anonymous

Leader of the Team - 8

 Leader of the Team - 8
 Dr.V.N.Shrikhande

I do not do any transplant work. But kidney transplants are becoming more and more common. Time and again there are discussions about the ethics of transplant. Unfortunately our country has earned a bad name abroad, about the unethical modus operandi in getting donors for transplants. Cases are reported of poor people being brought to Bombay only to have their kidney removed for which they are paid a pittance. One does not know the frequency of such cases of cheating. We are living in a world where money can buy anything and everything.

The only corrective to dubious practices regarding organ donation is by changing the definition of death. When there is an irreversible damage to brain called brain death, the law should accept that the person indeed is dead even if his heart, lungs, kidneys and liver are working. All these organs can then be used for transplant. But we have not yet changed the law. That requires political will. Even our curriculae have not changed though the information at our command has drastically altered concepts of disease and their management.

 

I have observed a sea of change in the last fifteen years in the use of modern technology in the management of surgical problems. Whenever anything new is introduced, there are people who oppose it; some accept change with blind enthusiasm. There is no doubt that modern technology has increased our confidence in collecting accurate information and also in solving some specific problems. It has altered the scope and zone of activities and plans in specialities amongst medical men. An endoscopist who is not a surgeon can remove a stone in the bile duct. A Radiologist under X-ray control can perform a similar job via a different route. This has both solved problems and created problems. The world fears a new experience. Hard-earned skills can be displaced by a new technology. Indeed, some hard-earned skills come to have decreasing utility value. Readymade clothes produced on a mass scale have made many tailors redundant. Discovery of ball point pens must have manufacturing blotting paper. Telephone and Fax have been responsible for the decline in the art of letter-writing. Even conversation has become a less-practised art under the impact of television. One can watch wars, Olympic games, Cricket Tests and Wimbledon from bedrooms and the philosophy "the universe is my home' is replaced by ‘My flat is my Universe’.

Where once people gathered for a social purpose, now they tend to live in isolation. Individuals suffer from problems related to stress which affect the smooth functioning of the body organs. Today we often see patients who are afflicted not by diseases but by disturbances. They belong to three types:

* Those who have a specific disease.

* Those who think they have a disease.

* Those who suffer from a disease, but couldn't care less.

The patients belonging to the first category are described in textbooks. The classical picture of a disease is not very common. Patients belonging to the third category do not approach the doctor because they have no discomfort or pain. Even now pain is the most important symptom that brings a patient to a surgeon. Some serious diseases like cancer where there is no pain remain neglected by patients. When pain subsides in diseases like gall stones, the assurance that they will get the operation done is forgotten, basically because nobody likes an operation. Patients belonging to the second category are increasing rapidly. Patients come to us with several symptoms but there are no signs of any disease. Many times, symptoms are so vague that nobody understands them. Investigations are therefore asked and often repeated. The patients come with thick files that contain a lot of investigations. We are living in an era of supermarket of investigations and an uncritical doctor may go on multiplying investigations in a futile attempt to diagnose a disease that does not exist. A doctor who is aware of a close link between the body and mind should be able to see through the patient who has symptoms resulting from a restless mind. A good diagnostician is one who arrives at a decision without ordering a plethora of investigations. Modern tools and technology are certainly a great asset but to some they have become Gods, little realising that they are bad masters for uncritical doctors.

There is a great deal of curiosity about a surgeon's life. A great deal is exaggerated. Laymen are awed by the skills of a surgeon and by reports of the kind of income they have. What is forgotten is that it takes many years for a surgeon to establish his reputation. At the peak of his career which usually comes in the evening of his life, a surgeon may have a large in come but even that wouldn't be much in comparison to what someone, say in real estate, may earn. And a surgeon works under great stress. It may sound unbelievable but there have been occasions when I had to operate under the light of a torch. And one often works under a great sense of loneliness and of functioning under incomplete data.

After a day's hard work at the Operation Theatre, it is a strain to look fresh, smiling and cordial to friends of patients. Telephones at night are a nightmare. My basic need is six hours of sound sleep, a hot cup of tea and an evening meal without the telephone bell's imperious summoning. I am surrounded by unread books, unreplied letters and phone calls. They deny me a zone of comfort.

There is a lot of criticism about the commercial and unethical behavior of doctors. This criticism is, in general, a justifiable one but I know of surgeons of outstanding ability and integrity who have worked against great odds and with a sense of total commitment and service. Moralists should look at the services of a surgeon in a holistic way.

I enjoy surgery because I like to express myself through skills I have mastered over a long period. My work gives me aesthetic pleasure. I see pain giving way to joy. Very few professions make such transformation so apparent as successful surgery can. A surgeon's rewards are truly great in that sense. Should I be reborn, the profession of my choice would still be surgery.

There is a letter which I once received from a young surgeon. It said: "I was very much impressed by the demonstration lecture you gave which cleansed my mind of all false ideas about gall bladder disease. Really, your students must be lucky. I am very keen to learn more of surgery directly from you. Sir, are you ready to teach me?” I have always encouraged students and colleagues to come as observers. I can teach them how to think, even explain the details of technique but it is impossible to transfer the art of surgery to someone else.

One young, brilliant surgeon from a taluka town spent some time working with me. He had the necessary skills but he had no opportunities to see all that he wanted to know. Long afterwards he wrote to me, saying: "The most important part of my visit was that I could operate on a case of ulcer in our primitive set-up for the first time because I assisted you in Bombay. I would not have dared to undertake this operation had I not watched doing a similar one so methodically. That was the first time I noted that no blood transfusion was required".
 
 
Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar