Surgeons Out of This World

I have come across a large number of surgeons. Many of them follow a standard technique of surgery. Maybe one person will hold an instrument with a ten degrees more or less tilt than others. But other than minor variations, there is overall uniformity. But I have come across some rather peculiar ones too, and today I am going to write about two of them. One was an honorary professor when I was an undergraduate student and then a resident. He had a very busy private practice, and used to be quite pressed for time. If he had a patient in his private practice could not afford his charges, he would send her to our hospital, and operate on her for free. But that could took valuable time, which he did not afford. So he adopted a technique which was unique. Hysterectomy or surgical removal of the uterus usually involved application of a clamp to six pedicles, one at a time. The clamped structures are cut and a ligature is placed in place of the clamp. The ligature prevents bleeding from the structures cut. The process is then repeated for the next pedicle. Our erstwhile professor would use six clamps. He would clamp and cut each of the six pedicles one after another, without replacing any clamp with a ligature, Then he would leave the patient with six clamps poking out of her open abdomen, instructing his assistant to put a ligature in place of each damp, and then close the abdomen. It worked for him. But had any of the ligatures become loose and the patient bled, he would have got into serious trouble. Luckily for him and the patients, nothing of this sort happened. It is definitely wrong to do so. But in those days, doctors were like Gods, allowed to do whatever they pleased. The other one I want to write about is a modern professor working in my department at present. She is a full-time worker with plenty of time on her hands between9.00 a.m, and 4.00 p.m. to do things. She does not have to rush anywhere. She does not put six clamps at a time like our erstwhile honorary professor. She probably cannot, because it would require skill far beyond her. She places one clamp, cuts the pedicle, and then asks her assistant to place a ligature to replace the clamp while she stands there and observes. Then she places the clamp on the next pedicle and so on. It is not known why she does this. One theory is that if the patient bleeds due to a loose ligature, she can put blame on the assistant who tied the ligature. How it will work in a court is difficult to say. Another theory is that her tummy comes in the way and she cannot bend forward to tie the ligature. The third theory is that she thinks it is below her dignity to suture something she has cut. It is like the old-time bosses doing a case and going away, asking the assistant to close the abdomen, or the autopsy surgeon asking the autopsy room servant to stitch up the open abdomen of a dead body after he finishes the autopsy. Hopefully I will ask her one day why she does this. If I learn the reason, I will definitely let you know.

Life Comes a Full Circle

Life Often comes full circle. You just have to wait for it, and remember the past to realize what has happened, You will remember my post about how a professor and head of another department had sent me a malicious e-mail in the disguise of a mail from a dissatisfied resident doctor. I had electronic proof to show that the mail had never been to the Yahoo server that it was made to look like. I also knew the origin of the e-mail. However I had let go and gone ahead with life. It was meaningless to keep holding onto some hurt, when the person who handed out that hurt was enjoying his own life. But something interesting happened yesterday. The resident in whose name the e-mail had been sent came back to work in my department for three months after being away for 3 months. I knew he had not sent the mail, because I knew who had. Now it confirmed what I knew. No one would come back to work under a person whom he has sent a malicious e-mail in his own name. But I was curious. When he came along with his immediate boss to meet me, I welcomed him back to the department. Then I asked him to stay for a while; for a brief discussion. He agreed he had the e-mail ID as in the mail. He said he had not sent any such mail. He also read the mail in my in-box, and said it was rubbish. The horrible language, the atrocious grammar, and the malicious content were indeed quite rubbish. He was aghast when he read the line about the sender threatening to trouble my son in college, away from home, But he could not understand how it was done. I suggested he checked his sent mail box. He opened it and showed me. He had not sent any mail to anyone for three months that he was away, because he had gone home for his wife's delivery, and had no internet facility there. I convinced him to change his password, because theoretically it was possible that someone had hacked into his mail account. I knew it would not be the case, since resident doctors in my hospital were not so tech-savvy, Even my son cannot, though he is a geek or nerd or whatever they call computer experts. Then he said something brilliant. He said perhaps it was a mistake of the person who did the sorting on our mail server. I agreed, but I knew his choice of verbs was wrong. It was not a a "mistake", it was a "misdeed". He said he was sorry so much trouble he had caused. I told him he had no part to play in it. Someone believed he would never come back and used his name. That was a very cowardly and mean trick, setting him up as the scapegoat. Luckily for him, I had enough technical knowledge to understand the whole issue and absolve him. I hope the evil one reads all this, and makes an effort to improve.

Destructive Politics

As head of an institution, the well-being of the institution should be the top priority of the Dean. Just because one has the power to do what one wants, and make others do what one wants them to do, one must not be vindictive, taking pleasure in giving irrational orders. I initially thought that the Dean was troubling me because I had expressed inability to take her daughter's private tuition. I had two reasons for doing so: the most important one was that it was prohibited by University and our service rules, The other was that it put tremendous pressure on me, and I could not stand the stress. I gave her the second reason, saying my health did not permit me to take tuitions. She had not become Dean at that time. But after she did, she mentioned this, just to remind me of what I had said, and that she remembered it too. I must say the time of reign of the Head of department before me had been good for those who loved to have parties and picnics, and taking coffee-breaks every now and then. It had been good for those who licked ass, since the rules would change to suit their needs and situations. I even have a document stating that the decision in any situation would be that of the Head, not a natural (democratic) privilege of anybody, as based on any existing rules. But the new Dean even topped this. She did this in all departments, but I came to know about it much later. She decided what work should be assigned to whom, in each department. she stripped Heads of decision-making rights. She gave prestigious projects to people she liked. She divided departmental staff so that the Head would not become too powerful. She destroyed interpersonal relationships of staff members, so that the in-fighting between staff members would keep them busy and prevent them challenging her authority in any way. This sort of thing is OK in politics, but not in an academic healthcare-institute. In case of my department, she did something even worse. She called the ex-Head for the meeting in which she decided who did what. She kept all of us waiting, while she conferred with the ex-Head. Then she did the distribution, in the style of a king/queen giving territories to his/her favorite court members. She did this without consulting me, the real Head of my department. I had not read Covey at that time, so it hurt. Now I know one can get hurt by someone only if one gives the power to hurt to that someone. Now I don’t hurt anymore. But the fact remains that the two years that I had to spend undoing the damage those two women jointly did to my department, thinking they were damaging me! The loss was not mine, but of the institute I served, because two years of time and effort of the leader of the team were lost. If the Head of institute did not care, why should I? Anyway I did care, and continued to make efforts, because I am a doer, not one to give up. In my next post, I shall write about the final blow that the Dean dealt my department before retiring from the institute.

Babu at large

There are very few truly saintly people around. The general rule is power corrupts, unless an originally corrupt person manages to become powerful. Either way, the end result is the same. No matter how brilliant one is, and how difficult it is to pass the Administrative Service exam, if the Babu so generated uses his intelligence and expertise to manipulate people and situations for personal gains, the situation is of total loss for the society and the country. There was such a Babu, an AMC, who was in charge of the appointments of lecturers in medical colleges. He had a niece who was desirous of becoming a lecturer in Ob-Gyn in the most central institute (my institute), but was not adequately meritorious to reach the top spot. The top spot was occupied by me, thanks to a life time of studying. So he decided to post the toppers to the most peripheral places, so as to improve those places. As if a new lecturer could improve anything. He should have sent veterans there. But even then, she would not reach the center, since her rank was in-between the top and the bottom, so his next trick was to place the topper (No. 1) to the most peripheral place, No. 2 to less peripheral place, No. 3 at less central place, and No 4 (which was his niece) at the central place. Then he started another cycle of No. 5 to No. 8. The flaw in this policy was obvious. No. 1 and 2 should have been placed in the most peripheral places, if the peripheral places needed them for improvement. Sending No. 5 there instead of No. 2 was defeating that purpose. There was another major flaw in the policy. This policy was not applied to all subjects uniformly, but only after a cut-off, the cut-off happened to be between the morning and afternoon of the same fateful day. Orthopedics interviews were conducted in the morning, and Ob-Gyn in the afternoon, There was no need to apply old rule to half the specialties and the new rule to the other half, since the appointments were made in all the specialties after all the interviews were over. The real explanation was that it was not convenient to apply the rule to Orthopedics, there being influential candidates near the top of that merit list. The Babu got away with it, because non-influential people cannot fight the system and win. People without money do not go to court against the system, because the have to spend their own money (if they have any) on court cases, while the Babus use the resources of the system, which uses public money (paid as taxes by poor people). The same Babu was involved in a scam of selling land of a port. He got away honorably, probably by using standard means, like money or influence. His niece took advantage of the system like taking maternity leave, full vacation for undergoing appendectomy (which she never underwent) and then left. Those doctors like me who truly wanted to work had to struggle to get back into the central institute. But that we will keep for another post.

Questionnaire

I should have read Stephen Covey much before I actually did, Actually, I would have benefited tremendously if I had the book in my formative years, But probably Covey himself was in his formative years at that time. Anyway I read his book much after I went through the hurt I felt I did not deserve, and being people-centered then, it hurt quite a lot. It all began after I became Head of my department. I had been a resident doctor in the same institute20 years ago, but somehow it did not feel such a long time ago. I still felt the pains I had experienced as a resident, and wanted to set things right for those doing residency now, and for those who would do it in future. I held a few meetings with the resident doctors, trying to find out their current problems, and how they expected to get them solved. The meetings yielded nothing. They would just stare somewhere waiting for the meeting to get over, so that they could go away to do whatever they had to. I decided not to waste everybody's time, and asked them to elect one representative for each unit, I would meet the six representatives every fourth Thursday. Now six residents started staring somewhere, waiting for the meetings to get over. Nothing was gained, Then I declared that only those representatives who had any problems or anything to discuss should attend the meetings. I was astonished to find that I was the only person attending the meeting. I knew very well that things were not so well that they did not have any problems. I don't know why they refused to communicate with me, though I had been Adult-Adult in my approach,. Perhaps they were conditioned to expect a Parent-Child relationship with their bosses, and could not accept anything different. I put up the suggestion box, and it failed miserably, I have written about it in another post. Then I had this brainwave, and I got an Associate professor to help me build a questionnaire in which we included a lot of questions about their living and working conditions. I put up questions like whether they got time for breakfast, lunch, and dinner everyday. I tried to find out if they got reasonable duration of sleep every night. I asked if they had time to read. My colleague put questions to find out if they were stressed, depressed, and if they ever had to take recourse to psychoactive medication. We thought we had prepared a comprehensive questionnaire. We distributed copies to the residents. In my democratic method of management, I used to call all staff members, and discuss issues at hand, So I told them about this idea. I know four of the staff members disliked me, not because of my looks or such things, but probably because of my type A personality, perfectionist approach, and being a stickler for rules and discipline. So one of them, a Professor, said they were not consulted, and the content of the questionnaire wasn't approved by them. I said I needed that information for improving the working and living conditions of the residents, and I did not consult them, since there was no policy decision to be made, Then the professor said that Ethics committee's permission was required for this study. I said that it wasn't a study on human subjects, but just a questionnaire for finding out what they needed. Another professor, quite friendly with this first professor, and equally unfriendly with me, supported the first one. Finally I got exasperated and told them that I had done this in my capacity of Head of the department and was not asking their opinion, but just giving them information. They did not like it, It came out later that two resident doctors who went around speaking against the questionnaire were inspired to do so by their heads of units, which were none other than these two professors. They said we had asked unethical information like use of or need for psychoactive drugs, and the question “At what time do you get to go to sleep” was not proper, that it was sexually oriented. If I were not directly involved, I would have laughed. I couldn't. The two professors could be seen standing outside the canteen, counseling the two residents. The second professor got his resident to write to the municipal commissioner on the stationery of the Association of Resident Doctors, of which the said resident was local secretary. My colleague who had helped me develop the questionnaire was quite upset, when she saw a copy of that letter. I finally got my own unit resident to collect signatures of all residents who were supporting me. All except these two residents, and one who was on long leave signed. Some even said that I was the only person who had shown desire to improve their lot. My senior resident, wise for his years, said something I cannot forget. He said “Self-proclaimed leaders believe the world is following them. But when they turn back to see, they find there is no one following them, This leader falls in that category", The storm settled down. What I find difficult to accept even after having read Covey is that the world has a lot of people who cannot accept any activity, however good it might be, only because it is undertaken by someone they cannot stand. They fight it, even if it means a great loss to a number of people in need. That also reminds me of the person who was Head of Department before me. This person had grown to dislike me so much that wherever I made any good suggestion, this person would criticize it even before thinking about it. Well, you have to live with people of all sorts, including such people, and make progress despite them.

Suggestion Box

When I became the Head of my department, I was enthusiastic, and quite keen to bring about changes for better. I was full of ideas. At the same time, I was keen to pick up ideas from others if worthwhile. I soon realized that very few staff members wanted any change, leave alone wanting to contribute any ideas for a change.I strongly urged the resident doctors to make any suggestions on the department’s management they felt like. No resident doctor came forward to ask for any change that would improve things for themselves, leave alone the institute. I thought they were not feeling ready to meet me in person, so I went to the market, purchased a letter box, and got the hospital carpenters to fix it outside my office, Then I printed “Suggestion Box" in New Times Roman" font size 72, and pasted it on the front of the letter box. Initially I opened it everyday. When there was nothing found in it over 2 weeks, I reduced the frequency to twice a week, and later once a week. Finally it dwindled to once a month. Nothing was dropped in for one whole year, then an outgoing resident asked me if I had read his suggestion. I had not, because it was not one month since I had opened the box last. I opened it, discussed the issues with him, and he left the institute. Then another year went by, without any more suggestions. Finally one day I found an empty cover of a sachet of tobacco in it. It could not have been a staff member or a resident doctor, because none of them chewed tobacco. Some patient's male relative must have thought my suggestion box was the dustbin. I appreciated his desire of not throwing his litter on the floor. I removed the box without help from the carpenter, never to put it up again.

Height of meanness

If there is an adult-adult relationship between the Dean and staff members, there is not much possibility of strained situations and unhappiness, But most of the Deans assume a superior approach, and the relationship becomes parent-child. (This refers to transactional analysis) If the Dean will be a good parent, I would not mind it at all. But if the Dean behaves like a step parent, I mind it very much, This Dean was a step parent, and quite a mean one, There are many stories of her meanness. I will tell you a short one. It was the day of floods in the city, 26th July 2005. She had called a meeting of some staff members at 3.00 p.m., but true to her style and efficiency, she started the meeting at 4.00 P.M. The city was already flooded, but most of us did not know the true enormity of the calamity. Many had left for the day. Those in the meeting kept waiting for her to end the meeting, so that they could go home. She just wouldn't. She knew the nature of the situation outside, because as Dean of our hospital, she had constant contact with the control room, being responsible for managing health aspects of disaster in the drainage area of the hospital, The audience knew she knew, because she kept calling her husband on his mobile, urging him to reach home at the earliest, advising him of the situation, and guiding him of safer route home, Those in the audience (members in the meeting) had family members to worry about, and had to go. This mean step parent kept them there till 6.00 P.M. and then said, “Ok, Go!'' There was no way they could have gone home, Roads were closed by floods. Trains had stopped. People were being washed away and dying, she conveniently forgot to mention this. She did not say, “Don’t go out, stay in the hospital”. One of my female colleague, an Associate professor, oblivious of the havoc outside, decided to go home, Her son was hopefully home, probably alone. On her way, she met the Dean, who was going to the canteen with the usual crowd of ass-lickers. The Dean asked her, “What are you doing?” “I am going home”, she said. “Where is your home?" the Dean asked. ''Malad'; she said (which is about half an hour’s drive when the roads are clear). "OK!'' grinned the Dean all over her face. "If you reach home, tell me also the route you find easy'! thy colleague left in her car, which she had to abandon on the highway, submerged 2/3 in water. Then she had to walk a few kilometers in chin-deep water, on dark roads, afraid of many things a lone woman can be afraid of at night on a dark road. She managed to reach a friend's home past midnight. Her son was OK at home, she learnt using someone's phone which wasn't dead, quite miraculously. She told us this story when roads opened and we met at the hospital two days later. The emotions on her face made us feel what she must have felt going through all this. The mean woman in the Dean's chair continued to sit on her throne like a queen, unharmed, unaffected, remorseless. God must have been watching, and if He did not choose to punish that woman, He must have a strong reason to do so, just as He must have had strong reasons to make her Dean of our hospital, instead of someone worthy of the post, someone who would do something good for the institute, instead of mentally torturing people under one's power, and sending some of them out to suffer, perhaps die, without any qualms.