When surgeons can’t vanquish fate

Men of science are often made to come to terms with their limited powers when the human body reminds them who is God 

SHE was a single mother. She carried him horizontally in her arms. The pallu of her disheveled cotton saree covered his head to avoid attention from inquisitorial onlookers prying on her plight in a crammed outpatient clinic of our public hospital. One of the men, showing some rectitude, jostled on the wooden bench to give her six inches on the edge of the plank. She sat heavily, the weight in her arms seeming infinitesimally lesser than the encumbrance on her face.

I could see her through the slit of the half double door of my cabin, which swung open and shut constantly, typifying the busyness of a government hospital imbued with patients wanting to be seen first. I gently gestured for the crowd to ease off a little and allow for her to come in on priority. They acquiesced gracefully. The civility that indigent people display to accommodate their own often transcends that of the affluent.

She thanked me with an unbridled smile as she gently lifted the veil of her child’s head, a move that summed up for me the months of her anguish. His head was twice the size of his body. The skin over it was tightly stretched and the scalp veins dilated enough to insert an intravenous cannula into any of them. His eyes were sunken, like the setting sun, a dull grey because of the raised pressure inside his head. He was 18 months old and emaciated with delayed milestones. I could count his ribs without feeling them. I pored over the sheaves of tattered papers she was carrying after having visited multiple doctors in her village.

She removed a folded CT scan film that showed an abnormal accumulation of cerebrospinal fluid due to a humongous tumour in the cerebellum, which obstructed the normal outflow of brain fluid. The brain was pushed to its edges, leaving only a thin mantle, and was unlikely to assist in the development of a fully functional child. The pressure of the fluid within prevented the skull bones from fusing, allowing me to palpate the contour of his pulsating brain over the vertex of his head. We call this area the fontanel, which, in normal children is soft and sunken, but in this case was tense was bulging.

I pulled out a measuring tape. Active babies get extremely irritated when you measure the head circumference, but he lay there lethargic, numbed by the pressure within his internal world. His head circumference was 56 cm, comparable to an average healthy adult. When a baby is born, the diameter of its head measures about 33-35 cm and reaches about 46-47 cm by its first birthday. This child’s head was growing exponentially and the rest of his body seemed like its appendage.

Surgery was the only option, I explained in mangled Marathi, describing in detail the risks of an operation for a child of this nature. A few sentences in, I was perplexed by the smile on her face and so I paused. “Aap Hindi mein baat karenge to bhi chalega,” she said wryly. I was pleased to bring momentary relief to her tormented world with my language skills. Being Parsi, I must confess that this was not the first time such a request has been made. What’s even more embarrassing is that on a few previous occasions, Hindi is what I had started with.

When we counsel the poor and helpless about the dangers of complex brain surgery, the possibility of death is the first thing we mention loud and clear, which annuls all responsibility of minor aberrations. When we do the same with the educated and prosperous peerage of society, we enlist a menagerie of minor complications, very deftly mentioning the macabre possibilities some where in-between. We must admit that we cannot escape our biases.

A few days later, after optimizing his nutritional status and temporarily draining some fluid from the head to release tension, we wheeled him into the operating room, his mother stoically standing as the door shut on her, relinquishing probably for the first time in their togetherness all control on his fate. The anaesthetist clenched onto his wrist to bring alive his buried veins and secure an intravenous access. They put a tiny breathing tube down his throat, flipped him over and strapped him down.

We made an incision over the back of the head until where it meets the neck and held apart the layers of tissue with a retractor. The bone was so thinned out that we could cut it with a scissor. We encountered the bulging of the two lobes of the cerebellum shaped like a healthy baby’s bottom, a stark contrast to his own anorectic counterpart.

In a set of quick microscopic manoeuvres, we encountered the tumour and that appeared like the rotten core of an Alphonso mango.

We debulked it amidst brisk bleeding. It appeared to be a high-grade cancer. In children this small and tender, even minute amounts of blood loss can be catastrophic. Adults have something called an ‘allowable blood loss’ that can be compensated for physiologically, but this child’s allowable blood loss was zero ml. Through all the opaque barriers that separate a surgeon from the anaesthetists, I could visualise them squeezing the blood bag to hasten the transfusion. Pressures dropped, alarms beeped, but we managed to remove the tumour completely and were back in control. We closed safely.

After a few days of turmoil in the ICU, he stabilized and opened his eyes wide enough to see. The bulging fontanel had saucered in. For the first time, one could see a semblance of a smile on his face and his limbs moved actively. We discharged him a month later after ensuring that he had gained some weight and was feeding well. We gave instructions for chemotherapy, but I didn’t see the mother at follow-up. I assumed one of the others in the team must have.

A year and a half later, I recognised the same lady in the outpatient clinic with her baby wrapped in muslin and the head covered. Her face was imprinted on my cortex after all that we’d been through. Even if her identity was mistakable, her grief wasn’t. I wondered why she still carried her child around when he should have started walking or at least sitting up. I lifted the shroud off his head myself this time, with self-congratulatory enthusiasm to keenly track if my surgery had done wonders. The head was still huge. But the baby was much smaller. I peered closely. This child was her next one; the first had died six months after surgery from dissemination of the cancer.

The obscenity of heredity was on full display.

29 Comments on “When surgeons can’t vanquish fate
  • Anushree says:

    A moving tale of a stoic mother whose children did not know each other yet shared so much in common… Truly heart-wrenching

    Reply
  • dr gaurav jain says:

    Very Heartly writting
    Describing the reality

    Reply
  • Sumit Singh says:

    Sometimes it is willed by a higher power which cannot be explained.

    Reply
  • Supriya Correa says:

    Mazda, one of your best written ever. Words fall short to express how moving and superbly crafted your articles are.

    Reply
  • Dr Kiran Coelho says:

    Very very touching and very real ! You have a great gift ! You must publish all your articles in a book eventually! It will surely be a best seller !

    Reply
  • Lakshmi Nair says:

    Sometimes there are other plans in place !

    Reply
  • Hutoxi Doodhwala says:

    Mazda it’s such a well written article. So well written that I could sense your feelings as a doctor wanting to heal both mother and child and also that of the mother who bravely went through the ordeal not once but twice.
    Keep on writing.
    Every article of yours brings to light the trials and tribulations in a surgeon’s professional life .

    Reply
  • Vineeta says:

    Moved by the touching narration of your day to day experiences as a neurosurgeon ! This was one of the best ones.

    Reply
  • Subramanyeshwar Rao Thammineedi says:

    Would never contest your experience and your feelings..As you specialise and treat difficult problems you understand that you only treat…and God heals..Very well written

    Reply
  • Cecilia Modise says:

    😭😭 I am out of words as I try to comment but only cry and thank God for my childrens health

    Reply
  • Anjali Patki says:

    A very touching story, written with great sensitivity. You’ve surpassed your own expertise…at both writing and healing. Best wishes to keep up the good work dr Mazda

    Reply
  • Anjali Patki says:

    An extremely touching story written with great sensitivity. You have surpassed your own expertise, in both writing and healing. Good work, dr Mazda

    Reply
  • Vinod Ahuja says:

    Deftly written narrative. I TREAT HE CURES is an old saying. Keep on writing and continue to enthrall us . Thanks.

    Reply
  • Prasanna says:

    Indeed heartfelt and very touching storyline of suffering doctor i amazed by your art of putting things on paper with full of emotion and suffering which that lady went through

    Reply
  • Marzin R Shroff says:

    Man proposes. God disposes. Doctors try but are only human
    Thank you for always trying and most importantly, being human

    Reply
  • Kvvnraju says:

    Beautifully written, bringing emotional issues subtly.
    You have natural flair as a writer.

    Reply
  • T George Koshy says:

    Searing and honest & touching ..it’s liking pouring salt on an open wound

    Reply
  • Rita Singh says:

    U as a doctor always try ur best but God is above all. We have to learn to accept his devine plan.Try ur best let Him take care of the final result.

    Reply
  • Gool Alam Limzerwal says:

    Very touching ! Reality of life and death ! God bless you for your humanity and endeavour to do your very best put all your efforts and emotions in saving life whether affluent or not so fortunate at all cost. Very sorry at the fate metted out to this unfortunate lady but God knows the best and may be He knows she could not endure more in the long run. . Salute your sensitivity and your professional talent and Praying God give you and all specialists such healing touch and compassion.🤲🤲🙏🙏👌👍

    Reply
  • Shruti says:

    You are an alchemist with words. Brilliantly written.

    Reply
  • Renji Mathew says:

    Hugs… What a writing

    Reply
  • ADI ENGINEER says:

    ‘MAZDA’ is the word that Zoroastrians (PARSIS) consider equivalent to ‘God’ in English. Since you carry that in your name it has undoubtedly influenced you in your philosophical and compassionate outlook. Added to that is your gift of expressing your thoughts in such lucid language that it leaves the reader dumbstruck. Keep up your work with missionary zeal. MAY AHURA MAZDA BLESS YOU .

    Reply
  • B. J . Damany says:

    Dr Mazda- your article shows great command over the language &describing emotions—brings up a
    live picture of the pt & his mother before eyes of the reader, especially a doctor .
    Congratulations Dr Mazda
    Sure , had you written a book like this, you would have been a candidate for Booker’s Prize…

    Reply
  • Kemrad Lakdawala says:

    Really well written article Mazda. I love reading your articles. Your team and you are doing some great work. More power to your team and you.

    Reply
  • Chandan Sanjana says:

    Well written Mazda, but this article I found so hard to read. Lost the first child to this condition and now the second one with a similar fate, how much can one person bear! They say that God gives to some only what they can bear, but this… the dear mother! 😥😥😥

    Reply
  • Vipul shah says:

    Dear Dr Mazda

    Fantastic way of expressing detailed explanation of
    Complicated procedure for common man ….

    I salute you Dil se for your Humanitarian approach for patients…..
    Keep on enlighten us for Many more years with your extraordinary writing Skill

    Reply
  • Dr. Nisha Savla says:

    Dr. Mazda, Thank you for sharing this article…very touching narration of doctor ‘s journey in the emotional world with his patient’s illness…which doesn’t end just by treating him or her…what a shocking feeling one gets when not the story but reality repeats itself in hereditary illnesses….I am encouraged to promote genetic counseling…

    Reply
  • Dr.Budhaditya Chakraborty says:

    Very palpable and eloquent.The imagery is so tinged in a subtle melancholy and yet its the stoic trudge that rears its head. Compliments brother .Your empathy shines thru.From one surgeon to another -Best wishes – looking forward to more from your pen.

    Reply
  • COOMI S VEVAINA says:

    All your articles reveal that the quilt of your personality is created with an astonishing blend of head, heart and hands. As reAders, you make us see through your eyes, listen with your ears and feel with your heart. Undoubtedly, you are a skilled neurosurgeon but to me you are a far greater HUMAN (E) being.

    Reply

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