In that moment, I felt our shared humanity, and something else – that I had so much to learn. About life, and about myself. About who I had become and who I could still be. Lessons about life, loss and rules for survival are everywhere: in the individual cells in our brains, in our minds, in my patients, in the surgery, in my practice, operating at the margins of life and death, hope and hopelessness. Life at its edges and depths also reveals its heights. That no tragedy or triumph is forever. We are new every day in our brains and, if we try – in our minds. 

Brain cells have rules for their survival, developing into special cell types that automatically coalesce, from a mysterious force drawing together the components of our brains, as if we were meant to be part of something greater. Individual neurons reach out not just towards neighbours but across vast ensembles, creating forests with trillions of overlapping branches and producing symphonies of brainwaves from a design that favours greater complexity, kinship and possibility. 

Our minds, too, push us towards survival. To cope, we strive towards a coherent sense of self, balancing the cognitive and the emotional, all to make us better equipped for threat, trauma, pressure, performance and loss. Struggles endured and overcome inoculate us for future struggles. Habits of thought, care and discipline in our thinking can harness emotions without becoming harnessed by them. Emotional regulation is not the lack of emotion, rather it is emotion at its finest and most lush. This realization can actually change the very nature of the flesh from which it arises, leaving us with an understanding of how we are anchored in biology, but not imprisoned by it. 

Patients have their own methods of survival. Not every patient suffers well, yet some are triumphant, accessing human nature at its most transcendent, their lives punctuated by growth in trying circumstances. For these people, their diagnosis did not put their life on hold. Not blinded by death, or dying, they are able to find their true priorities, casting aside dis tractions that had long encumbered them. Their ability to see themselves in a new light is their most important transformation, whether it’s gradual or comes as an epiphany. 

In the operating theatre, I have my own rules of survival. I’ve come to savour the craft of surgery, knowing that what matters is not dazzling man oeuvres or groundbreaking operations but the lives patients have when they wake up. Being at my best means engaging emotions in the moment and balancing them, breathing through any fear into a flow state. True performance in the operating theatre means performing in a way that is true to myself. 

I have learned many lessons on survival through my life. Mostly from my patients. They have shown me that the evolution of our interior life is not a constant process but fluctuates in and out of equilibrium; it is both vulnerable and resilient. That introspection and imagination allow us not to be solely defined by our origins but by our direction, too. 

More and more, I am amazed by their gratitude, often thinking to myself: for what? I should thank them for graciously allowing me to be a part of their most intense and intimate moments. And permitting me to learn from their trials: to not wait for calamity to provide clarity. The goal is not to become imperturbable. Savour the joys and create a process for coping through difficult times. 

I thank my patients for trusting me. For teaching me. For so long, I thought myself to be a spectator of their lives. But I have been touched by their journey. Informed by it. Transformed by it.

Excerpted from LIFE ON A KNIFE’S EDGE: A BRAIN SURGEON’S REFLECTIONS ON LIFE, LOSS AND SURVIVAL by Dr. Rahul Jandial. Copyright 2021 by Dr. Rahul Jandial. Used by permission of Penguin Life, an imprint of Penguin Books. All rights reserved.