The surgical anger

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I remember patients more by the geography of their brain tumour than by the topography of their face. Vivek's tumour was in the left insula - an island of brain nestled between the frontal and temporal lobes - a place that processes emotion, sensation, and awareness. I operated on him in January of 2020. The tumour was excised immaculately, but as it was grade 3, radiation and chemotherapy were mandatory for a decent outcome.

"We'll skip the radiation and chemotherapy," the elder brother told me a few weeks after surgery. "He's absolutely fine and has already gone back to his job," he reasoned. Vivek was 22 years old at the time, a bright computer engineer with a full crop of hair that we had delicately preserved during the operation. "Why would you do such a thing?" I fumed. "This is our best chance at controlling the tumour; otherwise, it'll come back for sure," I warned them, the way you warn someone in Mumbai that the streets are likely to flood on a monsoon day even if the sun is shining at the moment. "The elders in the family have consulted with Babaji and they want him to try some alternative medicine," he argued. "I've spent 6 hours operating on this tumour, removing every visible cell under the microscope and preserving all his functions, and I know for a fact that this tumour will come back," I tried to explain. "We understand, doctor, and we thank you for doing what you did, but we have instructions from a higher order," they folded their hands and left.

I understand that science does not have all the answers, but I would respect the ones it does. Thousands of researchers are working on hundreds of drugs that have reshaped the topography of cancer over the past few decades. Their research has not only extended a cancer patient's survival but improved their quality of life substantially. Yes, there is an alternate world of healing that we are now increasingly exposed to, and I deeply respect it, but it is surely less consistent in its results than science is. Medicine works because of its reproducibility.

A year later, Vivek returned with his family and a fresh MRI of the brain. You couldn't tell he had ever had surgery for a malignant brain tumour, either on the outside or on the inside. He looked good and so did his scan. "Babaji's medicines are working," his father told me. Vivek had been promoted to a senior manager role in his company. His cognition was sharper than ever before and his memory crisp. "If it was a grade 4 tumour, it would have returned by now, but as it's grade 3, these take longer to recur," I explained. "Maybe it won't," was the argument. "It will," I said authoritatively, trying to sound less like a prophet of doom and more like a weary meteorologist predicting rain.

The famous Canadian writer Margaret Atwood once said, "Having experienced both, I'm not sure which is worse: intense feeling or the absence of it." That's how I felt. Should I rejoice that Vivek was thriving, or mourn the biology I knew too well? Or should I simply shrug it off with a friend's favourite line: not my circus, not my monkeys.

They kept coming back. Each time I wondered why, because they did exactly what they wanted to anyway. "He's doing much better than ever before," the brother said, and strangely, I remembered Margaret Atwood again: "Better never means better for everyone; it always means worse, for some." I took a look at the scan and informed them that I could see footprints of a tumour crawling back. "Babaji has told us to continue with his medication," they retorted. "Then I have nothing else to offer except my love," I said, "but along with that I would still take the radiation and chemotherapy."

Three years later and two weeks ago on a Saturday afternoon, I got a call from the ER. "There is a 27-year-old boy who was found unconscious at home this morning. The family says you operated on him 5 years ago for an insular glioma." "Vivek?" I instinctively asked. "That is correct," said the voice on the other end. "He's unresponsive and one pupil is blown." I went down and scrolled through the scan on the monitor. The tumour had grown tenfold with a massive haemorrhage within it. I should have felt sorrow but all I felt was rage.

The family stood there with hands folded. "Do whatever it takes to save him," the father said. "It's unlikely he's going to make it," I said sternly. The mother collapsed to the ground hearing those words. I contemplated if it was worth operating, because even if he survived the surgery, he would never be himself. The family insisted I operate. In the next hour, as I performed a big craniotomy, brain squished out of the opening. I got into the tumour that was mixed with large clots of blood. "There goes emotion, memory, and cognition," I muttered to my assistant as we cleaned up all the debris from the site of a bomb blast. The damage was done. We wheeled him out from the theatre without a skull bone, allowing space for the swollen brain.

He did not wake on day one. Or on day two. On day three, he opened his eyes. He could breathe without the ventilator. He looked around purposefully. His family was thrilled that he was alive. But he couldn't speak. I don't think he knows where he is or what his thoughts are. I'm not sure he can feel either. I am supposed to be filled with joy that I had saved a life. But I am angry. Very angry. Still, patients don't need to know you're raging inside. They just want to know you won't let your scalpel slip, no matter who they thank afterward - you, science, or Babaji.

Because better never means better for everyone; it always means worse, for some.

The writer is practising neurosurgeon at Wockhardt Hospitals. He posts on Instagram @mazdaturel mazda.turel@mid-day.com