I have sharp shooting pain in my throat when I swallow,” Freny aunty told me as she came in with her daughter. “It is like a fish bone stuck in my throat for over a year now!” She was in her early 80s and wore a nice floral dress, quintessential of one worn by Parsi ladies of yesteryear as a tribute to the queen of England. She had the perfect amount of lipstick and makeup to pass off as ‘propah’.
The ENT surgeon they had gone to had performed an endoscopy and declared that all was clear. “Do you have pain at the bottom of your tongue?” I asked a ninja question, one that allows you to clinch the diagnosis swiftly. She nodded in the affirmative, opening her mouth and pointing to the exact spot on the left side.
“You have glossopharyngeal neuralgia,” I declared, acknowledging the irony of diagnosing her issue with two tongue-twisting words. “Dikra, jara aapri language ma please explain!” she requested for a dumbed-down understanding. I elucidated that the glosso (tongue) pharyngeal (pharynx) nerve, the ninth cranial nerve, was being disturbed by something going on in the brain. Neuralgia meant nerve pain. “An MRI will give us the answer,” I said, insisting she get one done. When they returned with the result, sure enough, there was an abnormal loop of an artery pressing against the nerve.
Imaging: Deni Lal
On occasion, in some patients, there could be an elongated bony spicule that could do the same, but in her case, it was the former. “Since you’ve tried medication for over six months and nothing has worked, I suggest surgery to separate the vessel from the nerve.” “What?” she gasped, shocked. “Surgery at 82?” “At least that way you will be able to eat whatever you want for the next two decades,” I smiled, making light of the situation. She couldn’t help but giggle, knowing that longevity runs in the race. A few weeks later and after a lot of thought, she agreed; she wasn’t able to even drink water anymore without pain.
In the operating room, the anaesthetist put her to sleep. The electrophysiologist connected all the muscles of her face and body to a computer so that they can monitor in real time if any damage was being done. We positioned her on her side and strapped her frail body firmly against bolsters, then cleaning and draping her in the usual fashion. I made an incision behind the ear and entered the brain like we usually do. The ninth nerve is not a single nerve but several white rivulets that join together with the topography of an Alaskan glacier. A large abnormal loop of the vertebral artery was pressing against its main trunk. I meticulously mobilised it, seeing the blood flow through it with every heartbeat. I don’t think such an immersive experience is possible in any metaverse. Tiny red blood cells, millions of them, summersaulted within the artery as if enjoying their own water slide at an amusement park. A little padding of Teflon helped keep the artery away from the nerve.
The next morning, she drank a cup of hot tea for the first time without pain and requested that I get some mint leaves by evening to make the experience even more magical. She indulged in a nice warm south Indian breakfast and thanked me with folded hands for insisting that she do the operation. She was no longer worried about the fish bone being lodged in her throat; all she wanted was ‘patra ni machhi’.
A lot of people still fear brain surgery, especially the elderly. While it may be a reasonable emotion to entertain because complications occasionally do occur, one must know that they are the exception. Modern neurosurgery is able to successfully restore quality of life in a majority of patients, and if they are otherwise in great shape, we want our patients to live to a hundred. Especially the Parsis; there are so few of us left now. The queen must have smiled from above on the day Freny aunty went home: a fan of hers had been restored to good health.
The author is consultant neurosurgeon at Wockhardt Hospital, Mumbai.
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