Mariamma arrives at Saint Bridget’s with Digby and is led to a secluded room where Lenin lies unconscious, emaciated, and bradycardic with hypertension. She notes the Cushing response and has Lenin propped up to reduce intracranial pressure. Her exam reveals a left facial nerve palsy and papilledema.

Digby suggests a burr hole, but Mariamma rejects it, diagnosing obstructive hydrocephalus from a left acoustic neuroma compressing the brain stem and blocking cerebrospinal fluid outflow. She proposes an urgent ventricular tap to buy time, potentially enabling transfer to Vellore if Lenin improves.

In the theater, they mark cranial landmarks and choose the right side to avoid speech centers. Using a twist drill for a small skull opening, Mariamma advances a spinal needle under Digby’s guidance. After an initial pause, clear cerebrospinal fluid flows; the brain visibly relaxes, and she closes the tiny wound.

As the drapes come off, Lenin awakens, tracking from Digby to Mariamma. The room falls silent as he recognizes her and says, “I am so happy to see you.” The successful tap reverses his coma and offers a brief window for further care.