This is a very unusual looking tumour you have there in the lower part of your spinal cord,” I told Nilesh as I displayed his MRI scan films against the brightness of the viewing box. He was a high performing executive in his late 40s and wore a conventional white shirt and khadi pants. He came in being supported by his doting wife, walking with a limp that typified spinal cord compression. “I have been in agonising pain over the past few months and am simply unable to lie down,” he said, clearly struggling, the creases on his face doubling up on each other. “Last few weeks, he’s been sleeping on a chair at night,” his wife interjected in Gujarati. 

“Is it cancer?” he asked, worrying about a diagnosis that most patients would be disquieted by. “I can’t be a hundred per cent sure, but it doesn’t look like it,” I said, studying the morphology of this growth on half a dozen films. Whenever I peer through each of the MRI sequences longer than usual, I wonder if my patients begin to think that I am as clueless as they are, but I have no qualms in expressing my uncertainty in front of them. “I think this is a dermoid cyst in the spinal cord,” I finally declared, wondering if using technical terms would make any difference to them. “But doesn’t ‘derm’ have something to do with skin?’” he asked, confused. A surprisingly intelligent question, I thought.