The Surgical Sadness

How do you tell an undefeated patient that there perhaps might never be a road to recovery?

“Will I be able to walk again?” Ronald asked me, peering deeply into my eyes as I stood next to his hospital bed.Three months ago, in another country, he was waiting at a red light on his bike when a truck lost control and thrust into him from behind, transecting his spinal cordand leaving him paralyzed below the waist. He had surgery back home to realign the spine, which they did with some screws and rods to stabilize the broken fragments, but, as expected, with an injury of this nature, there was no gain of function in his lower limbs. He was transferred to our hospital for extensive rehabilitation.

The short answer to his question was ‘No’. The long answer was also ‘No’. But how do you tell that to a 45-year-old father of two sprightly children, an image of whom I could see on the screen saver on his phone. He had left them behind with his parents and had travelled here with his wife, promising them that he would come home walking in two months. “My hands are fine,” he said, raising them up and opening and clenching his fists. He had rounded biceps and chiselled forearms, probably from using them to move his torso around. “But I can’t feel anything below my chest,” he mourned with a listless anguish. “I don’t even get an erection.” He pointed to the urine bag that his catheter drained into.It had flaky sediments that made the urine appear hazy; a consequence of prolonged catheterization.

I gently lifted the blanket off him to examine his legs. He had no power. He couldn’t move at the hip, knee, or ankle, even though the grimace on his face showed that he was trying. He couldn’t even wiggle his toes. He had no sensation from below his chest to the soles of his feet. “And yet, everything below feels so heavy,” he said, miserable.

I helped him onto his side as he wanted to show me his bed sore. Like an asteroid had landed on his planet, he had a crater on his buttock, with dying skin of varying hues sloughing away and tracking down to bone. “This is what we need to fix first,” I told him. “Without this, we can’t do any physiotherapy. We’ll get a plastic surgeon to clean it up and rotate a muscle flap over it.”His melancholic expression told me that he wasn’t interested in the technicality of any of it. “I just want to be able to walk,” was his doleful one-liner. “We’ll get there,” interjected his wife who was standing beside him. She was half his size but was astonishingly able to transfer him off the bed onto a wheelchair all by herself. “What doesn’t kill you makes you stronger,” she reminded him,summarizing the story of their togetherness.

I ordered some investigations and explained to them a plan for what we should do over the course of the next few months, which they agreed to. I walked out of the room and stared at my feet for a full minute. I stood on my toes, on my heels, and did a squat. I thanked God. As neurosurgeons, even though we treat patients with spinal cord injuries all the time, this man’s pain felt unbearable. The heartbreak in his eyeswas as tangible as the dysphoria in his voice. However hard we try, we can never fathom what these patients must be going through. I sometimes wonder what’s worse – to have an active mind in a paralyzed body or a functional form with loss of insight, judgement, and creativity?

About half a million people globally sustain a spinal cord injury, annually. A majority of these are young adults. The social, cultural, and economic burden of this is unconceivable. Its impact on the immediate caregiver is beyond belief. The assault on their emotional and sexual needs is just as devastating as the damage to their sensory and motor function. Physical barriers to basic mobility result in their exclusion from society,ensuing in a plethora of mental health issues. Billions of dollars are pumped into research to enhance recovery of spinal cord function with no promising results that could be universally applied.

“Why am I still not walking?” Ronald questioned me after a month. His bed sore had healed and his rehabilitation was in progress. “We’re building strength in your upper body so that it’s strong enough to support your crutches when you stand,” I deflected. Every time we chatted, he spoke in the same monotone without blinking his eyes. Day after day, I went into his room and we talked for about 20 minutes or more. On some days, I took him down to the cafeteria and we spoke there. I got him a book to read. We cut a cake on his birthday and got all the hospital staff to sing for him, but it barely turned the corners of his mouth upward. “How about we watch a raunchy film?” I tried, willing to sound inappropriate. He didn’t concede.

I recalled lines from a poem by Australian author Erin Hanson. It starts with ‘They say happiness will find you/ But I think sadness will find you too’ and goes on to say, ‘You can’t remember how it started/ And you don’t know when it will end/ But you know that you’d give anything/ To stand up on your feet again/ Sadness is that feeling/ When the falling doesn’t stop/ And it saps your life of meaning/ And of the good things that you’ve got.’

Every day, I would pause before entering his room. I would close my eyes and takea deep breath, then enter sounding loud and chirpy,but he looked at me with those brooding eyes and a tediousness in his voice, as though he could see through the facade. “When will I walk?” his grief questioned me, almost making it seem that I was the one responsible for his infliction. The physiotherapist showed him videos of his improvement, but he refused to acknowledge those. From being unable to sit, he was now standing with calipers and holding onto a monkey bar, but he was nowhere close to walking, even with any kind of support.

On my rounds one morning, I saw all my patients on his floor but didn’t enter his room. As I was heading to the next ward, the nurse reminded me that we hadn’t seen Ronald yet. “I can’t,” I told her, defeated. “It exhausts me completely and I have nothing to offer that makes any kind of difference to him,” I conceded. We had failed him. His wistful eyes and his despondent voice told me so.

It’s been three months and Ronald is still at the hospital. He does his physiotherapy religiously and is making progress. He still cannot walk. Maybe he never will. But he hopes. As do I.

26 Comments on “The Surgical Sadness
  • T George Koshy says:

    Mazda..u have a heart of gold..u r truly able to EMPATHISE with that poor comes out in ur writing and I am pretty sure in the way you look after ur patients too..u r right ..the sadness & melancholy in their eyes will haunt u for a long time..I have seen it countless times in the Neuro wards and when these poor men..and women come as “cases” for under graduate and post graduate practical exams..hope we can find a solution for them..🙏🙏

  • Vipul Shah says:

    Dear Dr Mazda

    Very very painful Piece written with clear cut sad feelings that proved that Final Call is always taken by some one UP there who is running the show..

    It’s the Message from Gita ji written by Lord Krishna…” Your Job is only to do Good Karma & Leave the Results in HIS Hands “”

    May you get Magical Super powers & Ronald will start running ASAP ..

    Good bless Sir

  • Vishnu Mulchandani says:

    When medicines fail ….prayers start working ….hopefully with family and doctors support he should be able to walk with calipers, walker, stick etc He who has health, has hope ….and he who has hope has everything. Best warm regards Dr. Vishnu Mulchandani past president A ward medical association colaba Mumbai India

  • Arun Pushkarna says:

    Wonderful piece of writing!
    Impactful, heart wrenching and coming from the depths of the soul!
    Despite the hopelessness there’s a glimmer of hope.
    You’ve literally bared your soul Doctor!!

  • Constance says:

    Doc we can feel your deep empathy towards Ronald. Thank you for always trying to make it better and lighter for your patients. It is a rare gift that makes your patients comfortable around you. Ronald’s case is indeed a sad sad situation. The “what if it was me” question just never leaves the mind of the care giver. Your human side exudes from you in all your wrongs. Now that you are giving Ronald your best, please leave the rest to God.

  • Avinash Karnik says:

    Dr. Mazda,
    This article of yours tells us how difficult life you lead when you find yourself helpless in spite of having such wonderful skills your hands display during many surgeries to enable your patients to recover fully.
    With your genuine feelings, you also share the sadness of some patients when the damage is beyond repairs and yet you try to pump in some temporary happiness in your patients. May you always stay humbled forever

  • Anuradha says:

    Dear Mazda, loved this piece of writing as it touches the heart and goes to show that you are a pure soul. Wishing you loads of luck in your endeavours. God bless!

  • Natwar Panchal says:

    Dr. I too agree with Mr. Vipul. Karma Karo, Phal ki chintaa mat karo.

  • Herois Kambata says:

    An extremely touching case. The learned Doc has done his job. We now forward this case to the Master Healer. The only He can heal this tormented soul. May His will prevail.

  • Sonali says:

    So heart wrenching and painful….this is life….we do not know what we have to face the next minute, but it is the faith to overcome all obstacles that keep us going. Maybe and God willing there will be a miracle and he will walk again.🙏

  • Burzin Panthaki says:

    Doc you have poured your heart and soul in this peace. Such a touching peace. You have done your best.
    It is all upto the master above.

  • Rita singh says:

    Doctor sahib,u have done ur best as a doctor and counsellor. But somethings have to b left to God.I am sure God will heal him with our combined prayers and good wishes. Ronald will live to walk .

  • Anjali Patki says:

    Heart touching story written with empathy and sincerity. God bless both of you.

  • Marzin R Shroff says:

    Ronald is a braveheart and he will walk one day.
    Don’t give up hope on him Doc. Stay with him as he stays positive.
    Hope is everything and often, it’s the only thing when medicine fails.
    Will pray for his speedy recovery and pray for you to give you the strength to support him both mentally and physically
    Three cheers to your persistence. May your grub increase

  • Lois Juma says:

    Extremely emotional! May Donald and those in his shoes walk again. My prayer for you too Dr. Mazda.

  • Aban says:

    As I read this very deep book The Surrender Experiment “ by Michael Singer ( A meditator and yoga advocate) I am realizing that we do our best but leave the matter to Him. You have clearly done your best and supported Ronald emotionally, something unusual and not experienced with doctors today. A heart of gold Dr Mazda! God bless you So now it is the Healer in Chief who will complete Ronald’s healing. There is still hope.

  • Dorothy Mupfanochiya says:

    DR Mazda you always put in 100% . You have done the same in this case. May you find peace of mind as you hand Ronald up to the Almighty for further healing.
    Thank you for such love and care.

  • Anita says:

    Very truly and genuinely expressed. Very often best efforts don’t give the desired results on time. Prayers, God Bless🙏

  • Perviz Tarapore says:

    What a touching write up. You are providing Ronald with extraordinary support, strength and hope. Every interaction of yours is with empathy, grace and kindness. This must bring Ronald and his wife some measure of comfort. God is great and we must remain hopeful and positive that Ronald will be able to overcome this to some extent with physical therapy. I realize it’s not easy but we must leave it in His hands.
    God Bless you too for your compassion and service to your patients.

  • Dr Shivkumar V Dalvi says:

    Dr Mazda , u have certainly made best n Herculian of efforts still all by know including the unfortunate patient knows that he is never going to tecover n walk on his own. I feel under such circumstancs it is best to slowly let the patient know he has this permanently n build him up for the reality.I think by now patient will accept reality

  • Nutei says:

    Hi Dr. Mazda,
    You are multi talented and have a golden heart…I prayed to God that Ronald recover soon and walk again… through God and you miracle will happen… God pls give strength to Ronald and his family… I am glad that Ronald has some hopes and believes that one day he will be able to walk again…without hopes life has no meaning… sending love… prayer and good wishes for Ronald 💐

  • Germaine Boatwala says:

    Miracles happen everyday and God does the impossible. Often in our darkest times we need to turn to God the most. It is noticed that people throw anger, violence and claims of never believing again. The very contrary to that which restores through miracles; making a way where there is none. I don’t know yours or the patient’s level of Faith and its endurance. But without it, there is no hope.

  • Priyadarshan Pradhan says:

    doctor saheb is that a full fledged sci centre like the one at cmc vellore?

  • Nawaz Vijayakumar says:

    Prayers for Ronald. May he walk again. Dear Dr. Mazda can absolutely understand how you feel while dealing with Ronald. Medically you think it is hopeless. But let us prayer and beseech the Master Healer to perform His miracle and prove all of wrong.

  • Di says:

    As always well written and so beautifully expressed… this article touched my heart and was heart wrenching… painful but have to face the harsh reality… so so sooo difficult for Ronald, his loved ones and you… Praying that he can walk again… sometimes we take things for granted… being well and able to do things is a blessing everyday… may God bless him

  • Cyrus Desai says:

    Phenomenal empathy. Very touching and thought provoking. Beautifully written and delivered
    Thank you
    Cyrus Desai


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