The non-surgical tragedy

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Hey, Maaz," a friend randomly called up. She's the kind of friend you don't talk to often but feel connected to the moment you have a conversation. We all have these friends. There is no compulsion to make small talk or exchange pleasantries, asking about families and discussing other trivia before getting to the meat of the discussion, even if you've picked up the phone after months or, at times, years.

"I'm calling about my second cousin, who is 20," she gave me the brief. "Last night, she was out at a family function where she was perfectly fine. She doesn't have diabetes, blood pressure, or heart problems. No drinking or smoking," she categorically emphasised like an astute narrator, as these are the questions doctors ask first. "This morning, she woke up and walked to her parents' bedroom, saying that her right arm was feeling funny. As she was describing the problem to her father, it stopped moving. She started weeping profusely, not understanding what was going on, as she was suddenly not able to lift the hand," she tried to narrate the sequence of events as accurately as possible. "Then the right leg went numb within the next few minutes and was paralysed," she explained. "It was as if she had had a stroke where one half of the body couldn't move," she gave her interpretation. I listened intently; all this was unusual for a young girl.

"They planned to rush her to a hospital in the suburbs close to their home, but within the next few minutes, she collapsed and stopped breathing. Her sister, who was also at home, had received some paramedical training at her workplace for emergencies. She felt her pulse, realised it was absent, and started CPR, which revived her transiently. They put her in a car and took her to a hospital 15 minutes away. When they reached, the doctors recorded no pulse or blood pressure but nonetheless tried to resuscitate her. After several attempts and after the heart having stopped on multiple occasions, they were able to get her back to life," she described as best as she could.

"But an MRI done after stabilising her has shown severe damage owing to a lack of blood supply to the deep parts of the brain, and the doctors are unable to clearly say if the issue is in the heart or the brain or the blood vessels that connect the two," she sounded exasperated. "They've said she may not make it, but it's been only 24 hours since all this began!" she exclaimed rhetorically, as if to ask how someone could make such a declaration within a day.

"What would you like from me?" I asked, as I wasn't the treating doctor, nor was she in my hospital. "Can such a thing happen to a 20-year-old?" she asked in utter disbelief. "Obviously, it's extremely rare, and whatever has happened seems freaky, but I'll talk to the neurologist there, who is a friend, and get a more technical picture,"I offered.

"She's brain dead," the neurologist told me. "Her pupils are not reacting, the brainstem reflexes are absent, and there is no response to any sort of deep pain. The MRI shows extensive infarcts in the brainstem, but the blood vessels and heart are okay, so we really don't know where this has come from," he confessed a truth that we deal with daily - that we know so little. "We can only postulate multiple possibilities," he went on to list all the causes of strokes in the young. I conveyed the message to my friend to pass on the information to the family. Her father asked if he could speak with me, and I agreed.

It was nine at night. I had just finished seeing my patients and was readying to leave for the day when the father called. "I want you to come and see her once," he pleaded. "She was laughing and dancing the previous evening; the life of the party. Today, I'm being told she's not going to make it," he said with profound grief. I was moist eyed. I seldom cry; the last time I did was when I lost a patient two years ago after making multiple attempts to save her over a month. "I'm unlikely to tell you anything different from what the doctors there have told you," I said. "Come as a friend, don't come as a doctor," I could hear him sob. "I cannot let my baby die." I couldn't refuse. "I'll be there around 11." I requested the neurologist to allow me to see her. He willingly obliged.

After the phone call, I sat in my office with my feet up on the table, and in the eerie silence on the floor, I couldn't help but wonder what I'd do if this were my child. What would I want from the universe? We have heard about the brutality of a life coming to an unexpected end, but when that happens to someone in the effervescence of their youth, it is shocking. The truth is that unless it is our own blood, we can never fathom the depth of grief. It is a bottomless pit. And however hard we try, there will be no answers.

Closure is often a myth.

I reached the hospital close to midnight, where the family and several friends waited for someone to tell them something different. I examined her and peered through the scans in detail. I could only reinforce what the doctors had told them. I had nothing more to offer. "Is there no way to reverse this?" the father asked with an ashen face, as the mother stood next to him, lifeless herself. I shook my head sideways.

"Is there any way to know why this happened?" they wanted some clarity. "A postmortem might give us some clue," I said, but I later realised how cruel that must have sounded. "You can consider donating her organs; that way, she lives on," I tried to propose an alternative, but that didn't go down well either. "We'll try whatever we can for a miracle to happen," they told me. I knew that I, as a man of science, would probably do the same if this were my child. At some point, the acceptance must come, but these journeys are extremely personal, and doctors should never impose their belief beyond providing an honest, heartfelt opinion. I left the hospital feeling helpless and hopeless. We have made remarkable advances in the neuro sciences, and yet, at times, it feels like so little.

She passed on two weeks later.

The writer is practicing 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