The Surgical Roller Coaster

Nothing in life is foolproof; doctors who have witnessed an otherwise uncomplicated surgery go awry, will tell you why

“Stick your tongue out for me,” I requested 56-year-old Liza as I checked to see if it jutted out straight in the centre or deviated to any one side. It made a sharp swerve to the right, denoting a weak hypoglossal nerve on that side. The hypoglossal is the last of the twelve paired cranial nerves that supply motor control to the tongue, allowing one to speak, swallow, and move stuff around in your mouth. It’s also the nerve that helps Americans roll their Rs and Maharashtrians liven their ळs.Now that you have tried out both accents, we can get back to Liza.

Her nerve was feeble because of a tumour that arose from it after having gradually grown to the size of a Mediterranean lemon, where it compressed her brainstem, making it hard for her to even walk unsupported. “We have to get this thing out,” I told her, assuring her it was not cancer but a benign tumour that we call a schwannoma, receiving its name from the outer covering of Schwann cells that encircle the nerve.

“I’m HIV positive, you do know that,” she reiterated tentatively. “That’s fine,” I said brushing it off in my understanding that HIV is now a well-controlled, easily managed entity in a majority of cases. “There’s just a slightly increased chance of an infection,” I said casually, “but it’s nothing we can’t deal with.” Little did I realize that these words would come back to bite me in the backside.

The next morning, we opened up the back of her head behind the ear in the usual fashion. The cerebellum was tense and became soft after the release of some cerebrospinal fluid. With gentle retraction of the pulsating brain, we saw part of the Mediterranean lemon glistening back at us. It was like a sighting of a yellow moon after waiting for a cloud to pass, except that in this case, we were moving the cloud. We entered the tumour, patiently coring it from its centre until it collapsed on itself, relieving the tension from the stretched hypoglossal nerve. With a set of sharp instruments and soft movements, we teased off the last bit of tumour from the nerve, which appeared weary but intact. Every single time I remove a tumour like this, which obscures most of the anatomy when we begin but brings into view the entire panoramic vista of nerves and arteries once it has been removed completely, I can’t help but marvel at a beauty that one can never quite be bored of. It is simply mesmerising.

The next day, she woke-up crisp with no further worsening of tongue function. She could eat, chew, and swallow, and I was confident that with some oro-facial rehab, she would regain normal function in a few months. As long as the nerve is not damaged completely, it almost always heals over time. “You’ll have to work your tongue in ways you haven’t before,” I said in jest a few days later, when she was discharged.

When she came back a week later to remove her stitches, I noticed some pus seeping out of the wound. This is always an ominous sign. A CT scan showed it was tracking out from deep within. “We have to take you back to surgery and wash this thing out,” I said to her, my head in my hand. “Can I not just take some antibiotics to see if it settles?” she reasoned. I said it was an option but cleaning it up from within would help allow the antibiotics to act better, and we could also send the pus for testing.” She agreed meekly. It pains a surgeon just as much as it hurts the patient to go back to surgery.

We took her back and washed out all the muck that had defiled such a pristine operation. We valiantly attempted to refurbish it to a state where we left it last, akin to restoring the Mona Lisa. Once again, we thought we had done a pretty good job, as she was up and about the next day in mint condition.

The day after when we went on our rounds, we noticed she was talking abnormally, not responding to simple commands, and refusing to get out of bed. All she did was moan in pain. Her neck was stiff. We stuck a needle in her spine to drain some fluid via a lumbar puncture, and as suspected, the results proclaimed meningitis – a life-threatening infection to the central nervous system. We had to step up the antibiotics and pray. “We have to hope she responds to the medication,” I told her daughter, Grace, feeling dejected and confused by the mayhem her mother was being put through but stoically accepting it all the same.

My car key was strung to a keychain that coincidentally had her name, Grace, etched on it, and I pulled it out and gave it to her. The other side had ‘Grit’ inscribed on it; I think seeing it made her feel better. Two days later, Liza was back to her usual self, eating her breakfast, taking walks in the hospital corridor, and making jokes with the hospital staff. My anguish was finally subsiding. She told me she was eager to go home. “Soon,” I said, “very soon.”

She was getting better each day until one morning, I walked into her room smiling to wish her a good morning, but she was still asleep. Grace explained, “She went to sleep with a headache, so I’m just letting her rest it out.” “Wake up, Liza,” I shook her, first gently and then with some vigour. She refused to budge, and all I could hear was heavy breathing. I dug my fist deep into her sternum but there was no response, even to pain. “She’s deteriorated!” I shouted. The crash-cart came in and we thrust a breathing tube down her throat to secure her airway. What had been a tranquil room in a hospital ward suddenly transformed into a battlefield. We connected her to a ventilator and got an urgent CT scan. She had suffered a massive haemorrhage in the cerebellum. It was as if a bomb of blood had burst in her head.

We rushed her back to surgery, excising part of the cerebellum and removing all of the blood clot. She came out alive but never completely woke up. We eventually sent her to rehab, the roller coaster finally at a precipitous stand still. One day, a few months later, Grace messaged me to say, “She’s opening her eyes and moving around.”

It had been one hell of a ride.


22 Comments on “The Surgical Roller Coaster
  • Anuradha karnik says:

    It is a horror story of pain, anguish and hope. But you as a doctor got the right pulse and never gave up. More to such heart rending stories and prayers for both the patients and their doctors who have to endure and heal respectively.

  • Hutoxi Doodhwala says:

    Grit and Grace! To have the grit to face it and grace to accept the situation! Heart rending!

  • Khursheed says:

    Bless you Mazda! Your words bring back our faith in this Noble profession!

  • Khyati says:

    GRACE & GRIT..salutes to strong willed doctors like you..

  • Tozar Heerjee says:

    Really admire the way you look after all your patients Doc. It must be taking nerves of steel to cut open the skull and treat the insides. God Bless.

  • Jasmin says:

    Prayers for both Liza and Grace and their families. This seems a nightmare to have lived through. I hope Liza makes a full recovery, she has so much life yet to live. 🙏🙏 These memories of surgeries that didn’t quite pan out as planned must be hard for you Mazda. I’m sure all every doctor wants is that their patient walks out healthy. Hats off to you for persevering and doing what was needed.

  • Mahashweta Biswas says:

    OMG what a heart wrenching experience. But the way you have described your experience, as I kept reading, I was holding my breath wondering what’s coming next. You never give up & that’s commendable. Kudos to you. You have a way with words & write beautifully. God bless

  • Rita Shirwadkar says:

    Marvel of medicine & dedication by doctors like u ….. ….reading this was almost like suspense story.


    You NEVER give up Mazda !!! We have to admire that beautiful quality of yours ‼️
    What a night mare you and Grace and her family have gone through. With the help of the almighty I sincerely hope Grace gets better soon .
    GRACE AND GRIT …. Hats off to Drs like you ‼️
    Thanks Mazda for ALWAYS caring about your patients .

  • Marzian Mowji says:

    It really amazes me how doctors fight for their patients. It must be so disheartening to see a patient suffer even after all you do. Being a Doctor needs a special kind of Grit & Grace that not everyone has. Thank you for all you do.

  • Gladys T K Kokorwe says:

    Shuuu so touching. I hope she made it. It’s a sad story. If it’s sad for me, imagine how it was for you and Grace.
    May God always strengthen you when you go through these painful experiences.

  • T George Koshy says:

    Great writing..grit and grace..u people really have to deal with so much stress..
    How is she now?

  • Dr John Quaghe says:

    Dr. Mazda; Thanks a lot for your stylistic & honest presentation of your experiences with your patients. I appreciate your courage, knowledge & skill. Cheers

  • Vipul Shah says:

    Dear Dr Mazda

    It’s heart touching case of Liza……

    More encouraging fact is you never give up & keep on trying with positive approach …

    I am facing very recently similar situation of Roller coaster with my brother-in-law…

    You are an inspiration boss …

    May Lord All mighty give tremendous powers in your hands to continue with your magical touch

    God bless Sir

  • Homi R. Cooper says:

    As a Front Line Neurosurgeon you are Always Blessed by God; as you & your Team operate under most precarious conditions.
    So Be Brave & Always Pray as you embark on each Sensitive Surgical Procedure.
    Ultimately His Will Shall Prevail thru you!!
    Keep up The Great Work you do!!

  • Rita singh says:

    Whenever I start one of ur writings I wonder what more amazing experience can he give.But each time I am equally amazed and full of admiration for ur dedication to ur work and ur patients.May all suffering from neurological problems find their way to u.God bless you.

  • Germaine Boatwala says:

    My God! Up and down and finally come up right again! Both women went through harrowing nightmare! And you, the doctor too, though it is known that people often unjustly blame the doctor for mishaps. On occasion it is merited, but never always. You have skill, patience and nerve, to keep going with such difficult cases. Was HIV a silent cause for a loud problem? The infection? I pray Lisa and Grace are supported by God’s Compassion and Healing hereon. 🙏. And this was really a fender-bender story in medical annals, doc! Well done! ✊

  • Chandan R. Sanjana says:

    Honestly found it hard to reach this article and everything that Liza went through and what you suffered along with your patient. Bless you for your dedication and care you give to each patient of yours. God bless you and your profession. 🙏👏🏻

  • Dr Parul Jaiswal says:

    Goose bumps
    It takes lot of nerves to write these stories
    As usual simply mesmerizing
    You really are too good

  • Manjeet Brar says:

    Prayers she gets well soon 🙏
    You too take care Mazda

  • Altaf Ladak says:

    Your writings always incite goose bumps! Reading about Liza& your teams’ battle was like reading a thriller… Hope she’s fine now… Prayers for her.

  • Di says:

    A heart touching article.. Up and down… a roller coaster indeed.. what a tough time Liza, Grace and you had to go through… and the marvelous way you fought in the battlefield to save her life… Grace and Grit.. grace to accept it and grit to fight it.. another well written story!


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