The surgical questions

This picture has been used for representational purpose

Will I be able to have vigorous sex after surgery?" a robust Parsi gentleman in his late 60s enquired. I had been explaining the procedure for a lumbar spine surgery that would relieve the compression of his pinched nerves. He was in immense pain; his body contoured and tilting to the right in an awkward looking posture gave him some relief. Patients often ask me questions such as how long before they can get back to work, are there any postures they should avoid, will their implants beep while passing through metal detectors at airports, what are the chances of this happening again, was there a possibility that this could lead to paralysis or problems with passing urine or stool, and so on and so forth. I guess, in our community, the priorities are slightly different, or rather, simply elementary. I wanted to understand in some depth his definition of "vigorous", but refrained.

I met him the first day after surgery, when he was completely free of his agonising pain and walking around like a king in the hospital corridor. On greeting me, he bobbled his head and raised his index finger as if to remind me of the question he had asked me in my office a few days ago. I, in return, gave him the thumbs up. In that single unspoken gesture, I communicated a confirmation that everyone else watching us was baffled by. Two weeks later, he sent me the message, "Doc, my back is as good as my front!" followed by an emoji, which suggested he was "back in action".

Some patients have the propensity of asking the same question repeatedly, even if it has been answered just a few minutes ago. A patient, who got admitted for surgery the next day, asked me, "I have my period, can we still do the cervical spine operation tomorrow?" I reassured her that it was perfectly safe and alright to do so. She then asked the same question to my colleague who would assist me in surgery, the anaesthetist who came in to check on her fitness levels, the nurse on duty, the dietician who recorded her food preference, the janitor lady who came to clean the washroom, and even the ward boy who was left befuddled. Within a few hours, the entire hospital knew that the patient in 1832 had her period.

We have the hardest, but most fun times with superstitious patients. "Doctor saab, our pandit has said to do the important part of the operation between 11 am and 12 pm, and then between 2 and 2.45 pm. Will you?" "Of course!," I said, with an ever-pleasant demeanour, wanting to ask if the entire surgical team should simply go for a two-hour lunch break, while leaving his brain open to air. I have replied to so many messages from patients' astrologers that the word "neurologist" now autocorrects to "numerologist" on my phone.

Another avid Gujarati stockbroker had bought some shares on the morning of his operation for the removal of a tumour from within his spinal cord. As he was being wheeled out of the operating room, I asked him to move his legs, which he did so very well. Then, still groggy and slurred from the anaesthesia, he asked me what time it was. Most patients usually ask how the operation went, or how long it lasted, but he was insistent on knowing the exact time. When I told him it was 5 pm, he looked thoroughly dejected, and when I probed a little deeper for why, he lamented, "It's past 4 pm; I can't trade on the market anymore today!"

"Why did this happen to me?" This is the eternal question that most people seem to ponder about and even struggle with. For the longest time as I sought to comprehend how to answer this question for my patients - those who had fractured their spine, slipped a disc, or developed a brain tumour - I used to point at the big guy in the sky or stroke two fingers across my forehead to call it destiny, almost as an escape route. Until, one day, I heard Eckhart Tolle on my drive to the hospital. He says, and I'm paraphrasing here, "Whatever the illness, accept it as if you have chosen it. Always work with it, not against it. Make it your friend and ally, not your enemy, and this will transform your life."

Those who have been able to do this have healed well inside, and soon. But for many others, the struggle of acceptance continues.

Some even have a more arrogant attitude to illness. They say, "I don't deserve this. I have never harmed anyone in my life. I have never done a single bad deed or even told a lie. How can I have cancer?" To this, I simply say, nobody deserves anything. The rich don't deserve to be rich and the poor don't deserve to be poor. Mediocrity doesn't deserve success and extraordinary talent doesn't deserve failure. Princess Diana didn't deserve to die the way she did, but no one asked if she deserved to be a princess in the first place.

"How we spend our days is of course, how we spend our lives," the prolific American author Annie Dillard wrote in her timeless reflection on presence over productivity. Doctors spend a large part of their day answering all kinds of questions. Often, it's the same spiel on the surgical procedure, its possible complications, and what recovery would look like. Sometimes,the questions are insightful and make you ponder; sometimes, they are repetitive and make you wander. Occasionally, they are heart-breaking. Periodically, they are accusatory. Consistently, they are hilarious, and that's what makes up for all the other kinds.

"Will I be able to play the piano after surgery," a Christian guy in his mid-40s asked me after I explained the need to remove a brain tumour pressing down on the motor cortex of the brain that is responsible for hand function. My reflex reaction was to say "Of course!" but the therapist in me resorted to asking him a counter question instead: "Could you play the piano before surgery?" Very serenely, he nodded his head sideways and said, "No."

I was done for the day.

The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals.