The Surgical Toolkit

Sometimes, you need more than just a tool for surgery—you need a hand, a head, and a heart

“Which instruments will you use to cut open my spine?” Rasiklal asked me after I examined him for a herniated lumbar disc. I had just explained to him why he was a candidate for spine surgery. He was a tailor in his mid-fifties, slightly potbellied, and wearing a white shirt that, in his own words, “used to fit him well before he put on some weight.” He had tried everything to avoid an operation – medication, physiotherapy, ayurveda, homeopathy, acupressure, and acupuncture. He had visited a chiropractor, osteopath, and even a ‘baba’ who claimed to cure slip discs by kicking people on the bottom. Needless to say, his pain was much worse after that experiment, and now, he was unable to cut fabric sitting on the floor. He needed to stand to do it, and that too just barely, before his back pain shot down his legs – the classical sciatica that people with disc disease describe.

When I asked him to sit, before doing so, he removed a large 10-inch pair of metal scissors from his pocket and placed it on the table. You could feel the intense sharpness of its blade just by looking at it. The bronze metal handles mixed with shades of silver had been softened by years of usage. “This is my tool; I never leave my house without it. It’s been part of my entire life. If I must have surgery, I need to know what you will be using.” He had made his point; I understood what he was trying to say.

“We do this operation with what we call minimally invasive technology,” I told him, explaining that we didn’t have to cut any muscle like they did in the good old days. “We’ll first use a knife to make a 2-cm incision into the skin and then dilate the back muscles with a series of tubes, each a size larger than the other. We’ll dock the tube on the bone of the spine, and using a fine drill that rotates at sixty thousand revolutions per minute, we’ll shave a portion of the lamina of the spine that covers and protects the dura,” I described. He was listening intently. “You need to have a rock-steady hand to be able to work the drill, because one slip and we could rip apart all the nerve roots of the spine,” I said, showing off slightly to make what we do sound more complex than what it is.

“Then, we identify the nerve root that is being compressed by the disc, and once we expose the bulging disc, we cut into it with a sharp knife,” I showed him an aminated video. Sometimes, the disc is just lying there, waiting to be popped out, and in those cases, we use forceps to grasp it and pull it out, thus relieving the pressure on the nerve root, which, in turn, relieves the pain. On occasion, we need to use a curette to scrape the disc, making sure there is nothing floating free to pop back out again. “You don’t ever need to use scissors?” he asked, slightly disappointed that we were neglecting his favourite tool. “We do – to cut the stitches we make when we sew you back up,” I said to a look of delight on his face. “If you don’t trust the ones we have, we could use yours,” I joked, “but actually, they’re a little too big,” I dismissed the idea before he could agree.

“You don’t use a laser?” he then asked. I wasn’t surprised; this is another question every patient has, especially those who come from the Middle East in lure of having laser spine surgery. “People use the term ‘laser’ only to make it sound fancy and attractive,” I acknowledged. “The use of an actual laser if very limited in this field,” I explained, “but we do the entire operation with a high magnification and brilliant illumination microscope and the focus point is a sharp red dot of light, which looks like a laser, if it makes you feel any better!” I concluded.

“At the end of the day, while the tool is extremely important, it is what you do with your hands, your head, and your heart that makes all the difference,” I said. “For instance, I could never cut fabric the way you do if you gave me your scissors,” I tried to explain. I told him how clinical decision-making was the key to any successful surgery, and emphasized how one needs to have the heart and the courage to deal with a complication if it were to occur. But I understand why, for some patients, it is very important to know what a surgeon will use, especially if they use a tool themselves: artists and architects, plumbers and painters, cricketers and carpenters, musicians and maestros never cease to ask me what I will use to open up their spine or brain.

When we operate on the brain, we mainly use a suction in one hand and an instrument in the other, which could vary from bipolar forceps to buzz bleeding vessels and tissue to micro scissors to cut what we have coagulated and an entire spectrum of micro dissectors  of varying shapes, curves, and sizes to get into nooks and corners of the brain that were once deemed unapproachable. We even have instruments that have lights at their tips to further illuminate what we’re looking at so that we cut only what is intended to be cut. And we also use dyes that light up tumours and help us differentiate it from normal brain tissue.

There are several surgeons who, when they operate in multiple hospitals, travel with their own tool kit comprising instruments they are familiar with. The touch and feel of using your own tool (no pun intended) provides a certain sense of comfort and control. The joy of owning your own instruments and looking after them like you would after your own children is unparalleled. I know an orthopaedic surgeon who carries his own portable operating table with him for joint replacement surgeries. There is a neurosurgeon from Japan who used only his own gold-plated microscope to perform his surgeries. In the interiors of India, just like farmers ask for a tractor in their dowry, surgeons ask for instruments, ultrasonic aspirators, and microscopes. These are extensions of a surgeon’s hands, head, and heart, also called our second wife by a few of us, and the first wife by most others. Don’t ask me which group I fall into.

Rasiklal came for a follow-up two weeks after his spine surgery, completely pain free and delighted that he could get back to doing what he loved the most. “Here, try this for me,” he said, pulling out an elegant formal shirt and pant he had stitched for me. “This is my gift to you for making me walk again,” he insisted, his eyes welling up as he insisted that I try it on in front of him. Without any reservation, I removed my clothes and put on his. They fit immaculately. “But you didn’t even take my measurements!” I exclaimed. “Sometimes, you need more than just a tool – you need a hand, a head, and a heart,” he reminded me of what I had told him. I spent the rest of my day in the clothes he had stitched for me so affectionately.

32 Comments on “The Surgical Toolkit
  • Sunita Masani says:

    Thank you for sharing 🙏 so sweet of you to remain the erest of the day, in the set he sewed you..

  • Dr mrs karapurkar says:

    Excellent article.
    One must keep a relation like you with the patient.
    Very good

  • Martha Favour says:

    Very true Dr. You have a heart of gold, heart of love and of compassion. I witness it in your life. God bless you and keep the good job going Please.

  • Dr.Sukhmeet K Kalsi Consultant Family Physician, Cousleing Psychologist ,International Life Coach says:

    Emotional Intelligence is what we could also call it,a must for every Medico,rather every human being. Having the head and the heart well connected makes the hand take the right action steps towards your goal.
    Reassurance is what the patients need the most

    Also, earlier there used to be a saying which goes–Treat the person like what you would like to be treated as &it could be revised to — Treat the person as he/she wants to be treated like .

    Communicate in the language that would align with them the most and the bond in any relationship could last forever. That is what we actually invest in the relationship,be it personal or professional.

    The entire article speaks of the Value addition that you do to your patients’ lives through your amazing skillset

  • Sunaina saraf says:

    Hello sir
    So inspiring to read your thoughts
    Ur quality is your humbleness & down to earth
    Thats why you are so special ☺

    Mrs Sunaina N Saraf

  • Kersi Naushir Daruvala says:

    No matter what tools you use weather a Doctor or a Tailor, the hand will finish the job, but it’s the heart that guide you to perfection till the very end.

  • Obaid ( Your patient- Brain Tumor) says:

    Amazing Dr , all words touching heart.

  • Dr.bipin says:

    Such type of pts make medical practice and practising doctor very proud of his profession.

  • Marzin R Shroff says:

    What a captivating and heartfelt account of the surgeon-patient interaction! Mazda, you have beautifully illustrated the delicate balance between the technical precision of medical tools and the human touch, emphasising the importance of hands, head, and heart in surgical expertise.
    Keep sharing these gems with us

  • Marzin R Shroff says:

    What a captivating and heartfelt account of the surgeon-patient interaction! Mazda, you have beautifully illustrated the delicate balance between the technical precision of medical tools and the human touch, emphasising the importance of hands, head, and heart in surgical expertise.

  • Anuradha says:

    A very inspiring article as it teaches us to rever those things which assist us in our journeys towards knowledge and growth.
    You’ve made your journey a resounding success. Please continue to enlighten us about your field of neurosurgery with your signature wit and sense of humour. Thank you.

  • Vipul shah says:

    Dearest Dr Mazda sir……

    Extremely Extremely happy the way you converse with Rasiklal about Tools sets used by him & Surgeons ……….❤️

    The patient will be very happy with Surgeons who explain all minute details & Questions ask for mental satisfaction although patient may or may not understand the complicated medical terminology…🌹

    I particularly like the great affection shown by Rasiklal for giving lovely Gift of perfectly stitched pant & shirt without taking measurements & giving tit for tat Answer to your intelligent Question 🤣…

    Lastly I am super happy to read your Toolkit piece bcos my Late father whom I adore the most was also RASIKLAL not tailor but C A…..❤️‍🩹

  • Dr. Divya Shetty says:

    Such a heart warming article. Being the daughter of a tailor and knowing the pain that most tailors go through because of their standing job i understand what the gentleman felt. It is so nice of you sir to explain the entire procedure in such detail and establish such a good rapport with the patient sir. Truly inspiring. Also it was so sweet when the patient offered the shirt and pant that he stitched personally for you sir… Even my papa felt very emotional after hearing this.

  • Juma jonathan says:

    Your narrations are always heartwarming and inspiring. Keep up the great works

  • Dr M Abid Saleem says:

    Sir…it always so inspiring to read your write ups.wish more power to you.

  • Sanjay P Sonar says:

    Super, as always

  • Thando Wale says:

    Thank you for sharing this.
    It is all about the head, the heart and the hands. And a touch of humour! Blessed Sunday Doc!!!

  • Tasneem says:

    Learnt quite a bit in this blog. Heart and head combo … awesome combo 👍👍👍

  • Dr Narendra GATHANI says:

    U cared and treated the patient first, then u operated and cured the disease. A doc with spine and heart in brain.I m proud to know u

  • Sushma Sowraj says:

    What a heartwarming story! In our next meeting I insist you to share your magical pen so we can also write a beautiful reply to your beautiful stories. Your connection with Rasiklal goes beyond surgery; it’s a testament to the power of compassion in medicine. It’s a beautiful reminder that sometimes, healing isn’t just about medical expertise; it’s about the human connection and empathy.

  • Teko Fulele says:

    Amazing write up as usual. Patients give you a go a TRUST in you that always produces 100%results as you have time to listen, reassure & explain the procedure. Always humble & showing love to the patient as I know you. You gave this patient a holistic approach of wisdom, perspective, curiosity & capability. You can never go wrong if you use a combination of preferences of thinking (head) doing (hands) feeling & focusing (heart.) You have been blessed by a healing hand my Doctor! May God grant you many more years to serve humanity. God bless you!

  • Rita singh says:

    A very wonderful tale of a tailor and a surjoun.Both of u have played ur part so well.These true stories u relate r more interesting then any fiction we may Read . Thank u for sharing ur experiences. God bless you.

  • Bruce Blewett says:

    An excellent article Mazda and it brings home the personal side of what you do to put your patients at ease.

  • T George Koshy says:

    Loved the ending Mazda and ur sarcasm abt the first wife and second wife..never stop operating and never stop writing

  • Pita says:

    You are a very good human being,God bless you!We saw that first hand!

  • Anjali Patki says:

    Sweet and endearing story, well written, and captivating. Your unique style keeps one engrossed and brings a smile on a sunday morning.

  • Dr. Rafat Ansari says:

    Absolutely!!! The love n blessings the patient bestows out of gratitude means so much more n the impact it leaves on r being is to carry on…

  • Arun Pushkarna says:

    I don’t know if Rasiklal actually exists because you probably changed the name, but your description of this interaction has made him immortal. Lovely, compassionate article – yet again!

  • Natwar says:

    Sorry Dr could not read yesterday, But you are a Dr. Gold Heart.

  • SANMIT SHAH says:

    Amazing as ever Dr Mazda…. Always looking forward for your write ups…..

  • Setu Ram says:

    Dr M .. you are compassionate .. you treat all patients equally.. caste creed color is no bar for you. truly you uphold your oath as a dr

  • Chandan Sanjana says:

    Congrats Mazda. Another piece of great writing. Glad your tailor was pain free and can continue with his profession. Just imagine making a perfect shirt and trouser for you says a lot about his talent in his profession. God bless you for your large heart and compassion towards your patients. Bless you


Leave a reply

Your email address will not be published. Required fields are marked *