The surgical food

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Good evening, doctor saab!" Jayesh bhai walked in with his wife. The couple were in their mid-fifties and seemed pretty jovial. He had a round face that sat atop an even rounder torso. The buttons of his bright yellow shirt were struggling to keep its two halves together. Through two of those buttons, his navel was his third eye, staring me in the face. Sensing my unwavering gaze from his centre of mystical enlightenment, his wife remarked, "He loves to eat," which I acknowledged, because I do too. "And I love to cook for him," she continued dotingly.

It was of little concern to them that Jayesh bhai had a brain tumour. "I was having headaches and my GP suggested I do an MRI. He said he had heard you at a lecture where you mentioned that people with headaches should get an MRI," he explained. I peered through the scan to note it was a craniopharyngioma - a benign tumour with a malignant pronunciation. It was arising from the pituitary stalk and pressing against his hypothalamus - the control centre for hunger and satiety besides a myriad other functions such as regulating hormones, body temperature, heart rate, blood pressure, thirst, mood, sleep and sex drive.

He had no issues with any of the other functions, he clarified, and his wife confirmed. The weight he was putting on had been simplistically attributed to his love for food. I explained to them that not everyone who lives to eat has a brain tumour, but subtle shifts in patterns should not be neglected. He had put on over 20 kg in just six months.

"Can I continue to eat dhokla, khandvi, and undhiyu before surgery?" he questioned, listing out his favourite foods. "Of course," I said without hesitation, "but we will need to check your hormone and sugar levels," I cautioned. I detailed a battery of blood investigations and booked an appointment with our endocrinologist, who helped manage such patients perioperatively.

Before leaving, he asked, "Is it true that you become hot tempered if you consume too much spicy food?" He smiled at his wife, who shook her head, denying the allegation. "It's possible," I said, having read this in a publication. "I'm telling her to eat more sweets but she's just not listening," he said, as both of them left the room laughing.

He came back really upset a few days later. "The endo doctor you sent me to has stopped me from having all desserts! No chocolate, no cake, no jalebi, no gulaab jamun, not even aam ras! [Mango] Season is about to finish. What does one eat?"

"One day, science will show that sugar is really good for us and the medical community will have to eat its words," he muttered, disgruntled. "As long as we are eating only words, we won't put on physical weight," I punned, later realising that the emotional burden of eating one's own words is even heavier. "Let us quickly get over with the surgery, so that I don't have to deal with dietary restrictions," he told me. I agreed, adding, "It's also possible that you might not want to eat as much after surgery after the pressure on your hypothalamus is relieved," and I watched his face shrink with dismay.

Patients often ask what foods to avoid after brain or spine surgery, and unless they have a specific medical condition, my answer is always peppered with the sagacity of ancient wisdom: Everything in moderation is okay. I advise them on eating fresh fruits and vegetables and to go easy on the carbs and avoid red meat. People wonder if certain foods will affect wound healing or cause a tumour to grow back.

They wonder even more if eating too much pizza, dosa, or spring rolls might have caused the tumour. I also get asked what foods are good for the brain, and the answer is berries, nuts, green leafy vegetables, avocado, fish, and eggs. And, if you are Parsi, make that eggs-on-top-of-eggs. The foods we eat should bring us both, health and happiness.

We operated on Jayesh bhai a few days later. The tumour had a large cyst with golden fluid, resembling the crystalline oil his jalebis were fried in. We peeled it off the hypothalamus and the pituitary stalk in the hope of restoring his internal balance. "Your hospital food is very tasty," he proclaimed, sipping on cream of tomato soup, his eyes fixated on the pudding beside it. "Can I eat pav bhaji once home?" he asked, before getting discharged. I nodded. "And a small drink once in a while is okay?" he winked. I granted permission with a big smile.

According to a lot of data, research, and science, we are what we eat. But we are also the five people we spend most of our time with. We are the culmination of the experiences of our several lifetimes. We are the ratio of the suffering we caused and the suffering we endured.

We are the failures we were unable to fathom or the success we were able to surpass. We are the hope we racked up and the sorrows we shared. We are the strings we pulled and the ropes we hung on to. We are how stoically we portray ourselves and also how vulnerable we might choose to be. We are the questions that quench and the answers that ask more questions. We are the ships we sailed in and the ships we saluted from the shore. We are our insight and intuition. We are our hunger and our cravings, our weight gain and our weight loss. We are the stories we tell ourselves. We are all. We are one.

Jayesh bhai returned in three months for a follow up. He had lost 10 kilos. Now he was Jayesh bhai Jordar. His shirt fit well. The third eye had closed. "Doctor saab!" he greeted me in his trademark fashion handing me a box of chocolates. "Can I eat sweet and sour pickle that might sometimes be spicy too?" I don't know if there was any item on the menu that he hadn't cross-checked with me in our time together. "Besides human beings, you can eat whatever you want," I professed with folded hands.

The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazda.turel@mid-day.com