Doctor, I keep smelling things that aren’t there.” That is not usually how neurosurgical consultations begin. Seizures, headaches, weakness, numbness—those are familiar openings. But smells? Imaginary ones? That belongs more to poetry than medicine.
“What kind of smells?” I asked. She thought for a moment. “Burnt toast,” she said. “Sometimes cigarette smoke. Once… wet earth after rain.” A pause. All my favourite fragrances, I thought to myself. “And once,” she added quietly, “my grandmother’s perfumed talc.” That last one stayed with me. Anyone with a Parsi grandmother will instantly recognise the fragrance of Yardley London English Lavender Fragrant Beauty Talc.
She was a 34-year-old school teacher: articulate and funny. For nearly a year, she had been having strange episodes. A smell would suddenly appear out of nowhere—intense, vivid, undeniable. Then came a rising sensation in her stomach, like the slow climb of a roller coaster. And then, silence. Not unconsciousness. Not convulsions. Just absence. For 30 or 40 seconds, she would stare blankly ahead while the world continued without her. Then she would return, slightly confused, profoundly embarrassed, and deeply frightened.
Her husband described it best. “It is like she leaves the room,” he said, “without actually going anywhere.” The brain, for all its sophistication, is a terrible fan of subtlety. When it malfunctions, it rarely does so politely. Sometimes it whispers through smells. Sometimes through memories or emotions that arrive without invitation. And buried deep within the folds of the brain lies a structure capable of all three.
The insula. A part of the brain so hidden that early anatomists barely knew what to make of it. Tucked beneath the frontal and temporal lobes, concealed under layers of cortex, it was once nicknamed the Island of Reil. More ominously, neurosurgeons later began calling it ‘No Man’s Land’. Not because nobody lived there, but because nobody wanted to go there.
The insula sits in one of the brain’s most crowded neighbourhoods. Major arteries drape across it. Critical language pathways run beside it. Motor fibres lurk nearby like electrical wiring behind an expensive wall.
Operating there was once considered reckless. It was the neurological equivalent of trying to renovate a bathroom by entering through the neighbour’s apartment. And yet, the insula itself is fascinating. It is involved in emotion, taste, visceral sensation, self-awareness, disgust, addiction, empathy, even the strange feeling of being you.
As the Portuguese writer Fernando Pessoa once wrote, “What we feel is not what we feel, but what we think we feel.” Her MRI revealed a small tumour buried deep within the left insula. Not large. Not dramatic. But perfectly positioned to irritate the surrounding cortex and trigger seizures.
Insular seizures are masters of disguise. They masquerade as panic attacks, acid reflux, cardiac symptoms, strange smells, peculiar tastes, or feelings of doom. Patients often spend months seeing gastroenterologists, psychiatrists, or cardiologists—everyone except the person eventually staring at the MRI saying, “Ah”.
The smell of burnt toast, incidentally, has become almost mythical in neurology. Popular culture loves it. Patients mention it constantly. Somewhere along the line, the brain collectively decided that if neurones misfire, breakfast must suffer.
Her seizures were becoming more frequent. Medication helped, but not completely.
And so, we discussed surgery. “Is it dangerous?” she asked. I chose honesty. “Yes,” I said. “But so is leaving it alone.” She nodded slowly.
There is something extraordinary about the trust patients place in surgeons. A complete stranger calmly explains that he intends to navigate through the most complex object in the known universe using microscopes, suction devices, and optimism. And somehow, they sign the consent form.
The surgery itself was meticulous. The tumour revealed itself gradually, pale and soft against the normal architecture of the brain. Piece by piece, the insula surrendered it. No dramatic soundtrack. No cinematic tension. Just concentration so intense that the rest of the world disappears. Several hours later, it was out. Completely.
The next morning, she looked at me and smiled. “You know what’s funny?” she said.
“What?” “For the first time in a year, the hospital coffee actually smells like hospital coffee.” A neurosurgeon learns to celebrate unusual victories. Weeks later, her seizures had stopped entirely. No burnt toast. No phantom perfumed talc. No disappearing from conversations midway through sentences. Just life returning quietly to itself.
At her final follow-up, she handed me a small handwritten note. Inside was a quote from Virginia Woolf: “No need to hurry. No need to sparkle. No need to be anybody but oneself.” I remember smiling when I read it. Because that, ultimately, is what successful brain surgery tries to preserve. Not merely movement or speech, but selfhood. The delicate, invisible continuity of being oneself.
As she got up to leave, she paused at the door. “Doctor,” she said, “do you know what I miss the least?” “The seizures?” I asked. “No,” she laughed. “The smell of burnt toast!” I asked her if she had switched to croissants and we both had a hearty laugh.
The author is consultant neurosurgeon at Wockhardt Hospital, Mumbai.
mazdaturel@gmail.com @mazdaturel