This had to be done... There aren't enough cynics around

Times Change...

It has been almost one year. And how things have changed… and not changed. I am back in Chennai… as a student… first year for the third time... parents have moved to another city… CSK is back… Roger is back… But just like Rafa and the clay court, some things don’t change… like me liking a girl and being bat shit scared about talking to her about this because of cultural and ideological differences… poor pay and difficulty in obtaining leaves. But I got over the fear of asking for leave and hence I found myself in a shitty coach in an overpriced premium train and it made less sense than a Kamal speech. I was dabbing the dosa in a very unSaravanaBhavanish  sambhar, wondering how the quality of the once spectacular restaurant had gone down the drain, all in a matter of years.

Speaking of institutions that once were deservedly held in high regard but are now pale shadows of their former selves, I have been a resident in Neurosurgery for the past 10 months in a 'premier', very old teaching institution/hospital in Madras. Of the dozen major cases and three score minor cases I have done, I have around fifteen alive men and women to showcase my hard work.  The hardest part here is not the sleepless nights or the operating room that is hotter than the innermost circle of hell, but it is the apathy and ignorance and ignorance of the apathy that was more common than the paracetamol prescription in an ortho OPD or a mismanaged trauma case in emergency ward. A week back, there was yet another death. The surgery went fine. The man showed a marginal improvement. Yet inexplicably, he died. The look on his widow’s face still haunts me. For a brief second, Mrs. P’s optimistic face came in front of my eye.

The first anastomosis (here, joining two non-adjacent parts of the bowel because the intervening part was non-viable and toxic) that leaked happened on the second anastomosis I had performed on the same patient- Mr. P. It happened on post-operative day 14. By that time, his heart had gone into irregular beating, he developed a reaction to transfused blood, his lungs were washed out and he was loaded with steroids. Yet, he soldiered on. His wife believed in us. We had once managed to save him from a precarious situation. He withstood another surgery to treat the leak. But his weak lungs gave away. We lost him after a month in ICU. It brought out the best and worst in me and the best in my junior colleague. With the very little the setup had to offer, we kept him alive aided by his strong will and presumably the prayers of his wife.

The anastomosis I did immediately after this leak was so difficult for me that the above said colleague had to reassure me after every bite. All went well for that lady. But Mrs. P wasn’t lucky. Yet she brought her son to me. She trusted me. Moments like that are what we live for. Be it Mr. R- brought intubated without the ability to withdraw to pain- walking home after surgery (performed under able supervision, of course) or seeing your junior perform a difficult surgery admirably. These joyous moments let us live to break the bad news to a young wife or an old father who had lost his only hope. After all, as JD paraphrased, every surgeon worth his salt carries with him a cemetery of all those who died under his care only to revisit the memories and find solace.