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Knife for life

From those healing sick hearts to others improving a child’s smile... surgeons toil hard to ease people’s suffering, says Ayesha Banerjee.

education Updated: Sep 22, 2011 11:41 IST
Ayesha Banerjee

Though there has been a lot of debate over the urban-rural disconnect in this country, Indian villages have often been throwing up big surprises which more often than not convince the optimists among us that all is right with this world. If someone is destined to greatness, then no village or mofussil town or sprawling metropolis is going to get in his or her way.

For Yugal K Mishra (profiled recently in HT Horizons for his work in the field of robotic surgery), considered one of the world’s top cardiac surgeons, the beginning was humble. Born and brought up in the village of Jariyari, Amarpathan Tehsil in Satna district of Madhya Pradesh, Mishra grew up helping his uncle, a medical practitioner, prepare medicines from herbs. The art of healing so appealed to him, that he studied hard to get into medical college, completing his MBBS and MS (Surgery) from S.S.Medical College, Rewa in the same state.

One of the people responsible for his success, Dr Mishra says, was Dr. Curtis Man, a cardiac surgeon “I worked with during my training in Bakulev Research institute for cardiovascular surgery, Moscow. Every single moment in the operation theatre was a teaching session without Dr Man compromising on the patient’s safety but giving enough attention to queries posted by his assistants – whether a routine triple bypass or a complex aortic surgery. His mastery over surgical operations remained the same - whether he was operating on a sick heart in the middle of the night or fresh after a night’s rest,” says Dr Mishra, who is now director, department of cardiovascular surgery, Escorts Heart Institute & Research Centre, New Delhi.

A good teacher makes things easy, but working your way to the top is not easy. Says Dr Rashmi Taneja, senior consultant, plastic and micro vascular surgeon, Fortis La-femme hospital, “the competitive examinations required a lot of dedicated studies and hard work. Most of us who were appearing in the entrance examinations took extra coaching from coaching institutes. But all the institutes are really there to guide you and help you understand the subject matter.

There is no replacement for hard work and studies when preparing for the exam.”

Does anything prepare one for the rigours of medical college? No one at the age of 18 entering college is prepared emotionally or mentally, says Taneja, who is from Delhi and did her schooling from Mater Dei. “The adventure and excitement of learning and seeing everything more than makes up for it,” she adds.
And the first cadaver? “The first anatomy dissection and seeing a cadaver is an experience that every medical student remembers,” says Taneja. Students should be ready for varied responses from fainting to tears to a great deal of excitement, advises she. Taneja was one of the bolder ones and soon realised that she enjoyed the dissection process and was the designated dissector at her dissection table.

A graduate from the Armed Forces Medical College in Pune, Taneja completed her medical schooling from Maulana Azad Medical College, Delhi. She started her MS in general surgery from Delhi’s Safdarjung hospital and did the remainder of the training from the US, where getting admission into a general surgery residency training programme was extremely tough. “After taking the exams and appearing in multiple interviews I was selected to the programme at the University of Medicine and Dentistry of New Jersey, but had to prove myself in my surgical knowledge, skills as a surgeon and as a hard worker before I was selected to advance into the programme to complete the training,” adds Taneja. Training in the US is much more rigorous than in any other country. The day starts at 5 or 5.30 am for most surgery residents and ends when all tasks of the day are complete. The exposure and breath of knowledge and types of research, problem solving skills and patient management skills that Taneja says she developed during the training, however, still stand her in good stead. “I have not regretted a moment of the those six years of training, which were followed by other specialisations in various US medical schools,” she adds.

Dr Mishra’s advice to those aspiring to be surgeons is, “concentrate on bedside teaching. For a doctor, the patient’s ward is the biggest laboratory. Of course, research is mandatory as medical science is evolving every day, hence, medical professionals should always try to gain new knowledge and adopting that knowledge is clinical practice. Also, there should be appropriate balance of research and practice for a clinician,” he adds.

What's it about?
Getting to be a surgeon is not easy. One has to go through rigorous training to qualify as a surgeon and operate on the human body. Surgical procedures are followed to diagnose, treat, and cure diseases and medical conditions

Clock Work
7.30 am: Breakfast
8.30 am: Day at hospital/clinic begins
9 am to 3.30 pm: At OT operating on patient
4 pm to 7 pm: Have late lunch, attend clinic and see patients
7.30 pm: Check mails, respond to patients’ queries
8 pm: Attend to an emergency call
10 pm: Return home
11 pm: Have dinner
12 midnight: Start reading patients’ reports and catch up on general reading

The payoff
. MBBS and postgraduation in general surgery is teh basic requirement to practice surgery in India.
. Monthly salaries can vary and are usually high in private hospitals but a general break-up could mean:
. Internship: Rs2000
. Junior residency: Rs20,000
. Junior residency (PG training) Rs22000
. Senior residency (post degree traiing): Rs40,000
. Associate consultant: Rs60,000
. Consultant: Varies and can go up to lakhs
. Those in private practice can earn in crores

Skills
. Excellent surgical skills with a pair of steady head and a calm mind
. Motivation to learn and excel at his or her job
. Consistently high academic record

How do i get there?
Step 1: Biology in Class 11 and 12. Medical entrance exam after class 12. Those who pass study for an MBBS degree. After MBBS
Step II: Qualify the PG entrance exam
Step III: Qualify for MS in surgery
Step IV: Training as senior resident
Step V: Super-specialisation - M Ch
Six years of training makes you a surgeon. At teh end of the training you can opt for a government job or work in a private hospital. You can also start your own practice

Institutes & urls
. All India Institute of Medical Science (AIIMS), Delhi
www.aiims.edu
. ostgraduate Institute of Medical Education and Research, Chandigarh
www.pgimer.nic.in
. Christian Medical College, Vellore;
www.cmch-vellore.edu/t-main.asp
. Maulana Azad Medical College, New Delhi
www.mamc.ac/ion
. Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI) , Lucknow;
www.sgpgi.ac.in
. JIPMER Prondicherry
www.jipmer.edu
. King Edward Memorial Hospital (KEM) Mumbai
www.kem.edu/
. Sree Chitra Tirunal Institute for Medical Sciences and Technology
http://www.sctimst.ac.in/

Pros & cons


.

You save lives and ease people’s pain and suffering


.

Much respected profession


.

High remuneration


.

The more skilled you are the more your growth prospects


.

Talent can take you places


.

Surgery is a risky procedure and losing a patient can be a hard blow


.

Element of risk also leaves no margin for errors – you can be held responsible for a patient’s death


.

Extremely tough work conditions and hardly any family life

Govt medical colleges Are good training grounds

A veteran talks about ‘doors opening to places where gods tread majestically’

How did you get into the medical profession? Your specialisation?
I am the only son of immigrant parents from Quetta, Pakistan. I was born in Ludhiana in 1953. My decision to become a physician originated from an incident that had happened in the winter of 1967. On December 3, 1967, the world woke up to the seemingly impossible feat of Dr Christiaan Barnard having transplanted the human heart.

To my young mind it was as if a door had opened to a place where gods tread majestically. This was a life I thought I would love to live, shaping the course of the lives of my fellow men, healing sick hearts, a life worth the living.

How did you get into medical college? Were preparations tough?
In our times the premier examination was the objective common entrance test for entry into the All India Institute of Medical Sciences and Mahatma Gandhi Institute of Medical Sciences, Wardha. I had qualified in this and joined Wardha in 1969. However, I soon learnt that I had qualified in my home state examination as well and shifted to the Government Medical College, Patiala – since it was closer home.

I believe that no competitive examination is ever a breeze and I ascribe my good performance in these examinations to the hard yards I had put in, in the two years prior to the exams.

Were you prepared for the rigours of medical college?
Medical school was an eye opener in the sense that the subject matter is way different from what I had been exposed to, to date and the course at best can be described as vast and intimidating. However, a few months into the curriculum my sense of wonder and curiosity overcame the fear I had initially felt. Every day seemed filled with magical possibilities and learning new things about the human body was like walking into the proverbial Aladdin’s cave. All this was tempered with the realisation that there was no subject I could ignore because my real test would not be a written exam, but the patient.

How tough is it to do MS?
I went on to do my masters in surgery from Medical College, Patiala. Those days are a blur in my memory. I was always in the wards, seeing patients, operating day and night, and oh the endless academic forums!

At the end of three years I knew I was ready for the next step – learning to operate on the human heart.

The institutes that provide the best training for MBBS and MS?
I trained for cardiac surgery at the Post Graduate Institute of Medical Education and Research, Chandigarh. I was selected as the first British Heart Foundation fellow in the world and I went to the United Kingdom to hone my skills, acquiring my Fellowship of the Royal College of Surgeons from Edinburgh and FRCS-CTVS from the intercollegiate board. I then travelled to Australia and obtained FRACS from the Royal Australasian College of Surgeons. I believe that all government medical colleges are good training grounds for MBBS and MS. The best training centres for superspeciality training in cardiac surgery are AIIMS and SCT Trivandrum.

Dr. I S Virdi, Sr. Consultant & Chief – Cardiothoracic & Vascular Surgery, Max Healthcare interviewed by Ayesha Banerjee

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