‘Everything will be fine, I know. Medicine is so advanced nowadays.’
When he mentioned orthopaedics as a possible career choice, Dr Neil Ganguly’s sister burst out laughing. The twins were especially close. They had studied in the same school and college and had hung out in the same crowd.
‘Look at him dad – strong as a bull and equally smart,’ Nisha exclaimed.
‘What exactly does an orthopaedic doctor do?’ Dad asked looking thoughtful. ‘I had kind of hoped that you would do cardiology or something like that.’
Neil’s grandfather had a cardiac condition. He had had a bypass and a pacemaker within the last five years.
‘An orthopaedic surgeon deals with bones. All sorts of problems—fractures, bone disease, arthritis.’
‘And this is sufficient to earn a living?’ Mr. Ganguly senior persisted looking doubtful. He was a geography professor at Jadavpur University and knew practically nothing about the medical profession except what his two doctor children told him.
‘You should have chosen psychiatry.’ This was mom adding her own thoughts. ‘You are a good listener and have been interested in reading Erich Fromm and Sigmund Freud since childhood.’ These books had belonged to her and she had been surprised that he enjoyed them so much, unlike Nisha who hardly ever read and was more into singing.
‘Of course, there is a living to be made. Never heard of a surgeon who died in penury. And regarding psychiatry—it is one thing to read various theories of mental health and another being cooped with mad people 24 by 7. They say most of the psychiatrists are half mad themselves!’
‘Now that is very sensitive of you,’ posed Nisha laughing with her eyes. They were enjoying a family dinner at the Waldorf restaurant. Internship was ending in two weeks and postgraduate entrance forms had had to be submitted within two days. Nisha had already decided on ophthalmology six months ago. It was Neil who had been procrastinating.
All that was nearly twenty years ago – but he remembered the evening with his family like it was yesterday. And now his own son had to take a career call. Or maybe it was too early. After all, Soumitra had only just finished his class 10 boards. What was the rush? He recalled himself being undecided about medicine till the last minute. In fact, it was Nisha who had motivated him.
Soumitra wanted to study in an IIT. ‘That’s where all the action happens.’ And he was obsessed with civil engineering. The reason was fairly obvious—in the last 10 years real estate projects were springing up all over the place, almost in the face of anyone who cared to look.
An IIT? Soumitra was a good student, but was he that good? He enjoyed his maths and physics and was in the top 10% of his class but was that sufficient? It would have been in Neil’s time. Neil thought back to his school days. Ten students had got into IIT from his batch. At that time there had only been five IITs. And another 15 classmates had gotten through the medical entrances including himself and Nisha.
In his time Class 11 and 12 had been tough. But people did make it through the entrances even while leading regular lives. He had enjoyed his cricket and table tennis and rarely studied after 10 pm, except right before the exams. And Nisha had pursued her singing all throughout school and college. Yes, they had been normal happy kids and yet had done honourably well in the competitive exams.
But that was rarely the case now. Kids these days had to attend tuition and extra classes in addition to their schools. None of the kids who were serious about clearing their post school entrances played any games or pursued any real hobbies.
His hospital clinics were testimony to that. Parents brought in teenage kids with back and neck pain. Most of them were overweight and looked tired.
‘How many hours does he study?’ he would quiz the parents. ‘And how much time does he sit in front of the computer?’
‘Eight to ten hours at least,’ the proud parents would proclaim. They were from lower-middle-class families. Education and the internet were one-way tickets out of their ghetto.
‘And when does he play?’ Neil Ganguly would persist.
‘He doesn’t. Where is the time? He returns from school around four and then has to go to his teacher’s home by five-thirty. He returns at eight and then sits down to study. He can’t keep his eyes open after ten-thirty, Doctor.’
‘That is completely unacceptable. Your son must play a sport, for at least one hour daily – and vigorously. Otherwise he will be a physical wreck soon.’
The mom would then look unhappy. ‘How can he play, Doctor? He has so many exams and tests. So many tuitions? Maybe on a Sunday—’
‘How can I play on Sunday, Mom? I have to attend English tuitions in Jadavpur. It takes me three hours just to travel . . . ’
‘Look, you have to play daily if you want to stay healthy. What good will studying do if you become sick?’ Neil would interject.
‘Doctor, can’t you just prescribe a pill and solve the problem?’ The message was obvious. I have come to see a specialist and am paying beyond my economic means. It’s your job to solve the problem.
‘No, there are no pills. It’s a lifestyle issue.’ PLAY ONE HOUR DAILY—Dr Ganguly would write into his prescription pad in bold. The unhappy families would then nod sadly and leave never to return.
‘What does an Orthopaedic Surgeon do?’The memory brought a smile to his lips. There are 208 bones in the human body. Contrast that to two eyes, two ears and two kidneys. Close your eyes and think about the road conditions of India—narrow spaces shared by trucks, tempos, bikers and a swirling and unending mass of undisciplined humanity. The bikers particularly were a law unto themselves. It was a wonder that the number of accidents leading to fractures were what they were and not a thousand-fold greater. Was it just plain luck or did God have a role to play?
Suddenly he remembered Indranil, an old classmate. Once they had a gone to Meerut together and Indranil had wanted to visit the local temple. Neil was an agnostic and not too keen.
‘How do you know God even exists?’ he challenged Indranil.
‘Of course, he does. How do you think a chaotic country like India runs? The existence of a place like India is a direct proof of the existence of God. Think about it.’
There was truth in the statement though he wasn’t sure if Indranil was being flippant or profound.
And then there was the rising epidemic of arthritis. The Indian female population has terrible knees. Why he wondered? Was it pure genetics, squatting habits or increasing body weight? Text books have never considered this question seriously as most epidemiologic data originates from the West. And Western societies have more problems with hips, something that is rare in India.
And then there were bone diseases, bone infections and the newest fad—minimally invasive surgery or the so called “keyhole surgery”. There was a fair amount of work to do all right. And he enjoyed it—the challenge of surgery, the stress which it generated and the calm when it was all under control.
When Neil had started training, two decades ago, orthopaedics was very basic. Hardly ten operations were done for trauma in those days, and most of them were doomed to fail. Infections were frequent as were breakage of plates and screws used, during operations or afterwards. The operating tools had been primitive and crude. They certainly looked barbarous enough to scare off patients or timid doctor wannabes. The pathophysiology of bone problems were incomprehensible and ill understood. People did not understand why certain procedures failed and others succeeded.
But a revolution had happened in front of his eyes. Operating equipments improved as did supporting and complementary specialties such as anaesthetics, plastic surgery and radiology. Operations became exact, not approximate and surgical competence became the norm rather than an exception. And with it the stock of the orthopaedicians had risen. From a peripheral and exotic option, it had become a main-line choice. In fact, the best students all over the country were now queuing up to join the specialty through difficult post graduate entrances.
Soumitra wanted to join IIT. In fact it had become an obsession with him. Neil wondered if his son really understood what this entailed – that it would mean classes, extra classes, tuitions and tutorials for the next two years. Every waking hour would be spent cramming. It was goodbye to his guitar lessons. Goodbye to cricket and goodbye to a normal childhood. But what if even then the sacrifice was not enough? It was not sufficient to get a seat in any IIT. To be meaningful it had to be a seat in civil engineering – in a good IIT. He was not sure that Soumitra could do it, and far more importantly was the sacrifice worth it? He tried to reason with his son. And that is when Soumitra dropped the bombshell.
‘I want to go to Kota,’ exclaimed Soumitra one Sunday morning.
KOTA! He had barely heard the name. It was a nondescript industrial town somewhere in Rajasthan, which had a factory like approach to college entrances. Aspiring engineering students would arrive in busloads and join one of its many institutes. Bansal, Allen and Career points had been around for decades. Now even the South Korean firm Etoos had joined the fray.
These institutes had tie ups with local schools and higher secondary boards. They also had an industrial approach to entrance examinations. Classes would start in mid-morning and continue till late afternoon. Whatever time was left over would be spent in self-study—the practicing and re-practising of complicated mathematical equations.
Families would spend their entire savings on the IIT aspirant. The question of games, recreation or cultural activities did not arise. ‘Fun’ was a blasphemous word. Why did Soumitra want to put himself through this torture? The Gangulys were comfortably off, and there was no pressure on Soumitra to ruin his childhood and his health by undertaking such an endeavour!
It was not family pressure – it was peer pressure. Saibal was Soumitra’s closest friend. The two were virtually inseparable just as Neil and Nisha had been. Saibal had been the class topper and virtually a role model for Soumitra. Nerdish and very quiet, he was the typical ‘good boy’ that every Indian parent craves for. Very unlike Soumitra who was sporty and gregarious.
He reasoned with his son. Cajoled, shouted and warned – but to no avail. ‘Sixteen is the wrong age to leave home.’ he told his wife. He tried to get her to talk to him separately. But Soumitra was adamant.
‘Why are you not encouraging me?’ Soumitra countered. ‘Saibal’s parents are very supportive. Saibal’s father had even taken a major loan to finance his Kota stint. Dad has enough financial muscle. Anyway, it is only for two years and there will be trips home in between. Did you not tell me to pursue my dreams, Dad? To have a mission in life- to have focus? Were they just empty rhetoric?’
Neil had no answers to give to his son. He had spewed the same dialogues that every Indian parent gives their children. Now his words came back to haunt him.
Soumitra remained positive and cheerful over the next eighteen months in Kota. He was studying very hard and trying to be organised and methodical. The competition was intense. He was amazed at the quality and the sincerity of the students around him. They were mostly Hindi speaking with a very few from the South. Very few Calcuttans as well. Luckily Saibal was with him. The two of them would study together. Saibal was more hard working than he was and he wished he could muster the same degree of commitment.
Neil texted frequently with advice – eat correctly, avoid junk food and fizzy drinks. Have lots of vegetables, fruits and meat. Do yoga for half-an-hour before classes. Go for a run in the evening after classes. The last bit caused tension between father and son.
‘Baba, this is Rajasthan. It’s too hot to run here. I will get a heat stroke.’
‘OK then go for a swim.’
‘There are no swimming pools here. Anyway, I feel too tired after classes.’
‘Join a gym. There is an AC gym a block away.’
‘But that would disrupt my sleep schedule. We generally sleep for two hours after we return from classes. I have to study till late.’
‘Look Soumitra, I don’t care what you do. I insist that you do some vigorous sports for at least one hour every evening. This is non-negotiable. If you don’t listen, I will pull you out of Kota and make you study in Calcutta. The gym is your best option. The AC will help. And make sure Saibal goes with you.’
‘Saibal is unlikely to listen, Baba. He is already in the top ten of our group. He studies day and night. I wish I had his stamina and brains.’
‘I wish you had my wisdom and common sense. We wouldn’t be having this conversation then.’
Luckily Soumitra agreed to join the gym. Saibal declined.
Dr Neil Ganguly was examining a young man in his busy Friday clinic. There were at least a dozen patients waiting outside his chamber. Many were walking with crutches. Others had various kinds of bandages and plasters on. Suddenly, he heard a commotion from the adjacent emergency. He ignored it and started to write a prescription for painkillers to hand over to his patient.
After a few minutes a member of the emergency staff knocked at his door. “
‘Sir, a young adult has been brought to the emergency. He tried to commit suicide by jumping off a roof. There are a lot of important people with him. Could you please have a look.It looks like a serious injury.’
There was a twenty-five-year old lying motionless in front of him with a hard surgical neck collar on. Neil realised that the boy was paralysed neck downwards. His right femur and tibia were badly twisted and obviously broken. The right arm was oozing blood—definitely a ‘compound fracture’ in lay man terminology. The correct orthopaedic term was open fracture type IIIB of the humerus.
The fractures in the arm and thigh would get better but the paralysis would perhaps never recover. Most likely the neck was broken and the spinal cord was transected. It was bad news. But something he had handled before. This guy was in trouble—deep trouble. His active life was probably over. The MRI of the neck held his future in hostage.
‘Admit him to the ITU immediately and start a drip. Get him worked up for surgery and get the neurosurgical consultant on the line immediately. Be very gentle while doing the x-rays as he has a neck injury. Also start a police case. All the routine stuff.’
The parents – a shaken father and wailing mother, with their dozen other relatives besieged him as soon as he came out of the ER. This too was routine. But what followed was not.
‘I don’t know what got into my son – Swarup. He is such a good student. He has just finished his M-Tech from IIT Kharagpur. He has already got a reasonable job offer from Wipro in a campus interview. Two of his friends got offers in the US . . . I think that unhinged him. He was depressed for a few days. I told him it hardly mattered. You know these young boys—they don’t listen to reason….. Everything will be fine, I know. Medicine is so advanced nowadays.’
Suddenly Neil felt as if someone was twisting a knife into him. This boy would not recover the use of his limbs. Would he survive? He tried to explain this in a professional and sympathetic way. Everything would be done as required. Everything depended on the neck MRI. His thoughts, however, were elsewhere. They hovered over the deserts of Rajasthan. He thought about a boy who was not yet eighteen, trying to crack one of the most competitive exams in the world. If this twenty-five-year-old already having an M-Tech and a secure future could not handle a minor setback in his career what would his son do?
The MRI pictures were scary. The neurosurgeon shook his head.
‘No chance of a neurological recovery. There is only one thing to do. We must stabilise the neck with a 360-degree fixation—front and back—that will mean two operations.’
‘He needs to have lots of fluids and blood before you can operate,’ Neil discussed with Amitesh the young neurosurgeon who had just returned from AIIMS. ‘Let’s make a plan. Can you do both the neck surgeries is one sitting?’
‘In that case, you do the posterior fixation on Monday morning and I will follow-up with an external fixation of the femur. On Wednesday do the anterior fixation of neck. On Saturday I will nail the tibia and plate the humerus. Do you agree?’
The major operation on Monday was uneventful. On Wednesday too, the surgical procedure had gone without a hitch. It had been difficult to take the patient off the ventilator. There was already the beginnings of a chest infection. Things looked better on Thursday and further improved on Friday. Finally, Saturday arrived. Neil still had more surgeries to complete but Swarup had a fever of 101°F. Should he operate or postpone the surgery?
It was not really a chest infection. More likely he was going into ARDS or Adult Respiratory Distress Syndrome. Multiple injuries in young patients often caused ARDS—a life threatening condition. A situation when the lungs function is severely compromised. And surgery sometimes compounded the problem. He decided to wait another three days before operating.
Swarup’s dad was a general manager in the State Bank of India. He seemed to have aged ten years in a week. Neil explained his plan of action.
‘Doctor, do what you think is right. He is like your own son. Spare no expense.’
‘If he survives, he will be permanently paralysed- you realise that.’
‘Is there no chance of recovery? With so much advance in surgery?If we go to Vellore or America?’
‘Yes, we have advanced but severance of the spinal cord is still not treatable. Anyway, let him survive first.’
‘Do the best you can, Doctor. He is like your son.’
Swarup’s vital parameters improved and Neil got the green signal from the intensivist and anaesthetist to operate. Neil enjoyed nailing tibial fractures. However, this was a complicated injury with the bone being broken in two places.
He had ordered a newer nailan Expert tibial nail which is more versatile and is used for complicated fractures. The surgery went off well enough. There were no surprises. Even the arm fractures did not pose any problems. At the end of five hours he sat down quietly in the adjacent room and attacked his rice and chicken. He was a mixture of emotions. Sadness for Swarup, anger at his needless idiocy, concern about Soumitra’s exams and hoping that his son would handle stress better. He wondered if he should waive his surgical fees.
His surgical assistant suddenly asked him, ‘Sir, will you be waiving your surgical fees in this case? It is such a tragic case. I cannot bear to look at the mother’s face. The accounts officer also asked me. He said, “Your boss will not take money in this case. I know him.”’
Neil felt a sudden rage swell all over his body. This idiot had jumped on his own accord without any valid reason and now Dr Neil Ganguly was expected to waive his surgical fees. Why? Just because doctors are supposed to be noble and good. In a rotting society where the corruption and vice were out of control, why were doctors supposed to be a hybrid of Vivekananda and Ramkrishna? Neil Ganguly had operated for eight hours on this mentally unstable idiot. He had physically laboured for eight hours and worried about him non-stop for a week and had seen him endless times in the ITU.
The medical administration was always up to its petty little tricks. They would almost never give discounts and yet expected the doctor to ‘do the right thing.’ Anyway, in this case money was not the issue. The parents were well off.
‘Of course, I will charge my full fees,’ he snarled at his assistant. ‘Why would I operate for free? Do the parents look poor to you?’ Suddenly he felt a chest pain. It was low intensity. Definitely not cardiac, he convinced himself.
His chastened assistant mumbled something and apologised. But Neil could read his thoughts. And they were not complimentary.
Swarup died the week after. The ARDS had worsened. The police came to claim the body. There were at-least 50 students and teachers from IIT standing in the driveway in silence. Swarup’s father came to meet Neil for the last time.
‘Doctor, I thought about what you said. It is perhaps better that he died. It is better to die fast than to die slowly with bedsores and catheters. I just feel it is such a waste. How could he do this to us? He was such a nice boy. He had such a promising life ahead of him. Anyway, thank you for your efforts. And please thank Dr Amitesh for me.’
He was trying his best not to cry.
After he left, Neil sat quietly in his room. He locked the door and asked his assistants to leave. He tried meditating in a yogic pose. The chest pain still niggled. He wondered if he should get himself tested.
His cell phone rang noisily. It was Soumitra.
‘My IIT results just came out.’
‘And . . .? ’
‘I did not make it. My name is not on the list. Saibal, however, did well. He will probably get mechanical in Delhi.’ There was anxiety in the voice. ‘Baba, I lost my battle. What should I do? Should I come home and take a break?’
A ridiculous yet somehow appropriate rhyme hummed in his head—‘He who fights and runs away lives to fight another day.’
‘Soumitra, you are absolutely right. You just lost a small battle. It’s not of any consequence. I am sure you will win the war. Just come home, Son.’ He said with sudden emotion in his voice. ‘We will make a better plan this time together.’
All of a sudden, the chest pain was gone.
He had never realised that the scent of failure could be so sweet.