Disarming honesty and one life well lived
Sunil K Pandya
VN Shrikhande, Reflections of a surgeon. 2nd edition, Popular Prakashan, 2015, ISBN 9788179918395, Paperback, 288 pp, Rs 350.
Dr Samiran Nundy’s foreword to the book sums up its contents accurately. Let me quote just one paragraph from it to give you the flavour of this autobiography: “…I started reading the book on a Friday and by Sunday I had finished it and was absolutely enthralled. The opening page sets the tone of this book which is full of optimism and gratitude of what life has given to the author – work when young, guidance and protection from mistakes during operations, a disdain for money and ‘good health to enjoy the evening of his life’. His prayers have been answered.”
Dr Shrikhande being asked to operate on President Shankar Dayal Sharma in 1994, though of interest and described in fair detail in chapter 1, is merely evidence of his reputed expertise as a surgeon. He has performed far more complex operations with equal success. The operation on President Sharma is noteworthy because several surgeons had expressed the opinion that the risks were too high and, indeed, “that the operation is not possible”. President Sharma’s systemic illnesses disallowed the use of general anaesthesia and surgeons in Delhi and from abroad had ruled out surgery under local anaesthesia. Dr Shrikhande’s confidence in his ability to succeed was based on his experience of over 35 years. Even so, “the night before (the operation) was not without its jitters.” I shall not rob you of the experience of reading about the operation in Dr Shrikhande’s own words. Additional details on how he acquired his skill in surgery under local anaesthesia are to be found on pages 64–5.
Dr Shrikhande’s honesty is disarming. He holds nothing back. He puts his arm around the reader’s shoulders and chats amiably, as to a friend, throughout the book. He voices his frustrations as he was teased from childhood about his stammer and how this handicap continued to plague him till he gained the respect of his peers and seniors as a consultant in India and abroad. Seared into his memory is the cruelty of a surgeon in Grant Medical College who berated him thus: “You cannot utter a few sentences smoothly. How can you be a doctor?… Do not waste your father’s money.” It amused him that, years later, the same surgeon took his permission to watch him operate on a pancreatic tumour, watched the five-hourlong surgery and showered him with praise! The scars from ragging and unthinking comments on his stammer are on display in chapter 10.
His accounts of interactions with patients and their families are to be found throughout the book but are focused on in chapters 12 and 18, the latter dealing with individuals of renown who also inspired him. Budding surgeons will find chapters 14 (“Stress in a surgery”) and 15 (“Skill and the surgeon”) especially useful.
He continues to consider himself the boy from a small town who remains surprised at his renown in the metropolis he has made his home and, indeed, throughout the country. His tribute to his mother precedes that to his father, though the latter served as his role model. The lessons in honesty learnt from his father and the anecdote on Chanakya (p 51) have been incorporated into his own work and life. Small wonder that his medical practice has constantly exemplified the principles of ethics.
His strong desire to learn, assimilate and teach has led him down several paths. While people remain his principal source of interest, he uses books, travels and the modern miracles provided by the internet to great advantage. Early on in this book, we learn that the judge’s bungalow in Karwar allotted to his father during his posting there had earlier been occupied by Rabindranath Tagore’s brother and by Dennis Kincaid. The details provided on the author of British social life in India 1608– 1937 and other books are of considerable interest.
His sensitivity makes itself felt throughout the book. Here is one example from his initial experience in the dissection hall of the Grant Medical College: “The sight of the cadavers would trigger a chain of thought. Where was he born? How did he live? They had died unheard, unsung and unwept. What must have been the dreams of their parents? Did they go to school? How much did they suffer?…” I must confess that such thoughts did not disturb me as I started learning anatomy in the same hall 13 years later.
It was a natural progression for such a medical student to consider the plight of patients seeking his help. Over time, they learnt that they – and not he – were to decide whether or not a fee was to be paid to him and the amount to be paid. He insisted that they were better judges of their abilities to pay him and he had no desire to impose on them.
His account of the first occasion to travel abroad to further his training in surgery will remind many of us of similar feelings as we made our way with little by way of funds or experience of the wider world. His qualities won him the friendship of Mr Andrew Laird, his teacher in Glasgow. Likewise he won the admiration of Mr Charles Rob, his examiner for the FRCS, who went on to offer him an appointment in his unit. His experiences as a surgeon in a busy hospital in the Lancashire industrial region in England demonstrate his growing confidence in his own abilities and the admiration he evoked in his seniors, discerning nursing sisters and, of course, his patients (pages 84–110).
Returning to India after four years in Britain, he started practice. His meeting with Dr GM Phadke led to work on restoration of fertility in males who had undergone vasectomy. Famed for his expertise in such operations, he went on to develop the field of complex surgery for diseases of the pancreas, gall bladder, parotid tumours and other ailments. He encouraged surgeons working in villages and small towns by visiting them and operating using the limited facilities available to them.
His experiences as an Assistant Honorary Surgeon at the Goculdas Tejpal Hospital in Mumbai and at the Bombay Hospital are described in considerable detail. The contrast in attitudes towards patients in the former, run by the state government and the latter, a private trust hospital, are striking. It remains a pity that poor patients in public hospitals continue to be treated by most staff members as third class citizens while the affluent in private hospitals are kowtowed to.
An avid reader, Dr Shrikhande prefers constructive books (such as Hans Eysenck’s Uses and abuses of psychology, Booker T Washington’s Up from slavery, biographies and tomes on medical history and ethics. His library must be a treasure house.
Photographs provide vivid introductions to his parents, his family members, some of his teachers, colleagues and patients who are etched into his memory.
The small boy from Belgaum has come a long way and now, in his eighties, he remains just as keen to learn from others, admire excellence and help by example and precept.
Chapter 19 describes how he faced his own major illnesses and a near-death experience. Equally inspiring is the next chapter “Courage in the face of death”. We are granted the privilege of an introduction to Keroba, a poor man rendered paraplegic by a car accident and two other dying patients. As Dr Shrikhande puts it in his final chapter, “My patients have taught me how to live, why to live and also how to die… One life enough for me. I have enjoyed my long life and remain grateful.” Each of us would dearly love to echo these sentiments when Yamaraja decides to call on us.
This book is warmly commended. You will be the richer as you ponder the many lessons taught by its author.