The 'Pushpa' CTVS Surgeon

Recently the movie ‘Pushpa’ was creating waves in India. One of the famous scenes in the movie is when the protagonist/hero of the movie vehemently declares that he will not bend. His dialogue reminds me of a great cardiac surgeon who was in AIIMS, New Delhi.

While doing his junior residency in MS General Surgery at AIIMS, New Delhi, Dr. Dev (fictional name) was posted in the Cardio-Thoracic-Vascular Surgery (CTVS) department on rotational posting during. Once, he was assisting in the operation of CABG, cardiac bypass grafting, in which the vein of the leg was taken and attached as a bypass graft between the Aorta and the heart arteries for blockage of the heart arteries. While the chief surgeon was busy doing the main part of the operation in the chest region, Dr. Dev was suturing the skin and subcutaneous tissue in the leg. 

As the leg was at a lower level than the chest, Dr. Dev bent at his waist level and was stitching the wound. Dr. Murli (fictional name) who was his batchmate and was posted in the adjoining operation theater (OT) came to see what was going on in that theatre.

On seeing Dr. Dev bending while applying the stitches, he remarked, ‘Dr. Dev you are lucky that you are not posted in my OT with Professor Sampath Kumar. Dr. Sampath is very particular in having a good posture while working in OT. According to him a surgeon should always stand straight and never bend while performing surgery. If he sees some trainee surgeon take a stitch while bending, he will ask the trainee to remove the stitch and apply it once again while standing in the correct posture.’

Not just for surgeons but poor posture at work if ignored and not actively avoided can lead to chronic pain, fatigue, poor performance, and productivity. This is so important that a branch of science, Ergonomics is devoted to the study of people in their working environment to improve safety and reduce chances of injury. 

Some recommendations for people working for a prolonged period while sitting at their desk are:

Choose a chair with good lower back support.

The chair should be adequate width and depth with proper padding. There should be a gap of around 2 inches between the edge of the chair and the back of your knees.

The chair should have an adjustable armrest so that your arms rest gently on them with your shoulders in a relaxed neutral position.

While sitting, the thighs should be parallel or slightly inclined upwards so that your knees are at the level or slightly higher than your hips. Your feet should rest flat on the floor. The height of the chair should be adjusted or use a footrest. You can use other items such as a small stool, empty boxes, etc. if a proper footrest is not available. 

Keep routinely used objects such as your telephone, mouse, highlighters, stapler, etc. close to you to minimize twisting, bending, or overstretching to reach them.

Use a speakerphone or headset to use the phone while working. Avoid cradling the phone between your head and neck.

The monitor should be directly in front of your eyes, around 2 to 2½ feet from you. The top of the screen should be slightly below your eye level as our eyes are most comfortable position while seeing objects 10-15 degrees below the eye level. 

The monitor and the keyboard should be in a straight line.

The keyboard should be about an inch above elbow level.

The mouse should be close to you and on the same level as the keyboard. Try to learn using the mouse with both hands and alternate between them.

There should be adequate space under the desk for your knees, thighs, and legs. The legs can be easily moved and stretched.

🎯 Be aware of your posture while working. Avoid bad posture even if it is easy in the short term. Learn and practice good posture so that it becomes a habit. Take the service of a physiotherapist or ergonomist to get professional advice if needed. You can also search on the internet for specific advice for your particular job or working condition.

 Lastly, if Pushpa was the resident of Dr. Sampath Kumar he might have said something like this: 

Professor Sampath is my Guru's name

This disciple will not bend

 NB: This is not a scientific article. Please verify the facts yourself before trying anything.

— ND

(Based on allegedly true incident.)

© Author. All rights reserved. 

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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. 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 NMC and other Board norms.

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NB: This is not a scientific article. Please verify the facts yourself before trying anything.

— ND

(Based on allegedly true incident.)

© Author. All rights reserved. 

Please share this post on WhatsApp, Facebook, Twitter, Pinterest, etc.

If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

Please give your valuable feedback via the comments below. Please note that comments will appear later only after moderation. Please Log in with Google Id before writing comments.

You can receive a notification on the latest post by subscribing via clicking on the bottom of the page on the Subscribe to: Posts (Atom)

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. 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 NMC and other Board norms.

 

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

© Author. All rights reserved. 

Please share this post on WhatsApp, Facebook, Twitter, Pinterest, etc.

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Please give your valuable feedback via the comments below. Please note that comments will appear later only after moderation. Please Log in with Google Id before writing comments.

You can receive a notification on latest post by subscribing via clicking on the bottom of the page on the Subscribe to: Posts (Atom)

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.