Can a doctor ever put their patients out of their minds, even as they vacation? Maybe not
I had operated on a brain tumour exactly a week before I was scheduled to travel for work to Uzbekistan. This 66-year-old lady had a tumour growing from her pituitary gland that was compressing her optic nerves and rapidly diminishing her vision. We removed it with finesse using an endoscope through the nose. The family was delighted that her vision had dramatically improved after surgery. The day before I was to leave the country, I saw her in the morning and asked the floor doctor to process her discharge. She was chatty and chirpy, and happy to be home soon. “I’m going to be travelling for 4 days, so I’ll see her after a week, as planned,” I told her daughter while conveying all the necessary post-operative care instructions.
A few hours before she left the hospital, she collapsed in the washroom. Luckily, a nurse accompanying her prevented her from falling to the ground. When we rushed to examine her, her speech was slurred and she was facing weakness in the right arm and leg. She was having a stroke. Innumerable thoughts crossed my mind as to what could have caused it, as she was wheeled in for a CT scan after the medics ensured that her vital parameters were stable. In contrast, my heart rate and blood pressure were through the roof. It always happens… something always happens before I travel, I told myself. It is the experience of countless surgeons: Something goes wrong when you least expect it to. Or want it to. It’s nature’s way of keeping you grounded every time you plan on ‘flying high’.
Luckily, the CT scan didn’t show any major bleeding in the region of the tumour, neither was there any evidence of reduced blood supply to the left half of the brain, which would have explained the speech disturbance and paralysis of the right half of the body. “There’s nothing that needs to be corrected surgically,” I assured the family. “But doctor, you’re not going to be here,” the daughter lamented. “If you want me to cancel my travel, I can, but we need to investigate this further medically, and our neurologist will take care of it,” I tried to alleviate their anguish. “We have an entire team here looking after patients and no doctor is indispensable. Also, I’m always available on the phone,” I reassured them.
She steadfastly improved under the care of our specialist, although we could never identify the cause of her stroke. Oftentimes, patients with hypertension and uncontrolled diabetes are prone to such occurrences when their system is stressed beyond measure, which any kind of surgery contributes to. Thankfully, with timely intervention and medication, she made a complete recovery.
Two weeks later, I was scheduled to climb Mount Kilimanjaro, a trip that a bunch of us had planned (but not prepared for) over the past few months. In the days leading up to my trip, I promised myself I’d operate only on spine cases, as they are relatively free of any worry or post-operative complications. But as luck may have it, in addition to my scheduled list for surgery, three massive brain tumours showed up. “I’m not in town from Friday onwards and I’d suggest you get operated elsewhere, because this can’t wait beyond a week,” I told all three patients on the Monday they showed up in my OPD.
The first patient was known to the principal of the nursery my children used to go to. She was a 29-year old girl with a big tumour in the back of the head causing pressure symptoms – headache and vomiting. They insisted I do it. We slotted her for Tuesday and removed it with ease. The second patient had a. haemorrhage inside his tumour and simply couldn’t wait, and he was therefore operated on Wednesday. That chap too made an excellent recovery.
The third patient was scheduled for Thursday but was told that I’d be travelling the day after surgery. This was a large tumour arising from the hearing nerve but pressing against the cerebellum, causing balance issues. They understood the risks of my not being around from the second day of surgery but insisted I do it anyway, as I was referred to them from multiple sources. Nothing fans a surgeon’s ego more than that, and it’s a web most of us succumb to, almost unfailingly.
The morning of surgery, I was informed that her platelet count was below the acceptable range to perform surgery. This was God sending me a signal, I thought. “It’s best to wait until we get the platelets up, because there could be a risk of torrential bleeding with a low platelet count,” I explained. “Once the platelets are normalized, I will get one of my colleagues to perform the surgery.” They were convinced with my explanation, but just before I was about the cancel the surgery, the pathology lab called up to say that some people have large platelets that don’t get counted appropriately with the machine, and by manually counting them, this girl’s platelets appeared adequate. I went back to the family to tell them, and they requested I go ahead with surgery.
I didn’t know whose side the ‘higher force’ was on. We went ahead and opened her up. We fashioned the bone removal behind the ear to get access to the tumour. The brain was tense and swollen, and even on gently retracting the cerebellum, tributaries of blood started filling up my field of vision, which, under the magnification of the microscope, seemed torrential. I shouldn’t have agreed to do this operation… This patient is going to land up with a complication… You saw all the red flags and yet you didn’t play heed to them… I lamented to myself silently, all the while trying to control the bleeding. Through a narrow corridor, I found access to the tumour, which I quickly shrunk to the size of a raisin from that of a lemon, preserving the facial nerve it was stuck to. Throughout surgery, her blood pressure had surges and drops, probably from pressure on the brainstem. We ventilated her overnight and removed the tube the next morning, and thankfully, she was perfect. “Anything can happen over the next few days,” I cautioned the family, “but my team will take care of it, as I won’t have any network.”
Are surgeons allowed to take a break? Is it ethical to operate on a patient and travel the very next day Where do we draw the line? Although patients understand that you might be away, if something goes wrong, they might not be so forgiving. Even when we are away, we are thinking more about our patients than the ones we are away with. That’s exactly what I did while climbing that mountain. I played on loop every single step of my last operation in my head, whilst in the biting cold, even when it seemed impossible to put one foot ahead of the next. Even when it was hard to breathe. Even when it transiently felt as though my soul had left my body.
When I returned to civilization a week later, after successfully summitting the highest free-standing mountain in the world and the tallest peak in Africa (yes, I am showing off a little!), my phone downloaded a barrage of messages. The first one I went to was my colleague’s: “All patients are doing great. Nothing to worry. I hope you reached the peak.”
It was a different kind of high.
20 thoughts on “The Surgical Travel”
God bless you and may yr love to humanity always keep growing
Great write up and sums up the anguish of surgeons who plan a trip
Thank you very much doctors for being so sacrificial and selfless to a point where you have us ( your patients) in your mind.
Sometimes, as patients we forget oit of pressure that you too are human and need to live yoir lives. Forgive us for such indiscretion at times.
But you are an incredible lot.
Wish you long and fulfilled life and careers!!
Thank you very much doctors for being so sacrificial and selfless to a point where you have us ( your patients) in your mind all the time.
Sometimes, as patients we forget, out of pressure that you too are human, and need to live your lives. Forgive us for such indiscretion at times.
But you are an incredible lot.
Wish you long and fulfilled life and careers!!
Very well written. Enjoyed reading.
Everyone deserves a break ,why should surgeon’s be left out .
Wow ! Amazing all that you do ,all in a day’s work.
Absolutely true!
You have an incredible way of capturing feelings through words. Reading your insights, I can sense how many of us doctors experience these very phases. Wonderfully written. One of the best parts of my Sunday is reading your posts.
Superb, Maaz
excellent write up
You are right . I am a physician internist .Whenever I leave for a holiday I avoid trying to admit patients in the hospital but invariably some critical patients lands up and spoil my departure.I try to tell them that my locum will look after them but if their condition does not improve there is always a feeling of guilt that they be better looked after if I was there.
You are a good human being so Ahura Mazda is always on your side leave it to nature and enjoy normal life too. Congratulations on climbing the tallest peak of Africa, the achievement is small compared to when you deal with human being problem at the hospital.
I can imagine your relief on reading the all your patients were doing well and no complications with anyone. God bless you.
Hope you had a good time and exhilarating experience climbing Kilimanjaro. Congrats on your achievement.
First and foremost: I’m glad all your patients did well while you were on Mt Kilimanjaro
Second, congratulations on getting to the summit of this mountain; what a feat.
I was born and brought up in a neighbouring country Malawi; it also has a mountain called Mt Mulanje, not as high but a favourite of local mountaineers. If you ever decide to try scaling it please let me know. I still have half my family there and they will gladly help.
Thanks for sharing 🙏
Dearest Dr Mazda sir
First of all special congratulation for achieving the Credit in your Long List of various achievements the addition of reaching second highest peak in the world Killimanjaro in Tanzania 🌹
Bravo !! for years you & your fellow mountaineers will cherish the memories of special expedition……
Secondly it’s creditable that even in difficult situations of Thin Air & extreme cold you are remembering & thinking of your patients….. This is True professionalism sir ……
I once again pray & wish for your All Round Success & Happiness in every walk of life with Pink Radiant Health…
Good Luck for everything 🌹🌹
Great !
Highly impressed with your heart to heart talk !
Reach out to HIGHER PEAKS !
Heartiest congratulations Sir.
For scaling the peak and for your success in surgery.
May God bless you
Definitely all prayers do get answered..God alone knows when to grant them in HIS divine wisdom!
The worrisome supplications that v make while thinking of the ailing ones, I believe gives us hope n courage to the patients!
May u scale the highest peak in all spheres of life ! Stand tall my friend!
Born to serve!!!
Loved this..Mazda please keep operating and please keep writing..don’t ever stop..👍👏
U r so caring about all ur patients. Not allowing urself to have a free holiday ever.which I think is a great quality for any good doctor. Ur dedication to ur work is highly praiseworthy. God bless.
Dear Dr. Mazda,
So true and so well written.
A TRAVEL is A necessary TOOL for knowledge, attending conference, presenting papers, vacation etc..
AND…
Every-time, a surgeon plans to take-off for out of town, such fears ALWAYS ARISES.
We were equally nervous after you removed an overgrown PITUITARY GLAND from my 96-years old Dad’s brain and were to travel the very next day..
It all worked out great.
His recovery was fantastic.
We all family members return back to US leaving papa under your care.
Your tremendous help and preparations for pre-surgery, during the surgery and post care was awesome!
I call my 96-years old mom & papa everyday AND behind every laugh & talk with them, I praise the lord for your valuable gift of his life to my family.
You gave another life to my papa!
God Bless you.
Pls Travel more.
You are our Ratan TATA.
Pls help so many, as you always have.
I will visit you soon from Los Angeles with my wife and small daughter who is A nephrologist so they can meet your giant soul!
With humble Regards, Doc!
Pankaj KADAKIA