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Table of Contents
COMMENTARY
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 188-189

Beyond the clouds of darkness


Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Web Publication02-Nov-2021

Correspondence Address:
Dr. Harsh Deora
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJNO.IJNO_426_21

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How to cite this article:
Deora H. Beyond the clouds of darkness. Int J Neurooncol 2021;4, Suppl S1:188-9

How to cite this URL:
Deora H. Beyond the clouds of darkness. Int J Neurooncol [serial online] 2021 [cited 2021 Dec 5];4, Suppl S1:188-9. Available from: https://www.Internationaljneurooncology.com/text.asp?2021/4/3/188/329821



Fifteen minutes have passed since I first started examining my patient. A young 30-year-something laborer, who fell from a coconut tree in an attempt to retrieve the fruit, is lying in front of me unable to move his legs, puddles of urine flooding his stretcher, scared, and confused.

On my 1st day of neurosurgery residency, I hurriedly go back to my desk, start filling the spine injury sheet, trying to remember what I had half done. There is a contingent of restless eyes staring at me waiting for their turn; someone skidded off their motorcycle, another having rammed a tractor. Among the bleeding and bruised are a few who have a time bomb in their brains, a glioma that could herniate at any moment, a metastasis with an ominous-looking edematous brain, two elderly gentlemen with blood thinners who have a slow-developing bleed. I start to triage, reviewing the computed tomography (CT) scans and expertly calling for plans and orders on priority. Slowly but surely, all cases are examined, imaged, and operated on a priority basis. By the time, my shift ends and I finish my assigned work, it is late. The whole day has been a blur, much like what Captain John Miller felt after the blast in “Saving Private Ryan,” only to be suddenly whooshed back to reality.

A few days pass, I become more accustomed to the crowds, the expectations. One day in the middle of the commotion, a young male is wheeled in. He has vomit dripping down his mouth with severe spasms of extensor posturing like a bow being stretched. One look at him and I whizz him to the resuscitation chamber. Swiftly, a team of nurses descends on him, lines are secured, fluids started, all the vomit suctioned off, and an endotracheal tube is placed in one smooth motion. He is whirled off for the CT scan, and within minutes, he is in the procedure room ready for insertion of a soft tube that will drain the cerebrospinal fluid, which has been blocked by a benign growth in the outlet of one of the ventricles. I summon all my courage, as it would be my first bed-side procedure and after a careful review of the CT scan and surface landmarks. I carefully mark the site on his head using the coronal suture and the middle of the pupil as my landmarks and paint it with povidone-iodine and spirit, all the while my heart thumping. Gradually, I descend into the aftershock zone, oblivious to the commotion outside, only the ventricle in focus. A small hole is drilled in the bone, and a brain cannula is handed to me. As I start inserting it, there is a collective pause, as though the moment has frozen, everybody holding their breath waiting for the spurt of clear fluid.

And Viola!

Five centimeters in, the fluid trickles out, and the cannula is replaced by a soft tube and carefully secured, gradually draining the pressure off his brain. The patient is shifted to intensive care; I finish my notes and return to my desk. My senior response with a jibe on being late, dumps a load of files on me, and just as he is leaving to attend a call, he says, “Well done.”

India has a glaring shortage of medical professionals, having just one doctor for nearly 1700 of its population. The shortage is even worse in rural areas, as most professionals after having spent a better part for their life being trained, choose to settle in better-paying zones. Add to that the frequent instances of violence against medical professionals, there has been an appreciable drop in the number of aspiring doctors. This has only worsened a bad situation. Instances of relatives carrying their patients on their shoulders or not having access to even ambulance services are everyday news. Public health care is under severe pressure, and with paltry resources, it is hard to find willing individuals who would want to stay in their homeland and not go overseas where the situation is more to their liking. Despite the hardships, many still aspire to work in government sectors and an even smaller bunch dream to be an academic neurosurgeon.

Be unfazed with the burden, and continue to work with a level head. There are occasions, which will shape or destroy your future, and surprisingly, it is not the skills that matter at that time. It is your attitude. Be selfless. It does not require astute clinical knowledge, precise surgical skills, or path-breaking publications. All it needs is a clinician's heart. There have been doctors or even health-care personnel who go beyond what is expected and deliver what is required. Individuals of such nature inspire many around them and they, in turn, “Pay it Forward,” like the Mimi Leder movie.

When Odysseus, king of Ithaca fought in the Trojan War, he entrusted his son, Telemachus to Mentor; and since that day, the word has come to symbolize a trusted advisor, a teacher, an older brother, someone who would set an example for others to follow. Be that mentor for someone, be the example that you would want for your children and for yourself. There is always a dark side of the moon; there will be setbacks and problems that you cannot foresee. What we do not need at this moment is a rainbow of darkness [Figure 1]. It is easy to be cynical but what is required is to go beyond the ordinary and set examples for others to be inspired by. No matter the road keeps moving ahead, that path will become better. All because we chose to look beyond the darkness of clouds and see life in its true colors.
Figure 1: Clouds over the banks of the river Ganga at Rishikesh

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