The Surgical Observer

Prashanti Patel, a budding scientist (and a prolific writer) from Israel with a keen interest in neuroscience spent a day at the hospital with Dr. Mazda Turel and wrote this poetic piece.

Ever since man became conscious of himself and the environment, he has turned increasingly wondrous (and a little fearful) of the prowess of the seething electric activity that sits in his skull and directs his body. After all, an entire human community laid a stronghold upon Earth simply through the transformative powers of higher cognitive centres, even while, in contrast, another reptilian set of connections still persists and unfailingly elicits comic hysterics upon encountering a bemused cockroach. The demons of Hiroshima and the Holocaust arose from brains wired differently and a disastrous paucity of empathy, while the flood of oxytocin explains, in part, the propensity of the working professional to watch silly cat videos during lulls in Zoom meets. The human brain continues to be an object of wonderment in itself, as a harbinger of both genius and stupidity.

I was recently given the unlikely opportunity to have a dekho at this “thinker of thoughts” up close and personal and was predictably knocked out of mental breath. As an introductory aside, I am an aspiring fledgling scientist working with the calm, stoic plant kingdom but nursing an oddball fascination for blood and gore and a particular appetite for neurosurgery. I have long yearned to be admitted into the ranks of the neurosurgeon. However, being wooed by diverse interests and woefully dissatisfied with any one of them ensured that I finally careened my career off the railroads of medicine and into the metro of applied research. Nevertheless, I continued to harbour this yearning in secret, much like the typical soap opera vamp nurtures a cobra in her bosom.

A column by Dr. Mazda Turel, a renowned Mumbai neurosurgeon in the Sunday Mid-Day, caught my eye. I began to devour his writing. Much reading, wringing of hands, and a few email exchanges later, I let spring the proverbial snake I’d been nursing. He very kindly caught the non-biting end and suggested I come observe a typical day in his life. It was thus that I found myself at the doorstep of operation theatre (OT) no. 5 on floor 11 of the hospital he works at, my heart thudding, acutely aware of being a distinctive misfit in the seamless whir of a slew of pre-operative preparations. A quick change later, I stared at myself garbed in the clinical freshness of blue OT scrubs, cap, mask, and oversized Crocs, suddenly officious and tingling with excitement.

My first impression of neurosurgery was that of a cold, stern, but wondrous dance theatre act, with the anaesthetized protagonist cloaked in sterile drapes, sanitized, and centrally immobilized under a massive robotic pincer bearing a sterile-bagged scope and two giant lamps. With the exception of the two neurosurgeons and scrub nurse who are relatively restricted in movement as they fuss about the patient, the others perform graceful terpsichorean moves about the room, a coordinated orchestra of tearing open saline drip packs and fine instrument bags, adjusting levers and valves, helping dress the surgeons in scrubs, and generally maintaining order for what’s to come. Masking up means that communication is Kathakali-style, with a spectrum of expressions finding voice in the eloquent movement of ocular muscles, conveying exasperation (scrub nurse to principal surgeon), frustration (principal surgeon to scrub nurse), and joint responsibility (principal surgeon to assistant surgeon). The neuro anaesthetists are at home, nonchalantly strolling in place amidst the hum of beeping monitors and tangled wires, but with watchful eyes on the screens, ever so gently tuning gas flow and ensuring uninterrupted anaesthesia. I, as the fourth wall, had such an earnest desire to be useful that I occasionally assisted by pulling shut the OT door every time someone went in or out, earning myself a quizzical yet kindly glance of acknowledgement from the scrub nurse.

While neurons themselves are largely quiescent, some cell groups in the nervous system are occasionally rebellious, shoving past cell division checkpoints like commuters in a Virar (fast) local and enthusiastically foundering dynasties that disrupt normal function. Some of these tumours in the brain present additional challenges of inaccessibility, infuriating the surgeon and distressing his colleagues. I watched Dr. Mazda manoeuvre through two excruciating surgeries with the able aid of the assistant neurosurgeon and a sprinkling of colourful language. Both surgeries had contrasting aspects: one patient had a right frontal lobe tumour and the other had a tumour arising from the tentorium cerebelli, a glistening protective sheet that separates the cerebellum from the cerebrum. One could do with the relatively simple opening of the frontal cranium, but the other needed a tortuous inroad through the retromastoid route. Both procedures involved a lot of noisy suctioning, blood vessel cautery to stem bleeding, and copious requirements for absorbent patties, which the scrub nurse artfully arranged along with the other instruments on her trolley. No matter what the strain, Dr. Mazda in an avuncular fashion treated me to explanations of the origin and consequences of the tumour, readouts of the MRI scans, and the use of the silvery hemostatic pads that dammed the rivulets of blood seeping into the gaping cavities that once housed the angry engorged tumour. No textbook or video, though, could have prepared me for the sight of the brain itself, softly pulsing in synchrony with the heart monitor, every detail of its topography starkly visible through the scope and reminding me that the entire intangibility of my life’s experiences was wholly contingent on the smooth corporeal functioning of this organ. As the ‘good doctor’ controlled the last bit of torrential bleeding, the room too was silent, the obvious vulnerability of the patient weighing heavily on everyone’s shoulders, the only sound being a prodigious sigh from Dr. Mazda, who had just swallowed an expletive.

Once all patties that had gone in were extricated and tallied, the surgery culminated with a silent prayer under his lips and I followed Dr. Mazda into the OPD, where a string of patients with interesting symptoms and even more interesting descriptions of the same filed through. Here, too, I co-studied scans, read through histories, and understood that body language – not only words – instantly puts the sufferer at ease. It had been a full twelve hours since I’d left home when I finally pulled off the cap and mask, donned street clothes, and prepared to leave, adrenaline still coursing through my body as I yanked open the taxi door, while both starving neurosurgeons stayed on to observe the patient until she was wheeled into intensive care. A full week elapsed before I ceased looking at people as brains with bodies and resisting the urge to pry open their skulls.