In the world of neurosurgery, we often find ourselves not just confronting the stark clinical realities of the human body, but also the deeper, more elusive realm of the human soul. It is a balance between science and empathy, where the scalpel must delicately cut through not only tissue but the very fabric of a person’s life. This delicate dance becomes all the more poignant when treating patients whose very personalities seem to shift beneath the weight of their illnesses.
Not a long ago, I met an elderly lady, 74 years old, whose presence carried the weight of decades of life and memories. I vividly remember my first consultation with her who presented with subtle yet troubling behavioral disturbances. She was accompanied by her son, a gentle and attentive man, always by her side. Despite his love and care, she seemed unusually irritable. I listened to her speak, noting that her speech was slightly disjointed, and she struggled to find the right words at times. This was my first clue. The irritability and emotional instability pointed to something deeper, and my experience in neurosurgery told me there might be a lesion somewhere in the brain’s emotional or memory centers.
I conducted a thorough neurological examination, observing the nuances of her behavior and memory. She seemed to be experiencing anterograde amnesia, struggling to form new memories, a classic sign of hippocampal involvement. Her son also mentioned that she had become unusually fearful and anxious, often reacting with agitation to seemingly minor triggers. These emotional responses pointed towards possible dysfunction of the amygdala, which is key in regulating fear, aggression, and emotional responses.
Her language difficulties became more apparent as our conversation progressed—there was a subtle aphasia, with occasional difficulty in word-finding, though she was able to comprehend most of what was being said. This hinted at involvement of the left temporal lobe, where speech and comprehension are primarily processed. I also noted her mild depression, something that had been present long before she or her family knew the gravity of her diagnosis.
Interestingly, there were no signs of significant headache or severe neurological deficits beyond these behavioral and emotional disturbances. Still, the constellation of symptoms—memory loss, emotional changes, speech difficulties, and subtle cognitive impairment—led me to localize the lesion to the left hippocampus, amygdala, and left temporal lobe. These regions of the brain govern not only memory and emotions but also speech, intelligence, and social behavior, functions central to our humanity.
To confirm my suspicions, I ordered an MRI. The scan revealed the presence of a lesion precisely where I had anticipated—within the left hippocampus and amygdala, extending into the left temporal lobe. The DTI sequences showed tumor engulfed around the important tracts. My heart sank when the radiologist pointed to what appeared to be a malignant tumor, a Grade 4 Glioblastoma Multiforme (GBM), a terminal diagnosis.
GBM is a devastating diagnosis. Over the past 15 years in my neurosurgical career, I have operated on countless patients with brain tumors, many of them GBMs. It is the most aggressive type of primary brain cancer, known for its rapid growth and resistance to treatment. While surgery can remove much of the tumor, GBM tends to infiltrate surrounding brain tissue, making complete removal impossible. Despite advances in medical science, the prognosis remains poor, with most patients living only 12 to 18 months after diagnosis. The harsh reality of GBM is that it rarely offers hope for a cure—only time, borrowed at great cost. For this woman and her family, the road ahead would be marked by difficult decisions and emotional battles.
I sat down with her son and daughter—both educated and well aware of what lay ahead. Together, we discussed the options. Surgery, though not a cure, could provide some relief. It was the best we could offer. They agreed, and we proceeded with the operation. The surgery was uneventful, but the diagnosis confirmed our worst fears: GBM, the most aggressive form of brain cancer. The once mild irritability grew into moments of aggression, though she remained calm and cooperative during our clinical interactions. Her son stayed by her side, balancing his own sorrow with his duty to his mother, yet soon the weight of life’s demands began to pull him away.
In India, families often shield their loved ones from the truth of terminal illness. The diagnosis remains a whispered secret, shared among relatives but rarely with the patient. It’s a practice born of love and protection, though it dances in the grey of medical ethics. Would it have been better to tell her? Should she have known the true nature of her disease? I can’t say. As Oscar Wilde once wrote, “The truth is rarely pure and never simple.” Here, in the intricacies of our culture, the truth is often seen as a burden, one that many believe the elderly need not carry in their final days.
In the midst of her recovery, another twist of fate occurred. Her son, her steadfast companion, was soon to leave for the United States to pursue a new job, an opportunity he could not afford to lose. The demands of the “American Dream” weigh heavily on many, and life sometimes forces us to choose between family and the future. I could see the pain in his eyes, torn between the ailing mother he adored and the future he had long worked for. Life, as we say, “goes on,” but it never goes on without a cost.
The daughter soon stepped in, moving from Pune to Mumbai to care for her mother in her final year. During that time, her tumor went into remission, thanks to radiation and chemotherapy. She seemed stable, but the woman I saw after surgery was not the same person I had met before. The emotional disturbances persisted, though her children never revealed to me whether they had told her about the true nature of her illness. I suspect they kept it hidden, allowing her to live with peace, unaware of the storm brewing inside her brain. She met me for follow-up appointments, sometimes chatting, sometimes reflective. I remember her telling me, “I’ve lived a good life, Doctor. Whatever happens next, I’m ready.” It struck me deeply. Whether she knew or not, her acceptance of life’s final chapter was more graceful than most. Life, as Robert Frost wrote, “is a series of losses, but you start losing everything that holds you together in the end.”
Eventually, the inevitable came. One quiet morning, I received a Whatsapp message from her daughter—she had passed away in her sleep. Peacefully, they said. Her son, unable to leave the U.S. due to visa constraints, couldn’t return in time for the funeral. Once again, life showed its cruelty. So many Indians abroad, bound by the limitations of their visas, have missed final goodbyes during the Covid19 pandemic. Mark Twain’s words come to mind: “The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time.” Perhaps that was true for her, but for those left behind, the absence lingers.
Now, as I reflect on her case, I am left with questions that may never have answers. Were her emotional disturbances truly the result of the tumor, or were they borne of something deeper—the sorrow of separation from her family, the pain of distance from her son, her daughter, her grandchildren? Her husband had passed long ago, and in her final days, perhaps it wasn’t the lesion in her brain that caused her suffering, but the loneliness of knowing that those she loved were slipping away. Oscar Wilde once said, “The heart was made to be broken,” and for this woman, I often wondered how much of her pain came from the cancer inside her brain, and how much came from her children being away—her son across the ocean, her daughter in another city. Was her anger the product of a tumor pressing on her hippocampus, or was it a reflection of a deeper emotional fracture?
I found myself questioning—was this disease of the brain, or of the heart? As doctors, we rely heavily on science, on technology, on clinical examination to guide our decisions. Yet, as Charles Dickens once noted, “There is a wisdom of the head, and a wisdom of the heart.” In this case, the wisdom of the heart tells me that her story was more than a neurological diagnosis. It was about love, loss, and the cruel passage of time. We often attribute changes in personality to biological causes, especially in neurology, where we are trained to seek out lesions, tumors, and strokes. But as a surgeon, I know that medicine is both art and science. No scan, no biopsy can reveal the secrets of the human heart.
To her children, if you ever read this, please know that you did all you could. We make choices in life, some driven by duty, others by love, and sometimes by both. You cared for your mother in her final days, and that is all that can be asked. There is no guilt in life’s circumstances, only the knowledge that you did what was right, even when the world around you seemed so unkind. As Oscar Wilde said, “To live is the rarest thing in the world. Most people exist, that is all.” Your mother lived. She loved. And in the end, she left this world surrounded by that love, even if it was separated by oceans and miles.
As Robert Frost reminds us, “In three words I can sum up everything I’ve learned about life: it goes on.”
With guidance from the Brain, powered by the Heart,
Dr. Nitin Jagdhane
Your Trusted Neurosurgeon
The Author is a distinguished Senior Consultant Neurosurgeon and Professor of Neurosurgery in Mumbai, India, specializes in endovascular neuro-intervention, microneurosurgery and endoscopic spine surgery, renowned for his precision, innovation, and commitment to patient care. He’s currently associated with Cleveland Clinic Florida as a Clinical Fellow in Neurosurgery-Spine.
Great thought process and duties with emotions too. It’s always between illness and balance of brain, precisely mind. The process of illness is somehow related with hormonal balance and here need to be more curious clinician and Dr Nitin clearly pointed out that.
Thank you so much sir
Dr. Nitin Jagdhane’s work is truly commendable, blending technical expertise with profound compassion. His ability to articulate the emotional complexities of neurosurgery not only enriches the understanding of patient care but also honors the human experience behind each diagnosis. Congratulations on your insightful reflections and dedication to your patients, Dr. Nitin Jagdhane. Your contributions are invaluable to both the medical community and those you serve.A great salute my dear friend.
Truth of human life today .
Dr Nitin you are great writer ,neurosurgeon and above all humble human
Thank you so much ma’am !
Hats off sir! I feel blessed to get chance to work under ideal personality like you!
Thanks Gazan
Thank you so much!
Very well penned
Thank you so much!
Excellent insight in neurology by Dr Nitin Jagdhane..
So true we do come across same situations in our neuro ICUs.
Dilemma to do and not do..
Plethora of emotions managing such patients..
Thank you so much!
Excellent article.. very well articulated..every emotion is so finely captured.. I could actually imagine the situation in my mind..All of us go through this dilemma with our parents and children in our life at some point.
Thank you so much!
Excellent write up! We often tend to not look beyond treatment but in reality, if we pay close attention, the story of each patient is a novel.
Thanks dear
Not a single article has failed to impress, being a literature student I envy the gift in you Doctor. Keep inspiring us
Thanks!
A neurosurgeon by profession but an author in heart, well written my friend.
Thank you so much!
Excellent write up Dr Nitin
So true.
Thank you so much!
Dr. Nitin Jagdhane’s approach with the patients and their relatives, touch both their hearts and head. He is very friendly and listens patiently and very joyfully suggests practicable solutions avoiding head long jumps into medical procedures.
He is both a successful and good doctor with great knowledge of the latest techniques and calm approach to patients.
Thank you so much
Dr Nitin clearly pointed out the lesion in the brain by correlating emotional symptoms,Great Nitin
Thanks sir
“Your exceptional skill and precision in the operating room are truly impressive.”
“Your dedication to delivering outstanding patient care is inspiring.”
Thanks a lot
The most excellent, true to the Heart , vividly elaborated with. Blend of Emotions. An example of Science & Art. Congrats will not be enough. Just cultivate & consistency will be key factors. All the BEST.
Thanks sir!
Congratulations Dr Nitin. very well written with scientific and emotional background it’s each one of us feelings very nice to go through thank you
Such a great work done Dr nitin sir. You are truly pasionate and faithfull towards your work and that very impressive the way you presented your thoughts. Our hearts are filled with happiness.
Thank you so much!
Very well written article. Write more often.
Thanks sir!
Thank you so much!
Very nice and engaging article written in a very elegant style.
Thank you sir! You’re the inspiration for the artiste within me
Thank you so much!
Excellent and very well written article. Dr. Nitin you have nicely highlighted state of mind, emotions and neurological problem. All the best.
Thanks
Dr. Nitin you written very well. I have encountered a similar case. The GBM was in selenium unresectable. I could not tell the son nothing much can be done. I put her on steroids for life long though the life was not going to be long for her. She improved significantly did “kanyadan” of her grand daughter and passed away 3 months after diagnosis. Had i subjected her to the standard of care she would have spent her rest of the prolonged life in hospital. The family was grateful to me as I offered a treatment that lead to fulfilment of the purpose of life left. The role of palliative medicine is never taught during residency.
Thank you so much sir! A compliment from a giant in this field like you means a lot! As you rightly said, sometimes doing no intervention and providing tender loving care is better than chasing the monster..
Such a great work done Dr nitin sir. You are truly pasionate and faithfull towards your work and that very impressive the way you presented your thoughts. Our hearts are filled with happiness.
Thank you so much!
What an amazing piece sir. Truly heart touching. You should write more often and even publish a book in future of your blogs.
I can relate to this story, when I came to see you for my father who is suffering from same same type of brain cancer.
It was really heartbreaking event for our family, but You give us some hopes and courage for acceptance.
Thanks you so much Doctor ❤️
Dr. Nitin Sir, this blog is truly insightful and very helpful! You’ve shared some valuable information that is easy to understand and implement.
Keep up the great work, your efforts are making a positive impact!
Thank you so much!
Yes, I know. I’ve something in my mind to write about him. Thank you so much!
Thank you so much!
Excellent practical perspective. Runs in every Neurosurgeons life. A look beyond the scalpel. Great.
Thanks sir!
Beautiful article, Dear Nitin.
Thank you so much sir!
Dear Nitin , you are an excellent surgeon and you write very well too.
Thank you so much!
लाइफ गोज ऑन…to live is the rarest thing in the world.Most people exist that is all.
जीवनाकडे पाहण्याचे प्रत्येकाचे दृष्टिकोन वेगवेगळे असतात.परंतु ह्या ही पलीकडे जाऊन एक संवेदनशील मनाचे डॉक्टर म्हणून पेशंटच्या मनाशी जुळवून घेण्याचा आपला प्रयत्न हा खराच कौतुकास्पद आहे.विज्ञान आणि मानवी भावनांची सांगड साधण्याचा,तो डॉक्टर म्हणून समजून घेण्याचा,समजावून सांगण्याचा प्रयत्न स्तुत्य म्हणावा लागेल.अप्रतिम लिहिले आहे.आज काल कट प्रॅक्टिस सारख्या अनेक अनैतिक,चुकीच्या पद्धतीने काही डॉक्टरांकडून रुग्णांना दिली जात असणारी वागणूक पाहता,केवळ पैशांच्या मागे लागलेले असे काही डॉक्टर जे पेशंट त्यांना देव समजतात त्यांच्याशी बोलायला सुद्धा वेळ देत नाहीत.अशा काळात आपण त्यांच्याविषयी लिहिता सुद्धा हे नक्कीच आपले वेगळेपण अधोरेखित करणारे आहे.आपल्यातील ही संवेदना इतरही डॉक्टर्स मध्ये रुजल्या जावून ती सार्वत्रिक होवो,ही निर्मिक चरणी प्रार्थना.
Thank you so much!
Scientific writing with emotional touch… It shows u r empathy towards u r patient.. keep it up the good and noble work sir
Thank you so much Dr. Amol!
A Neurosurgeon’s Journey, Dr. Nitin Jagdhane tells the touching story of an elderly woman with glioblastoma. He explores how her illness affects her and her family, highlighting themes of love and loss. The writing is compassionate and engaging, showing the human side of medicine. This story is a powerful reminder of the importance of empathy in healthcare. I highly recommend it to anyone interested in the emotional challenges faced by patients and their families.
Thank you so much!
Awesome
Thank you so much!
Good work sir. Keep shining
Thanks Pranu
Keep shining, the world needs your light! .
Thank you so much!
Sir, very well said. Your commitments towords patient’s well-being is known to us.
It is difficult to maintain the balance of emotional challenges faced by patients….
Thanks!
I could feel the pain of the lady…this happens when an artist becomes the healer…keep touching their lives with your Midas touch buddy. God bless those hands….
Thank you dear!
Dear Dr Nitin,
Well written straight from the heart.
We often find ourselves with similar dilemmas.
I for one always tell my patients the prognosis and am often surprised at the maturity with which patients accept the reality.
Rarely a patient tells us not to tell him/her anything at all and let life go on.
Keep writing more stories.
Dr Anil Karapurkar
Blessed with your feedback sir, thanks!
Very nice write up Dr Jagdhane. It shows how difficult it is to treat patients with such incurable conditions.