving parents is laudable.

    Keep doing your good deeds. Blessings and thank you for a wonderful article.

  • Jude W. Vaz says:

    A well-written account of a valiant attempt to restore life in spite of monumental odds ; surgery under such dire circumstances is like clutching at straws . The compassion with which you handled the parents is commendable . Well-done , Dr Turel !

  • Vipul Shah says:

    My dear Mazda sir ……

    Death is inevitable as everyone knows …..
    For common people like us the death of near & dear one only make us realize the true sadness ..
    However for Surgeons to see death upon failure of surgery or otherwise do happens in medical careers……
    You explained so nicely in your peace the philosophy of death involving & giving example of your own family member…..

    Appreciate your handling serious subject so nicely….shows Your grip on your pen …



    It is very rare to find a man who is equally at ease with his pen as he is with his knife.

    Your description of the pupils will make Shakespeare envious. So simple yet so prophetic.

    I am so glad you didn’t settle in USA.

    India needs a competent, compassionate, and caring Neuro Surgeon connecting seamlessly with people and patients.

    Wish you the best in your crusade to alleviate human suffering and building bridges between patients and physicians


  • Marzin R Shroff says:

    So well written. Despite the Title and the Sub head, i was hoping against hope that at the end of the article, the girl would survive.
    But then, such is life. One has to take a stoic view and move on.
    It must be particularly difficult for a Doctor who has to go through these situations regularly
    Look forward to a more optimistic article next week

  • Jasmin says:

    Gut wrenching Mazda … absolutely gut wrenching … I feel the anguish the parents must have been going through and the suffocating tight grip of reality you as her doctor must have been going through too. So young. My heart goes out to her parents and to her. 😢😭

  • Marzian Mowji says:

    It must be terrible for the parents but think it must have been terrible for you too. Seeing a young 26 year old literally die in front of your eyes. Devastating for all involved. The only way they could prolong their daughter’s life would have been if they donated her vital organs. Her life would not have been wasted. She would have lived through other people.

  • Gloria Msampha says:

    Harsh reality of a doctor’s life. Really sad. You can’t save all of us. It’s especially sad when one so young dies so suddenly. Death is a mystery that can never be solved. Praying for the bereaved family for acceptance of God’s will.

  • Ralecha Mmatli says:

    Clearly our doctors go thorough some trauma as they try to save lives that cannot be salvaged. But we find solace in the fact that as patients and relatives we believe doctors would have done everything and fought with all they could. Indeed death is mysterious and unfortunate

  • Dr B C Malpani says:

    Dear Dr Mazda Turel
    Very well narrated.
    Reality embeded with emotions.

  • Dr B C Malpani says:

    Dear Dr Mazda Turel
    Very well narrated.
    Reality embeded with emotions.

  • Prashanti Patel says:

    Death is the pin that pricks our self-woven bubble of complacency. It shatters the illusion of forever. While most people engage with death in sporadic bursts, you as a doctor play roulette with her daily, never knowing when she plays her card
    The more I hear from you the more respect deepens for you. Keep going Dr Mazda, you are an inspiration

  • Sunil Dhiliwal says:

    Yes, it is traumatic not only for the relatives but also the primary medical professionals/carers…. As a Palliative Care practitioner I can totally relate the emotions (we)go through and breaking bad/sad news is quite challenging and this piece of writing yours have touch my heart and brain together…

  • Vinod Ahuja says:

    Well crafted article which tugs yours emotions, and gives you food for thought regarding the mystery of life and death.

  • Rita singh says:

    A very touchy reality tale.Death is the only reality , every thing else a dream in this cosmic drama,yet so hard to accept.I feel life is all about understanding and accepting this.

  • Cyrus Desai says:

    Your latest narration leaves us remembering how mortal and.vulnerable is life. Here one moment and gone the next. Wonderfully realistic. Truly cannot wait until the next episode. Keep them coming

  • Di says:

    Indeed a mystery… always sad to hear about a person who has left us at such a young age… understandable that parents didn’t want to let go.. so difficult for them.. this article was very touching.. like u wrote.. probably their purpose on earth has been fulfilled


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