Sometimes the scans look innocent, but a doctor’s gut says otherwise. The dilemma: Do we stand by that intuition or give in to the patient’s desire to buy time?
Pratims’s son brought her to me for the first time around three months ago. He was a big burly fellow with the gentleness of candy floss. “She had a very transient speech disturbance a few days ago,” he described his 77-year-old mother’s symptoms with a certain softness that has escaped today’s world. “The slurring lasted about five minutes and then she was absolutely fine,” he went on to explain. I confirmed that she didn’t have frothing from her mouth, an upward rolling of her eyes, or any jerky movements or weakness in the arms or legs – the additional features of a possible seizure or even a stroke. She sat beside him, a quarter of his size but holding her own. “There is nothing wrong with me,” she insisted. “I can cook, eat, bathe, and go out on my own,” she asserted her independence.
“Then why are you here?” I asked with a smile. “The MRI shows something,” she justified, as her son pulled out the films for me to see. There was a tiny bright dot surrounded by a celestial blush, a distant galaxy in the lower part of her left frontal lobe, which was her speech area. “You look great, but this doesn’t,” I explained, gently nudging her to get it removed. “Can we not wait it out a little, given her age and the fact that she’s doing well?” the son asked respectfully. “You can,” I wavered a little, not entirely sure if this was as sinister as my first impression was, “but it’s taking a chance,” I added. We concluded that we would repeat an MRI after three months or earlier if her speech decided to throw a bigger party.
Eight weeks later when her son called me on the phone, I instantly recognised his voice because no one in this chaotic world had spoken to me that respectfully since I’d last met him. “Mom’s speech has gotten worse over the last few days,” he described. “She’s mixing up words, she repeats the same thing over and over again like a broken record, and some sentences are incomprehensible,” he said, his tone dampening to an inaudible thud. “Repeat an MRI and come and see me,” I urged. When they returned the day after, I was a little taken aback to see that the dot on the MRI had exploded. The frontal lobe looked like it had been hit by an asteroid. There was a galactic collision. The tumour had exponentially grown tenfold. “We have no choice but to remove this,” I declared, and they agreed without any hesitation this time, without even a polite request to procrastinate.
Anushree, the bright-eyed over-enthused intern shadowing our team, took it upon herself to become her local guardian. She did a detailed evaluation, running cognitive tests that Pratima navigated with the charming grace of a tipsy ballerina. Words escaped her, simple math became rocket science, but Anushree, with the wisdom of an old soul, kept encouraging her: “Perfect! Great going!” Sometimes, kindness is more diagnostic than any score.
Pratima’s brain, much like the world outside, had gone to war. Grade 4 brain cancer. Survival: Less than a year. And yet, there she sat, a radiant beacon of hope, smiling and asking, “I’ll be alright, won’t I?” Because no matter how hard life hits, despite all its vicissitudes, no one wants to die. We all want to rewrite our script, even if it’s written in invisible ink. She was a child in a 77-year-old’s disguise, holding on to hope like it was a precious, fragile bird.
I operated upon her on my birthday. “Couldn’t you have taken the day off?” Anushree, the medical student, wondered. “This is the best birthday gift I can give myself – there is no greater joy than to be able to rid this lady of her affliction,” I explained to the medical student , she who was eager to be a neurosurgeon but hadn’t yet had the opportunity for neurosurgery to flow through her veins. I fixed Pratima’s head on a clamp, ready to open it up. While we performed the craniotomy, I explained to Anushree all the rainbow-coloured tracts circuiting the tumour and the importance each of them had in her speech. All the functional areas of her brain were drawn with an AI algorithm and visible on a giant screen in front of us while we were operating. “If I damage even a sliver of normal brain, she could lose her speech completely,” I explained, as I monitored each part before I incised it. “Mapping miracles!” she whispered from behind in awe. The surgery was seamless, a beautiful dance between precision and preservation. We delineated the debris of the dirty tumour from the pristine whiteness of the normal brain and removed it completely, protecting the multitude of fibres that were threatening to get in the way. Astral harmony was restored.
As I walked out of the OT, a tiny doubt gnawed at me. What if I had been firmer two months ago in insisting that I operate then itself? But deep down, I knew it wouldn’t have changed a thing. I often marvel at my own inability to stand my ground, giving in to a patient’s desire to buy time, even when my gut screams otherwise. It’s bewildering how some tumours can look like innocent angels on a scan, only to morph into full-blown demons before their horns even sprout. “Never a dull moment in neurosurgery,” I quipped to Anushree, who was probably already daydreaming about her own heroic surgical adventures of the future.
The next day, Pratima greeted us with a denture-less smile that beamed like a thousand suns. With her shaven head and missing teeth, she looked even smaller next to her towering son. But then she spoke, fluently, about her wonderful sleep and the breakfast she had devoured, and we knew – her speech was back! She could name every object, repeat complex phrases, and her cognition scores had skyrocketed. Best birthday present ever.
“I’m going to go back to teaching social studies and mathematics,” she decreed with the authority of a queen reclaiming her throne. That’s when I thought of what Christopher Poindexter, the Bohemian poet, had once written: “How bravely beautiful it is, that sometimes, the sea wants the city, even when it has been told its entire life it was meant for the shore.” That’s what she was: the sea – and the vast expanse of her resilience was reaching for the city and everything she loved about it. Her spirit, like the ocean, was unstoppable, and utterly magnificent.
21 thoughts on “The surgical ominousness”
Doc,
There has to be a full stop for admiration – in your case it’s never ending.
Waaaow! Loved the galactic description
One of the best you have ever written ! Your only competitor in the use of metaphors is your own past articles !
Absolutely loved this profound and beautiful – “We all want to rewrite our script even it’s written in invisible ink”!
Bravo Doctor Mazda!
Must Sunday read … optimism
Beautiful, your descriptions are awesome ..
Dearest Dr Mazda sir
Absolutely Lovely piece written with superb English about to be or not to be , the OMINOUS, gut feelings in the mind of a surgeon vis-a-vis Patient’s menace ……..
First time more importace given to intern Anushree than patient 🤣🤣
However Your usual Humor is missing in the Article …..,,,😳
Happy to read Dance between….🥰
God bless sir & best of Luck on your belated birthday sir for more & more Successful surgeries & amazing blogs ❤️❤️
Admire you doctor !
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