The Surgical Stroke

Diagnosing a patient whose symptoms are as indiscernible as the expressions on their face when masked, throws another kind of a challenge for a doctor

Do you ever wonder what someone looks like behind their mask, someone you’re speaking to but have never met?

As a doctor, I indulge in this amusing activity daily. When we talk to new patients, the brain subconsciously analyses what the rest of their face must look like. Inevitably, at some point in the consultation, every single patient brings down their mask – either because their nose itches, their glasses are fogging, or from an inherent human desire to establish a personal connection – only to confirm to me that reality matches imagination in no way; those you perceive to be clean shaven have a scruffy beard, and those you think might have a sharp jawline have it covered by chubby cheeks instead.

A patient once asked me matter-of-factly, “Doctor, please could you lower your mask? I would like to see the full face of someone who is going to stick a knife into me!” I obliged gingerly, understanding fully well that an honest human connection demands transparency beyond the opacity of a veil that is dividing the entire human race in these times. Often, I am unable to recognize people who acknowledge me, and in a kind gesture, lower their mask to reveal their physiognomy. I am sometimes even more embarrassed when I fail to make the recognition despite this courtesy shown to me.

I was recently examining a hypertensive patient who had come to me after enduring a severe headache over the past few days. In the middle of the assessment, his fluorescent orange mask started to flutter. Given the variations in masks these days, for the first two seconds, I wondered if this was something new in the market – until I realized he was having a seizure. I pulled his visor down and saw his face twitching uncontrollably. Within seconds, his arms and legs started jerking, his mouth was frothing, and his eyes had rolled up. I lay him on the examining bed and put him on his side for the next few minutes until the fit abated, while his relatives stood there aghast at what they were seeing.

I dug my fist into into his sternum, deliberately causing him pain, and realized that he didn’t react by moving his left arm or leg. He was paralysed on that side while the right moved briskly. We immediately transferred him on to a hospital trolley and connected him to some oxygen while a nurse promptly pricked him to get intravenous access and pumped in some drugs, just like we see on every medical drama series on television. Except, over here, as the cliché goes, there are no retakes. Also, in television, the elevator is always ready, but in reality, the sicker the patient, the longer the elevator takes to get to you. Luckily, where I work, we have a system set in place for emergencies.

We rushed him down to the CT scan room and rolled him into the machine, watching it dissect an image of the patient’s head into 256 slices on the computer console. The scan revealed a large bleed in the right half of his brain, which explained why he wasn’t moving his left side. By the time we spiralled him out of the gantry, he was stuporous. We needed to shove a breathing tube down his throat to guard his airway and connected him to a ventilator to keep him breathing. His blood pressure was 220/110 mm Hg.

I explained to the family that he had had a stroke. “80% of strokes happen because of blockage of a blood vessel, which disturbs the brain because of a lack of blood supply to it. In these cases, we can give a clot-busting drug. He falls into the remaining 20%, where a stroke occurs owing to haemorrhage inside the brain,” I elucidated, while the team was already shaving his head, prepping him for surgery, which the family had instantly agreed to. Given its typical location, I told them with authority that the bleed was because of high blood pressure in his case, although sometimes, a large blood clot can ‘mask’ an underlying tumour, arteriovenous malformation, or aneurysm. We did a few more investigations to clear all of the above and swiftly transferred him to the operating room where a team was already spruced up and geared for his arrival.

Within minutes, we made a linear cut over his scalp and secured the bleeding from his thick skin with some plastic clips. We drilled a small hole and swirled around it to make it larger. I nicked into the dura and met the blood clot where it reached the surface of the brain. Blood clots in the brain are like people in a Matt Kahn quote: “They can meet you only as deeply as they have met themselves.” Using an endoscope to visualize it and a sucker to slurp it out, I navigated around to get all of it out until the tense brain regained its supple composure. Within a few days, he was alert enough to have his breathing tube removed, and his paralysis showed signs of reversal. “Quick removal of a clot like this prevents an entire cascade of secondary injury to the brain,” I explained to the family, who was relieved to see him finally being shifted out of the ICU and complaining about the horrible food in the hospital. He had every right to do so; after all, he was a Parsi being served vegetarian food.

On the 29th of October, we celebrated World Stroke Day. It’s frightening to know that 1 in every 4 adults above the age of 25 will suffer a stroke at some point in their life. It’s heart-breaking to learn that a stroke occurs every 5 seconds across the world, and gut-wrenching to fathom that out of every 10 strokes that happen worldwide, 1 of them happens in India. Mumbai itself sees about 50 strokes a day. Time is of essence in the diagnosis and treatment of strokes, and, very often, minutes can save lives.

Three months later, my patient came back to the clinic having completely regained function and resuming work. This time, his mask was fluorescent green with a big smiley on it. He removed it for me in a flourish so that I could check the symmetry of his face, the intonation of his voice, and the fluency of his speech, all of which had taken a beating from the stroke but were back in perfect harmony. I asked him to put his mask back on, lest he catch COVID from somewhere, which, I told him, also has an increased propensity to cause a stroke.

“Don’t worry, doctor! I have already taken the booster,” he winked. Now that’s a face I’ll always remember.


18 Comments on “The Surgical Stroke
  • Avinash Karnik says:

    After taking us through the tough times till your patient recovered fully, the end of your article will always be remembered just like his face. Very well written. Keep it up

  • Quresh Karachiwala says:


  • Anjali Patki says:

    Engaging article. True that, so much has changed with the mask as you point out. Keep up the amazing work dr Mazda.

  • Arun Pushkarna says:

    Another fabulous article. I cannot decide what to admire most – the quick-thinking surgeon, the topical thehe chosen, the empathetic human or the hugely talented writer.
    Love you Dr. Mazda Turel!!

  • Chanda says:

    Even in seriousness, the merriment remains.
    Loved it. Thank you for making my day!

  • Manoj MALKAN says:

    As usual very lucid writing. For layman it is magical recovery. But being a doctor myself, I can visualize the stress, the speed at which your brain would have worked, the decision making and the composure during that 1st most critical hour.

  • Vipul Shah says:

    Dear Mazda sir……

    Once again in your series of Surgical….
    You have mentioned in your wonderful piece about timely Treatment & timely surgery cured the Parsee patient in the nick of time ….

    Your journey for non medical person is like imagining virtual Operation Theater Tour without spending a penny ……

    God bless you sir with unlimited power in your hands to cure Parsee & Non Parsee Patients 🤣

  • Bikram says:

    Time is brain …

  • Mahashweta Biswas says:

    As usual very well written experience with a dash of humour. Quick thinking saved his life.

    Kudos to you Mazda

  • Anuradha karnik says:

    Dear Mazda

    A very sweet article! Loved reading it!

  • Rita singh says:

    What an article! every bit of it increasing heart beat to know what next! Its scary to know about the strokes u have written.we hope to .have more neuro doctors like u

  • Herois Kambata says:

    Dr. Mazda, I have saved your number on my mobile and told my wife that if I ever get a stroke, put me under this doctor. God bless.

  • ZMT says:

    Some superheroes come in…. Masks 😷 😆 great work Mazda! Interesting to learn about the experience of operating on a brain!

  • Gloria Msampha says:

    Praise God the patient is well and recovered fully. There is nothing worst than having a stroke. I would hate to have a stroke and be dependent on other people to give you your dignity. Great story as usual. Well written.


    Mazda, you truly are godsend for your patients. Your quick thinking and your timely surgery saved your patient. You are truly a talented writer , and a very quick thinking Dr . May you always be blessed with your skilful hands. 🤗🤗

  • Laina Emmanuel says:

    Blood clots in the brain are like people in a Matt Kahn quote: “They can meet you only as deeply as they have met themselves.”

    This is so meta and so good!

  • Di says:

    Another well written, engaging and enjoyable article… although dealing with a serious subject like strokes.. there were light funny bits blended in like is it a new type of mask in market, parsi getting vegetarian food, elevator always ready in television series lol…
    as u said time is of the essence.. every minute or second counts when dealing with an emergency and to get on with the surgery… quick thinking and action in a timely manner by you and the team saved the patient’s life… Kudos to you the good doctor or rather the great doctor!

  • Azmin says:

    Dearest Mazda,

    This article had more visual imagery and description than most fiction pieces I’ve read! Your sense of humour while discussing such a serious concern and continuing to enlighten lesser mortals is just too engaging, which is why I’m always hooked to your article as a reader!

    Your fan


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