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‘During surgery communication is Kathakali-style’

Updated on: 26 June,2022 12:59 PM IST  |  Mumbai
Prashanti Patel | mailbag@mid-day.com

Inspired by Sunday Mid-day column Doctor In the House, researcher Prashanti Patel shadows Dr Mazda Turel in the OT for a day

 ‘During surgery communication is Kathakali-style’

Representative image. Pic/iStock


Ever since man became conscious of himself and the environment, he has turned increasingly wondrous (and a little fearful) of the prowess of the mass of seething electric activity that sits in his skull and directs his body. How an entire human community laid stronghold upon Earth simply through the transformative powers of higher cognitive centers. In contrast, how the other reptilian set of connections still persists and unfailingly elicits comic hysterics upon encountering a bemused cockroach. How the demons of Hiroshima and the Holocaust arose from a disastrous paucity of connections that engender empathy while the flood of oxytocin explains in part the propensity of the working professional towards watching silly cat videos during Zoom meets. The human brain continues to be an object of wonderment for it’s own self, as harbinger of both genius and stupidity.

I was recently given the implausible opportunity to have a dekho at this “thinker of thoughts” up close and personal and was predictably knocked out of mental breath. As an introductory aside, I am an aspiring fledgling scientist working with the calm, stoic plant kingdom, but nursing an oddball fascination for blood and gore and a particular appetite for neurosurgery. I have long yearned to be admitted into the ranks of the neurosurgeon. However wooed by diverse interests and woefully dissatisfied with any one, ensured that I finally careened my career off the railroads of medicine into the metro of applied research. Nevertheless, I continued to harbor this yearning in secret just as the typical soap opera vamp nurtures a cobra in her bosom.

The Sunday Mid-day column by Dr Mazda Turel, a well known Mumbai neurosurgeon, caught my eye. I began to devour his writing. Much reading, wringing of hands and a few email exchanges later, I let spring the proverbial snake I’d been nursing. He very kindly caught the non-biting end and suggested I come observe a typical day in his life. It was thus that I found myself at the doorstep of the operation theatre complex on floor 11, my heart thudding, acutely aware of my distinctive misfit in the seamless whir of a slew of pre-operative preparations. A quick change however and I stared at myself garbed in the clinical freshness of blue OT pants, cap, mask and oversized Crocs, suddenly officious and tingling with excitement.


My first impression of neurosurgery OT-5 was that of a cold, stern but wondrous dance theater with the anaesthetized protagonist cloaked in sterile drapes, sanitized and centrally immobilized under a massive robotic pincer bearing a sterile-bagged scope and two giant lamps. With the exception of the two neurosurgeons and the scrub nurse who are relatively restricted in movement as they fuss about the patient, the others perform graceful terpsichorean moves about the room, in a coordinated orchestra of tearing open saline drip packs, fine instrument bags, adjusting levers and valves, helping dress the surgeons in scrubs and generally maintaining order. Masking up means that communication is Kathakali-style; with a spectrum of expressions finding voice in the eloquent movement of ocular muscles, conveying exasperation (scrub nurse to principle surgeon), frustration (principle surgeon to scrub nurse) and joint responsibility (principle surgeon to assistant surgeon). The neuroanaesthetists are at home, nonchalantly strolling in place amidst the hum of beeping monitors and tangled wires, but with watchful eyes on the screens, ever-so gently tuning gas flow and ensuring uninterrupted anesthesia. I as the fourth wall, had such an earnest desire to be useful that I occasionally assisted by pulling shut the malfunctioning OT door every time someone went out and earned a quizzical yet kindly look from the scrub nurse.

While neurons themselves are largely quiescent, some cell groups in the nervous system are occasionally rebellious, shoving past cell division checkpoints in Virar-fast local fashion and enthusiastically foundering dynasties that disrupt normal function. Some of these tumors in the brain present additional challenges of inaccessibility, infuriating the surgeon and distressing his colleagues. I watched Dr. Mazda maneuver with the able aid of the assistant neurosurgeon and a sprinkling of colourful language, through two excruciating surgeries with contrasting aspects — one patient with a right frontal lobe tumor and the other with a tumor emergent from the tentorium cerebelli — a glistening protective sheet that separates the cerebellum from the cerebrum. One could do with the relatively simple opening of the frontal cranium while the latter needed a tortuous inroad through the retromastoid route. Both procedures involved a lot of noisy suctioning, blood vessel cautery to stem bleeding and copious requirements for absorbent patties, which the scrub nurse artfully arranged along with the other instruments on her trolley. No matter what the strain however, Dr. Mazda in an avuncular fashion, treated me to explanations surrounding the origin and consequences of the tumor, the readout of MRI scans and the use of silvery hemostatic pads that dammed the rivulets of blood seeping into the gaping cavities that once housed the angry engorged tumor. No textbook or video though, could have prepared me for the sight of the brain itself, softly pulsing in synchrony with the heart monitor, every detail of its topography starkly visible through the scope and reminding me that the entire intangibility of my life’s experiences was wholly contingent on the smooth corporeal functioning of this organ. In that moment the room too was silent, the obvious vulnerability of the patient weighing heavily on everyone’s shoulders, the only sound being a prodigious sigh from Dr. Mazda, who had just swallowed an expletive.

Once all patties gone in were extricated and tallied, the surgery culminated with a prayer and I followed Dr. Mazda into the OPD where a string of patients with interesting symptoms and even more interesting descriptions of the same, filed through. Here too, I co-studied scans, read though histories and understood that body language and not only words, instantly puts the sufferer at ease. It was a full 12 hours since I left home, that I finally pulled off the cap and mask, donned street clothes and prepared to leave, adrenaline still coursing through my body as I yanked open the taxi door, while both starving neurosurgeons insisted on observing the patient till she was wheeled into intensive care. A full week elapsed before I ceased looking at people as brains with bodies and resisting the urge to pry open their skulls.

 


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