THE BRAIN LOCKED DOWN FOREVER…
The lockdown status, with its uncertainties and future
projections highlight a resemblance to situations that are close to
what I as a neurosurgeon very often encounter during the
management of patients with severe brain injury.
A 45 years old man is brought to emergency room
unconscious with head injury in a road-accident. Close relatives
wait in the counseling room for the neurosurgeon to come out and
give some satisfactory breaking news. The neurosurgeon’s grim façade spells a serious
verdict “patient has suffered severe injuries to his brain and as a result he is unconscious and
having difficulty in breathing for which ventilator’s support has been started”.
The Neurosurgeon faces a shower of questions, all phrased differently, but hinting at
the same underlying doubt –“When will he open his eyes and start talking?” And, so the
responses from the neurosurgeon were all phrased differently, but all indicated the same
meaning, – “his brain is injured badly, the condition is serious and the first couple of days
(about 48 hours) are crucial, at the end of that period we may gain some insight about the
progress”. The relatives are unable to grasp all that was told, and retire for the day,
optimistically expecting that everything would be alright after 48 hours.
We had a similar situation when our Prime Minister warned the masses that the
corona pandemic is spreading fast and that the condition of India is very serious. On the 22 nd
March 2020 he imposed the Janata Curfew (similar to the entire country being pushed into
ICU for one day). All the countrymen accepted it unwaveringly, expecting the clouds to clear
The way millions of
people are feeling today
due to the corona
pandemic is exactly how
the relatives of a severely
head injured patient feel
when he is being treated
by a neurosurgeon in ICU.
The author compares the
life of a brain injured
victim with that of lock
down victims.
2
soon. The entire nation was in a state of total bandh (shutdown), an unprecedented successful
total national bandh which perhaps any political party aspiring to call for a bandh in normal
times would be envious of.
A few days later doctors in the ICU informed the relatives that his condition was
worsening since the injuries were deep and wide spread and recovery is unpredictable. The
wife’s anxious questions regarding gaining consciousness and duration of stay in the ICU
were not answered with any confident affirmation from the doctor.
On the national scale also, after two days the PM announced that corona pandemic is
taking a serious turn and we have to follow three weeks of strict discipline, stay quarantined
at home, no going out, businesses and factories closed, no gym, no malls, no restaurants,
devoid of all social pleasures only stay at home and home only; a state of total lock down was
imposed in the country. “Lock down”! A phrase, heard first time being used for a region or
whole country, was destined to become the most commonly used phrase in the coming
months. For most of us so far, it was linked to criminals and prisons only.
In the ICU also, doctors informed that the patient continues to be serious, intracranial
(inside the brain) pressure is increasing, and which needs constant monitoring and ventilator
support. He may remain ICU bound for three to four weeks. “Will he be alright? Will he start
talking after that?” were the curious queries that got sidelined in the midst of medical jargon
explaining challenges in managing such serious patients and uncertainties posed by each
case.
Three weeks passed, people stayed at home, and got used to a new life pattern of
working from home to working for home, self -cleaning, self-cooking, sans restaurants, sans
outside entertainment, sans the luxury of moving outside freely, sans habits that were so
easily adopted unknowingly over the past many years. The common habits of paan, gutaka,
3
smoking, alcohol, and even innocuous pleasures such as fine dining, movies, gym etc. all
receded from ‘essential’ aspects of life to ‘livable-without’ pleasures. For some, what more
they would have achieved by visiting a de-addiction center; time and money saved was a
bonus.
By now, financial impact due to lockdown was visible on millions of people across the
country due to lost jobs and businesses, and was similar to what the family of head injured
victim were facing due to abrupt seize in business on one hand and mounting hospital bills on
the other. Excitement of the family at weaning off the ventilator and starting of nasal tube
feeds was akin to the relaxation in lockdown where people were allowed to go out to get
some essential items. But essentially the lockdown continues, and so also the patient
continues to remain in ICU.
Finally, the locked down was lifted, but only in certain green zone areas. People
were delighted, restricted movements were seen in many parts of the cities. People began to
question when life- as such would return to a state of normalcy. In hospital also the family
was delighted to see him eat some food, communicate with gestures and moving out on a
wheelchair but when would he return to normal life was the lingering question. Thus the
uncertainties continued with both, the head injury victim and locked down victims. The
question of returning to normalcy got rephrased from when to whether.
Experts state that even if the lockdown is completely lifted and the pandemic passes
away, the life, businesses, free and fearless movements, gatherings and enjoyment, work in
offices and factories, attendance in schools and colleges, movements in malls, theatres and
clubs would never again be the same. We will have to learn to live a different life in the post
corona phase.
4
In hospital also the neurosurgeon predicted a similar future for the patient. Even if he
recovers, he will have poor attention, poor memory and dependent life, and certainly will not
return to his business and usual enjoyments. With limited activities he will never be the same
person as before. He will have to learn to live a different life in the post head injury phase.
The brain will be locked down for ever...
Dr Dilip Kiyawat
Consultant Neurosurgeon
Jehangir Hospital, Pune
dilipkiyawat@gmail.com
+91 9822046043
