Opportunity Knocks But Once

What have I done ? He was bleeding, helpless, and ….I, a qualified surgeon with seventeen years of independent clinical experience, should’ve known what to do. Now it’s too late. Damn. Listen to what I’m saying. I don’t have much regards for you shrinks, you guys were the ones who scraped through, the etceteras of any class. But I have this urge to tell someone what happened just to get it off my chest. I’m not a confessing type, but …is this what you call stress? Just a word really, describing certain emotions. First it was obesity, heart-attacks, and stuff. Now it’s osteoporosis, AIDs. And stress.

Ok, I’ll get to the point. Let me give you a narrative summary first or history or whatever you call it in your vocabulary.

How’m I to know what to do, I’ve never been a patient. You tell me, you’re the expert on the mind things, eh?
At the beginning ? What beginning ? Childhood was ok, typical middle class, do your homework, what did you get in maths, lost a mark here, that sort of thing. Parents? They were ok, mother taught at the same school, primary section, father was a bank-officer. Oh, yes, lots of time for me they had. Rather boring, their company, but they made sure I’d cricket coaching, music classes, … all-round development, you know.

Funny, how little we knew about each other in spite of being room-mates for five years.

Vacations were in our village, with the grandparents, finishing holiday homework. Hobbies ? I collected matchboxes for a while, a waste of time. You know how tiny our flats are, there was no place for them. Threw them away. No, no other interests.

My brother ? What about him ? Father’s still upset that he quit his cushy job to get into this HR training thing…like, how to talk, what to wear, how to shake hands, stuff. Did engineering, then MBA, then chucked his job. Father still doesn’t know what to tell people when they ask what he’s doing.

I want to tell you about what happened in the OR and……. OR’s an operating room, you moron. Ok, you can call it an operating theatre if you wish, what’s the bloody difference. You don’t want to hear about it yet ? Alright, my childhood was fine, sped by. By some weird chance, I got into the merit list in my tenth boards. Haven’t a clue how; I was always one of the bright ones, but never a school topper. I hadn’t cheated, either. In our family, we always did things right. The world was bad, not us. We never even mentioned the word cheating.

Come to think of it, all we ever spoke of at home was how so and so did in his sixth or seventh or whatever finals. In fact, strange, now that you’re asking, whenever I was asked what I wanted to become, my parents answered, ‘doctor’. I didn’t. Never took any decision. Ate what was given, wore whatever was bought. At one stage, I wanted to become a musician. Yes, strange. I was made to do yoga to improve my concentration, and swallow some pasty medicine to make my memory strong. Brilliant, that was what I was supposed to become. No one was to be better, in class, in the family, wherever.

Friends? Arjun, Chandra,…..no, he was in college….why d’you interrupt me like this, they weren’t relevant.
That tenth standard result changed my life. Father withdrew from his Fixed Deposits to enroll me in the best coaching class. Reminded me everyday how much it cost, how grateful I should be. Mother made sure every moment was ‘study, study’. Actually, I began to get pretty good marks in my tests, gave me a solid high. I had to do well, had to be first, I thought about nothing else. Every moment, I lived for my marks. A single mistake would upset me. For the twelfth boards, mother had taken leave without pay for six months, so I got healthy, you know, eating food that was good for the brain: badams and jaggery. No chicken soup lest some temperamental God object to it, only veggies. Every fast and prayer you could think of was for me. I knew then, there was no option for me but medical college. My entire family depended upon my results. It meant wealth, it meant we’d be somebodies. It didn’t matter whether I went to a private or a government one, I just had to get in. I remember my father checking out whether our community came under the scheduled category so I could get some benefit. My horoscope indicated ‘success, but with effort’. Vague, come to think of it, but it prodded me on.

Listen, Somu…..can I get on with my problem, why’re you insisting on all this….I’m upset about what I didn’t do during the surgery, I want to know whether my thought processes are ok, it’s bothering me. I actually feel a kind of heaviness under the shoulder, so…….ok, ok, I’ll continue with the narration. You’re the boss here. Where was I ?

Medical college was no problem. I was used to the slog, the long hours. My presentations were superb, I generally swung the prizes, yeah, I excelled in whatever I did. Never bunked, never cheated, never did anything that might blotch my career.

Weaknesses ? none…oh well, never thought about it, actually.
My parents ? they weren’t involved. Ok, I’ll try to remember what they did……once, Father bought a hideous chair for the Head of Surgery, sent it across for his birthday….no, I didn’t mind, why would I ? He liked it. Mother was forever sending goodies for the professors. Friends ? Abhijit, Sandhya, both abroad now. They didn’t, but many of us did return after a few years. It’s a culture thing, not just the money. Who wants to mow the lawn and drive one’s own car after ten, fifteen years of practice ? Here, the money’s good, life’s easy. No litigations, no insurance fellows breathing down one’s neck. No regrets about returning. One thing I learnt there, though, was professionalism.

It’d become a habit, coming first. If I did badly, I sank into depression. I knew then, it wasn’t good for me. But I couldn’t do much about it. Since I was topping every exam I took, it didn’t matter.

Marriage ? Sita’s brilliant. Of course, her own practice. Natural, physiological function, and you get money for it. You want a little extra, just cut up the patient? It’s the done thing. If you ask me, I made a mistake with general surgery, should’ve gone into obstetrics and gynaec myself. No problem setting up practice, and you don’t even need to liaise with the general practitioners. You wouldn’t want to know about that, haha, because no one sends anyone to you anyway, and know what, after some years, you guys lose it all. I guess you don’t have much to lose, eh ? haha. Just joking, no offence.

The certificates on the wall were a reminder of times past.
A glance around them indicated that he was in good hands. The brimming ashtray reminded him of the first time they had smoked. Both had choked. The tea he’d asked for finally arrived. It was cold. Today it didn’t matter that it was.

Yes, coming back to my problem.

No, enough about my love life and parents. Yes, they’re retired, they’re living with me, yes, they look after the children, they love it. For god’s sake, we take them for holidays abroad. What about Sita ? Yes, her parents, too.
Dammit, of course we have domestic help, we’re not monsters, no they don’t do the work, oh my god, you’re the limit.
Yes, my career means everything to me. I am not shouting.
Finally, you want to hear what I’ve come to say. Yes, I’m calmer now. See, if there’s one person I’ve been…not afraid, not apprehensive,…but maybe wary of, is Dr. Shankar Pesta. Yes, the same, he’s forever in the news. Known him from my post-grad days. You wouldn’t remember him, he wasn’t in our college. Besides, he’s junior. We both had won the same scholarship to the US, but he returned much earlier. By the time I got here, he already had an established practice. No, no, who has the time to run private surgeries, we both were attached to different hospitals. I always wondered…... He was so popular. Why ? Because he participated in Annual Day Functions, gossiped with the staff, joked with patients.

What irked me was that everyone thought he had more patients. Of course, I was the better surgeon. Still am. Are you laughing? You’d better not. He challenged me several times, spoke about me, my patients, it’s not done.

Yes, I don’t have to be reminded, I am the patient here.
Thing is, even amongst us surgeons, no one can truly say if a mistake is made. That’s why, though he’s gunning for me, he hasn’t been able to catch me yet. Shanks was always checking up on my cases. Was that splenectomy required in that gang rivalry case? Could that haemorraghing have been prevented in that minister’s mother? Was it my mistake that she bled like she did ? No one can say for sure. But Shanks, what an apt surname he has, Pest-a, he was one chap who would ask stupid questions not even he could answer.
Moreover, all this was my business, not his.

Did I say ‘was’? It’s inadvertent. Honest, I’m not nervous.
If a patient dies on the table, it’s his luck, not my negligence. I’ve never been negligent. Yes, I’ve lost a couple of patients who would’ve died anyway. What would you know about an aneurism that’s burst in the abdomen? Pierced ribs? I’m a trauma specialist, not a bloody tonsils-‘n-‘appendix man. Yes, Shanks was my only competitor. Ok, I won’t use the past tense. I’m not shouting.

We hate each other. I certainly don’t like him. At conferences, he’s always the extra serious one, more sarcastic than real. I’m the one that does the homework, checks out what’s happening abroad, he’s always asking stupid questions, getting involved in some consumer activity. What do I like in him? His perfection. Takes no chances. That we have in common. He fights for his patients.

Nope, he’s never caught me. What case? That wasn’t my fault, that stupid anaesthetist gave an overdose. Why, should I take the blame ?

Which registrar? Oh, that was a simple mistake, yes, these things happen in theatres, human error, you know, rather unfortunate. Any surgery is a risk and this one had a terribly burnt oesophagus, drank acid, I’m told, might have died anyway. I can’t take the responsibility for that. I hadn’t seen the case. Yes, she was under my treatment. Of course registrars handle the surgeries, else how will they learn? Come on, don’t be naïve. I can’t be present for all,… . No, no one finds out. Yes, Shanks knew about these things, kept track of it all. Sort of policed everybody, the swine.
What a strange décor this room had. He’d never seen a clinic with pink and red hearts on the curtains. Reminded him of the Barbie dollhouse his daughter had. The pictures were abstract water colour prints, probably gifted by some pharmaceutical company, and they were of snow-covered landscapes and Christmas scenes. Here, in a Bombay suburb.
He’d have loved to have more tea. But the chipped mug had put him off.

He knew just how much I make in cash. That money is for my skills, for my registrars. Shanks called it greed. But for god’s sake, a life is worth more than a couple of thousands. If it wasn’t for the good life, why’d we leave the US to return? Everybody does it, why did Shanks pick on me ? I’m not shouting.

Ok, no more past tense. Shanks knows a lot I’d not want anyone to know. He has brought up cases which I knew were mine at conferences; never gave me away, but.. how he found out, I never guessed. Could be a bright ward boy spying on me for a price. But yes, he knew, sorry, knows, all that happens to my bad cases. He sort of studies my faults.
Mistakes. Not just mine, perhaps, but I couldn’t care less who else he’s after. He can nail me down just with one or two cases, he can. Deep down, it’s not just hatred, it’s fear as well. Of what he can do to me.

Strange, now that you point it out, we do have many similarities. He doesn’t give up, takes risks. What? Oh, the hatred’s mutual. I wouldn’t enter a room if I knew he was inside. And vice-versa.

I know he’s waiting for a chance to hang me.

What would he have done if I were on his table instead of he on mine? I haven’t thought about it.

Yes, I’ll tell you what happened. I got an emergency call from my registrar Sheetal. Dr. Pesta, he said, had had an accident, was being brought in an ambulance, was unconscious, all parameters, as per the CMO, were poor. The pressure was dropping, he’d lost an enormous amount of blood. I was excited. I wanted to see him dead. I’d give him a slow morphine drip if required to exit him from my world. This was my chance. I couldn’t believe I could think like that; it was as if I was someone else.

I scrubbed. My heart was beating a little faster. At forty-six, I felt like a sixteen-year-old going in for a squash championship finals’ match. To win.

“Should we page for Dr. Karamali for assistance, sir?” It was that idiot, Abhay. Who made him a doctor…. Must have bought his certificates.

“No.” I barked. “Let me take a look first, then we’ll decide.”

He asked for the tea. He needed it badly. The memory was overwhelming.

The abdomen was open, torn in several places. I took a look at the CT—wow, the trachea was torn, I didn’t have to do much, Shanks was in deep trouble anyway. The broken rib had just missed puncturing the lung. Sister handed me the forceps and adjusted the forehead light. I cauterized some of the vessels. Sheetal, suctioned off whatever fluid she could, we barely breathed, we were tense. Every moment I was aware who was under that green sheet. Couldn’t see his face, but I snatched a glance once when the anaesthetist adjusted the tubes. He looked like any other comatose being. I spotted the mole on his lower lip, the one that bobbed when he spoke.

He was breathing deeply whilst he spoke. Hyperventilating, in medical jargon. The cup clattered as he placed it down. Trembles are a surgeon’s nightmare. He willed himself to
steady his hands. Somu noticed.

Apparently, Shanks was dashing across the road when a speeding jeep slammed into him. His friend had called up the hospital instantly, but it had taken about an hour before he was brought in, and another forty minutes had passed before I arrived. Of course, he’d been given blood and the diagnostic tests had been reported already. All those who were present were ready to make arrangements for his funeral.

Occasionally, an instance or two from the past came to mind, like fairly recently, when he’d openly defied an old technique of mine. Said it was risky, said I was experimenting, said there aught to be a law against me. He said it in public, accused me of operating when he felt there was no need for a surgery in certain patients. How dare he? It had affected my practice. Somu, I can’t stand him. The man’s full of malice.

The voice was now controlled, the words came out evenly. The cup was empty, and both doctors adjusted their positions in their respective chairs. The session was taking longer than expected. Good thing this was the last case of the evening.
What a chance this was, the man was under my scalpel, the conditions were to my benefit… an interesting case, would need a lot of work, the patient was unstable… good riddance.
Now, what? ….oh yes, my relationship with Sita. Her practice was easy, women were going to get pregnant, her stream of patients was assured. I had to struggle, what with numbers and statistics being so important. If you couldn’t generate revenue, out you went. With heart-attacks being so fashionable, no one seemed to want general surgeons any more. To add to it were those like Shanks who wouldn’t stick together. Professional ethics, the fraternity, meant nothing to him. This guy was strangling me. And he was lying before me, bleeding to death. If he survived, he’d be a vegetable. His brain must have suffered a lot of damage by now, I figured.

I carried on, my hands working, my mind working, contrarywise.

He wiped his brow, his face, neck and ears.

I don’t know who’d paged for Karmali in spite of my
instructions, perhaps he’d already been paged before I was told. He stood by, silently. He did help out with the swabbing and things, but not a squeak out of him. As always, we worked like a single being with four hands. I don’t like Karmali, but he’s a good assistant. Later, whilst changing, I heard him say to someone, “Shanks will be lucky if he pulls through”.

This Karmali, I’d heard he was Shanks’ man. Was he the mole in our OR ? Who knew ?

I hope you’re listening to what I’m telling you. Stop taking down those notes.

I sweat a lot, in spite of the low temperature of the OR. I don’t like music, I don’t like much talk when I’m working. Time flew. It always does in a difficult surgery. My neck was aching. Always does, I have cervical spondyliosis. Sad, we doctors can’t cure ourselves of our own afflictions.
After all the suturing and cleaning I finally looked up: it was 5:00 am. I’d come in a little after midnight. I changed whilst Sheetal and Abhay closed up Shanks. He’s doing ok, I heard the anaesthesist say. No he isn’t, I thought. I knew. Who’s she fooling, I wondered. Our man isn’t going to see dawn. I slept in the recovery room. Relaxed in the knowledge that my foe was no more, and it wasn’t going to be my fault. He’d been a bad, really bad case. If he died, I wasn’t to blame.

The sink in the corner irked him. Why did psychiatrists need sinks? Maybe he shared the clinic with someone else. He couldn’t imagine a cardiologist or a neurosurgeon seeing patients in a room with pink hearts on the curtains. His mind wasn’t wandering, he was ‘multi-tasking’ as they say.

I’d done my best, Karmali was there as proof. It was a fitful sleep. I was afraid. Very afraid. Prayed, and I’m not used to it.

He clenched his hands and held them to his chest.

What had I done? My primary duty was to save … I was brought up in a good family….I’m a doctor, not a murderer. I had taken an oath. But I was relieved: no one but me knew. My head was throbbing. It was seven when I awoke. The night seemed a memory. I was still wearing the greens. Groggy, I asked, how’s the patient….. and sprinted down. There was a feeling of relief, too. No more Shanks. I felt giddy, lightheaded. I couldn’t remember anything.

The window had to be closed because the curtains were billowing those hearts all over them, and it was irritating for both. He instinctively tidied the table before him as he spoke stretching out to empty the ashtray in the bin.

It was in the ICU that I came to know what I’d done. No !!
The cardiologist, Dr. Bahadur, the Director, Dr. Amlakar, were there. So many faces, staring at me. Sombrely.

Silence. The sounds of the traffic below seemed like it was far, far away.

I had failed to do what I wanted. I had toiled through the night and saved (‘congrats, you did a good job, boss’, ‘amazing, you really are the best’) the man I wanted to kill.

Years of training and discipline had taken over my life.