The Two CTVS Surgeons

Dr. Dev (Fictional Name) when he was a junior resident (JR) in the Department of Surgery, AIIMS, New Delhi, was posted on rotation posting to the CTVS (Cardio-Thoracic-Vascular-Surgery) department.

He was to report daily to the operation theatre (OT) at 8.00 am and do alternate day ward duty in the evening and night. 

A Warning: Unlike, Dr. Shahid Hasan (Fictional Name) in The CTVS Selected Doctor https://agnipathdoctors.blogspot.com/2020/05/the-ctvs-selected-doctor.html, before the rotation posting, Dr. Dev had limited exposure to the CTVS department and the Surgeons working there. Even there, he was on the fringes, not privy to the life and thinking of the surgeons working there, so his impressions are at the least incomplete if not entirely wrong.

Professor P. Venugopal was the head of the CTVS department at that time and Dr. Dev was initially posted in Professor Balram Airan’s OT and then later posted to Prof. Venugopal’s OT. 

Before his CTVS posting, Dr. Dev thought that only the JR in surgery were the most hard-working doctors in AIIMS. 

He was shocked to see even the senior cardiac surgeons in the CTVS department working 14 to 20 hours a day. First, there were the pre-OT rounds to see the patients operated the previous days, then the long OT hours with the operation going late in the evening, then the ward rounds and in between the urgent call to see any serious patient or re-exploration for some complication in a patient operated before. This was in addition to the Out-Patient clinics, and the teaching classes and the research activities and, last but not the least, the administrative work. 

The stress, the tension, the long work hours was just unimaginable. Watching them work continuously where sometimes one-day changes to another workday without a break makes you feel that all cardiac surgeons are aliens or robots. 

After a few days, Dr. Dev noticed that not all cardiac surgeons are following the same routine of work, work, and work. 

While Dr. Dev was assisting Dr. Balram Airan in the first case of the day, a CABG (Coronary Artery Bypass Graft, or ‘Heart Bypass’), a senior cardiac surgeon entered the OT. As Dr. Dev later learned, he was Dr. A. Sampath Kumar. 

Looking around he remarked, ‘Oh, CABG. Looks quite complex.’ Midway in the operation with the most difficult part underway, Dr. Airan just made some acknowledging sound and kept on working. The Mch senior resident, perhaps to sound civil to his teacher, asked, ‘How are the cases in your OT, sir?’ Dr. Sampath replied, ‘I am going for lunch. The senior resident is closing the last case in my OT.’ 

This was a moment of epiphany for Dev. He started looking around and observed things that were a revelation.

Most cardiac surgeons in AIIMS used to post either a single case of CABG in their OT or in combination with a simpler (relatively) case like heart valve repair/replacement or ASD repair so that their OT finishes by early evening. Dr. Venugopal used to run two OT simultaneously and used to operate a minimum of one CABG case in each OT with sometimes even 2 cases in one of the OT. He had two teams of supportive surgeons, which will start and finish the cases while he goes from OT to another without taking a break. Sometimes his operation time gets extended to the night.

In contrast, Dr. Sampath used to post only a maximum of two or even one cases of heart valve repair or replacement in his OT.  He used to finish both cases before other surgeons used to finish their first case of CABG. So, he was able to have a leisurely lunch and have the rest of the afternoon free for his other work, while other surgeons were toiling in the OT. This enabled him to even have time to go to the college gym in the evening and play a game or two of badminton.

There were other differences as well. The patients for CABG were usually elderly, well connected, rich, or VIPs. The patients posted in Prof. Venugopal’s OT were usually big politicians, senior bureaucrats, the ultra-rich, or their relatives. The patients with CABG usually had other co-morbidities such as hypertension (Increased Blood Pressure) or diabetes, requiring much more close watch and care in the post-operative period. So, the surgeon performing CABG had to do frequent hospital visits and do close personal monitoring of his patients, keeping them busy and worried, and leaving them little personal time. In fact, even with a well-qualified team of doctors to take care of his patients, Dr. Venugopal used to stay for almost 18-20 hours in the hospital.

In contrast, the patients coming with a defective heart valve were usually from a poor socio-economic background. They were generally not so choosy or demanding as the patients coming for CABG. They used to get satisfied by the senior resident taking care of them and not demand the senior cardiac surgeon to attend them personally in the evening or night time. So the cardiac surgeon operating on them had a relatively relaxed mind and more free time in the postoperative period. 

But the opportunity for fame and fortune was in operating on the rich and VIP patients with CABG. Cardiac surgeons skilled in CABG operation were in high demand in the private sector with big pay packages.

So, choosing what surgery to do, how many to do, what kind of patient he will serve, Dr. A. Sampath Kumar was able to strike a work-life balance.

When it comes to your profession or work, what are you? Are you like Professor P. Venugopal or like Professor A. Sampath Kumar?

Whatever it is, remember: It is a question of your choice.

 

Don’t blame your job, your career, your industry, your profession for the lack of your time, or ill-effects on your mind or body. 

It is you who have chosen to give or not give the extra time to your work.

It is you who have chosen to relax or work hard for progress in your life or career.

It is you who have chosen to have success or peace from your profession.

It is you who have chosen to earn fame and fortune or obscurity and paucity from your profession.

It is your choice.

Love it or Leave it.

Please also read 'Where is the Time' https://agnipathdoctors.blogspot.com/2020/05/where-is-time.html

(Based on allegedly true incidents)

— ND

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your 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 norms.