The surgical whirlpool

Irsquove had a horrible monthmdashappalling may be a more appropriate way to describe it Awful Dire Disheartening Harrowing Now that I have a rapt and ravenous reader eager to know of my grief let me tell you moreldquoRajesh bhairsquos wound is not looking goodrdquo my colleague said sending me a picture of the patient we operated on a week ago for a malignant cerebellar tumour Hersquod removed the bandage covering the incision behind the ear and found a blackish discolouration of the skin that looked ominous I was out of the country and insisted that the patient not be discharged ldquoTheyrsquore adamant on going because they feel hersquoll be absolutely okayrdquo I was informedRajesh bhai returned two weeks latermdashwith the wound gaping and exacerbated ldquoWersquoll have to take him back to the operating room and clean up the debrisrdquo I insisted The family acquiesced knowing that if they had listened to begin with we wouldrsquove been able to avoid this entirelyldquoSomething as simple as a little extra pressure from a bandage can cause trouble like this so letrsquos be really careful while cleaning up this woundrdquo I said to my team cautioning them about the importance of doing the small things well so that the big stuff can be taken care of ldquoMurphyrsquos law bossrdquo my colleague responded reminding me ldquoIf anything can go wrong it willrdquoI understood what he was saying However much we take care sometimes things are not in our control ldquoHave you heard the corollary to thatrdquo I asked him He shook his head ldquoItrsquoll always go wrong with the worst possible outcome at the worst possible timerdquo I saidThe day Rajesh bhai got discharged with a healthylooking wound we breathed a sigh of relief The family thanked us for going out of our way to do what wersquod done despite their having dismissed our advice initiallyThat morning wersquod just finished surgery on Charles who was experiencing intractable facial pain The surgery went off impeccably and he woke up painfreemdashhardly able to control his excitement over being absolved of years of agony A routine CT scan performed after surgery was clean A few hours later he started thumping his chest and walking around his room as if he were possessed His blood pressure shot up over 200 and he sustained a fatal brainstem haemorrhage Before we could do anything he was dead I was unable to explain to the family that a man who they had been speaking to a few minutes ago was no longer alive ldquoMother nature is a bhrdquo Murphy saidA few days prior we operated on Lalita ben for spinal compression which we relieved with surgery Her sciatica resolved well enough for her to start using the bathroom by herself but on one foggy morning she slipped in it and fractured her foot This needed a cast She came to the hospital limping on one foot and was now limping on the other Her leg pain returned because of the pressure her back was subjected to from unequal load bearing I advised her to rest it out and that it would hopefully resolve itself ldquoEverything takes longer than you thinkrdquo I said to my team reminding them of Murphy againldquoWhy is this happening to us all of a sudden after going through the entire year with no glitchesrdquo I questioned my colleague ldquoKarmardquo he replied ldquoWhoserdquo I asked ldquoMine yours or the patientsrsquordquoldquoItrsquos always collectiverdquo he reminded me ldquoItrsquos naturersquos way of keeping us groundedrdquoJust as I was recovering from the heartbreak of these three storms Joannarsquos mother called from Africa A month ago we removed a bony overgrowth from the base of Joannarsquos skull through an incision in her eyebrowmdasha neat and easy surgery I was so proud of the operation that Irsquod asked my friends to guess which eye brow we went through they couldnrsquot make out But today everything was different ldquoShersquos leaking brain fluid through the noserdquo her mother said panicking ldquoand the doctors here are refusing to treat herrdquoThe leak was hard for me to fathom as we had not opened the duramdashthe layer that protects the brain and contains the fluid ldquoIf the fluid gets infected she could dierdquo I told her over the phone Joanna is just 18 years old ldquoFly her down back to us flat in bedrdquo I instructed and the family obeyed When I saw her cerebrospinal fluid was leaking from her nose as if someone had left a tap open inside her headWe reoperated on her to find a 5 mm hole in the dura from a bony spicule on the undersurface of the bone rubbing against it We repaired it and sealed the defect When we made her sit up after a few days she was fine Initially wersquod considered this to be a simple operation But Murphy reminded us ldquoNothing is as easy as it looksrdquoThe ongoing challenge in a life of surgery is this How does one maintain outward confidence and stoicism in the face of internal cataclysm and upheaval How to yearn for an inner stillness amid extraneous cacophony How to make loss a reason to live more deeply Maybe Kipling had the answer when he said ldquoHold on when there is nothing in you except the will which says to them lsquoHold onrsquordquoAnd just when I thought I had paid my debts earlier this week we operated on an elderly man for a brain tumour It was a beautiful operation done in the most pristine manner He woke up well after surgery but as he was being wheeled into the ICU he stopped breathing We had to resuscitate him and shove a breathing tube down his throat to protect his airway The CT scan of his brain did not show any cause for concern There must have been some swelling in his vocal cord that obstructed his airway the anaesthetist opined The next morning we were able to extubate him and shift him out of the ICU where he continued to recover for two days He was soon his usual chirpy self cracking old uncle jokes But as Murphy says ldquoThe light at the end of the tunnel is only the light of the oncoming trainrdquoThe next day he had a seizure and turned drowsy His neck was stiff and hersquod developed meningitismdasha complicated brain infection we confirmed this by sticking a needle in his back and drawing some spinal fluid Murphy had reared his ugly head yet again We gave him a high dose of antibiotics and he seemed to start recovering ldquoI fear this may take timerdquo I told the son ldquoThe more you fear something the more itrsquoll happenrdquo whispered Murphy ldquoWe trust you doctorrdquo the daughter said as I exited the ICU I wasnrsquot sure if I trusted myself anymoreDecember please be kind And screw you Murphy Because as my friend Abe Lincoln once said this too shall passThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals