The surgical chatter

Wake up Elizabeth your operation is over everything went off very well Now open your eyesrdquo I heard the anaesthetist bellow as they went through the routine of reversing the anaesthesia to awaken the patient and remove the breathing tubeIt was an operation to clip an unruptured aneurysm arising from the bifurcation of the right internal carotid artery I sat in one corner of the operating room writing down the postop orders feeling a kind of inner joy as I typed out my notes for having performed a masterful surgery After I finished I made a quick dash with my team to check on our admitted patients When I returned to the ICU an hour later I was informed that Elizabeth hadnrsquot been shifted yetldquoThatrsquos strangerdquo I said to myself swiftly climbing the stairs that led to the operating room to hear four words from the anaesthetist that no surgeon wants to ever hear ldquoShersquos not waking uprdquoThe anaesthetist peered right into my eyes ldquoThe muscle relaxant has been reversed blood gas analysis is fine but shersquos just not opening her eyesrdquo she finished looked at me with the finality of not having a plausible explanation for this from her end This was also her polite way of saying yoursquove done something wrong inside now fix itI went through the steps of surgery in my mind running my hands through my scanty hair Could it be because we buzzed a surface vein Have I taken a perforating artery supplying the hypothalamus in the clip Did we retract the brain too much Is the main artery kinked by the clipThe selfintrospection then made way for chatter Should I have operated on her in the first place I should have just asked the interventional radiologist to coil the aneurysm Shersquos a mother of two have I destroyed her family Do I really think I have the skill to do these complex cases Who am I trying to impress And at whose expense Better do something before itrsquos too late Or is the damage already done Itrsquos a sickening feeling when someone yoursquove operated on doesnrsquot wake up the way you expect them to It is literally gutwrenching your intestines feel as though they are physically being squeezedI looked at the numbers on the monitor and then at the anaesthetist repeating the same words over and over ldquoWake up Elizabeth wake upmdashyour surgery is overrdquoldquoRaise the blood pressure to 170180rdquo I ordered thinking that some crucial vessel might be in spasm She transiently opened her eyes but within a few seconds went back into a deep slumber We got an urgent MRI done but that was clean no area of ischemia or infarction No blood clot as well The clip was positioned perfectly and we ruled out her having subclinical seizures too We shifted her to the ICU on the breathing tube as my gaze vacillated between the monitor and her body lying motionless when it should have been sitting up in bed and talking to me insteadThe chatter turned to a fullblown tirade Am I missing something here Should I call someone and ask for help Should I just give this some time What would I do if someone else operated on this patient and I was called to opine on how to proceed I use this last analogy a lot when Irsquom in distress I try and distance myself from the problem at hand and adopt the flyonthewall approach Itrsquos easier said than done of course but all you have to do is zoom out I remember reading somewhere ldquoThe only people who see the whole picture are the onersquos who step out of the framerdquoThere is a Chinese proverb that says ldquoHe who blames others has a long way to go on his journey He who blames himself is halfway there He who blames no one has arrivedrdquo I was halfway there The countless permutations and combinations of the infinite possibilities of things that could have gone wrong kept buzzing in my headWe all have a voice in our head We tune into its incessant chatter to look for ideas guidance and wisdomSometimes these conversations uplift us and sometimes they sink us into the deep dark hole of despairEthan Kross a renowned experimental psychologist and neuroscientist and one of the worldrsquos leading experts on how to control the conscious mind has written a book called Chatter The Voice in Our Head Why It Matters and How to Harness In that he states ldquoIn recent years a robust body of new research has demonstrated that when we experience distress engaging in introspection often does more harm than good It undermines our performance at work interferes with our ability to make good decisions and negatively influences our relationshipsrdquoInstead he reveals tools you need to harness that voice so that you can be happier healthier and more productive ldquoChatter doesnrsquot simply hurt people in an emotional sense it has physical implications for our body as well from the way we experience physical pain all the way down to the way our genes operate in our cellrdquo he warnsI hadnrsquot read the book at the time and my head was spinning with thoughts as I stood at the edge of her bed for three hours waiting for her to move just a little I was following the old age adage of ldquojust give it timerdquo when dealing with this unsettling experienceAfter a long painful wait Elizabeth moved a little And then a lot She opened her eyes and made chewing movements and brought her arms to the tube as if to denote she wanted it out We took it out once she was fully awake and briskly obeying commands indicating to us that she was conscious alert and awareI am still intrigued about why she took so long to wake up Probably it was a tiny artery that went into spasm but opened up later But the relief of shifting her out of the ICU the next morning and then home with the family in a few days was intense Finally there was no one to blameThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals