Jayshree came to me from Chandigarh over a year ago. She was in her mid-sixties and spoke her Hindi with a Punjabi twang. Her daughter sat next to her, trepidatious; they had made this arduous journey already knowing what was to come. She had a ghoulish brain tumour in her right temporal lobe. The moment I picked up the scan, from its beastly appearance, I knew it was Grade 4 cancer. “How did you happen to get an MRI?” I asked, since she looked relatively well to me. “I had a seizure,” she told me, “and my doctor asked for a scan,” she narrated simply. “I’m from a small town. I am resigned to my fate,” she surrendered. 

After a detailed examination to ascertain she had no neurological dysfunction, I gently explained that she would need an operation to remove this tumour, followed by radiation and chemotherapy to control it, and “despite all of that, it would come back at some point,” I emphasised. “So then why are we going through all this?” she logically questioned. “It’ll improve your longevity by around a year or two,” I said honestly. “And I’m hoping even the quality of your life.” To most healthy people, adding a year to their life might not mean much, but to someone who has terminal cancer, it’s a lifetime. With Jayshree, we had gone from completely healthy to a diagnosis of end-stage cancer in a matter of days. It is a simple yet complex fact of life: things are neither separate nor identical.

We went ahead and removed Jayshree’s tumour. Under the high magnification of the surgical microscope, a world of intricate vascularity and delicate neural tissue comes into sharp focus. The discolouration of the tumour was clearly visible on the surface as I delineated it from normal brain. Its insides were necrotic and rotten — a grim testament to its aggressive nature. I used my suction as a fine tip magic wand in one hand while a combination of micro-scissors, dissectors, and bipolar forceps in the other hand worked in concert, their impossibly thin and precisely angled tips meticulously dissecting, coagulating, and teasing away the tumour, helping me get the whole thing out. Every subtle difference in texture, every micro-vessel, was magnified, allowing me to carefully navigate the treacherous interface between the malignancy and healthy neural pathways. Once complete, I methodically inspected the cavity for any remaining specks of abnormal tissue. The brain looked clean again — devoid of any unwanted intruder. The dura was carefully reapproximated, the bone flap was secured, and the scalp was closed in layers.