by Dr. K. Javeed Nayeem, MD

Being constantly by his side, Dr. Shivashankar Halkai and I naturally used to get many chances to assist Prof. Narasanagi during operations as our college then did not have post-graduate students who now do most of the minor surgical work and assist their professors in all major operations. During our free time, Dr. Shivashankar and the senior operation theatre nurse, Saramma would teach me how to tie the different kinds of surgical knots which they had mastered exceedingly well under the training imparted by our mentor. With our constant association and practical interaction, a stage soon came when Prof. Narasanagi would ask Dr. Shivashankar, Saramma and me to start ‘opening up’ as soon as we called him over the phone to inform him about the need to come for an emergency operation.

He would then arrive and take over the main part of the operation after finishing which he would again ask us to ‘close up’ while he watched our work with an eagle’s eye. Whenever one of us was a little apprehensive about doing some tricky part of a surgical procedure, he would say “Useless fellow, don’t hesitate. I’m watching you closely. You need to have a lion’s heart. Be bold and go ahead, it’s not so easy to kill a man!” He was such a committed teacher that he would not let any of us go home after his classes until everyone in the group answered every one of his questions to his full satisfaction. The result of this insistence was that we would all interact and help each other to meet his expectations thus ensuring that even the dullest members of our group mastered the subject which was actually the man’s game plan!

Once we had a situation where a truck driver had been very badly injured with much blood loss. Prof. Narasanagi examined the man and advised us about the treatment protocol although he expressed much doubt about the man’s survival. Upon my request he allowed me to do a Venesection on this patient independently. This is a procedure where a peripheral vein is surgically exposed and a cannula is inserted into it to allow intravenous fluids to be transfused quickly to maintain blood pressure and circulation. The nurses quickly put up a screen across the waist of the patient while I seated myself on a stool at his foot end and started working on his ankle. The other doctors were busy managing the head end of the patient, inserting a tube into his wind pipe and giving him artificial respiration with a bladder-like device called an Ambu Bag. Assisted by an experienced nurse I took my time with my first independent attempt at such a procedure and I managed to do a pretty neat and surprisingly bloodless job of inserting the cannula into the vein.

Once it was over, hiding my sense of elation, I looked at my professor who was standing behind me and watching my work and asked him if the procedure was satisfactory. He smiled and thumped my back hard and said “Congratulations my boy, you’ve done a great job. The only problem is that although it has given you valuable experience it will serve no useful purpose for your patient because he has been dead for the past forty-five minutes! Did you not notice that he had stopped bleeding long ago?” That is when I realised that the reassuring absence of blood loss was not because of my proficiency and skill but simply because the patient’s heart was not beating at all! All the others in the room, especially the young student nurses, had a hearty laugh at my expense while I looked like a stupid fool.

The great teacher that he was, my professor had quietly instructed all the others in the room to remain silent and allow me to work without interruption to keep my morale high! While we were interns we used to do many odd jobs in the emergency room including suturing injuries and bandaging wounds. And, when it came to bandaging it was no big deal except when the part to be bandaged happened to be the patient’s head. Now because the head is a round object, no matter how well we did it, the bandage would not stay for long and it would simply slip off even before the patient reached his home, entailing a return to the hospital!

Our repeat attempts would only make us look like fools in the eyes of the patients’ relatives who would ridicule us at our lack of competence. But very soon through the hospital grapevine I gathered that there was a retired ward boy called Narayan who was an expert in bandaging the head. With a great deal of effort I soon located this elusive man who naturally was no longer a ‘boy’ and with much greater effort I persuaded him to teach me the art and science of bandaging the head. I spent an evening with him in my room being his pupil having persuaded my errand boy, Syed to be the dummy patient. And, lo and behold, in less than an hour I found that my bandages were staying put on Syed’s head no matter how violently he shook it. Elated beyond expression, I thrust a ten Rupee note into each of their hands and I packed Narayan and Syed off to have a sumptuous dinner!

I kept this project top secret from all my classmates and teachers but soon they began to notice the vastly better quality of my work and all the patients whose heads needed to be bandaged a second time would naturally be referred to me. I had suddenly become Narayan Junior! One day Dr. Narasanagi saw me at work seemingly with a look of admiration and asked me how I had mastered the art. “By much practice Sir,” I replied very humbly. He nodded his head and said “Very good, you’re doing a good job. Keep it up.” I felt like a hero in front of all my class mates.

Then he put his arm around my shoulders and walked with me up to his car and stopped there. With his arm still around me he smiled and asked me “Rascal, now tell me honestly how much you paid Narayan?” And, I told him. He then said “My son, you can learn things only when you conquer your ego. You have done it and that is why you are learning things which although seemingly very small will yet make a very big difference in your life. I feel very happy that you have this attitude and humility to learn from people as ordinary and humble as Saramma and Narayan!”

Contrary to my plans and although I had a great desire to become a surgeon, I ended up qualifying as a Physician later on in my life. The reason for this is that although I had got a seat for both the specialties, one at Mysore and the other at Davangere, while choosing between Surgery and Medicine I chose the latter because I felt that I would be happier working alone rather than with a well-organised team all through my life. The need to look after our coffee estate, located in a very remote area, also influenced my choice to a certain extent. However, this very unusual decision of mine made Prof. Narasanagi feel very sad and disappointed with me. It took him much time and effort to come to terms with it but the intensity of his love and affection for me thankfully remained the same for the rest of his life.

But although I became a physician, the ‘hands on’ surgical experience that I had gained during my under graduate days with Prof. Narasanagi helped me to independently manage almost all surgical and gynaecological cases even in the absence of the respective specialists when I had a long stint in the remote Holy Cross Mission Hospital in what was then considered the notorious ‘Veerappan Territory’ for many years. It was a place where my colleagues and I used to see and treat the poorest of the poor patients with no means to go to cities for the treatment of even their most serious problems. I used to at times be physician, surgeon, gynaecologist, orthopaedician, anaesthetist or dentist, depending on what problem the patient had. I also used to maintain and repair all the hospital equipment, pumps, generators and jeeps!

My wife and I used to stay in a solitary house in the middle of nowhere on a thirty acre plot of land, completely cut off from civilisation. But we enjoyed our stay and I enjoyed my work and that is what mattered most. Our humble abode served as holiday home for dozens of our relatives and friends who would lose no chance to come down and spend many happy days with us. The years I spent there were the most fulfilling years for me both professionally and personally.

[To be continued]

e-mail: kjnmysore@rediffmail.com

source: http://www.starofmysore.com / Star of Mysore / Home> Feature Articles / August 05th, 2016

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Part II contd..

Over a cup of evening tea : My last meeting with my Mentor 

by Dr. K. Javeed Nayeem, MD

In the year 2000 when I had been to Gulbarga with my family for the Silver Jubilee reunion of our batch, Prof. Narasanagi had retired and settled down at Bijapur. To pay my respects to him, I decided to return via Bijapur although it would entail a fairly long detour and so I called him up a day earlier from Gulbarga to say that I would be dropping in to see him. He was very excited to hear my voice and said that he would be very happy to see me after such a long time. When I met him the next morning, although he said that he was overjoyed to see me and my wife and children too, I could not help noticing that he was not at ease with himself.

During the course of our conversation he asked me if there was anything he could do for me. When I told him that the sole purpose of my visit was to meet him and pay my respects to him, he seemed visibly relieved and happy. He then became silent for a long time before saying “Javeed, I’m touched by your gesture and overjoyed to meet you and your family but let me confess that when you called me up yesterday to say that you were coming to see me you really gave me a sleepless night. From the moment you called me up I was wondering what the reason for your visit could be and whether I would be able at this age to fulfill your request if you had any. I even wondered whether you would be asking for my help in getting your daughter a medical seat here or at Gulbarga. I would have been heart-broken if you had asked for some help which I couldn’t extend to you!”

Once when my father visited Gulbarga to see me I took him to meet almost all my senior professors. When he met Prof. Narasanagi and asked him what impression he had of me my professor looked down, paused for a long while and then raising his eyes he said, “Sir, you have left a diamond in Gulbarga and I’m only polishing it. But mind you, polishing a diamond is very hard and slow work but don’t worry, I’ll do it to perfection!”

Talking of diamonds brings to my mind one more interesting incident about Prof. Narasanagi. As the time for our final year examination neared there was a strong rumour that he would become our internal examiner. Naturally all the students of our batch were happy that he would protect our interests if any of us ran into rough weather with any of the difficult clinical cases. But when the examination started we found that he was nowhere around. Thankfully, everything went very well with all of us and I in particular scored very high marks in all subjects including surgery.

While my close friend Ravi Dhaded scored the highest marks in surgery I stood second. When I went to meet Prof. Narasanagi after the results he congratulated me and said that he was very happy and satisfied that I had fared exceedingly well. He then revealed to me that he was supposed to be our examiner but he had turned down the offer of examiner-ship because the closeness he shared with me would seem unfair to the other students if he became our examiner! He then said, “You see, I am very particular that the diamonds that I polish should be absolutely flawless! No one should cast aspersions on their quality!”

Another lucky break in surgery

Having narrated the special relationship I had with Prof. Narasanagi, who was a really great surgeon and teacher, I feel I should tell about another chance encounter that introduced me to another great soul and enriched my life. Life is full of such serendipitous incidents and my life in particular seems to be richly endowed with them which are a great boon to the fledgling writer in me. This one is about how another very great surgeon took a liking for me and took me under his care and guidance due to a most unexpected turn of events.

Once very early during the course of my first posting in surgery I was among a group of students who were waiting to watch Dr. S.S. Hussain perform an operation. I just happened to be there in the operation theatre although I was never attached to his unit having been posted to his second-in-command, Prof. Narasanagi’s unit. Now, Prof. Hussain was the Head of the Department of Surgery and he was the person who held the record of having performed the highest number of Gastro-Jejunostomies in the country during his time. This operation was a kind of bypass that used to be done to overcome the narrowing of the duodenum and cure ulcers in the stomach at a time when specific drugs to suppress acid secretion were not yet on the scene. The arrival of this class of drugs has almost wiped out this operation which is now done only as a last resort to prolong the life of patients with stomach outlet cancer.

Prof. Hussain was a grey haired, stocky man and his most striking feature were his short stubby fingers which seemed completely out of place on a surgeon’s hands. An age old adage in surgery is that a good surgeon should have an eagle’s eyes, a lion’s heart and a lady’s fingers! While he certainly had the first two, Prof. Hussain certainly did not have the last of these three attributes. But he was a wizard when he picked up his operating knife and it was a joy to watch him at work especially when he was performing his favourite operation. Even as one saw him stitching layer after layer of tissues and wondered what was happening the net result of his handiwork would suddenly become evident as if by magic.

That day as Dr. Hussain emerged from the scrubbing room with his arms held aloft he seemed to be upset and furious about something. He looked around gravely and asked if anyone wanted to assist him in the operation that he was about to do. Seeing his angry countenance all those endowed with better judgment and common sense held their ground while I impulsively raised my hand and stepped out of the tightly huddled group of students. Being in the first clinical year I was actually among the junior-most ranks present there and my adventurism would have been seen as the most rash and disaster-inviting act by all my seniors of two years who were also in attendance there.

So when Prof. Hussain asked me which year I was from and I answered that I was from the first clinical year, they could not hold back their laughter despite their best efforts. He then pointed to the scrub room and said “Good, if you are sure that you want to assist me, for a start you can begin by cleaning all the three wash basins in the scrub room by the time I finish this operation. They are in a disgusting state and I hate it. And, mind you this too is very much a part of assisting me in this operation! Now that you have volunteered, please get to work.”

This time none of the others in the room made any effort to suppress their laughter which echoed around the room. After the commotion died down, Prof. Hussain and all the others entered the operation theatre and I entered the scrub room, alone. Yes, the wash basins there were indeed in a disgusting state, thanks to a lack of commitment in whoever was committed to keep them in a usable state. Wasting no time I pulled on a pair of surgical gloves and got down to work with a stiff brush and plenty of soap and in less than an hour I had them as sparkling clean as they had perhaps been when they were installed years ago.

When Prof Hussain emerged out of the operation theatre he walked into the scrub room and came out immediately with his blood stained hands still clasped together tightly. He looked at me long and hard and asked “Young man, what does your father do?” “He is a coffee planter and a former professor of Psychology Sir” I replied. “Ah, a coffee planter and a professor of Psychology! Very interesting, Very very interesting. Well, you may just be a first year clinical student but from now onwards, whenever I happen to be operating and whenever you happen to be free from your classes, you can scrub and join me as my second assistant. Young man, I’ll teach you how to operate!”

e-mail: kjnmysore@rediffmail.com

source:  http://www.starofmysore.com / Star of Mysore / Home> Feature Articles / August 17th, 2016