Kashmir – and The three “D” s.

Do you often see the roads in your neighbourhood at one am in the morning? I get a chance. Once in a while.

I drive briskly through roads that are startlingly calm. They lie winding and tired, like endlessly long dormant snakes, satiated after the heavy bustle of the blistering day.

In the hospital, you see pretty much what you expect to see- a mangled leg over which a car has run over. The owner of the leg is a young man. The foot is cold and dying, and there is no blood supply to it.

At this point there are no emotions from my side. It is all MESS scores, the possibility of salvage, CT angiograms and warm ischemic times. All this intellectual exercise is not for an academic orgasm, like in an online discussion forum, but to arrive at a practical decision. Should one, by complex microsurgery and vein grafting of minute arteries in the leg, and by tiresome bone work by our orthopaedic colleagues, try to save the ravaged limb?

Here the decision is to go ahead. From two in the morning till ten am, we try. Everything goes well. Amazingly well. But the foot remains cold and blue. You hope that it will pick up.

The next day dawns and the limb remain blue. It is a time for talking. Breaking bad news. The appropriate show of empathy. Crying parents. Crying patient. One is impeccably professional and admirably proper in communicating with everyone involved.

We will wait one more day, and then we will amputate the leg. Take it off.

As you walk back, it hits you. You suddenly remember that the patient is but a child, all of sixteen. His face. The jet black hair falling onto the eyes. Thin, lithe body. Crying like the child he is.

Suddenly you go through all the stages that he will have to go through, but in fast forward mode.

Denial- the next day, it might start becoming pink. Oh, no- it wont.

Anger- who the fuck gives a sixteen year old boy a bike to play with? What the fuck did I do wrong, God?- Bull- it is useless.

Depression- No. I have been through this a hundred times before. Snap out of it.

Acceptance- another day at work……

A post by a friend, Viswanathan.K, allowed me to see a curious parallel between this episode and Kashmir.

The bible, Bailey’s Textbook of surgery describes when one has to decide to cut off a leg or an arm: the three ‘D’s.

When it is:

Dead- It is gone. Black. No longer there and wont come back. It cannot be allowed to remain.

Deadly- there is a cancer on it, and if it has to be removed, the limb has to go with it. Or if there is infection, rapidly spreading, and once it reaches the blood stream, the patient might die.

Dead loss- this is the tricky one. The damage is so severe, that it will hurt a lot if it is kept there. The parents will have to sell their house to pay for the treatment. The patient may have to undergo scores of painful surgeries. And finally you may end up with a painful, insensate, swollen leg that may be riddled with holes discharging pus. Amputate, and he goes home in a week. One year later, he comes walking with a prosthetic limb, going to college as usual.

The past is painful. Partition happened. The pundits have been decimated. There has been genocide of Hindus on the part north of Jammu. Scores remain. Pakistan has played a dirty game.

We cannot afford to back down. It is not right. Isn’t it? Can we let them win?

But when we see teenage girls throwing stones, and an entire population that doesn’t consider themselves to be part of the Indian state, it sure makes one think.

See- only posterity can judge us.

Fifty or hundred years from now, no one will be interested in knowing why Kattappa killed Bahubali. Who the hell were they; they will ask.

But a hundred years from now, if the glorious Indian state still exists, as I am sure it will, our descendents will surely judge us, as a people, for the decisions that we take now.

Some leaders will be extolled for their strengths and some condemned for their weaknesses.

Again, some will be praised as they were pragmatic yet strong, and some may be abused for being strong, but foolishly headstrong in matters crucial.

But for now, the question shall remain:

Is it a dead loss?

Dr Jimmy

I am a Doctor, Writer and Science Communicator. I am a member of Info- Clinic, and have written a few books. This site features my blog posts and stories. Thank you for visiting. ഞാൻ എഴുതാൻ ഇഷ്ടമുള്ള ഉള്ള ഒരു ഡോക്ടർ ആണ് . നിങ്ങളുടെ താത്പര്യത്തിന് നന്ദി .