To the edge of the cliff and back. With The Beatles

No one in the entire continent is willing to operate on him said Jonathan on arriving from Africa with his younger brother Jude I glanced at the MRI films and wasnt surprised Gosh I thought projecting composed confidence as the two waited to hear the next words from meJude was a 16yearold pleasant kid He had started having headaches a few years ago but had got a brain MRI done only recently when he began to lose vision The MRI showed a colossal 10 cm tumour within the ventricles of his brain occupying 80 per cent of itVentricles are cavelike cavities filled with cerebrospinal fluid that give buoyancy to the brain They are the reason why you can carry 15 kg of it without feeling the weight even if you are pigheaded An obstruction in this normal pathway of fluid by a tumour within the ventricle results in raised intracranial pressure which manifests as headache vomiting and problems with visionThis is a very complex and highrisk operation I explained after examining Jude and noticing that his right arm and leg were slowly losing mobility There was a greaterthanusual chance of complications since the tumour was in a precarious location straddling the centres of consciousness It was enormous in size and had voluminous vascularity We went on to discuss the chances of death paralysis and even a vegetative statemdashall the possibilities that could arise despite the best of doctors taking on the case Whatever happens dont let him die Jonathan said quietly pressing my forearm I wanted to say we wont but stuck to Well do our best I left the hospital that day with the image of that beast of a tumour in my headFor the next two days I studied Judes scans from all angles reading up about his specific kind of tumour and watching surgical videos It might be scary for a patient to learn that the surgeon YouTubed the technicalities of the operation the night before surgery but if one sticks to credible sources I find this mode of research extremely useful and one that offers clarityI also WhatsApped the scans to my seniors to check what approach theyd take I received replies accompanied by the eye roll emoji most likely at the monstrosity of the tumourThe next morning I was inside Judes brain The snowy spotless walls of the ventricle soon disappeared from sight as we saw the tumour rearing its ugly head in the form of a red ball of fire Some tumours allow you to go around them but this one we had to get into From the moment we touched it it started bleeding The magnification of the microscope makes trickles of blood seem like roaring rivers What seemed like a calm start instantly turned into a battlefield it was like watching an episode of Man vs Wild The tumour had pearly lobules and each of them burst despite delicate handling flooding the field of visionGet another suction in here I ordered to improve visibility The nurses scrambled sensing the tension building up The monitors started beeping suggesting a drop in blood pressure The anaesthesiologists muttered in a whisper among themselves on how to tackle the situation They ordered more blood and administered medication to keep the blood pressure stableJust when we thought we were in control another tumour lobule exploded The blood pressure shot up this time owing to an autonomic dysfunction Control the damn BP I barkedMature anaesthesiologists never shout back at the surgeon knowing well the duress she is in They also dont make it known if there is a problem at their end even when things are out of control unless they need us to stop They efficiently go about pressing buttons turning down the volume of alarms connecting bottles of blood and injecting drugs like clockwork The communication with the surgeon is constant brief and firm Unfortunately they dont get enough credit for their competence Often lives are saved by them not usA famous surgeon once said there are four degrees of intraoperative haemorrhage One Why did I get involved with this operation Two Why did I become a surgeon Three Why did I study to become a doctor Four Why was I bornIn this case I surged directly from stage one to fourThe only way to control the bleeding from an aggressively vascular tumour is to remove it completely and briskly This took around six hours and six units of blood I think I also aged six years in that timeOnce we had removed it the ventricles finally reappeared in all their glory and the cerebrospinal fluid flowed uninterrupted like an immaculate waterfall The brain was soft and pulsating tenderly as we closedJude woke up the next morning as we got him off the ventilator He was paralyzed on the right side but movement improved dramatically over the next few days By the end of the week he was prancing not realising we had almost lost him His chirpy disposition helped him recover fasterSurgery is not an art its a personality disorder thats why we do what we do repeatedly I told his brother quoting a line I had once readHow did you pull off such a miracle doc he asked hugging meWe had the Beatles playing in the background I saidAnd we made the lyrics come true Hey Jude dont make it bad Take a sad song and make it betterThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals You can reach him at mazdaturelmiddaycomCatch up on all the latest Crime National International and Hatke news here Also download the new midday Android and iOS apps to get latest updates