Everything revolves around a centre. The earth pirouettes around a molten core. The solar system hums to the rhythm of the sun. Cities pulse with life around their downtowns. A newborn baby at a family gathering is the centre of all attraction. And in today’s context, it’s the one working charging outlet at an airport where a desperate cluster of travellers vie for their device to be the next to enter its precious electrical orbit.

Even the brain, our crowning glory of evolution, bows to this unassuming truth – that life is regulated around its centre. Tucked deep within its protective vault rests a delicate core. Between the awakened pituitary and the sleep-regulating pineal gland lies the third ventricle ensconced by the thalamus on either side, the hypothalamus below and the union of the optic nerves guarding it — all quietly regulating sight, thirst, temperature, wakefulness, and hormonal symphonies that makes us “us”. You mess with the centre; you rattle the entire axis. 

Akshay, a 30-year-old tall and lanky chap, much to his brain’s chagrin, housed a threat in exactly the same location. I had seen him a year ago when he came to me with dull aching headaches. The ophthalmological exam, for the so-called “window to the soul”, had come clean. But we neurosurgeons know better, that behind every window is a wall. And in his case, the MRI had revealed a small lesion trailing the optic chiasm, nestled near the third ventricle. Small. Subtle. Suspicious. More importantly, sentient, which I found out only after a year of watching it grow slowly but consciously. Due to the criticality of the location, him being relatively asymptomatic, and the possibly benign nature of the lesion, I had refrained from offering an operation. But now it was pushing against the optic chiasm, threatening to steal his sight. His sleep was a bit disturbed. He wasn’t eating well. The centre was misbehaving. And that’s the thing about central problems: They start quietly but rarely stay polite. We had no choice but to turn to the heart of our craft.