The Long Drive When Eyes Opened, Even Briefly.... Contd 4 (The Weight of Truth)

I hadn’t operated on her — but I was still responsible.

This was damage control, not surgery.

Medicine, not scalpel.

Time, not skill.

Only after calming that inner storm did I scroll to the unknown messages.

Message 1:“Hello Doctor, I am a family friend… wanted to know her status. Please let me know when I can call.”

Message 2:“Good morning sir. I am a relative of Mrs. XXXXXX. I work as a doctor in a government hospital. What is her condition, sir?”

Before I could reply, the phone rang — unknown number.

I already knew what this was.

Whenever a patient from an affluent family gets admitted to a new private medical college, someone —a doctor-relative, a senior colleague, a family friend with an MD/DM/MCh degree — calls to evaluate whether we are capable.

Not to know the patient’s status —but to judge whether we, the team and the institution, are worthy of trust.

Most days, I turn the tables around and convince them so deeply that they end up praising the institution and asking me,“Why don’t you move to a bigger hospital for practice?”

And I always smile and say:“Our training legacy taught us that our presence matters most where no one else is ready to offer the same impact.”

But right now, irritation brewed inside me.

Still sitting on the bed, I answered.

A stern, seasoned voice spoke.

Authority.

Experience.

Hierarchy.

“I am Dr. Sxxxxxx. Ex-Director, Institute of Child Health.”

The name itself carried weight — a level 4 referral center in Chennai.

“I got your number from Dr. Snnnnnn. I heard you are good. I want to know whether your hospital is equipped to handle this case.”

My blood heated.

Annoyance swelled.

But respect forced restraint.

Deep breath.

“Yes sir,” I replied evenly.“We are well equipped. I built this place over four years. We have an exclusive neuro team, dedicated nurses, neuro technicians. Two trained neuro-anaesthetists. An exclusive neuro OT with biplane cath lab. A neuropathology laboratory. Eight-bed dedicated Neuro ICU run entirely by our team.”

I hated having to say all this.

But sometimes you must verbalize your credibility because there is no advertising department to do it for you.

Then I explained the patient:

“She came unresponsive, barely breathing. GCS… unrecordable BP… threatened airway. Resuscitated aggressively for an hour before imaging. CT brain shows diffuse axonal injury — nothing surgical. Thorax shows massive hemopneumothorax requiring chest tube. Now stable on ventilator. We’re monitoring PCV six-hourly for 48 hours. If off noradrenaline, repeat CT in 24 hours to assess for cerebral edema.”

Finally, I said the line he needed to hear —and I meant every word:

“We are doing the best available in the world, sir.”

He understood.

He sensed involvement.

He sensed sincerity.

He sensed competence.

“Thank you, doctor. Please continue your good work. I’ll inform the family they’re in safe hands.”

When I cut the call, a wave of pride rushed through me —a strange, deep satisfaction that I had never felt even the day I received my MCh Neurosurgery degree.

I leaned back.

Suddenly —“Amaaaaan! What are you doing?” I called out, half playfully.

He ran to me instantly, climbed onto the bed, hugged me tight, and planted a kiss on my cheek.

That moment completed everything.

A happiness that felt like conquering the world.

And then there was Nufi — who would still look at me like I was a slightly ridiculous, imperfect, messy, disordered man.

And honestly — that was its own comfort.

You need one place in life where you’re allowed to be incomplete.

To be sloppy.

To be foolish.

To be human.

Only then one can return as a steady, sharp and unbreakable neurosurgeon.

---

Sunlight flooded the quarters when I stepped out.

Every car slot was empty — meaning everyone had already left for work.

It didn’t bother me.

Four hours of sleep was often more than enough.

Neurosurgery had engraved this pattern into my flesh and bones:If there is no work — eat. If there is no emergency — sleep. Because you never know when the next storm hits.

Calmness is not peace for us —it is preparation.

I got into the car and drove quickly to the hospital.

By the time I reached, the place was already alive.

Patients filtering in and out, footsteps echoing, the day unfolding in its habitual controlled chaos.

As I entered the main block, the security guard straightened into attention and saluted.

“Good morning, sir,” he said.

I smiled and replied, “Good morning.”A small gesture, but I knew it mattered.

To him, it was respect.

To me, it was grounding.

On the way to the ICU, I passed familiar faces — people I see every day, though I don’t know their names. A nod, a smile, a fleeting acknowledgment that we are all part of the same organisation called a hospital.

I approached the ICU door.

Inside, the atmosphere was as always — clean, cold, sterile, disciplined.

The nursing supervisor Ms. Vincy greeted me with the customary ritual:

“Good morning, sir.”

Morning wishes in hospitals always feel ironic. The sun may be bright, but the day can carry the weight of disaster.

I walked toward her bed.

Cherrisma was already there, her posture alert, her file open, ready to brief.

“All okay, sir,” she began.“She is holding on.

Blood pressure stable, saturation stable.

TCD velocities are good.

No elevation in ICP. We are continuing sedation, mannitol and anticonvulsants.”

Then she began the ritualistic recitation — intake, output, fluids, ventilator parameters, every line of medication.

It wasn’t just protocol.

It was an insurance.

This ritual existed because one wrong dose or one missed drug could shift the trajectory of her already-fragile brain.

I listened carefully.

Her brain was injured diffusely — no surgery to offer, only time and physiology to manage.In such cases, consistency saves more than creativity.

The morning had begun — bright outside, clinical inside.

And somewhere at the edge of this ICU, hope and uncertainty stood hand in hand, waiting for what the day would bring.

---

When morning rounds ended, I asked Naveen to bring the relatives for counselling.

This was….and still is…one of the most important parts of my daily routine.

Operating is skill.

Interventions are skill.

Critical care is skill.

But counselling… counselling is not skill.

It is art, empathy, psychology, credibility, timing.

It is more difficult than the knife — because it deals with emotions that are bleeding, not vessels.

Brain trauma is never planned.

It arrives like lightning.

Sudden.

Violent.

Paralysing the family in disbelief.

Even though I had already spoken to Dr. Sxxxxxx, and he had reassured the extended circle, the daughter and son-in-law still carried the weight of shock — a weight no external reassurance could lighten.

Naveen gently brought them into the counselling room.

They were still in the same clothes — the son-in-law’s T-shirt stained with dried blood.

Fatigue had carved itself into their expressions.

He looked at me with eyes that begged for a miracle — desperate for a single positive line.

Naveen placed a chair for the daughter.

They both sat.

I began softly.

“I know it was a difficult night.”

They nodded — acceptance mixed with fear.

“We have better control of her now,” I continued.“She responded well to the medications and treatment.”

A visible sigh passed through the daughter.

A flicker of relief lit her eyes.

But the son-in-law… he looked different.

More serious.

More informed.

Likely Dr. Sxxxxx had already spoken to him about the prognosis.

I gave them a few seconds — a deliberate pause to allow that momentary comfort.

Then I continued.

“But as I explained yesterday, the brain injury is still severe. The drop in blood pressure caused significant damage. The good thing is we now have her blood pressure stabilised, and she is sedated to prevent further secondary injury.”

Their relief evaporated slowly, like a wick burning out.

“The ICU stay will be long,” I said.

“At least four to six weeks. She will need a tracheostomy and prolonged ventilator support.”

He nodded, but I could sense distrust.

He was still assessing me, still uncertain, still carrying the guilt of being the driver.

Guilt that insisted on hope.

Then he asked what was buried beneath his fear:

“What about the lung fluid?”

“It has been drained. We transfused blood. She responded well.”

“So she should be alright, right?” he asked quickly — with desperation more than curiosity.

Humans search desperately for patterns of hope.

If A happens, then B must follow.

If we drain, she improves.

If we transfuse, she stabilises.

If she is stable, she must survive.

But trauma does not obey equations.

And diffuse axonal injury does not obey expectations.

I paused before answering.

“I understand what you’re hoping for… but this is a long journey. She will recover slowly, but she will be dependent.”

His face fell — deeply.

The words pierced through him.

I knew he would hate hearing it.

I knew he wasn’t ready.

But truth is not a luxury in my profession — it is a duty.

I ended gently,“I’ll speak to you again in the evening.”

Evening Counselling

After finishing my outpatient clinic, I returned

With new ICU patients, I always meet the family twice a day — morning and evening. Trust isn’t built in one conversation; it is built in consistency.

Naveen called him again.

He came reluctantly — but helplessly.

He had no option but to face me.

I spoke with calm firmness — the tone needed when families must absorb difficult truths.

“Sir, she is stable. But remember — this is how it will continue for now. We cannot expect dramatic improvement. She will not sit up or open her eyes in the next few days.”

Only heart rate, blood pressure, and serial scans could guide us.

I added the hardest truth:

“Her consciousness will take a long time to return. Some wake up in weeks, some in months.”

He looked at me as if I was incompetent for not giving an exact timeline.But there are no timelines with the injured brain.Only uncertainty and sincerity.

“We will repeat the scan tomorrow,” I concluded.

He simply nodded —pushed back his chair —stood —and said quietly,“Okay sir.”

His silence conveyed everything.

Next Morning

The scan was done.As part of the ritual, Naveen brought the relatives in.

I started with the positive.

“Scan looks good, sir. We will begin tapering sedation over the next 72 hours. After that, we wait for her to wake up.”

He immediately asked,“How long should we wait?”

“Until she breathes on her own and opens her eyes.”

He regretted asking —

My bluntness was not cruelty, but preparation.