Watching cricket while your head was open

AIYYOrdquo the nurse exclaimed as I heard something simulating the sound of wood falling to the ground in the operating room A neurosurgeon knows that reverberation with certitude when he hears it To most of us this has happened at least once in our training And trust me once is enoughWhen it fell for me over a decade ago it gripped me with an intense fear of being circled by a python and suffocated by its constricting squeeze You freeze from the momentum of that strikemdashnot from concern about what will happen to the patient but what yoursquore going to tell the bossItrsquos not the metallic clink of an instrument dropping or the robust thud of a plastic saline bottle slipping from the IV pole Itrsquos the unnerving softness of the bone flap hitting the floor Itrsquos a part of the patientrsquos skull that is sawed out during a craniotomymdashto be replaced once the brainwork is over so that the skull may retain its conventional form And if it has fallen to the floor by accident itrsquos not something that you can impulsively pick up in a fivesecond technique similar to what I use with my kids for edible items that land on the floorThis is akin to a baby slipping out of an obstetricianrsquos hands soon after delivery A piece of a patientrsquos body that is supposed to go home with the patient is suddenly lying on the floor in front of you The nurse looked at me with her eyes welling up In this case I was the python Life is a cycle I thought to myself Sometimes you are the pigeon and sometimes you are the statue I pardoned her and asked for the bone to be kept aside because luckily our plan in this case was not to replace the bone but to tuck it into the abdomen until later use This surgery was being performed for a hypertensive haemorrhage with malignant brain swelling and the bone was to be replaced only a few weeks laterIn other cases however where the intention is almost always to replace the bone one either disinfects it with betadine or autoclaves it and then puts it back albeit with an added risk of a postoperative infection or otherwise restores the contour of the head with a titanium mesh ldquoWhat will you tell the family sirrdquo my assistant asked wryly ldquoIf there is one guiding principle when you leave this hospital after finishing your training with me it should behelliprdquo and I stared at him waiting for him to complete my sentence ldquoAlways speak the truthrdquo he muttered underneath his mask It may seem like itrsquos the most onerous thing to do but it almost always calls for worthwhile outcomes After surgery we went out and spoke to the relatives together explaining to them what had happened and taking full responsibility and they were simply happy that he was alivePatients often ask me how many such cases I have handled when they see me in my clinic with a brain or spine condition What my successes and failures are Am I lying when I say a couple of hundredmdashbecause that allows me to play within a span of 900 What should younger surgeons say when theyrsquove only assisted tons of these cases but never actually performed one independently If I were to say this is my first time handling that specific medical condition would any patient show up to the party Truth and transparency sometimes with a little tact with patients however goes a long way in building trustOccasionally during spinal surgery we may inadvertently cause a spinal fluid leak Even if wersquove sealed it well I make it a point to mention it in the operation notes and tell the patient about it It can often rear its ugly head a few days or even weeks later and if the patient is being treated elsewhere later for any reason the treating physician ought to have a detailed account of what transpired at surgery for optimal managementI once cemented a fractured vertebra of a 70yearold man The needle positioned accurately transgressed right through the osteoporotic bone into the chest This happened because I had to use some additional force to inject the rapidly solidifying cement I removed it in a flash but it could have punctured his lung or even worse his aorta and he could have died on the spot Luckily nothing happened He was discharged the next day and several years later remains pain free Every time I see him I debate if I should tell him what happened at surgery I wonder if Irsquom not honouring my own guiding principleNot long ago in January 2021 I was operating on a complex brain tumour at 4 orsquoclock in the afternoon and the buzz in the operating room went up a few notches Suddenly the entrances and exits of people become a little quicker there was palpable energy in the room The anaesthetist bumped up the volume on her cell phone and I hear cricket commentary amidst the beating of the monitor I paused for a moment and turned my gaze outside the microscope enquiring ldquoGuys whatrsquos going on Irsquom inside someonersquos frontal lobe Can we have the volume down in the room pleaserdquo ldquoIndia is on the brink of a historic test series win against Australiamdashsix runs to win in three overs but only three wickets to sparerdquo came the retort with no regard for my requestFor a change I didnrsquot want to be a party pooper and as I wasnrsquot at a critical stage of the operation I packed the cavity with some cotton patties stood up and walked towards the phone while keeping one eye on the huge monitor displaying the surgical fieldldquoLetrsquos all watch the last over peacefullyrdquo I said to everyonersquos relief After about eight minutes a boundary commenced celebrations and everyonersquos smile could be seen beyond their masks ldquoAnd now can we get back to some surgeryrdquo I taunted with a grin We removed the rest of the tumour much faster than we expected and the patient made an excellent recovery but should I have told him of the little fun we had while his head was openWhen I think back on these incidents I am reminded of how doctors are after all human They may seem indestructiblemdashbut they feel and care just like the others they are excited by the same passions that drive the rest and make mistakes and create miracles just like everyone To be a doctor is to know when to rise above it all and treat someone with singular focus putting the patientrsquos dignity and onersquos own ethics above all elseThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals