A patient suffering from Peripheral Vascular Disease, i.e. decreased blood supply to the limbs, in this case to the left lower leg and foot, was admitted to the surgical ward in AIIMS, New Delhi. Dr. Dev, (Fictional Name) was the 2nd year surgical resident at that time. Professor (Dr.) Tarun Kumar Chaturji (Fictional Name) had advised the operation of Lumbar Sympathectomy in this patient.
In this operation, a group of nerves, known as Lumbar Sympathetic Chain is removed surgically. This increases the blood supply to the skin of the foot and lower leg.
All the residents were excited as Dr. Tarun Kumar Chaturji, usually, allow the residents to do this operation. Although there were two Senior Residents (SRs) and two 3rd year Junior Residents (JRs) senior to him in the hierarchy, Dr. Dev went to the AIIMS library and read about how to do the operation from 3-4 operative surgery atlas-textbooks till all the steps of the operation were clear in his mind.
The day came when the patient was posted for surgery. Professor Chaturji, being busy in some administrative work could not come to the Operation theatre (OT) on that day. Dr. Dev, the 2nd year surgical resident, Dr. Ramesh (Fictional Name) was the 3rd year surgical resident and Dr. Rajesh (Fictional Name) was the Senior Resident (SR) present at that time in the OT.
Dr. Ramesh, the 3rd year resident saw this as a golden opportunity. He requested the SR, Dr. Rajesh, to allow him to do the operation as the chief surgeon while the Senior Resident supervises him while doing the operation. The SR, Dr. Rajesh, was from the immediate senior batch in MBBS from Dr. Ramesh. They were also both living in the same hostel floor and were quite friendly even before joining Surgery Department. The SR quite readily agreed to Dr. Ramesh’s request and asked Dr. Dev to get ready to assist in the operation.
Suddenly, like a Ring-master entering the centre-stage, Dr. Tarun Kumar Chaturji, entered the OT. A silence descended in the OT. Dr. Chaturji walked up to the OT list stuck on the wall and reading it exclaimed with delight, “Ah, Lumbar Sympathectomy!”
Turning to the group of residents standing in the corner, he asked: “Which of you have come prepared to do this operation?” Dr. Ramesh, the 3rd junior resident, who was quite excited to get the opportunity to do the operation of Lumbar Sympathectomy suddenly became very quiet.
A word on Dr. Tarun Kumar Chaturji’s style of teaching operative surgery. Like ‘Life’ which takes the exam first and teaches you later, Dr. Chaturji used to grill you first then add some pearls of wisdom later.
He will first start asking questions about the history of the patient’s illness, the physical findings on clinical examination and the reports of the investigations done. If the resident is able to answer this question, he is asked to continue further and tell about the incision (cut) he will use in that operation. If the resident answers this satisfactorily, then he is allowed to start the operation.
If the resident continues to do the steps of the operation accurately at the same time answering Dr. Chaturji’s questions, he is allowed to proceed further till the operation is over. If at any stage the resident makes some mistake or is not able to answer Dr. Chaturji’s question satisfactorily, he asked to leave the OT or at least step down from being the operative surgeon to the position of the assistant frequently accompanied with a verbal blasting.
Dr. Dev looked at the SR and his senior 3rd year JR whether they will rise up to the challenge thrown by Dr. Chaturji. He wanted to tell Dr. Chaturji that he had studied to do the operation but he kept quite so as not to offend his seniors. But, the SR and the 3rd year JR on seeing Dr. Chaturji had become nervous and quite.
Since no one answered, Dr. Chaturji, once again asked, “Who had come prepared to do the operation?” Again it was met with silence from the SR and the 3rd year JR side. Seeing that his seniors were not venturing forth, with trepidation, Dr. Dev answered, “I had come prepared to do the operation.”
A surprised Dr. Chaturji looked at the relatively junior Dr. Dev and asked him to come forward. Dr. Dev complied. Dr. Chaturji taking the patient’s case-sheet in his hand started asking questions regarding the patient’s present illness, his physical finding and the investigations done. Dr. Dev managed to answer these questions satisfactorily.
Dr. Chaturji asked Dr. Dev to start the operation and the Senior Resident and the 3rd year Junior Residents to come work as the assistant in the operation. The SR and the 3rd year JR looked angrily at Dr. Dev but meekly complied due to the presence of Dr. Chaturji. So the junior most doctor became the Chief surgeon while being supervised by Dr. Chaturji, and his seniors became his assistant.
This how Dr. Dev performed the first Lumber Sympathectomy of his life.
Tip: If some interesting or unique operation/procedure/project come in your unit or department, keep your hopes high and study and prepare for it. You may be allotted the case even if due to your juniority this is highly unlikely. This will provide you with golden opportunity to impress your boss if you are well prepared.
Tip: Sometimes you may have to displease your seniors by volunteering to take on some challenge thrown by your boss. Well, you cannot please all the people all the time.
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behaviour illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost.
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behaviour illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm.
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