The League of Extraordinary Surgeons...!

After about a month of completing my postgraduate training in Orthopaedic surgery at India’s first rural medical college, whose foundation stone was laid by none other than our late Father of Nation himself; I joined a multi-specialty hospital owned and managed by the Asia’s largest corporate health care provider situated in the capital city of the Indian Republic . As could be anticipated, I was taking my own sweet time in coming to the terms with a diametrically differing set of circumstances, both at home as well as at the hospital. In the spring of 2004, on a sunny Friday morning while I was on routine ward rounds with my consultant, he told me that after the rounds we would be seeing a patient referred to us from the surgical specialty for a wound on finger.

There was this elderly gentleman lying lazily on a propped-up bed with bandages wrapped on both the arms, legs lying like logs of wood with intra-venous drip hydrating him leisurely, wrinkled loose skin with visible, subcutaneous hemorrhagic patches covering his limbs but still he was managing to flash a welcome smile through his visibly tired face. Looking at all him, I barely expected a heavy confident voice emanating out of his rough, rusty throat to greet us straight in our faces – “Hello! How are you doctor”? The consultant had some patients waiting for him in the out patient department, so was in a bit of hurry; he engaged the patient in talks and asked me to quickly wear gloves and examine his right index finger. This finger had developed osteomyelitis (infection of bone) of middle phalanx secondary to some soft tissue injury sustained years back and had been operating all these years with an ulcer sitting on it. The bone was wickedly glancing at us through a chronically painful, foul-smelling and non-healing ulcer at the inner aspect of the finger.

The decision to amputate that chubby right index finger was obvious in those circumstances; this was elaborately communicated to the patient; as if he had been discreetly anticipating the same, promptly came the question, as a form of reaction, barely expected by us whenever we take such decisions – “So, when can we do it, doctor?” The consultant addressed his query and left asking me to dress up the wound nicely. I completed one of the most gentle dressings of my lifetime and was about to say bye to this old man when he interrupted my thoughts by saying “sit down for a while, son”, feeling very hungry I just wanted to leave and tried to bluff him by saying that I would be back after finishing my rounds. But, a definite air of authority in his request just compelled me to sit and I found myself seated on a near by chair even before I could voluntarily take a decision regarding the request–cum-order.

He started off by saying that he first developed the injury on his right index finger a good thirty five years back when he was a fresh, enthusiastic surgeon motivated to serve the under privileged masses in southernmost regions of rural India. I blinked my eyes in disbelief, man – all this while I had been talking to a surgeon of yesteryears now struggling to keep up with the pace of life, which had dramatically turned around for him after he had sustained a presumably trivial fall prior to which he was absolutely independent and now is almost bedridden; all this happening within a surprising span of minutes when he unfortunately managed to lose his balance. Now, I realized why that professorial authority emanated from his seemingly fragile frame and from the every word that just whistled past through his thin, puckered lips. Having served in rural India for the last decade – at a time when India is being hailed as an emerging economic superpower and the health care infrastructure deeper in villages being worst than what the word dismal summarizes it up for you. I could hardly imagine what kind of facilities and problems he must have encountered while he was struggling to keep rural masses healthy in those times when the yellow light of a tungsten filament bulb was a celebrated luxury afforded only by the rich and influential, though it still is the case even now in some parts of this poor, over populated but rapidly transforming economy hailed as the next superpower.

He used to work when hospitals were as good as make shift huts or dispensaries were more of a rarity near by or in a village; he used to first administer the anaesthesia himself and then operate upon the patient assisted by auxiliary nurse midwives. He at this moment knew more about anaesthetic drugs & their doses than I could barely recall or would ever try to know in my lifetime, in spite of trying hard to keep myself in the thick of academics as far as possible; he had operated on human body from head to toe which is hardly possible for a single surgeon today, coz surgery as a specialty is fragmenting with every single day that passes by; he had encountered and successfully managed more complications than I would probably ever be a part of in my specialist surgical career. An hour quickly passed by just as a few minutes would do, as if I was glued to my television soap. Only when a nurse peeped in from the partially ajar door and requested him that his bed needs to be made, that he permitted me to leave on the promise that I would return back after finishing my ward chores.

Next day, when I met him in the pre-operative room, he was cool as a cucumber with out displaying any signs of anxiety what-so-ever; he just requested to be shifted on to the operating table very delicately as he was concerned more about his painful legs than the index finger of his once operating right hand. While performing amputations in his career as a surgeon, he must have hardly realized that the same surgical blade would be doing the similar honors for the most active finger of his dominant upper extremity. He was wheeled into the theater leisurely, shifted onto the table very diligently and as soon as he looked towards the ceiling mounted operating lights he whistled in delight and exclaimed in ecstasy “wowww..!!...doctor you are damn lucky to have such beautiful crystal-clear prismatic surgical lamps out here” later mumbling slowly, “I hardly used to get the services of a candle or a torch”. Ironically his joy was quite short-lived and was interrupted rather painfully when one technician suddenly but inadvertently lifted up his swollen legs to adjust the sheets below him, he just screamed in agony “oouchhh..!!!...please, please don’t touch them, they hurt very much.......oh god!” and was almost in tears. The anesthetist embarrassingly apologized and calmed him down saying “sir, please do not worry, no one would even touch them now”.

He was prudently offered a median nerve block at the wrist to knock off the sensations from the part to be amputated, which he gladly accepted knowing well the efficacy and comfort of operating in a nerve block and its benefits to the patient too; for which he was obviously more concerned, as for once in his lifetime now he was lying over the operating table. Ironically then, my consultant explained everything about the procedure to a patient, who as a doctor had been doing this for all his life. But, believe me on that day I realized how important this step was and then wittingly this patient requested my consultant to be cosmetic in closing the amputation stump saying “doctor, please avoid dog ears”. The operation was over quickly, and then I glanced at the finger that was moving with poise just a few minute earlier, now was lying lifeless in the kidney dish, like a fish that had been brutally pulled out of water. He surprised us all, by immediately asking, “do you know that I have now joined the league of a famous surgeon who operated whole his lifetime without the services of his right index finger?” the answer was obvious, Sir Hamilton Bailey, the great British surgeon. I saluted this old man’s die-hard positive attitude towards life.

A couple of days later he was discharged from the hospital after taking a look at his surgical wound which was doing fine. Wandering in the wards about a week later, I chanced to pass by the room where I first met him; I just wondered what would have been the result of the histo-pathological examination of that excision biopsy. I immediately reached out for the phone on the nursing station and rang up my consultant; he whispered slowly - "doctor, it was squamous cell carcinoma".