The surgical proposal

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She came to me with her father. They sat in my office for a consultation, looking at me a little tentatively. She looked like she was in her late twenties, hair parted somewhere between the centre and side, distinct enough for me to notice. Her dress had a valley of yellow flowers that resembled the golden fields of the South of France. "This might seem like a strange consultation, but we wanted your opinion on the matter," she said, looking sideways towards her father, who gave her a supportive smile. "I'm looking to get married and have received a proposal," she said, clearing her throat. I wasn't sure what exactly was so embarrassing for them to treat the subject so gingerly. "He's very nice. Has a good job. Earns well. Handsome also," she pulled out a photo on her phone as if I were Sima aunty from Indian Matchmaking. "So wherein lies the conundrum?" I asked. They leaned forward, I'm guessing for me to repeat myself. "What is the confusion?" I simplified. "He told us that his father has Parkinson's. We want to know if Parkinson's is hereditary and if the boy can be affected in the future." And I'm guessing, if it was, they would reject the proposal.

I started by explaining to them that Parkinson's was a degenerative condition of the brain, where dopamine, an important chemical, gets depleted, resulting in tremors and slowness of movement and some tightness in the limbs. "It's very often controlled well with medication, and sometimes, we can even offer an operation called deep brain stimulation if the tremors get out of control," I laid out the basics. In the midst of my explanation, I remembered an elderly couple who had once confided in me not to over-treat the husband's Parkinson's because their sex life was marginally better because of it. But it was not my place to get into this in the current conversation, and, dear reader, I request that you refrain from doing the same in your head.

"It's almost never hereditary," I explained to them, alleviating their anxiety. "And in the extremely rare cases that it is, it shows up early on in life. So, you have nothing to worry about if he's not shaking by this age," I said with a gentle smile. "Any other questions?" I asked. "His uncle died of a brain tumour, he told us. Anything to be concerned about?" the father added. "Certain brain tumours have a strong genetic predisposition," I cautioned, "but it's mostly for direct lineage, as in parent to child, so you should be fine," I said, seeing the relief on their faces. "How many boxes will you check before you get married?" I asked, intrigued by the practice of seeking a life partner. I believe you can be only one of two things in a marriage: lucky or unlucky. We can check as many boxes as we want, but we keep forgetting that they may all be Pandora's boxes. As Cheryl Strayed says, "You don't have a right to the cards you believe you should have been dealt. You have an obligation to play the hell out of the ones you're holding."

"Any ailment in your side of the family?" I asked, mostly out of curiosity. "No," she said instantly, until her dad reminded her that her mother had breast cancer several years ago and underwent surgery, radiation, and chemotherapy. "But she's fully cured now, so nothing to worry about, right?" she assumed. "Breast cancer has a pretty strong genetic disposition, especially if your mom had it when she was less than 40," I said, and they concurred that she did. "I don't mean to get you worked up; all you need to do is get screened regularly," I advised. "Is there any way to prevent it?" she asked. "Regular screening and early detection is the key," I guided. "Some people remove their breasts if they are positive for a certain mutation, but that might be too much," I opined. "We now have whole body genome sequencing for checking our predilection for thousands of diseases, but again, none of these are foolproof," I said, lamenting that despite all the advances made by medicine, we continue to remain so far behind in providing certainty. Nothing is in our control, and yet, we're busy checking boxes.

"So, will you tell him that your mother had breast cancer?" I asked upfront, even though it was none of my business. "I think I must," she said, owning up to her end of the deal. My heart was warmed.

"If you really want to discuss ailments, discuss mental health history in the family," I stated, referring to its under-diagnosed nature. "If you're getting married to a Parsi, there's nothing you can do about it," I joked, "but assuming you aren't, it might be worthwhile discussing," I mourned my wife's plight. "Also discuss bills and money, credit and debt, parenting styles, and what beliefs you'd like to instil in your children. Discuss how you'd deal with the extended family and what your financial and sexual expectations are. Talk about childhood traumas and check if they've been resolved. Speak about your careers and how you'd like them to take shape. Describe your bucket list, your dream home, and your political views," I listed out, my Sima aunty suddenly resurfacing. "And if you really want to go the distance, then cognitive neuroscience allows you a detailed testing of your personality and can identify the exact points of confrontation between the two of you. Knowing those in advance will help you understand each other better and divert the obstacle course ahead with ease," I finished.

"We came here with such a simple question, but we're leaving so much more informed," she confessed with a big smile.

"May you live happily ever after," I wished them the myth.

Six months later, they got married. Then, she brought her husband to me with back pain, which I treated with ease. Back pain in recently married couples has a specific diagnosis (excessive use of the front) but I gave him some exercises and told him he'd be okay.

"So, how's everything?" I asked at the end of the consult. "Parkinson's and breast cancer are the least of our worries, doctor," they both said smiling. I understood. "Marriage is just two people trying to stay together without saying the words ‘I hate you,'" I reminded them of what Jerry Seinfeld once said, and we all laughed together.

The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazda.turel@mid-day.com