A neurosurgeon’s night

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Author: Sachin Baldawa

It was a fine Sunday evening. I had just finished my dinner and planned to enjoy some rare moments with my family, before beginning my chaotic schedule next day, when my phone ring. A call from my hospital: “Doctor, we have an emergency. Two patients have suffered serious injuries following a road traffic accident. We need you now. Better hurry up.” I was up in a second and was ready to go.

My drive to the hospital takes about 10 minutes. During this drive, numerous thoughts started racing down my mind. What could it be? Another polytrauma, or just a severe head injury? Will one or both of them need emergency surgery in the middle of the night?

As soon as I reached the hospital and walked into Casualty, I was directed to the CT scan room where one of the patients was undergoing a scan of the brain. As the images appeared on the console monitor, I knew this was going to be one of those tiring, sleepless nights. The person had a life-threatening blood clot on the left side of his brain. I said: “Prepare him for emergency surgery.”

By the time the patient was being shifted to the intensive care unit, I turned to examine the other victim who was lying in a pool of blood, a kid with no signs of life. The resuscitation team member looked up and said: “Sorry, we could not resuscitate him.” I walked back to the intensive care unit to examine the other patient. I was told he was the father of the kid, who had been declared dead. The father was in his mid-40s, lying unconscious on a ventilator. The team was preparing him for surgery.

I walked down to the counselling room to see his relatives. Only his father-in-law was available for counselling. As I looked at him, I could see the desperation in his eyes, waiting for me to tell him about the condition of his son and grandson. I had this difficult job of breaking the bad news, that his grandson had succumbed and his son-in-law needed emergency life-saving surgery.

It is this aspect of my profession that I hate the most: breaking the bad news. “I’m afraid your grandson is no more,” I told him. He just sat there looking at me, not a sign of grief, not a sign of breakdown. “Your son-in-law has a life- threatening blood clot which needs emergency surgery.”

It was then that he spoke. “Doctor, please go ahead and do whatever is possible. Please save my son-in-law.” I assured him that the best possible efforts would be to save him, and walked to the operation theatre.

Neurosurgery is often considered a glamorous branch of medicine. No other field allows you to look into others’ minds, so to speak, to cut through the very matter that forms thoughts and memories. Neurosurgeons are often looked upon with admiration. They handle matters of life and death. This in fact means desperate attempts to save someone’s life by evacuating a life-threatening clot.

However, all that glitters is not gold. There is a flip side to this field. What lies beneath are some of the darkest secrets that have never been revealed. Once the mask is unravelled, it reveals the occasional success stories as well as the enormous morbidity and mortality associated with this field of medicine. Hours of work behind the microscope looking down into the narrow corridors of the brain may mean nothing if at the end of it all the patient is left wrecked. The physical and mental exertion of surgery is compounded by the stormy post-operative course that some patients undergo.

As I sat in the operation theatre with my eyes closed, my assistant told me the patient was ready. It meant it was time to get going. I scrubbed up and looked at the ticking watch. It was close to 1 a.m. As I was about to place the knife and cut through his scalp, a silent prayer went up: “God, help me do what is best for him.” By the time I had worked through his skull bone and finished taking the blood clot out from his brain, it was close to 3 a.m. I and my team heaved a sigh of relief, knowing that probably the patient would make it.

Over the next few days in the intensive care unit, he received good care. Follow-up imaging of the brain revealed e needed another life-saving surgery as his brain stem, the vital part of the brain which controls respiration and heart, was getting compressed by brain oedema. It came as no surprise to me that his father-in-law readily agreed.

The second surgery was successful, and over the next few days the patient gradually regained consciousness. It was now only a matter of time before he would recover completely. He was shifted out of the intensive care unit once he was fully awake and started comprehending speech. During the entire stay, his father-in-law stood by him.

Doctors, especially neurosurgeons, are always advised not to get too emotionally attached with their patients. If they do, their patient’s neurological disability is likely to take a heavy toll on their personal lives. As I treated this patient, I got to know more about his family. Here is the father who had lost his only son, yet once he came to know about it, all that he told me on the day he was about to be discharged was, “Doctor, I lost my son.”

I stood there helpless, speechless and just walked off, unable to console him. He was destined to survive, against the odds. His father-in-law hung on to hope in spite of adversities. I was destined to treat him. Ultimately I treat and he gets cured. A year later he has resumed his business and is hoping for another child.

That’s the cycle of life. Every dark cloud has a silver lining.