It was becoming difficult for me to go through with these operations. It wasn’t the long hours, the stress or even the nature of the surgery. It was the motivation. My mother had recently been diagnosed with a tumour and I had agreed to be a part of the team that operated on her. In the end, what should have been a simple procedure turned out to be a nightmare. Half-way through the surgery, we realised that it wasn’t easy to distinguish between how much of the matter had to be removed. Remove a bit too much and we would end-up leaving her severely impaired, but leave a little and it could again spread rapidly, risking yet another visit to the surgery table. By the time we were done, I was exhausted more than I had ever been in any surgery during these year. My mother only lived for a week after the surgery. And it was this feeling of tremendous exertion both at an emotional and physical level, coupled with imminent failure that eventually drained me of all my motivation. Here I was again, at the end of another brain surgery, and my heart was no longer in it.
This afternoon as I entered the OT, I was trying to find a meaning in what I was doing. Why was I going through with these operations any longer? There were enough people on Earth and I didn’t think that I was saving anything precious. I knew it was rather selfish of me, to think that there was no point to all this, only after I was unable to successfully operate on my mother. Until then, I had been an optimistic and committed surgeon. Now I felt I was doing things listlessly. It wasn’t right, but there was so much wrong with medicine right now that somehow I didn’t feel guilty.
Was it just my own fragility or had I finally crossed a point all humans cross, after which they simply lose the ability to care? Is that how our demise begins? Demise in everything we do: our work, relationships, the things we always wanted to accomplish and even our faith.
Every visit to the OT became a huge effort. The same drill, often the same procedure. Sometimes new people, but the same questions. Why was I finding their curiosity, falling into a pattern, when earlier, it used to impress me or even urge me to get better at what I did?
Patients and their families excited me. It was a chance to relate, empathise and comfort. It used to give me immense satisfaction whenever I was able to comprehend their grief and reassure them. I now avoided meeting kin and requested my juniors to do it for me. I still remember, how, as a trainee surgeon I would harass the Chief Surgeon into letting me interact with relatives and explain the case summary to them. Now, the reverence that many showed, irked me. I wasn’t anything special, I too was fumbling through life.
Mum had developed a small tumour and at first it had been difficult to diagnose. By the time it was clear that the tumour was malignant, it had advanced rapidly and it was necessary to have it removed. Once the tumour is removed, additional brain matter is sucked out through a thin tube. This is done to allow a little room for the swelling of the brain the occurs after the skull is sealed, as a reaction to the extraction of the tumour. One can never know how much is enough, and in my mother’s case, despite taking utmost care to remove the right amount, things still went wrong.
When the best of surgeons enter an operation theatre, there is still a chance of failure, no matter how slim. I had seen this happen in so many cases that my mother’s case should not have surprised me.
The more I researched and the older I got, the more I began to believe that mankind’s quest to become immortal, was misguided. Was not life, more beautiful and wondrous, simply because it balanced itself on the pebble of mortality? I saw unhealthy brains surviving in healthy bodies; something made possible only by dramatic advances in procedures, medicine and technology used in prognosis. But the brain remained a mystery and those who survived to an old age, often lived with acute dementia, incoherent speech and several impairments, caused by ageing brain cells.
Peers had moved away and I wondered if they were going through a similar phase or battling the same thoughts. But I dared not ask, for it would signal that I had lost my edge; not something any surgeon would desire. I was a good four years from retiring, though, I felt well-past retiring age. At times, this train of thought made me feel shameful: after all these years, was I not supposed to be in a good position to teach, guide and inspire – and of course save more lives?
I wasn’t questioning all that I had done in the past. I was looking ahead, unsure of what I was going to do till I retired and the years that followed. I dreaded all the operations to come, the failures that had already positioned themselves on the way and even the successes. People who recovered from brain surgeries, never really lived a full life, in a sense; it was compromised in many aspects. The truth was that most brain surgeons knew there was only so much, we could do in the brain. There have been great advances in mapping and understanding the various regions of the brain that control bodily functions, but there is very little that we can actually change. Many a time, surgeons are in the dark and minor errors committed during surgery, leave monstrous reminders in the form of disabilities that throw-up in survivors.
I was soon to operate on a young mother, Esther, who had been diagnosed with a tumour similar to what my mother had suffered. Her 8-year old daughter and parents were outside. The anxious parents used every opportunity to quiz the nurses or doctors that visited their daughter in the Neuro ICU. We soon gathered that either the little girl didn’t have a father or he wasn’t in their lives any longer.
After the craniotomy, we located the tumour quite easily. It was the size of a little berry and we had no problem isolating it. But as soon as I touched the tumour it burst open and started to bleed. Years ago, this would have unnerved me, but now I calmly acknowledged that I was going to be in the OT for longer than I had expected. The blood had submerged bits of the tumour and the neighbouring brain matter in a bright red pool. More than two gruelling hours later, we had removed the tumour and had the skull flap back in place. I was already feeling uneasy that something I had done listlessly had actually worked. Would it be the same if a less experienced surgeon were to do the same: do a procedure without putting their heart into it? For, if your mind and body do not focus on the same thing, weren’t things supposed to go wrong? Or was it simply that I had done this for so long that I was more like a mechanic, who absent-mindedly cleared a carburetor?
As I left the OT, I noticed Esther’s mother speaking to one of the doctors who had assisted in the operation. He seemed to have mentioned my name in their conversation, for I overheard the mother asking if she could personally thank me. For a brief moment I considered walking up to her and obliging her, but then I was still reeling in guilt. I had accomplished what we set out to do in the OT, but had I cared enough?
The next day, the patient was awake and responding well. Scans showed that we had removed every bit of the tumour and the operation was a success. It was a week later that I received a small note from Esther’s little daughter, who I had seen waiting restlessly outside the OT with her grandparents. It reminded me of the notes my daughter would send me when I was training as a house surgeon. It had kept me going in those difficult times.
It was a long note with several mentions of ‘thank you’ and little hearts drawn with a red sketch pen. The note itself, must have taken the child a good part of the day to write and draw; roughly the same amount of time I had spent operating on her mother. Obviously for the little girl, this meant a lot. What she said at the end of the note stayed with me. …and so you are my new best friend. Thank you for saving Mommy for me.
I didn’t see it as some divine message or something ominous. A lot of children leave notes for doctors and nurses. Maybe the stage I was in life, accounted for what I felt about this note. I was fragile and this note consoled me in more ways than one. I probably read a lot more into the note than there was, but all of a sudden – the four years to my retirement – didn’t seem all that dreadful any more.