Bachelor of Surgery

Akash the famous CTVS surgeon was too happy to receive the invitation to be a guest in the diamond jubilee academic meet of his college of graduation; Raman Medical College. During the flight, he traveled back and back in the memory lane like the clouds did. He did not think about his talk next day. He wished to replace the academic talk with something else. The nostalgia kept him engrossed. The entire built up of his career from his graduation to several post MCH skill upgradations played in front of him.

Why did he become a surgeon although he loved the subject of medicine more? He acknowledged the convergence of skills even if more and more super specialisations sprouted from a subject. What a cardiac physician is doing now or what a gastroenterologist is doing now is nothing but some skilled procedures. Akash considered them as surgical skills. 

And on the other hand, he always thought that the junior physician in him is still very much alive. He even thought that it is the physician in him that takes all the decisions regarding his surgical managements. Yes, of course there is a convergence. The convergence is well defined in the title of his basic degree; Bachelor of Medicine and Bachelor of Surgery.

Suddenly his mind travelled back to his final MBBS surgery examination. 

Akash never considered himself as a bright student. He studied not too much. But he stdied the bigger books above his level. Such futile attempts worked against him. He attended all examinations as under prepared, too much under prepared. Surgery was no exception.

Not to be nervous was what he was used to. In the Surgery theory papers, he found the questions to be very tough. While his friends answered their papers he felt the discomfort and he was about to leave the hall. Suddenly his own old dialogue for a friend who dropped an examination came flashing to his rescue. To drop an examination is a predated fail result only.

He started writing in his own way, in a clinical manner. 

Akash' home was not too far. Throughout his undergraduate days several patients from his area came to his college and he was there to take the responsibility. He remembered his patients and how the great professors his college managed them. So far department of Surgery is considered he remembered Prof Bankim Pattanaik, BP sir. Several of his known patients were treated by him. BP Sir's method was as academic as generous. He was a class surgeon. Akash, now a seasoned surgeon still considered; yes, BP sir was the surgeon and the teacher of excellence.

He started writing the answer to a question on pain abdomen.

He went on writing about his uncle's management. His uncle was successfully treated from a very bad condition to be cured and discharged in fifteen days. He wrote as if he had treated him. How his uncle was received in the out door, what differential diagnosis BP sir and team kept in mind, what investigations they did, how the case was diagnosed to be a case of chronic cholecystitis with cholelithiasis that meant long term infection of gall-bladder which was due to stones in the organ. He wrote everything and it took him one third of the duration. He wrote nothing from the book but what was the exact approach of BP sir and department.

He also answered other questions in a careless but as far as possible in a different way.

He was not very sure to pass in Surgery. In the clinical examination to his good luck he again got a case of Cholecystitis. The external examiner Prof DP Yadav came from Patna university of Bihar. Seniors told, he was very liberal as an examiner.

He asked simple questions which no student can make a wrong answer. He asked questions and gave hints. Akash loved to answer. He was very sure that the examiner asked these common questions to help him just to pass. He assumed that his theory mark was ordinary. However Prof Yadav did not allow him to be nervous. 

He asked mostly on management of burn injuries. Akash travelled through two of his known patients who were treated for severe burn injuries.

- So Akash, what is your next step of management?

- Sir, now we have to do skin grafting.

- Very good and you are passed right now. But will you take a risk. If you correctly answerd my next question I shall give you an honours but if you answered wrongly you will be failed.

Akash momentarily though, after assuring him a pass result, such a friendly examiner was not going to make him failed. He was only joking. He with a benign smile replied.

- Yes sir, I will like to take the risk.

- Then tell me what are the types of skin grafting and which type you will opt in this particular situation we are talking about.

- Sir, there are two types of skin grafting, partial thickness and full thickness. 

Then he took a pause he had no answer, he was about to buff taking a probability chance of success of fifty percent. And failur? Fifty percent too. 

He looked at the back ground. Final year Post graduate students were there. They tried to hint him. But they were not unanimous. Akash got confused and answered; - Full thickness sir.

Prof Yadav laughed and told, - Wrong. You can go now.

Akash had no worries his guts told him that he was going to pass sure. And he did. He scored very good mark in Surgery. That meant the last answer failed him to get the honours. But he was not unhappy as he was the one who thought to drop the examination in first place.

This was a turning point. He decided to be a Surgeon and nothing else. An external examiner in his fifteen minutes contact could be an idol for a student!

He did very well in Postgraduate entrance examination to get a seat in Postgraduate Institute of Simla.

Things were not as bright as they looked externally. Very soon he regretted for his choice of such a big institution. He felt as if he was doing his Bachelor of surgery again. All super speciality departments were there. All students of general surgery automatically wanted to do further higher study of MCH in different subjects. The academic environment was of very high standard but the practical learning and getting chance to do a surgery was less, much lesser than what was expected from his college of graduation. He was not too sure about doing further higher study.

Not that he did badly in his postgraduation study. He was top performer.

He came back to his native state and joined in government sector. He got his first posting in the community health center Bahalda, in the subdivision of Rairangpur in Mayurbhanj district. He enjoyed the life there, the scenic beauty the simple raw innocence of native people, tribal or others. He however had no work. There was a country doctor who claimed to cure many surgical condition with guarantee without any knife.

There was one Dr Binod, a famous MBBS doctor who did the cases of general surgery with great efficiency, a true bachelor of surgery. Akash loved and respected him. There was no anaesthetist and complicated cases were referred. 

So, Akash had nothing to do in that remote place. Dr Binod once suggested him to go for higher study. Other doctors also were of the same opinion.

Akash left the place in six months and joined AIIMS New Delhi as a senior resident doctor in Cardio Thoracic and Vascular Surgery department. And then he did MCH in CTVS there and joined as a faculty there. When the department head had to come under knife he chose Akash as his surgeon. This is how the entire country came to know him. Now he is of international fame.

He also did an open heart surgery of Dr Binod. While introducing him to his colleagues, Akash told, meet my teacher Dr Binod the best bachelor of surgery of the country. He added, this is a failure of the medical education that made the basic degree of MBBS appear good for nothing. But in the old school the degree was important. Anyone who would witness Dr Binod doing surgery for sure must agree to this.

We have to find a way to revive the glory. Might be by introducing MBBS with honours in a particular subject. We have taken super specialization too far but our youth are brilliant and we must empower them with much more skill and knowledge and capability with their bachelor degree.

He finished his talk and the auditorium jam packed with undergraduate students, aspiring post graduates and many old students clapped for a minute or two.

Akash woke up from a good nap as the air hostess announced, "Welcome to Biju Pattanaik international airport Bhubaneswar......".

Akash was in split mind to decide about his next talk, should it be academic or inspirational!?