“How can you say that you can’t save his leg? Don’t you understand how important one’s limb is for a person? What sort of a doctor are you… Can’t you even try?” said a man standing in the front row of the crowd rather angrily.
Doctor sanjay, who was one year senior to me, and was the second year orthopedic resident in the hospital, turned sideways and squinted to see who had spoken these words. Sanjay and I were sitting in the small counselling room near the emergency room, and were surrounded by a crowd of about 15-20 persons, all of them were relatives or acquaintances of Bhanwar singh, who had been admitted four hours ago in the emergency room of our hospital after he met with an accident on the highway nearby.
“His left leg is totally crushed, muscles and tendons have become a mesh, and there are many small pieces of shin-bone. In this condition there is no point in trying to save the leg, even if we somehow are able to put pieces of bone together, his leg will be useless. And also, the treatment will stretch quite long – consuming both time and money. What’s the point in doing a treatment which will drain your resources and won’t lead to a good outcome?” explained Sanjay to that man and others.
“Amputation is a better option in such cases, he will be walking independently with a prosthesis a lot sooner.” added Sanjay further.
“He will not have an amputation! My brother cannot and will not become an invalid,” thundered a man from the crowd, and came in front rather aggressively. He was a tall, well built man with thick moustache and a stern expression on his face. “I am Ram singh, Bhanwar’s elder brother, I and my family will do anything to save my brother’s leg. If you cannot do anything, write it down a paper and we will take him to another hospital.”
Doctor Sanjay sighed and muttered under his breath to me- ‘ Trying to save his leg is the surest way to make him an invalid, but these emotional fools won’t understand,’ then turning towards the crowd he said aloud, “All right, we will operate upon him and will try to reconstruct his left leg. My duty was to discuss with you all the modalities of treatment and their pros and cons; now as per your wish, we will do reconstructive surgery.”
“Ok, who amongst you will donate blood to him? We need atleast three units.”
As if by magic, the crowd in front of us thinned out on hearing these words, and all of the loving relatives excused themselves quickly citing one reason or the other, until a thin, frail old man was left standing alone. He must have been in his seventies and had a worn out stick in his hands.
Sanjay winked at me and said grinningly -“And that’s how you disperse a crowd in an Indian hospital.”
I smiled and thought- I had much to learn from my seniors apart from surgery.
At this moment, that old man came forward. He had folded his hands and said pleadingly, “Sir, I am Bhanwar’s father, he is my youngest son. He has a young wife and two small kids. We are not very rich and I have a small farming land in my native village, which I have divided amongst my three sons, but Bhanwar wanted to move to a big city, and so he came here and became a truck driver.”
“Sir, please take as much blood from my body as needed but save my son’s leg. He is the sole bread-winner of his family. ” he said, wiping a tear.
Both of us were moved by his words and Sanjay patted his shoulder and said, “Don’t worry, we will do our best.”
There was no way that he could have donated blood to his son or to anybody else, for that matter.
On the fourth day after the surgery, in which we had put an – External fixator- an orthopedic device initially kept for some time, while the tissues healed, before final surgery was performed; Bhanwar suddenly spoke to me, as I was dressing his wound-” Vivek sir, are you from Kota or nearby area?” He and I had been talking a lot lately in the ward, as I was mostly in the ward, being the junior most.
“Yes, true, I belong to Kota, how did you know?”
” I have detected an accent in your speech which points towards that area. Also, don’t know why, but your face reminds me of a famous doctor in Kota, whose clinic I had visited few years back with a relative. I belong to a village near kota sir.”
“Are you talking about Dr. Mukesh sharma?”
“Yes, exactly! How did you guess sir?”
I laughed and replied – “No wonder my face resembles his; he is my father.”
“You are the son of Dr sharma saheb!” ejaculated Bhanwar and held my hand, ” now I am sure I will be all right, he is not a doctor but an incarnation of god. No doubt, your hands have healing powers too. I will be allright sir, won’t I?”
” Of course you will be fit and fine, don’t you worry, it will just take some time with the kind of injuries you have had, but we will fix you up.” I said, rather over confidently. But I was feeling strangely happy and pompous.
After that day, Bhanwar developed special devotion towards me, and he regarded me the senior most doctor and behaved in that manner.
Four months later:–
I had seen Bhanwar after a gap of few months and immediately noticed the change in his appearance. He had lost considerable weight and his face had telle-tell signs of prolonged anxiety.
Though his face brightened when he saw me, I could see that his natural exuberance was nowhere to be seen and he seemed subdued. It’s not uncommon in orthopedic patients.
Noticeably, there was a significant decrease in the number of people accompanying him, his wife was there; like before, but somehow it seemed she had lost the reserve, which she displayed earlier in front of her husband and father-in-law, who was there too; looking more and more anaemic. There was only one other person, a brother, who had not appeared last time and was looking lost in the melee of the hospital.
“So Bhanwar, you are here again…this time we have decided to do a magnificent surgery, which will make your leg normal again.” I patted his back with the new found confidence of a second year resident, which I had become in the intervening months,.
I had discussed his case with my professors and seniors extensively and knew that the plan was to remove the fixator and implant another type of special external fixator called – Illizarov- that is helpful in such cases, but is a very long process, requiring multiple admissions and frequent adjustments, but my professors wanted to use this approach and assess it’s progress.
” Yes sir, I have faith in you,” he hesitated a bit before adding, ” please sir, make me walk normally, so that I can be an earning man again.”
“You know, it’s very depressing to be dependent on someone else all the time.”
I looked at him with concern, ” What’s wrong Bhanwar? Did anyone say anything to you?”
“No..No vivek sir, ” he exclaimed hastily and said in a low tone as his wife went away for some errand” but I do get this feeling that I have become a burden on everyone.”
“Don’t worry… everything will be fine, it’s normal for chronic patients like you to be depressed.”
I thought it would have been so good for him had he undergone an amputation the very first day, he would have been moving about with a well-fitting prosthesis by now. But, the aggressive and over-zealous relatives, who had been brimming up with camaraderie and noble intentions that day, were nowhere to be seen now. And, we hadn’t even reached the halfway point of the treatment!
‘You have to help him!…Don’t abandon him’ I was startled by this sudden burst of emotion in my sub-conscience, but it was anyway not possible for me to abandon him- professionally, and even personally – I considered him my protégé, if one can use this word for a patient.
Two days later as I was entering the male orthopedic ward to explain to Bhanwar the basic care and hygiene of his newly implanted Ilizarov fixator, I overheard Gulab, a senior male attendant in the ward, bragging to another attendant about his flirtation with Bhanwar’s wife, and how she was positively responding to his amorous overtures.
When I saw him, Bhanwar was sitting dejectedly on the cot and was starting at the fixator absently…..How soon a perfectly healthy and confident man can loose his mojo, I reflected.
I patted his shoulder and he gave me a sad smile. Through his honest eyes, it seemed, I could enter his soul and could feel the waves of helplessness and self-pity crashing on the shores of his embittered and belittled heart.
Seven months later:-
I was busy in the o.p.d. when he came and sat on the floor near my chair.
His appearance appalled me, a luxuriant beard was sitting on his face like a hive and he had become cachexic. His bright and benevolent countenance had been replaced by a personna which can be described in only one word – melancholic.
I was expecting him as we were again admitting him for the third and final readjustment of the fixator. Previous two adjustments had shown good results and the bone in his leg was growing and responding to the treatment, and we were quite hopeful that in few months time we would be able to remove the fixator and he would be able to move freely, without any aid again.
” We are quite happy with your progress Bhanwar. Infact, my professor commented yesterday that he had not seen a case like yours in his experience. Your treatment has exceeded all our expectations!” this was quite true.
“Hmmm…If you say so Vivek sir.”
“What is the matter? Aren’t you excited…You would be out of this fixator soon.”
” My wife left me…ran away with kids alongwith another man from my village.”
“It’s not your fault, she should have supported you in your time of need.” I said, stunned.
“Said, I was not a man enough for her now. I don’t blame her, sir…I have become an invalid, who does not earn a penny and whose own leg has become a giant hole in the pocket of his household.”
“I can unburden my heart in front of you vivek sir, you are my true friend and guide…My brothers have refused to give any more money to me, and I had a fight with all of them. Do you know I have come alone this time. My father is dying due to all this stress.”
“Please tell me what to do..” he started sobbing with these words.
I was at a loss of words for few moments, because how can one console a person who had lost so much? What can few soothing words achieve?
“You consider me your friend..right? So, listen to me – have heart, I know it’s difficult, considering the circumstances, but worse is over…We are reaching the end. Your leg is progressing so well. Just bide some more time…Keep floating on the log of hope…all right?”
He nodded slowly through a wall of tears.
“Dr. Vivek sharma?” said a voice as I picked up the phone.
“This is Dr. Nihar agarwal.”
“Good morning sir!” I tried hard to suppress my excitement.
“Morning…good news Vivek, we have selected you for Berlin, congratulations.”
“Thank you very much sir. When should I…”
He cut my sentence,”No hurry, I was told by your professor Dr Patel that you were getting married soon and going to Malaysia for your honeymoon … congratulations again”
“Thank you sir…that is right sir.”
“Ok..as soon as you are back from honeymoon, complete the remaining formalities and send everything to us. Then we will parcel you to Berlin.”
I laughed,” All right sir…Have a good day sir.”
Seven weeks later:-
It was a sunday morning when I leisurely walked up to the orthopedic ward to take a round and get acquainted myself with the patients who had been admitted during my absence of about three weeks. I had landed at Ahmedabad late last night.
‘Only three weeks!’..seemed like an eternity that I have had anything to do with orthopedics,’so much has happened in this time,’ I mused with a glowing satisfaction which was the result of a having spent a fairytale time in a distant land with my newly-wed wife, Ritika, and being genuinely happy.
As I turned round the corner in the corridor which lead to male orthopedic ward, I was forced to stop dead in my tracks, and all my warm and mushy feelings were jolted and then evaporated, to be replaced by a – horror! An unlpeasant and deep horror – there in the corridor was Bhanwar, leaning onto two crutches and where his left leg should have been, caged in the fixator with wires and pins – damaged, but on the point of healing; was a stump!..
He was walking towards me with his head down, concentrating on his gait, trying to learn the pattern of walking with the help of crutches and one leg. Then he looked up and saw me – a big smile spread on his face, a smile which representated his erstwhile nature – honest and child- like…
“Arre! When did you arrive Vivek sir? I had been waiting for you for the past ten days, look!” he pointed proudly to the freshly amputated stump below his left knee,” I am free at last.”
He came excitedly towards me gingerly balancing the crutches and held my hand, ” I should have listened to you the first day when I met with the accident and should have got the leg amputated. You are my true well-wisher, how correct you were that day in your advice to not to go for an attempt to save the leg. “
I felt as if an abyss had opened below my legs and I was falling into it. “But Bhanwar… why now ?…We were reaching the end of treatment…Why didn’t you call me? Didn’t other doctors tell you not to cut the leg at this point of time, when success was almost in our clutches?” I fired one question after another…there was a storm going on in my mind.
“I tried calling you so many times sir…but your phone was unreachable. Few days back my father expired and you know what my wicked brothers did? Expelled me from my own house! They usurped my home and my portion of land saying it was their due as they had lent me money over past one year and half, and now it all belonged to them as I had become an invalid and couldn’t repay them. They even did not let me attend my father’s funeral! Reason?…I had brought shame to our family by not controlling my wife and that scandal had ruined our family’s name forever.”
“I was mad with sorrow and rage…could not bear to have my left leg attached to my body one more moment!..that blasted useless peice of flesh had brought nothing but misfortune to me..God! how I hated it. It was like a cancerous growth at the end of my knee gobbling up my body, my wife, kids, my father… everything!”
“When I couldn’t contact you on the phone I immediately came here and asked the doctors to go for amputation. They all were very reluctant, Dr Patel sir told me that it was healing well, and I shouldn’t insist on getting it amputated. But I was like a madman…could not bear that damned leg…I had brought a knife with me and threatened to cut my leg then and there, in o p.d. in front of everyone and bleed to death. It was my leg after all… my decision.”
“Vivek sir, you have been so good to me..I know if you would have been here you would have supported me whole-heartedly. I am beginning a new life now…With the amputation of my leg I have cut all my ties to my previous life. After I have the artificial leg, I will go to your house in Kota…tell bade Dr Sharma saheb that a humble servant is coming to his house and clinic…I will do anything that he says.. Anything! Just let me be there..Don’t pay me ..Two meals a day would suffice for me.”
I was standing frozen … Couldn’t breath.. Couldn’t move…With a lot of effort I nodded to him slowly. He hugged me gently and ambled away in the corridor determined to learn the baby steps of his new life.
Suddenly all my muscles gave way and I sat with a thump on the ledge and the sheaf of papers which I had been clutching in my hand fell on the floor and were swept away in the wind.
If someone would have bothered to have a look on those papers littered on the floor, he or she, would have read the following title :-
‘Limb salvage with Illizarov fixation in a mangled extremity with M.E.S.S. score 7:- a case report. Dr Vivek sharma, Dr sanjay choksi, Dr Nishant Patel.’
It was the draft of the paper which had been selected to be published in the Indian journal of orthopedics, and I had been selected, after a lot of efforts and lobbying, to present the case report in a very reputed international conference going to be held at Berlin a few weeks later.
It was nearly complete..I had reported falsely that the patient in question had fully recovered and I would send the much needed last picture of fully healed leg and it’s x-ray soon. Dr Agarwal was a friend of my guide Dr patel, and had agreed to publish it in the journal as soon as I would send the last pictures. I was so confident that Bhanwar would listen to me and do what I told him to do! It was just a matter of time..
Now .. Everything had changed…there was a stump in place of a well healed leg…With one swift strike of the knife not only his leg had been amputated, but also struck off were my dreams, aspirations and ambitions.
He said I was his true well-wisher…That I would have supported him in his decision…
As I stared at his amputated stump…It seemed to mock me – I know your secret… you are not what you pretend to be…
“But I had good intentions for him!… Didn’t I and others told him and his family to cut the leg very first day?”
I found myself replying acidly to the retreating stump and threw a glance around to see whether anyone had seen me….