When surgical success is luck by chance
Should the surgeon honour the sun, moon and devi or turn dispassionate and stick to protocol? The answer will be evident on a Saturday before sunrise
We cannot get admitted on Thursday; Mataji no divas chhe," Mrs Desai said, vociferously objecting on behalf of her husband, who had agreed to a surgery to alleviate the accumulation of fluid in his brain, a condition we call normal pressure hydrocephalus. In his case, the fluid-containing cavities or ventricles were enlarging in size, causing progressive imbalance while walking, urinary incontinence, and some degree of dementia.
The operation involved placing a thin silicone shunt tube into the ventricle of the brain, tunnelling it behind the ear and under the skin of the chest, and then inserting it into the abdomen to drain excess fluid.
"This is not an emergency. You can choose to get admitted any day you like and we will perform the surgery the day after—unless you have a preference for that as well!" I said in jest, not realising what was in store for me.
"Of course, sir. Saturday is a good day, but we will have to make the cut before sunrise."
I explained the logistics of shift timings of the operating room personnel and reasoned with the couple that even if I were married to an anaesthetist, she would not arrive for surgery before dawn for a routine case. Most surgeries start at 8 am.
"Sir, we are followers of Mataji. Kindly adjust."
"I will do my best," I promised, as I directed them to the reception for the paper work.
"Sir, what brand of tube will you use?" he inquired.
I was expecting this question: patients like to hear the word "foreign" although Indian products are just as good. "Local, imported, no problem, sir. Just that the brand name should start with A, M, or K. These are Mataji's names."
Their smiles touched their ears when I said, "Medtronic Company."
I try hard to accommodate a patient's request, no matter how bizarre. It's unnerving to operate on someone on a Tuesday knowing that this is the worst day in the week for them. On the other hand, there are some who will only get operated on a Tuesday. Of course, at the end of the day, belief determines their disposition, but what is expected of the surgeon? Should the surgeon heed inconsequential requests or stick to protocol? I'm not brave enough to be dispassionate.
A few months ago, as one of my patients was being wheeled in for surgery, his mother grew hysterical and asked for the operation not to proceed. No amount of reasoning could change her mind. The relatives shared that a "devi" had entered her "atma", and instructed that the surgery be cancelled. We respectfully agreed, although the patient and the rest of the family had given their consent to proceed. He was operated elsewhere a few weeks later and suffered a devastating complication from surgery. It could have very well been on my hands, I reminded myself. The customer is always right, be it at a hotel or hospital.
Surgeons are superstitious too. Some don't operate on a full moon day. Others don't take emergency calls on amavas. A colleague always carries an evil eye pendant in his scrubs while operating. Another puts on the left glove first while scrubbing in. Some surgeons don't indulge in sex the night before a major operation. I know of a few who turned vegetarian and gave up alcohol when a postoperative case that wasn't faring well suddenly saw the patient improving.
Mr Desai finally did get operated on a Saturday before sunrise; I had to bribe my anaesthetist with an exotic breakfast after surgery. He made excellent recovery with significant improvement in his gait within a few days. Every morning, when I went to check on him, a gentle incense (although not allowed as per hospital rules) filled the room. Soft bhajans played in the background. His wife fasted the entire week, having only a glass of water in the mornings after visiting a temple.
On a Thursday, five days after surgery, I told the family that he could be discharged the next day. They were not thrilled. The Desais gestured that it was not a good day for them.
"But you got admitted on a Friday," I said, groaning a little and exhausted by now.
"We can get admitted on a Friday, but not discharged. Please understand, sir."
The 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 email@example.com
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