The surgical geriatrics

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Gulnar and Armaity had a combined age of 175 years. Together, they were as old as the iconic Sir JJ Hospital that their ancestors had built. The two Parsi ladies, in their late 80s, were like each other's appendages - always accompanying the other for their respective medical consults.

Armaity looked like Jon Bon Jovi's mother, with fair skin and a bouncy salt and pepper bob. Gulnar, who was fondly called Gul by her friends (because she kept getting lost on the foreign trips she took with them), was like an adorable, huggable Shih Tzu transformed into a zesty Parsi aunty. They gingerly supported each other onto the chairs in front of me in the consultation room.

"I have had this horrible back pain for 20 years," Armaity told me. "My buttocks are sore, my legs tingle, and I just can't walk anymore!" she said, exasperated. I assessed her in detail and told her she had severe compression in her lumbar spine. The MRI she reluctantly had done confirmed the same. "Your X-rays show that your spine is unstable, and we'll have to fix it with screws if you consider surgery," I explained.

"Surgery at 87 is okay?" she asked with trepidation. "Only if you want to live to be a hundred!" I said. "I don't mind!" she exclaimed, as her Parsi genes kicked in, "but not in this pain." "Then let's operate on you and fix it, once and for all," I proposed. "But people say all these bad things about spine surgery…" she further cautioned. "That's because all those who've had successful surgery are too busy enjoying their lives and don't have time to talk about how good they feel. But the handful of negative outcomes keep getting amplified," I reasoned.

"I also have back pain," Gul interjected. "Do you also want surgery?" I joked. "I'm a surgical veteran," she told me. "I had an emergency perforated appendix and had to fly back from my vacation in the Andaman Islands," she started. "Luckily, you weren't lost at that time, and they found you," I did masti with her. "Then I had surgery for diverticulitis, where they removed two feet of my intestine," she said, completely ignoring me in an attempt to finish her story. "I had a pouch coming out of my stomach for nine months, which they finally internalised," she said, making a face.

"Then, I had four dental surgeries interspersed across three falls, where I fractured my nose and blood splattered all over my face," she added colour to the scene. "I also had four major hernias repaired, and recently, they found three polyps in my uterus, which they suspected were cancerous, so they removed the whole system including my tubes and ovaries - not that I need them anymore," she said as she flexed her biceps.

"Never a dull moment in my life," she explained, smiling. "For the time being, we'll avoid your spine surgery," I confirmed with a reciprocal smile. "You don't even need one," I added after examining her and seeing her images. "We'll put you onto a good physiotherapist and that should do it."

A couple of days later, we took Armaity to the operating room. I drilled out the bone and removed the thickened ligament pressing on her nerves, decompressing them meticulously. We put in some screws and connected them with titanium rods to realign the spine and give it back its native shape and form.

"Even though you've put so much metal in my body, I feel 10 kg lighter," she told me when she came two weeks later for a checkup. "All the pain in my legs has vanished. My back is a bit sore, but I'm sure that'll go too," she said with relief. "I wish I had done this 10 years ago," she concluded, reiterating what most patients say when they undergo spine surgery after avoiding it for as long as they can.

The elderly are some of my favourite people; while they are the most vulnerable, they are also the toughest. They have accrued the wisdom and experience of several decades to know what's best for them. The youngsters who accompany them for a consult are often heard telling them to slow down or take it easy, which, I believe, is incorrect. The older you get, the more active you must be, and the harder you need to exercise - physically and mentally.

Armaity thought for less than five minutes before she decided she wanted to have surgery. I can recall so vividly a 95-year-old man who insisted I operate on him for a hematoma inside his head while his children suggested it was best for him to go peacefully. He calls me every year on his birthday to thank me for adding another precious year to his life. He is 98 now.

Three months later, Gulnar and Armaity walked into my clinic again. Armaity was limping and back to using the walking stick she had given up. She barely managed to seat herself onto the chair before lamenting, "I was doing so well after surgery, but one day, while I was taking a walk in the garden, this silly giant of a dog chasing a ball dashed right into me and I toppled over." She winced in pain while I examined her. "Doesn't look like anything's broken," I said, "but we'll confirm it with an X-ray." They came out clean. I gave her a few pills to take away the pain and asked her to come back in a couple of weeks.

"Give me also some medicines, na," Gulnar intervened as per usual. "All my friends are taking medication and I'm not taking a single pill. I feel left out!" she said, making a Shih Tzu face. Both Armaity and I looked at her as if she were crazy. But, then again, we are Parsi; if we don't have some idiosyncrasy, we aren't doing justice to our genes. "Give me some memory pills!" she requested. "My friends call me Gul Golmaal because I keep mixing up stuff." I gave her some multivitamins to go through in her last decade.

Three months passed, and the duo was back again. Armaity had no stick and Gulnar was beaming. They looked like they were reverse-ageing. I was amazed at their spirit, which they passed on to me both literally and metaphorically; they handed me a bottle of whisky. I pulled it out from the bag to take a look and reminded them to do what the bottle says. "What?" they asked, "Keep drinking?" "No," I said, although I knew that was part of the reason they were so full of life. "Keep walking!" I pointed to the label.

"You're our Santa," they said as they thanked me, "and the best gift you gave us this Christmas was our health." "Happy New Year!" we wished each other, in a group hug. "May you both live to be a hundred!" I added, telling them that they will be the subjects of my future article.

PS: Gul and Armaity are my mother's friends and their names have intentionally not been changed. So if you spot them on the street, or at CCI, or Willingdon, you can doff your hat to them. I promise you will recognise them from my description.

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