Lead surgeon Dr Ramakant Panda worked his scalpels and scissors without a tea or a lunch break for the 15 hours the prime minister was in the operation theatre (OT) on January 24. Pianist Brian Silas’s nostalgic tunes filled the air, barring a tense interregnum when doctors resorted to prayer.
As Panda, of Mumbai's Asian Heart Institute, cut through the long, flat chest-bone above the heart, the sternum, someone switched on the Mahamrityunjay mantra, a prayer for health and long life. “It was a critical moment,” recalled a member of the medical team, requesting anonymity. A deeper cut on the bone under Panda’s scalpel could have damaged the heart beyond repair. The risk was real: the pericardium, a double-walled sac around the heart, was left unstitched in the bypass Singh underwent in the UK in 1990.
That wasn’t the only moment when healthier hearts beat faster inside the OT.
Taken off blood-thinning drugs (Clopidogrel and Aspirin) some 48 hours before the surgery, the PM, who is also a diabetic, bled somewhat abnormally on the operation table, prompting the medical panel to stock up over two-dozen blood bottles.
But excessive post-surgical transfusion isn’t a good idea. A doctor who had access to the OT said there was obvious relief in the room when the bleeding stopped after the operation.
By way of abundant precaution, a heart-lung machine for operating on a “still, un-beating” heart was kept on standby. But it was not needed. That would have defeated the purpose of bringing in the Panda, who specializes in “re-do bypass on a beating heart”. The PM’s recovery could also have taken longer.
An AIIMS alumnus and former student of Dr Sampath Kumar -- who headed the team that conducted the surgery -- Panda wasn’t the “outsider” he was made out to by some in the medical fraternity. But a change in the treatment plan from “beating heart” to “still heart” surgery would have made the team, including the PM's cardiologist, Dr K Srinath Reddy, vulnerable to attacks in India's premier medical Institute, plagued as it now is by peer politics.
The Sampath-Reddy duo placed the PM’s well being above brittle professional egos while requisitioning Panda’s services.
"The whole team deserves credit, not just me," said Panda after Singh returned home on being discharged after a series of tests early Sunday morning. "I want the PM to recover in the shortest time and go back to looking after the country's affairs," he told HT.
Approached for his comments, Dr Sampath Kumar said there was no controversy over putting together a competent team. “Our objective was to ensure the best treatment for the prime minister,” he said.
For his part, the self-effacing Panda kept the confidence reposed in his abilities. Rated the best in India for a beating heart re-do procedure, he landed in Delhi on January 23 evening after conducting two operations in Mumbai.
Sources close to Panda said he had four surgeries lined up for the day and could persuade only two of his patients to wait. The other two left him little choice with their threats to go to the Press were to cancel their surgeries to attend to the PM.
The line of treatment for Singh -- barring the date on which he was to be operated---was decided on January 21 itself after a CT scan followed by angiography that revealed blocked blood vessels. A week before that, he was made to wear a portable device called a halter so his heart could be directly monitored 24x7. The surgery was scheduled when he decided to skip his Republic Day duties and returned to AIIMS on January 23.
The day the PM was wheeled into the OT was perhaps the longest in Panda’s career. The actual surgery lasted 13 excruciating hours -- the doctor leaving nothing to chance, from opening up the PM’s body to closing it around 8.45 pm after five grafts.
Panda had a suite booked at a five-star hotel. But he spent the night before the R-Day at AIIMS on the SPG’s specific request. The measure was precautionary. Delhi being on a red-alert, the security wanted him on the hospital premises for the PM’s post-surgical care, said an official.
What gave the doctors and Singh’s family strength in those testing times was the mortar of faith: PM’s wife Gursharan Kaur distributed prasad from Tirumala Devasthanam and Panda sought Lord Jagannath’s blessings at a Hauz Khas temple with Sampath and Reddy.