SURGEON'S DIARY: Gratitude to the gurus who sharpened my surgery skills

Saturday November 11 2017

During my surgical training I worked under a

During my surgical training I worked under a few gurus who were great motivators and became my mentors and I owe a big debt of gratitude to each one of them. ILLUSTRATION| JOHN NYAGAH 

By Yusuf K. Dawood
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During my surgical training I worked under a few gurus who were great motivators and became my mentors and I owe a big debt of gratitude to each one of them.

Recalling them is a study in the diversity of human nature because they were totally different personalities but they had one thing in common: they left indelible imprints on me.

After qualifying as a doctor, I did my mandatory surgical internship on the firm of Mr Khwaja and Mr Parekh at the JJ Hospital attached to the world renowned Grant Medical College (GMC) located in what was then known as Bombay, but now Mumbai.

They both contributed in their own way to put me on the road to becoming a surgeon.

Khwaja was a brilliant operator, a clean bloodless dissector, cool, calm and collected under the most trying emergencies which often arise in the operating theatre.

Parekh on the other hand was a very knowledgeable, academic surgeon, famous for his bedside teaching, especially his pre-examination tutorials which attracted students from  other units.

His counterpart in the Obstetric & Gynaecological department was Mr Saraiyya, whose bedside teaching was equally popular.

He was a chain smoker and always smoked cigarettes manufactured in Britain. Since India was fighting for independence from Britain at the time and boycotting British goods, every time Saraiyya lighted a cigarette, his topical refrain was, “Burning British goods!” His revision tutorials also drew a large number of students, due to appear in the final MBBS examination. At the last session his comforting remark was.”Don’t worry; everybody passes the examination – sooner or later!”

CONFESSION

His senior on the firm was Miss De Sa, known amongst the students as “Madam.” I can’t leave the topic of GMC without confessing what happened at the final MBBS examination in the subject of obstetrics and gynaecology, in which I was trying to obtain a medal.

The main part of the midwifery examination involved a clinical assessment of a full-term pregnant woman and for the candidate to be asked questions on his findings. The Madam left me to examine the woman and went for her coffee break. One of the instruments to listen to the foetal heart sounds, known as foetoscope is an hour-glass shaped gadget, one end of which is applied to the woman’s gravid abdomen and the other to the examiner’s ear.

It was lying on a stool in the cubicle and I was sure that Miss De-Sa would ask me to demonstrate how to use it. Stressed by examination nerves and the intense desire to win the medal, I just could not remember which end went where. I looked down from the window of the first floor where the examination was held and saw a dustbin invitingly looking at me.

I remembered the saying – Out of sight, out of mind – and quietly dropped the foetoscope in it. When the examiner came, true enough, she looked for the essential gadget and not finding it there remarked. “Well it is not here, so please use your stethoscope and tell me the foetal heart rate.” I quickly complied and did obtain the gold medal but the incident has irked me since and I feel partly relieved now that I have made a clean breast of it!

From Bombay after bagging my MBBS degree, it was an exciting flight on BOAC - British Overseas Airways Corporation - as British Airways was known then - to London. The flight was on a super-constellation and took 24 hours, with fuelling stops in five places, Aden, Damascus, Nicosia, Rome and Dusseldorf, in that order.

 In those days when there were no security problems, passengers were allowed to get off at every stop. In England I worked under a few specialists but will touch on three of them, two working in the same hospital for their idiosyncracies, and one, a great teacher at Guy’s Hospital, where I did my final FRCS course.

I worked with Michael Oldfield and Henry Shucksmith, in Dewsbury near Leeds, as their Registrar, a middle grade trainee position. They both were attached to Leeds Infirmary, a teaching Hospital and were visiting surgeons to Dewsbury Hospital. They were like two lions in one jungle and they had to decide which one out of the two was the king. Personality-wise, they were as different as chalk and cheese.

Oldfield had an aristocratic look about him and a tall slim upright body. He always wore a three- piece striped suit, with a gold watch chain going into the left pocket of his waist-coat, a white shirt with a stiff looking detached collar and Cambridge college tie with a miniscule knot at the top. He came to the hospital in a chauffeur driven Rolls-Royc. He had impeccable bedside manners and exhibited an elegant pair of hands in the operating theatre, methodical, meticulous and gentle. He was a man of few words and when they were spoken, there was usually a chilling effect.

Shucksmith on the other hand was short, stocky and his general demeanour reminded me of a rough diamond. His suits always looked crumpled. He was gregarious and slap-happy, equally untidy in the operating theatre, bent on speed and true to his character, drove a Jaguar racing car. In trying to establish supremacy in the hospital, they had set up two different regimes in the theatre.

If Oldfield covered his patients’ wounds with a crepe bandage, Shucksmith asked for strapping. If one painted the skin with acriflavine as an antiseptic, before incising the skin, the other wanted hibitane in spirit. Shucksmith used large hand needles with thick cotton to stitch the skin and if the same was offered by mistake to Oldfield by the Theatre Sister, he said. I must add that he always used a fine needle and nylon which left almost invisible scars. It is in connection with this extreme polarity that I remember a hilarious incident, which I must relate now, even at the risk of self-plagiarisation, because it has been narrated once before in the ‘Surgeon’s Diary’.

STRANGE

One of the complications of piles operation is constriction of the back passage and to prevent it, Shucksmith advised his patient to use a candle as a dilator.

In a deadly crossing of lines, the Sister of the female surgical ward advised Oldfield’s patient to use the candle and it came to Oldfield’s notice in a strange way.

When he was discharging the woman after her final check-up in the out-patient, she asked him. “Do I still need to use the candle?” When the penny dropped, there was a violent earthquake in the hospital, in which the Sister, the Matron and the Administrator were all blasted in turn by Mr Oldfield! Next day I told Mr. Shucksmith what happened. “And you sir were responsible for it.” I added.

“I have stopped using it,” he replied, “since a patient of mine who needed heat to her back for back-ache asked if she could light the candle and kill two birds with one stone!”

LAST BUT NOT LEAST

Last but not the least, Prof Hadley Atkins, who later became President of The Royal College of Surgeons of England and was knighted by the Queen. Sitting in the vast pathology museum at Guy’s Medical School, he taught us on surgical specimens, known in our jargon as “Pots.” He magically imbued the cold inanimate formalinised organs with life of their own.

For example, demonstrating and discussing a specimen of stomach ulcer, he would conjure up in our minds vividly why that patient would present to a surgeon with pain after food, how the ulcer could bleed, block, burst or turn malignant. He dealt with one specimen of his choice every day, until the last day of the course, when he announced.”Instead of me choosing the specimen, today you can select the topic of your choice and I will teach you on it.”

In reply, I, usually a shy stage-frightened student raised my hand and said. “Sir, you are a world authority on breast cancer and yet haven’t discussed a specimen of breast carcinoma with us.” He grinned and his eyes lit up knowingly, as if he expected the  challenge.

Pulling the ubiquitous pipe from his severely nicotine stained teeth, he replied. “You got me there, son. After devoting a lifetime to research and after conducting many trials on this topic, I have come across so many contradictory results that I am totally confused and simply don’t know what to believe. If you ask me talk on brain tumour, a case of which I haven’t seen for many years, I could give an erudite account of the disease.”

HONEST APPRAISAL

There was an honest appraisal by a world renowned authority on the subject as matters stood then, as he went on. If my wife developed breast cancer today, I wouldn’t know what treatment to give her.” There was a vague expression on his face which Einstein would have had if he had not discovered the Theory of Relativity.

I must end this column by giving Sir Hadley Atkins the credit for firing my interest in breast cancer and thank him and his colleagues for the tremendous progress we have made in understanding the disease, changing radical surgery to breast preserving operations. We now know what treatment to give, making breast cancer one of the curable ‘good’ cancers.