The Surgical Smell

One of the first senses to develop, smell and the lack of it, has taken on a new meaning in the Coronavirus pandemic; but, its alteration is a diagnostic aid in many medical conditions

A family of four entered and positioned themselves strategically in my consultation room. The middle-aged parents took the two seats in front of me, the teenage daughter plonked herself on the examination bed, and the son chose to stand. This was swift. Often, when there are two chairs and more people, the first 5 minutes are spent deciding who is going to sit where, and most often, one chair remains vacant because people opt to stand out of courtesy. Every culture is different, and every family has a distinct dynamic.

“He can’t smell anything,” the wife started off after pleasantries were exchanged, and then looked at her husband for him to continue. “My head hurts like hell,” he said clasping it with both his palms. He sat there like a stack of circular Russian dolls. His head was a perfectly round. His torso was also thoroughly spherical, albeit a voluminously larger version of his head. And the tumour inside his head was the size and shape of a cricket ball, a glowing third eye. It stood there like a road roller, compacting the nerves responsible for smell into the base of the skull.

The olfactory nerves are microscopic versions of spaghetti that line the insides of one’s nose and then enter the skull through a sieve in the bone, forming a bundle that resembles a thick flat noodle, one on each side. Now, thanks to the tumour, his nerves were thin flat noodles. The complex connections of the nerves with various parts of the brain via sophisticated networks allows smell to become integrated with emotion, memory, and taste.

“He’s also becoming very emotional lately,” the wife interjected. “We’ve been married for two decades, and he’s told me he loves me twice in 20 years. In the past 1 month, he’s said it a dozen times!” she said with the glimmer of a smile, one tinged with surprise and also concern. The teenage daughter had a bit of a twinkle in her eyes, probably drawing parallels to the affection her dad had also been showering on her. I plugged in the MRI films to show them that the downward pressure of the tumour on the olfactory nerves was causing the dysfunction of smell, and that the swelling of the surrounding frontal lobes was responsible for his emotional effusiveness.

They had all the answers but didn’t know what question to ask next. “We have to remove this with an operation,” I helped. “Surgery will relieve the headaches, restore his sentiments, and he will hopefully regain his smell, at least in one nostril,” I elucidated. “We’ll go ahead with surgery,” the son finally spoke as we discussed some more technical nuances related to surgery and its outcome.

A few days later, I walked into the operation theater at 7 AM for his surgery. An early morning OT has a profound and piercing smell you can feel in your bones. It’s ethereal. It is sweet and tangy, zesty and fresh. It has the aroma of mopped floors, buttery walls, sterile packs, warm-pressed linen, and gleaming Keralite nurses – the intense tenderness of whom you can feel even behind the veneer of their tripple-layered masks. And when you’ve operated hard and long enough like I have, the OT also has the smell of joy, grief, gladness, remorse, and hope, with, above all, a fragrance of resilience and compassion.

After fixing the patient’s circular head on a clamp, we made a semi-circular incision from ear to ear and reflected the scalp down. We then drilled out a 4 x 4 cm piece of bone above the right eyebrow. The brain was extremely tense as we opened the dura, requiring us to do away with a small and inconsequential part of the frontal lobe to get to the tumour, called the frontal pole. “We’re sucking away the ‘I love you’ centre of his brain,” I told my assistant in jest. “He’s now going to say ‘I lobe you’ to her!” he retorted, my wit rubbing off on him after the years we’ve spent chatting under the radiance of the microscope. “Finally, he’ll do justice to his Bengali linage,” I quipped, before we moved to a more critical stage of the surgery.

Once we got to the tumour we cut off its blood supply first and then cored into its centre so that it could fall on itself. Then, I gently peeled it off the right olfactory nerve followed by the left one, hoping it wouldn’t snap at its thinnest point, where it was almost transparent. I often whisper into patients’ brains when I operate: “Hang in there,” I implored to the cranial nerves, and they did so with tenacity. A few days later, he was discharged with a smile on his face that met the incision on his head.

The sense of smell is the first of all our senses to develop. Even before we are born, our sense of smell is fully formed and functional, although unfortunately, some children are born without the ability to smell, a condition called congenital anosmia. An alteration or loss of smell is a diagnostic aid in many medical conditions. It is a harbinger to Parkinson’s in several cases, predicting it several years before the actual onset in some individuals. Often, patients who have seizures report that it started with a disagreeable smell – rotten eggs, pigeon poop, burning rubber, and anything else one can imagine. In some people, strong smells of glue, petrol, or bleach can even trigger a convulsion. The coronavirus has given the loss of smell an elevated status, and many people have experienced what that feels like to not even be able to taste their meals, because it is smell that gives our food its flavour.

Six months later, the entire Das family was back in my consultation room. They positioned themselves in exactly the same fashion, as if it were home. A fresh MRI showed no tumour and pristine-looking frontal lobes. He was delighted that his sense of smell was back. “I’ve had to add more spice in his food, though,” his wife interjected. “And how is he emotionally?” I asked. “Absolutely fine,” she smiled. “In fact, he’s become kinder, softer, and still keeps saying he loves me, but I’m not complaining!” she said as they looked into each other’s eyes, happy faces all around.

“I’ll readily take credit for that, if you don’t mind,” I signed off with an equally happy face.

31 Comments on “The Surgical Smell
  • Dr. Neepa V says:

    Keep up the good work mazda..

  • Rustom says:

    If the patient had been the wife, she would have told YOU, I love you, after getting cured.

  • Arun Pushkarna says:

    Once again your amazing character shines through in your narration Mazda. The comment – “the extreme tenderness of the Keralite nurses you can feel even behind the the veneer of the triple masks” – is so elegantly delivered!
    Fortunately, I don’t need surgery to tell you that I love you.

  • Benita says:

    Nice one.

  • Anjali Patki says:

    You’ve smelt out the essence in all these patient’s stories! As usual, enjoyed the write up.

  • Dr Indu Bansal says:

    A truly marvellous piece yet again. Loved reading whole of the narrative but the way you described the smell of OT in mornings was just superb.

  • Marzin R Shroff says:

    Brilliantly crafted. I “Lobe you” was hilarious 🤣
    Enjoyed reading it as always

  • ADI Cooper says:

    This above message is very true and correct.
    Keep up the work Dr.Mazda, with Grace of God.
    Go on and Going on. Always in the Right directions.
    Adi Cooper

  • Navzer Irani says:

    Brilliant narration on the OT and Nurses. Something that patients in their anxiety miss all together. You should supply material to the likes of Top stand up comedians who could make the world laugh something that is always welcome.

  • Leah G says:

    Thank you for yet another beautifully and lovingly written piece Dr Mazda! What a gift you are sharing with us!! May this gift continue to grow from strength to strength!!!

  • Zarin Jasumani Bahmani says:

    Keep writing Mazda! we love your wit and style!

  • Hiten dadia says:

    Super sir just keep it up and keep posting

  • Dr. Vishnu Mulchandani says:

    Good job satisfaction … wishes to improve upon self ……congratulations sir ….

  • Vipul Shah says:

    Dearest Dr Mazda Sir ……

    Firstly congratulations on one more brilliant piece on your series of Surgical ………

    How many numbers of Series Articles completed ….

    My offer to publish whenever you are ready is open & standing forever…..

    Secondly Big Thanks for shifting from Parsee Patients to Non Parsee patients which proves that you are taking your comments seriously 😉

    The article as usual is witty & pvt conversation among Opreating Team is hilarious in Tense atmosphere….

    Bravo on very detailed description from First consultation meeting till discharge & follow up …
    We enjoy the journey along with you sir …

    God bless

  • Anuradha karnik says:

    Dear Mazda

    All I can say is that I get immersed in the fabulous narration from beginning to end. Just so interesting and suspenseful (what’s to follow next) and laced with your special wit.

    God bless and continue the good work

  • Mahashweta Biswas says:

    Superbly written. I was actually picturing this entire scene in my mind. I just loved the ‘I Lobe you’

  • Vineeta Rao says:

    Nerve wracking surgery to preserve nerve function .Lovely take on the bhadralok and their adorable accents!

  • Dr.Tapashi Sarkar says:

    A beautiful soothing presentation of an Excellent work done. So relieving to see a happy Das family and an efficient Dr.Mazda K. Turel…Please keep posting your experiences it was interesting to read…

  • Dr.Tapashi Sarkar says:

    It was a very interesting presentation of the entire operation and reading it gave a live experience of the great work..

  • Monica says:

    So refreshing,Mazda! Literally gives my soul a lift!
    I just love the way you craft dry science with the romance of words and ideas to cut out the harshness, pain
    and fear associated with illness. Such a beautiful blend of fact and artful terminology! You actually succeed in making surgery romantic!😇
    And of course your ‘ Mazdaesque ‘ humour!🤗

  • Burzin Panthaki says:

    Lovely write up. Specially the part about Keralite nurses was great. Keep up the good work doc.

  • Burzin Panthaki says:

    Lovely write up. Specially the part about Keralite nurses was great. Keep up the good work doc. A book about your articles would become a best seller

  • Dr R B Uttamani says:

    Wow, keep up the good work & your excellent write ups . You are god gifted, Doc

  • Quinee Patel says:

    Dear Mazda….your name intones intelligence, wisdom, harmony…..your parents must have been prescient to have named you that. You live up to your name and then some. Mazda, you have been abundantly blessed. You pulsate with precision on all fronts where senses are concerned….this article showcases most brilliantly your visual and olfactory senses. Thanks for sharing your gifts with us, Mazda. i wish I could read all that you put your pen to. I wait with bated breath each week to get an email from my cousin Sanober who forwards your articles to me. We, your readers are abundantly blessed to be privy to what your gifted lens see. Your note about the Keralite nurses touched me deeply. Continue to shine brightly for all of us.

  • Anil Karapurkar says:

    Your sense of humor shines through. Your empathy with patient and family is quite evident

  • Dinaz says:

    Super as usual Doc. The way you explain the surgery is mind blowing. It’s like being there in person with you in the OT. You are truly blessed Doc. God bless you abundantly.

  • Rita Singh says:

    Very good and intersting write up doctor.Given us quite a bit of knowledge on the sense of smell.Thanks.

  • Marzian Mowji says:

    I learn something new everytime I read one of your stories. This time I learnt the importance of smell. Thank you for that. I will never again complain of sweaty bus passengers, smelly toilets, burning rubbish, fish water dripping from delivery trucks at Sassoon Dock and so many annoying smells around Mumbai. I now realise that sense of smell is an indication of good health. Thank you for this lesson.

  • Dr Divya Shetty says:

    Brilliant narrative sir

  • Laina Emmanuel says:

    Wonderful as always!

  • Bapsy Bengali says:

    As usual your write ups are always very interesting ..every time there is something new to learn…keep it up Dr.Mazda…may God always bless you.


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