The surgical wait

For patients and their relatives, waiting for answers can be both unnerving and exhausting

How long will the surgery take?” a family of four nervously asked me outside the operating room, as I prepared to walk in to remove a jumbo brain tumour from their matriarch. “It’ll be about four to five hours, but don’t be surprised if we finish earlier or get worried if we take much longer,” I cautioned, always giving myself some room so that relatives don’t panic. “It’ll depend on the consistency of the tumour and the ease with which we can peel it off the internal carotid artery, which is the main blood vessel encased completely by the tumour and supplying blood to half the brain,” I explained.

“All the best,” they said, apprehensively. “Don’t worry, everything will be fine,” I signed off with the trademark sentence I give every family before disappearing into the mysterious world of the operating room, the sanctum sanctorum of every surgeon.

Once there, we studied the MRI in detail again as the anaesthesiologist effortlessly put the patient to sleep. We fixed the head on a clamp to stabilise it and then turned it to give us a straight trajectory to the tumour, locking it in the final position. I shaved a strip of hair behind the hairline and marked our incision site with a marker. Then, I cleaned the area with a combination of three differently coloured solutions to sterilise it and allowed for it to dry. Finally, we draped the patient in the usual fashion by neatly arranging wires, instruments, and suction devices, ready to start surgery.

Within the hour, a nurse walked in with a message. “The relatives are asking if everything is going well,” she said. “Tell them we’re just about to start,” I said, a little irritated, especially when I needed to be in the zone. “Also tell them, gently, that I will come out and talk to them once it’s over,” I course corrected.

I made a curvilinear incision behind the hair line and retracted the scalp to bare the bone. We drilled a few starry holes in the skull and cut off the bone in a shape resembling an almost perfect constellation of Orion. For the next hour, we drilled the bleeding bone down to the base of the skull, flattening all the ridges that looked like a mountainous terrain. Just as we were about to open the covering of the brain, the dura, another nurse came and mumbled something in Malayalam, her voice muffled by the sound of the drilling. “The relatives want to know, how much more time?” “Ask them to have breakfast and then some lunch, sister, and to come back after that. And the next time they ask, please handle it yourself because we cannot be disturbed now,” I instructed, even asking that a Do Not Open sign be put outside the operating room door.

Once we opened the dura, we saw the tumour that occupied the entire temporal lobe, displacing the brain several centimetres behind its usual position. Having disconnected its blood supply, we got into it, coring out its contents in a steady and meticulous fashion. We then went under the frontal lobe to remove the portion that had crept through. We spent the next two hours separating the tumour from the carotid artery and optic nerve, which it had straddled, in very slow and precise moves, because one wrong cut could be catastrophic.

“Sir, the relatives are crying outside,” one sister came in frantically. “They want to see you.” I looked at the clock and realised with surprise that it was already 6 pm; we had lost track of time and space. “It is we who are passing when we say time passes,” I remembered a quote from French philosopher Henri Bergson. “Tell them that surgery is over and everything went well,” I announced, as I removed the last piece of tumour and closed back everything the way we usually do it.

I walked out to meet the relatives, who looked like they had gone to war. I calmed their anxious nerves, explaining to them why surgery had taken longer than expected, but they were relieved only when they saw their mother being wheeled into the ICU fully awake, telling them she was okay.

Until that day, I had never stopped to wonder what waiting patients and their relatives go through—outside the operating room, ICU, or even a doctor’s office. The chief surgeon with whom I trained in the United States, when asked how long surgery would take, always told relatives, “It’ll take as long as it does,” and never gave a timeframe to probably mitigate the family’s anxiousness. We in India offer a more emotional response. I, at the very least, give my patients as much information as I can because I simply cannot fathom what they must be going through, waiting without any idea. However, I get some sense of that desperation when patients take longer than usual to wake up and gain consciousness after brain surgery. I believe no patient or their relative will ever be able to gauge the myriad thoughts and emotions a surgeon goes through in that brief period of waiting, which seems to stretch as long as eternity.

Outside every ICU of every hospital there are relatives who wait for their loved ones to be shifted out. The lucky ones wait for a day, the unfortunate ones wait for weeks or even months. Day after day, we shower people with various bits of information that we don’t know how much longer it’s going to take, whether it’s for someone to wake up or for an infection to subside or for a swelling to resolve or for someone to come off the ventilator. But there will always come a time when the wait is over. Oftentimes, it’s in our favour; sometimes, it isn’t.

In some sense we are all waiting. But it is important to remember, as the famous American professor Jason Farman once said, “Waiting isn’t a hurdle keeping us from intimacy and from living our lives to our fullest. Instead, waiting is essential to how we connect as humans.”

If you’re a parent, you’re waiting for your kids to go to school, and then you’re waiting for them to come home every evening. If you’re a housewife, you’re waiting for the maid to show up. If you have a corporate job, you’re waiting for the weekend. If you’ve lost a job, you’re waiting to find another. If you’re pregnant, you can’t wait to deliver. If you live in America, you’re waiting for July. If you live in Mumbai, you’re waiting for January. If you live in Canada, you’re simply waiting. Some are waiting to win the lottery. Some are waiting to move into their promised redeveloped buildings. If you’re single, you’re waiting to be married. If you’re married, you’re waiting to be single again. If you have five senses, you’re trying to cultivate the sixth. If you’re in Class X, you’re waiting for your exams to get over. If you’re in Class XII, you’re waiting to prepare for the next entrance exam you have to take. Some are waiting for the war to end. Some are waiting for the stock market to go up, while some are waiting for it to go down. Some of us are waiting to climb Mount Everest. Some of us are waiting to go deep sea diving. Some are waiting for their next meal. Some are waiting for the next messiah to save the planet.

I am waiting for my weight to go.

What are you waiting for?

The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals.

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