There will be an answer, let it be

Sometimes, the hardest thing to do is to do nothing. This is true for the Queen of England, and neurosurgeons with the latest technology and research at their fingertips 


IF this was your father, what would you do?” I asked a few members of my team in an exercise I regularly indulge in to evaluate decision-making.

A 78-year-old previously healthy man had come in with a large hypertensive haemorrhage in his brain that had left him mute and paralysed on his right side. He was in a coma partly because of the location of the bleed, but also because of the pressure it was creating. We could remove the clot and that would probably save his life, but it was unlikely to alter his overall condition. He could be on a ventilator for weeks and discharged home on a tracheostomy, but would still need months, if not years, of 24/7 nursing, continuous physiotherapy, being fed from tubes, and made to pass urine via a catheter – condemned to an existence of meaningless metabolism he would probably never have wanted. If he made a meaningful recovery after all, he would probably still be dependent on others for his daily needs, doomed either way.

“I would do whatever it takes to save him. I can’t live with the guilt of doing nothing, especially if there is a small chance of him making recovery,” appealed the senior resident unequivocally. I turned my eyes to the next person, someone who loves to rattle off numbers, who substantiated, “Literature suggests that in such cases, long-term functional independence is achieved in about 10–30 per cent cases, with mortality rates of 60 per cent at one year. Unfortunately, these numbers do not help me decide.” “It’s easy to make a perfect decision with perfect information. Medicine asks you to make perfect decisions with imperfect information,” I recalled having read an essay by Siddhartha Mukherjee.

I stared into the eyes of the junior-most member of the team. “If this was my father, I would not do anything, just keep him comfortable,” he adjudicated matter-of-factly. “Why?” I queried, ragging him with “is it because you don’t know what to do?” Years of training in medicine makes you tough. And when you’re on the other side and in charge, you need to ask tough questions even when you’re all sailing in the same boat of uncertainty.

“If he passes away, he passes away. If he survives, my family does not have the means to support full-time nursing over a long period. And I’m pretty sure that seeing him like this for months is going to be demoralising for everyone at home, leading to fights, discord, and a perpetual

state of unpleasantness. He’s led a full life. I don’t think we should mess with nature.”

Sometimes the most unassuming people take the most practical decisions, I thought to myself.

“Who are we to decide? Place the data on the table in front of the family, with the pros and cons of each approach, and let them take a call,” proposed another, concluding the discussion.

It is easy for a surgeon to present published data in a manner that goads a patient and their family to make the decision that the surgeon wants them to. You can either speak with

compassion or incite fear, especially if it’s a question of surgery at a time of emergency, when relatives are emotional and unable to think rationally. But it is the surgeon’s responsibility to help them make the decision that’s right for them. In such situations, after I explain things to the patient’s family, I always end the discussion with the golden, reassuring words my mentor used to say: “Whatever decision you take will be the right decision for you and your loved ones.”

Who are doctors to decide who will survive and who won’t… but subconsciously, we make these decisions all the time for patients and their families. What is important when doing so is to keep one’s own biases and opinions aside, and present things in a rational and unemotional way to relatives.

“When there’s no place for a scalpel, words are the surgeon’s only tool.” Paul Kalanithi sighed in his heart-wrenching memoir –When breath becomes air.

It’s the same thing with grade 4 brain cancer. If you don’t carry out any surgical intervention, survival is three to six months. If you operate and offer radiation and chemotherapy, survival can be one to two years. Of course, there are outliers who will survive a little longer, but would you offer the option of surgery to someone who has to sell his land or only cow, and have him exhaust all savings just to have them spend the rest of their lives between home and hospital? Even affluent people who can easily afford the whole works would think twice before opting for expensive and emotionally depleting treatment options that may or may not yield results. It is not our circumstances that make us or decide our fate, but the way we respond to them.“There is nothing good or bad,” as Shakespeare wrote in Hamlet, “but thinking makes it so.”

The relatives of the gentleman with the haemorrhage didn’t opt for any aggressive treatment. He passed away three days later. While that week must have been full of turmoil for them, the son came back a month later to simply say, thank you.

9 Comments on “There will be an answer, let it be
  • Divya Shetty says:

    This is one scenario that really confuses me. One hand is the emotion ‘dil’ which says ‘I can’t take the life away from someone’. While the ‘brain’ or the logical thinking says it is the right thing to do because they never really come back. They are just there… Breathing, surviving but it’s not the same person and it is terrible to live a life like that.
    On a deeper aspect I would like to ask you sir… What are your views on euthanasia. If you hav a patient with an incurable tumour, and has undergone aggressive treatment to no avail, if the patient wanted to die because it is too painful, what would you do? Given if euthanasia was legal in our country and the patient has signed proper forms.

  • Sandeep Shah says:

    Dear Dr Turel
    Through your coloumns you are helping many readers think rationally when the time to take decision for themselves come in. Your subtle messages will assist readers to recall what they have read. Thank you,

  • Hemendra Shah says:

    Very good article, Dr. Mazda. There is no right or wrong decision as even in poorest of poor cases the Finacial position may change but this may be rear. Yes Dr. Need to be unbiased but they need to understand the family situation and for this they need to spend time talking to all the members of the family and then put both sides of the coin and explain consequences of each decision.

  • Gloria Msampha says:

    Great article. No easy decision in these circumstances. My mother suffered a massive stroke at 7 pm and went into a coma. The doctors advised that if she came out of coma she would be a vegetable. We were given the choice of whether to put her on a machine or simply let her slip away. As the family was deciding what to do she passed on at 10 am the following day. Its not nice watching a once active person become a shell. The doctors are dealing with difficult decisions to make for relatives. May God guide you to make right decisions for your patients.


    very apt and timely in today’s situation.I just lost a close friend in the fight against the virus and the dilemma was when to stop the aggressive treatment and let nature take its course. Your piecce today gave me the much neede courage to face the situation. Thank you

  • Dr A S Randhawa, neurosurgeon says:

    Agreed its a difficult decision. Been operating on these patients since more than 25 yrs but its always a tough call. The patient’s relatives help you to decide a number of times. My policy is :- Be completely honest and truthful with your assessment and approach & let the relatives decide. Explain to them the likely course and end result. Respect their decision after that.

  • Prof V G Ramesh says:

    Dear Mazda,

    Congratulations on an excellent writeup on the dilemma Neurosurgeon faces day to day! I have been reading some of your writings in the public domain. I really appreciate your literary prowess. You are an excellent PRO for Neurosurgical community. Keep it up. God bless you. 

    Best wishes, 

    Prof V G Ramesh 


  • Nutei says:

    Dr. Mazda, it is always pleasure to read your article. Please be 💯 honest with patience relatives or with patience. Please give your honest opinion everything and guide them what is the best for your patience and relatives because relatives mostly we are not able to make our mind due to many reasons…honest advice from the doctor is very important. Doctor you are an angel coming straight from the universe to heal the world. Thank you.

  • water filter says:

    Dr. Mazda K. Turel’s article on “Let it be” is a remarkable reminder of the power of acceptance and the importance of mindfulness in our daily lives. By surrendering to life’s circumstances, we allow ourselves to find inner peace and focus on what truly matters. Turel’s approach to coping with anxiety and stress is a breath of fresh air, providing simple yet effective tools to cultivate a positive and meaningful life. Let it be; an answer will come, a message that resonates deeply and offers hope during times of uncertainty.


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