The surgical wait

How long will the surgery takerdquo a family of four nervously asked me outside the operating room as I prepared to walk in to remove a jumbo brain tumour from their matriarch ldquoItrsquoll be about four to five hours but donrsquot be surprised if we finish earlier or get worried if we take much longerrdquo I cautioned always giving myself some room so that relatives donrsquot panic ldquoItrsquoll depend on the consistency of the tumour and the ease with which we can peel it off the internal carotid artery which is the main blood vessel encased completely by the tumour and supplying blood to half the brainrdquo I explainedldquoAll the bestrdquo they said apprehensively ldquoDonrsquot worry everything will be finerdquo I signed off with the trademark sentence I give every family before disappearing into the mysterious world of the operating room the sanctum sanctorum of every surgeonOnce there we studied the MRI in detail again as the anaesthesiologist effortlessly put the patient to sleep We fixed the head on a clamp to stabilise it and then turned it to give us a straight trajectory to the tumour locking it in the final position I shaved a strip of hair behind the hairline and marked our incision site with a marker Then I cleaned the area with a combination of three differently coloured solutions to sterilise it and allowed for it to dry Finally we draped the patient in the usual fashion by neatly arranging wires instruments and suction devices ready to start surgeryWithin the hour a nurse walked in with a message ldquoThe relatives are asking if everything is going wellrdquo she said ldquoTell them wersquore just about to startrdquo I said a little irritated especially when I needed to be in the zone ldquoAlso tell them gently that I will come out and talk to them once itrsquos overrdquo I course correctedI made a curvilinear incision behind the hair line and retracted the scalp to bare the bone We drilled a few starry holes in the skull and cut off the bone in a shape resembling an almost perfect constellation of Orion For the next hour we drilled the bleeding bone down to the base of the skull flattening all the ridges that looked like a mountainous terrain Just as we were about to open the covering of the brain the dura another nurse came and mumbled something in Malayalam her voice muffled by the sound of the drilling ldquoThe relatives want to know how much more timerdquo ldquoAsk them to have breakfast and then some lunch sister and to come back after that And the next time they ask please handle it yourself because we cannot be disturbed nowrdquo I instructed even asking that a Do Not Open sign be put outside the operating room doorOnce we opened the dura we saw the tumour that occupied the entire temporal lobe displacing the brain several centimetres behind its usual position Having disconnected its blood supply we got into it coring out its contents in a steady and meticulous fashion We then went under the frontal lobe to remove the portion that had crept through We spent the next two hours separating the tumour from the carotid artery and optic nerve which it had straddled in very slow and precise moves because one wrong cut could be catastrophicldquoSir the relatives are crying outsiderdquo one sister came in frantically ldquoThey want to see yourdquo I looked at the clock and realised with surprise that it was already 6 pm we had lost track of time and space ldquoIt is we who are passing when we say time passesrdquo I remembered a quote from French philosopher Henri Bergson ldquoTell them that surgery is over and everything went wellrdquo I announced as I removed the last piece of tumour and closed back everything the way we usually do itI walked out to meet the relatives who looked like they had gone to war I calmed their anxious nerves explaining to them why surgery had taken longer than expected but they were relieved only when they saw their mother being wheeled into the ICU fully awake telling them she was okayUntil that day I had never stopped to wonder what waiting patients and their relatives go throughmdashoutside the operating room ICU or even a doctorrsquos office The chief surgeon with whom I trained in the United States when asked how long surgery would take always told relatives ldquoItrsquoll take as long as it doesrdquo and never gave a timeframe to probably mitigate the familyrsquos anxiousness We in India offer a more emotional response I at the very least give my patients as much information as I can because I simply cannot fathom what they must be going through waiting without any idea However I get some sense of that desperation when patients take longer than usual to wake up and gain consciousness after brain surgery I believe no patient or their relative will ever be able to gauge the myriad thoughts and emotions a surgeon goes through in that brief period of waiting which seems to stretch as long as eternityOutside every ICU of every hospital there are relatives who wait for their loved ones to be shifted out The lucky ones wait for a day the unfortunate ones wait for weeks or even months Day after day we shower people with various bits of information that we donrsquot know how much longer itrsquos going to take whether itrsquos for someone to wake up or for an infection to subside or for a swelling to resolve or for someone to come off the ventilator But there will always come a time when the wait is over Oftentimes itrsquos in our favour sometimes it isnrsquotIn some sense we are all waiting But it is important to remember as the famous American professor Jason Farman once said ldquoWaiting isnrsquot a hurdle keeping us from intimacy and from living our lives to our fullest Instead waiting is essential to how we connect as humansrdquoIf yoursquore a parent yoursquore waiting for your kids to go to school and then yoursquore waiting for them to come home every evening If yoursquore a housewife yoursquore waiting for the maid to show up If you have a corporate job yoursquore waiting for the weekend If yoursquove lost a job yoursquore waiting to find another If yoursquore pregnant you canrsquot wait to deliver If you live in America yoursquore waiting for July If you live in Mumbai yoursquore waiting for January If you live in Canada yoursquore simply waiting Some are waiting to win the lottery Some are waiting to move into their promised redeveloped buildings If yoursquore single yoursquore waiting to be married If yoursquore married yoursquore waiting to be single again If you have five senses yoursquore trying to cultivate the sixth If yoursquore in Class X yoursquore waiting for your exams to get over If yoursquore in Class XII yoursquore waiting to prepare for the next entrance exam you have to take Some are waiting for the war to end Some are waiting for the stock market to go up while some are waiting for it to go down Some of us are waiting to climb Mount Everest Some of us are waiting to go deep sea diving Some are waiting for their next meal Some are waiting for the next messiah to save the planetI am waiting for my weight to goWhat are you waiting forThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals