The Surgical Coldplay

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She was a young girl in her sixties (there - I just earned myself some brownie points with the elderly women who read my stories). They were a family of four - one husband and two sons. "I've been having headaches for a few weeks. My GP ordered an MRI of the brain, and they found this," she said, handing me the films. "I don't want surgery," she interjected even before I could say anything. I sighed internally. Whenever a patient's gut instinct is not to have an operation, and for whatever reason we do go ahead with it, I've more often than not had a complication, even if it's something minor.

I asked her a little more about her pain. She said it was making her miserable. Vomiting was a new symptom over the past three days. Her husband added that she even had a brief bout of unconsciousness yesterday, but recovered completely in a minute. "These are all red flags," I warned and began to examine her. "Stretch your arms out straight in front of you, palms facing up, and close your eyes," I instructed. The left arm drifted down considerably, indicating a problem in the right half of her brain.

I planted the black and white films against the incandescent light of the X-ray box and explained to her why she needed surgery. "There is an eight-cm tumour carpeting the entire surface of the right frontal and temporal lobe, pushing the brain to the opposite side. There is also a lot of swelling around the tumour which is causing raised pressure inside the brain," I detailed with a pointer. "Mom, you have to get this removed," one of the sons sitting next to her implored. "Are there any risks to this operation?" the other son asked. "There's always a risk, but the benefits outweigh it in your case," I stated, adding that there was a tiny possibility of death, paralysis, infection, bleeding, or seizures. This is what I call pulling a Coldplay - making someone experience strong emotions with a serious message. But I ended it with, "And I'll try to fix you," which is what Coldplay fans have been consoling each other with after being crushed.

After a lot of deliberation and a few more opinions, they returned to me for surgery because she was getting worse. It was the same week that Coldplay announced their Mumbai concert. I haven't planned for a complex surgery as much as I witnessed the entire city strategise on how to book their tickets. While people were planning how many devices to simultaneously log onto, I was thinking of the contraptions I would use to get this monstrosity out.

We operated on her the next day. I made a big incision over the scalp and opened the dura, the covering of the brain from which this tumour arose, and disconnected it from its attachment. "It was all yellow" and densely adherent to the brain, indenting the surface unevenly. Attempting to peel it off was an Adventure of a Lifetime because it was bleeding profusely. I dreaded Something Just Like This happening, but there's always a Higher Power guiding you, and we were able to remove the tumour uneventfully. The brain was soft and pulsating gently after the procedure.

I asked my colleague if we should replace the bone over the brain or place it in the abdomen to replace later. There was a small chance that the brain could swell further, and if it did, it would compress the internal structures. "The brain looks quite soft now… we could put the bone back," he suggested. "Plus, they are on a tight budget, and replacing the bone later will need a second operation," he justified. In the wise words of John Kirklin, a famous American surgeon, "At a given instant, everything the surgeon knows suddenly becomes important to the solution of the problem. You can't do it an hour later, or tomorrow. Nor can you go to the library and look it up." We could either remove the bone and replace it a month later or put it back now and pray she wouldn't need another surgery. The Scientist in us made us do the latter. You could almost call it Boldplay. We said a Hymn for the Weekend in the ICU, where she started recovering exceptionally well. I was delighted to have made the right choice. She spoke well, ate her food, and moved her limbs, ready to be shifted out. She was doing well.

Until she wasn't.

At 2 am the next morning, I got a call saying that she wasn't responding. Thoughts flashed in my mind faster than the Speed of Sound. I beat myself up in my head until I saw A Sky Full of Stars. My Universe came crashing down. We got an urgent CT scan done to see that the swelling had disproportionately increased. I ordered her to be rushed to the operation theatre to plan for the removal of the bone. As I drove to the hospital, I wondered how my judgement had failed me this time. After having been in this situation hundreds of times over, how could I have gotten this wrong.

She was prepped and ready in the OT by the time I reached, and we were quick to remove the bone flap. The brain jumped up like the foam of a beer topples over a glass when poured quickly. It seemed to me at that time that Death and All His Friends had come to visit, but we were able to tide over the situation. Over the next few days, she made a steady recovery.

As I drove back from work that evening after 20 hours of being at the hospital, I thought of all the challenges we face as surgeons and how often the decision making is more crucial than the technical expertise. How quickly the pendulum of our outcome swings between beauty and bleakness, transcendence and terror, faith and fear, magic and madness.

How every single thought and action centres around a patient's well-being, and yet, there are times we falter.

When you try your best, but you don't succeed/ When you get what you want, but not what you need/ When you feel so tired, but you can't sleep…

Lights will guide you home/
And ignite your bones/
But you will have to fix you.
No one will do it for you.
And that is our ticket to Paradise.

PS Chris Martin, if you happen to read this, our group of 16 friends were trying for your tickets while I was saving lives. Please do the needful.

The writer is practising neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazda.turel@mid-day.com