I WAS in the dressing room. Surgeons spend a lot of time in the dressing room. It is where the drama spills over from the operation theatre.
Outside the merciful orbit of the anaesthesiologists, here you can hear painful cries and anguished weeping. It is also the room of reckoning.
Here the unhealed wounds and infected surgical incisions open their jaws to haunt you in your dreams.
Sati lay on the dressing table in front of me. She lay prone, with her right thigh exposed till the hip. On the back of her thigh was a large ulcer. In fact, the entire back of the thigh was the ulcer.
Blood was dripping from it. Her head was turned to one side on the pillow and her mellow black eyes were expectant on my face.
‘How is it, doctor? Is it healing?’ she asked. There was more resignation than hope in her voice. We were repeating the sequence every two or three days for the past one month now.
But there was one difference today. Gokul Bhai, her husband, who had crouched respectfully by the side on all the previous occasions, was not there.
He was one of the most caring and patient husbands I had ever seen. And I had seen quite a few. Some were sullen; some resigned. Frustrated and angry ones were common.
Then there were the callous ones who were never there. Last were the genuinely loving ones. It was clear that Gokul Bhai belonged to the last category.
I assumed that he was out working. He was in construction – a manual worker, and they were desperate for money.
I blinked to clear my eyes of impending sleep. The evening before was relatively free, and I had spent it foolishly, staying up late into the night watching ‘Bruce Almighty’.
I should have caught up with some shut-eye. I had enjoyed the movie immensely. The problem was that Bruce was given godlike powers, but there was too much responsibility.
He took on everything and botched it up. If I had that chance, I would have used it very well. Being god would have been fun.
Now I wished I was he. I mean him. Alpha and Omega. With a sheer force of my will I could have healed up that huge and impossible wound and asked her to go home.
‘Go in peace, my child, and proclaim that you are healed.’ I imagined uttering these words in my mind. What a grand way to do things.
As such, I merely squirmed uncomfortably.
‘No. I thought I told you before. This wound will require skin grafting,’ I said. Not so grand. It would be a messy surgery. There were expenses. Again daily dressings would follow. It might heal eventually, but there will be no cure.
The abnormal communications between the arteries and veins at the edge of the wound will enlarge. New pathways will form, like treacherous snakes, wriggling and coiling into an ever enlarging tangled mass that would shunt precious oxygenated blood directly from arteries to the veins without feeding the body tissues.
They would just supply the monster that has been temporarily extinguished for now. Yet it was not cancer.
It was a localised abnormality of the blood vessels in an area of the body, present from birth. They slowly enlarge and grow into a tumour by adulthood. The big ones are really troublesome.
They may bleed or be painful. They can also overload the heart and cause cardiac failure, unless treated. Partial excision is sometimes the only thing you can do.
I was only a junior Reconstructive Surgery trainee at the time. My boss had removed most of Sati’s tumour, but the wound needed skin grafting to heal it.
‘My husband has already paid the fee and arranged for the surgery, doctor. He did it last week,’ Sati said.
‘That is good.’ He must have really struggled to put together the amount.
‘Where is he?’ I asked. He was usually with her on these visits.
‘I don’t know. He went off two days ago. He did not return.’ There was a tinge of sadness in the voice. But there was no panic or bewilderment. I was slightly startled at this revelation.
I knew Sati’s story. She was as good as an orphan, with a bedridden mother for company. Gokul Bhai was a migrant worker from Orissa.
When they married, Sati’s treacherous arterio-venous malformation was already a big burden on her thigh. He was always there for her. Always accepting, always caring. How could he?
‘Didn’t you call the police? What if something happened to him?’
‘That is not it, doctor. I think the poor man had enough of me. There is a limit to what a person can stand.’ She had a feeble smile. ‘He was a good man,’ she said as an afterthought.
Her acceptance and the essential truth of her words sank in and a deep melancholy smothered my heart. I felt for her, him and every human being in this universe.
We were always tested to the limits, some of us beyond the breaking point. It was inconceivable that an ever powerful and merciful one was in charge here.
She was right not to be angry. There was no place for anger. Just selfless understanding. But for most of us, that is just an ideal. Hers was something divine. Divine – what did it mean, anyway?
These thoughts were all just background noise, as meaningless as static from an under tuned radio. There were things to be done. The surgery had to be arranged.
Then there was the next patient. Then the next. Then something else. And so on till the grave.
As Gokul Bhai had already made the arrangements, the surgery went on smoothly. After the wound healed, I saw her a few times in the OPD.
The tumour seemed to have abated for the moment. Maybe we had succeeded in pulling it out by the roots. Only time would tell.
Time flew by, spurred on by the pressure of ceaseless activity and sleepless nights. Night followed day in a rapid succession of burn dressings, pressure sores and crushed limbs.
A few spasms of exams followed, like a repaired artery pulsating gratifyingly after the clamps are removed.
Sweet release! I had almost completed my training in Plastic and Reconstructive Surgery. One more month of posting was left. I stretched my limbs by walking around the campus every evening.
The path from the hospital to my rented apartment was all green, serene countryside. The medical college at Calicut was housed atop a hill.
As you climbed down to the valley below, you enter a parallel universe of trees, bushes and grasslands studded with green, weedy ponds shining like emeralds. Frantic crowds gave way to placid village folk taking a slow-motion approach to life.
Even the cows looked less hassled, chewing the cud in an unhurried fashion. Only the children seemed boisterous, playing uninhibitedly on the narrow dirt road.
In the distance, I could see a young couple walking with their backs to me. In India you sometimes don’t see public expressions of love between two people.
It is difficult to gauge the level of intimacy unless you are an expert in tones of voice, darting looks and minor twitches of the facial muscles. But even from a distance, one could make out that these were two people were in love.
They were holding hands. The woman leaned to the man, snuggling his side and looked up at his face occasionally. She was limping slightly on one leg. I could make out Sati as I came nearer.
I don’t know whom I expected to see, but I was surprised to realise that it was indeed Gokul Bhai. It was one year since I had last seen Sati, her wounds fully healed.
Now she smiled at me, showing a perfect set of white teeth. What the bright eyes said was difficult to miss. ‘I am happy to have him back’. I looked at the husband. He was finding it difficult to meet my eyes.
‘You are back,’ I said. That much was obvious.
‘He came three days back,’ she said with a suppressed thrill that I found rather offensive.
‘Nice. Very nice. I hope your vacation from real life went well.’ Acid poured out of my tongue, surprising me. I really didn’t want to judge other people. And I could sympathise with the man very well.
But you know how it is. It is so easy to take the moral high ground. Passing judgement is effortless when you are not in the other man’s shoes.
Five years passed. I was in another city, another big referral centre. The days when I was rummaging at the bottom of the dressing bin desperately for a few pieces of gauze seemed ages away.
It is curious how one gets used to luxury. It was with a sense of disbelief that I saw Sati and Gokul Bhai appear in the outpatient department one day. Gokul Bhai had the same diffident smile.
Sati’s toothy one had a tinge of sadness in it. She carried a three year old toddler in her arms. He had his head resting on her shoulder and looked at me placidly with large black eyes.
‘We didn’t know you were here,’she said. They had come to show the child. Apparently they were told to come to this centre. This was their last hope. They were happy to see me.
But I was not happy after I saw the baby. One of his legs was swollen grotesquely. It looked like an amoeboid monster, mocking the thin human child that was dragging it along.
Angry red streaks coursed under the skin, like small snakes, mobile with a rhythmic squirm. His heart beat like a drum, desperately trying to feed the owner as well as the lethal parasitic monster.
The bulging veins in the wasted neck told me that it was not succeeding.
The scourge had managed to pursue the child through the womb.
Partial excision of a tumour is called debulking. It sounds comically simple. It was formidably risky in this case. There was no other way forward. A date was given.
A cardiologist saw the child, to treat the cardiac failure. Anaesthesiologists were consulted well in advance. An absurdly large quantity of blood was arranged.
All this diminished the risk only a little. Gokul Bhai ran around and arranged everything, including the needed cash. But when the child was admitted for surgery, he was not there.
‘Where is he?’
‘I don’t know.’ Sati smiled.
She nodded. I gave the child a toffee. He smiled. He had the same diffident smile.
I felt trapped. I had decided firmly that I would not stand in judgement. But what will Sati do? She was practically an orphan. The old mother was probably dead. I didn’t ask. It was better for her if she was, I thought heartlessly. No one could tell how the child would fare after the surgery. It could be a long hospital stay.
A debulking will only beat back the evil disease for a while. He will be an invalid for life. There could be repeat surgeries. All the suffering might rewind repeatedly like a grotesque replay of a horror movie.
How was I to come to terms with her placid indifference? Was that what it was? Or a staunch refusal to think ahead?
On the other hand, why should I? It was not my battle. That lay in the operation room, with the scalpel in hand.
Other forms of involvement were an unaffordable luxury. In certain types of non-involvement lay normalcy, if not salvation.
The theatre was tense. A host of anaesthesiology trainees milled about the patient as he was being prepared to be ‘brought under’.
This is the term used for the process of making the patient unconscious. A barrage of questions flew between the chief anaesthesiologist and the surgeon, who was a senior colleague of mine, with vast experience in vascular malformations.
‘How much time will it take?’, How much blood loss?’, ‘How many pints of blood are arranged?’, ‘Are the cardiac surgeons on call if we need to go on by-pass?’. All these were answered in clipped formal tones.
The usual light exchange of jokes was ominous by their absence. I was to assist the case with my senior colleague.
The disease was more severe than we anticipated. Blood flew as if from wrenched out taps out of each cut surface. Crimson fountains danced up, and dotted our protective eye wears. I saw the chief surgeon’s mask turn into a speckled carpet of red.
Technicians scurried like mice for packets of blood to be warmed. The entire blood volume of our tiny patient was infused into him many times over, before the end of the surgery, four hours later.
He had a sudden cardiac arrest in the ICU an hour after the surgery. The dressings were drenched in blood.
The team tried to revive him, with increasing resignation. The monitor showed a stubborn straight line that was actually a full stop.
The monster had won.
Sati was devastated as she left the hospital. She had come with a husband and son. Now she was going alone. But I suspected that she may not remain so for long.
Two years later I got a letter from Sati. She was living with Gokul Bhai, who had reappeared three months after the child’s death. Now they had a daughter, who was normal. No trace of the tumour on her now.
‘All thanks to god,’ she had concluded.
I didn’t want to be Bruce Almighty. It is an extremely tricky job. All these nasty choices.
(Jimmy Mathew- For more, just go to google playstore, get the ‘Readify’ App and download the book- ‘Knife Edge’)