The Surgical Bride

I just got back from my prewedding shoot in Dubai last evening and I was perfectly fine It was such a fabulous experience The entire family went for dinner after that and we had a great time there toordquo she recalled as she spoke to me lying on a hospital bed 12 hours after having the best time of her lifeldquoAnd then what happenedrdquo I prompted her to continue ldquoI woke up this morning with severe back pain and realised I just couldnrsquot move my legsrdquo she said her face turning from a rosy pink to an ashen grey ldquoThen I vomited twice and with each vomit I felt like I had lost sensation first in the ankle and then at the knee and hips Itrsquos been several hours now and I canrsquot feel anything waist downwards My hands are absolutely finerdquo she finished flicking back her professionally doneup hair over a face that still had remnants of her photoshoot makeup I asked her to move her legs and nothing Zero I gently walked a needle poking it from her thighs to her toes to ascertain if she could sense the prick of a pin and again nothingHer physician had ordered an MRI of the spine and expeditiously sent her to me I plugged the films against the scintillant light of the scan viewer as the anguished family waited for me to pronounce my verdict ldquoThere is a thick blood clot compressing the spinal cord at T11 which has caused her to become paraplegicrdquo I said pointing to the eleventh thoracic vertebra ldquoThere could be an underlying tumour or a vascular malformation but that is secondary It has to come out at the earliestrdquo I decreed ldquoItrsquos choking the cord in full throttle Time is of key essence in this We should do it nowrdquoldquoWill she be able to move her legsrdquo the forlorn father asked the anatomy of illness intersecting with the geometry of grief in his heart ldquoThatrsquos the reason for rushing thisrdquo I responded ldquoThe faster we decompress the cord the better her chances of recoverymdashbut how soon she gets better is anyonersquos guess It could be a few days it could be several months There are a few patients who wonrsquot improve despite our trying everything ldquoShe was supposed to get married in three weeksrdquo the mother burst into a cloud of tears sobbing uncontrollablyldquoHer fiance is in another city and would like to speak with yourdquo said the brother handing me the phone ldquoDoctor saab tell me honestly what are we dealing with hererdquo he asked I wondered if he enquired with a subconscious trepidation of having committed his entire life to someone who might not be what he had imagined if he sounded like he was ready to back out of the contract until I quickly realised I was being judgemental without reasonI explained the reality of the situation to him while the operation theatre was being spruced up for her ldquoDo your best doctor I love her very muchrdquo he entreated trying to navigate the trifecta of sadness uncertainty and hope from a distance as he hung upIt was 6 pm I had already operated on two cases that day and realised I hadnrsquot eaten a morsel yet As the team prepped her for surgery I decided to step out to the Udupi restaurant across the street to grab a quick bite As I ate my idli sambhar it dawned on me that this was the first time I was eating in a restaurant since the start of the pandemic The food was gastronomically gorgeous I was so focused on thinking about the case that as a force of habit from eating food only at home for over a year I picked up my plate and walked towards the kitchen till the waiter politely stopped me midway and took over The lockdown has really rewired our brains I thought to myselfIn the operation room after the induction of general anaesthesia we flipped her on her back and cleaned and draped her in the usual fashion but with an added and intense swiftness I cut down the middle of her back to get to the bone which I drilled off with intention and urgency as my assistant irrigated the field to dissolve the bone dust Once we removed the bone we saw the thick blood clot sitting there stubbornly stuck to the covering of the spinal cord We gently scooped it out giving the spinal cord its desired space and respect We did not find an underlying lesion from which it had bled After having satisfactorily decompressed the cord we closedA few hours after surgery we checked to see if she had regained any function Nothing Perhaps just a flicker of the toe and that too if you imagined it hard enough ldquoLetrsquos wait and see what happens tomorrowrdquo I spoke with the despondent family and called it a dayOn my drive back home close to midnight I reflected on the famous adage of how someonersquos life can change in a day or even in a single moment What must be going through their minds when out of the blue they realise they canrsquot move their legs Often the cause is a viral affliction of the spinal cord called transverse myelitis or an autoimmune condition affecting the nerves that supply the legs In some rare cases when the potassium level drops it can lead to a condition called hypokalemic periodic paralysis and gulping coconut juice can reverse the problemThe next morning when I went to see her she waved at me with her ankles There seemed to be a glimmer of hope Two days later she could bend her knees and hips On Day 5 she could stand with a walker When she started walking a week later she said she felt the ground differently than before but her sensations seemed to return gradually She was discharged 10 days after surgery walking independently which is how she decided to leave the hospital A spinal angiogram did not determine the source of her bleed She had regained bowel and bladder function and exercised vehemently to strengthen her core hamstrings and quads She was determined not to postpone her big dayIrsquom going to the wedding next week Irsquom glad she got her shot at her happily ever after foreverThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals