The Surgical Reconsideration

One man’s refusal to undergo surgery could have led to a lifetime of overwhelming pain and distress, but a change of mind changed everything for the better.

“Please, could you turn off the air-conditioning?” an elderly gentleman requested me in Urdu as he gingerly sat on the chair in front of me, his wife helping him make the final adjustments. I instantly obliged by switching it off and he acknowledged the act by placing his hand on his heart and nodding his head. He was in his sixties and adorned a white kurta. His eyes looked troubled and were brooding with grief that I wanted to know the source of. “I have an intense pain over the left side of my face,” he mumbled keeping his mouth half closed. “If he opens his mouth more than this, he gets an electric shock down his jaw, sometimes his nose, and even his forehead,” his wife explained.

A few medical students interested in neurosurgery were sitting in my office, and I asked them to pay close attention to the patient’s history, as I had already made my diagnosis. “He can’t touch the left side of his face,” his wife continued. “He can touch his right forehead, can rub his right eye, dig his right nostril, but nothing on the left,” she narrated as her husband performed all these actions. It was like watching an elderly couple play dumb charades. “He hasn’t washed the left side of his face in a while,” she concluded. “I haven’t shaved in months,” he added,  pointing to his long glistening silvery beard. “Even the air of the fan bothers me, and that’s why I asked you to turn off the air-conditioner. It sends shivers down my spine even if it whiffs past the left side of my face,” he said in Urdu, to which the above English translation does no justice.

I wanted to examine him, but he didn’t allow me to touch his face. He had poor oral hygiene because he couldn’t brush on the left. I turned my gaze to the medical students who had just completed their final year and raised my eyebrows, asking them for a diagnosis. “Trigeminal neuralgia,” one of them jumped. “Correct,” said the patient’s wife having heard this term umpteen times since they had made the diagnosis three years ago. “He takes 14 pain killers a day, 4 in the morning and afternoon each and 6 at night,” she said. Even I was shocked. They had tried an injection into the trigeminal nerve, which hadn’t worked, and even had a single shot of radiation to the nerve 2 years ago. Both of these are valid treatments of this condition, but as I studied the MRI in detail, I explained to them that surgery seemed to be the only resort. I pointed out a loop of a dilated and tortuous artery pressing against the trigeminal nerve, and with every heartbeat, it was pulsating against the nerve, sending a current down the distribution of the nerve which was the entire face.

“We will do everything but we won’t have surgery,” he gently placed both his palms on the table. “We have lived with this pain, we will die with it,” he ordained, as if it was the will of God. The medical students, one of whom was from Ukraine and the other from Kenya, were surprised. I explained to them that India is a vast country and its citizens had varied religious and cultural beliefs, which we must regard and accept respectfully without being judgmental. But I really wanted to help this man, so I came up with an explanation in Hindi that hit close to home.

“Imagine that someone has placed a humongous rock on your chest because of which you can’t breathe. Any amount of oxygen or intravenous pain medication is not going to help unless I physically lift that rock of your chest,” I simplified. The artery pressing against the nerve was the rock on his chest. Most of us carry that rock metaphorically, and I wanted to say that but I didn’t know how in Hindi. I’m guessing you might try to do that too, as you read this.

Amidst the explanation, he had another attack of sharp-shooting lancinating pain but was unable to wipe the tears that rolled down the left side of his face. We waited till they stopped. After 3 or 4 minutes of silence, he said. “We will do the operation.” The medical students were excited because they would get to watch what they were googling on their phone. We admitted him the very next day, lest he changed his mind.

Two mornings later, we fixed his head on a clamp and positioned him on his side so we could make an incision behind his ear. I made a bony window and opened the covering over the cerebellum, which I gently retracted after draining some holy water, more specifically and technically called cerebrospinal fluid. I exposed a little more than usual because I wanted to show all the cranial nerves to the medical students who were watching on a screen what I saw through the microscope.

“That’s the hypoglossal nerve,” I said, pointing to a thin glistening structure at the base of the skull. “It helps you move your tongue. If it comes into my suction, he’ll have half his tongue paralysed.” I moved up to the vagus nerve. “That’s the nerve that makes your heart skip a beat or race furiously when you’re in love,” I continued, adding some spice to keep them glued. “I wish I could burn mine,” muttered one, who was just recovering from heartbreak. I quickly moved up to the facial nerve. “That’s what makes you smile,” I pointed, and then, finally we reached our target.

“And that’s the trigeminal nerve. Look how it is pushed up from below almost like a tumour sitting within it.” I gently teased all the arachnoid strands around the nerve and painstakingly mobilized artery from the nerve, making sure nothing snapped. After having separated the two structures that, until a while ago, looked like conjoined twins, we placed a pad of Teflon to make sure the artery didn’t bounce back onto the nerve. I inspected the nerve with an endoscope to ensure nothing else was touching it. “And we’re done,” I pronounced at the students still gawking at the screen with their mouths wide open.

“Dr. Peter Jannetta invented this operation in the 1960s,” I told them as we closed. “Often, patients go first to dentists with this problem and sometimes get cavities filled and root canals done with no pain relief. Most dentists nowadays are very astute and instantly identify this condition correctly for what it is. But in the past, I’ve even had a patient who was advised a jaw replacement surgery to relieve this pain,” I told them, as they listened, engrossed, to how tricky the diagnosis can be.

I went with the entire entourage to see him in the ICU a few hours later, when he was fully awake. His pain had gone completely. He dug his palm deep into the left half of his face, rubbing his eyes and forehead to prove it. The medical students were in awe. “It’s one of the most rewarding operations in neurosurgery and we have Dr.Jannetta to thank for that.”

The next morning when we walked into his room, he sat reading the newspaper after having brushed and shaved for the first time in months. “You’ve given me a new life,” he burst out in tears, but this time, he was able to wipe them off on his own without a worry. I embraced him. “It was the will of God that we could do this for you,” I said prophetically in Urdu.


22 Comments on “The Surgical Reconsideration
  • Gool Kotwal says:

    Will of God indeed, but the skill of a human. God Bless you

  • Khushroo patel says:

    It was truly the will of the Allah that the 2 of you should meet.

    Beautiful piece of surgery eloquently painted with the brush of Pablo Picasso.
    God bless you Mazda and may you help mankind

  • Dr Indu Bansal says:

    U are beyond words amazing not just with your knife but with your words which pour out straight from heart like a free waterfall. Smooth, straight ,to the point. Love reading every article that u write

  • Bikram says:

    It was breathtaking travel from skin to the culprit!!!

  • Anjali Patki says:

    Interesting and amazing read. Keep up the good work dr mazda

  • Supriya Correa says:

    Beautifully written. Such dignity for seniors. So proud, Mazda. Your students are so lucky.

  • Clera Menezes says:

    Beautiful narration of your live experience Sir.
    You are a gentle and kind all the ways .You touch the heart ❤️ of each of your patients with your humble and simple words and simle.
    God always bless your good work .Keep going Sir..

  • Zarin Bahmani says:

    We can never visit the operation theatre but every detail you describe gives us a grand stand view! Thank you Dr Mazda. I look forward to all your beautifully penned intersting articles. God bless you.

  • Gladys T K. Kokorwe says:

    Ah🤩 I’m out of words.
    Keep it up and God bless. 🙏🏾

  • Avinash Karnik says:

    Dear Mazda
    One more episode wherein you have taken us through the operation as if it was a routine procedure for anyone. The diagnosis and the operation you made it sound so simple and the introduction of some nerves that control the various functions of our body really educated us.
    It must be a great moment of joy and satisfaction to you to see your patient recovering fully post operation. Congratulations to help one more to ease his pain so that he can once again enjoy the normal body of a creator

  • Marzian Mowji says:

    Your patients must really believe that you are God.

    With every article you write you amaze us more and more. Hope I never need an operation of the head but if I do I want it to be your hands that do it.

  • Vipul Shah says:

    Dearest Dr Mazda

    As usual very lucid style of explanation from the correct interpretation of MRI by which the pin point exact problem with absolutely correct diagnosis..

    Unique experience yo learn even for the Students…

    Your affectionate words at initial consultation only reduces pain by Half ….
    Good True Noble Parsee Doctor without MC -BC 🤣

    God bless sir

    Keep on doing good medical help sir

  • Porus k Chinoy says:

    Tears of joy run when ever i read your articles. God bless you Dr Mazda

  • Marzin R Shroff says:

    A lot of people are afraid of surgery. But only a good holistic Doctor can convince them otherwise.
    It just shows us all that communication skills go a long way in giving confidence to patients.
    Cheers to you, Mazda and your genuine interest in helping patients (patiently)
    God Bless you always 🤗

  • Herois Kambata says:

    Awesome. I guess each day brings a new case, a new experience, a new challenge in the dear Doctor’s life. And at the end of it all , waves of satisfaction must be flooding his mind body and soul. Rightly so. God bless.

  • T George Koshy says:

    Mazda..beautiful description of a complicated surgery..congratulations on a job well done and all the best for many more..please keep writing..

  • Jonathan Juma says:

    I marvel at the level of Dr Mazda’s confidence which brings refreshing delight to patients, families and general readers. Keep it up for the benefit of humanity.

  • Laina Emmanuel says:

    Incredible story. I am glad he went for surgery!

  • Rita singh says:

    What change in this patient. It’s unbelievable. How can a doctor be so intelligent! Making a diagnosis even before seeing any tests.U r indeed a brain wizard.

    Wish we had more of ur kind.

  • Anita Tarneja says:

    Absolutely jaw dropping, The Good doctor has been able to apply his skills at the right time and place. God Bless !!

  • Dr Divya Shetty says:

    Yet another beautiful article sir. The descriptions are so vivid i almost feel jealous for not being able to witness the surgeries you perform. A gifted surgeon indeed.

  • Radha Narayanan says:

    Beautiful narrative. So full of facts. Like the way you narrate facts. Gives hopes to suffering people.


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