The surgical fisherman

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There is a 53-year-oldfisherman in the ER," the duty doctor called to inform me. He was experiencing severe lower back pain since that morning, but for a few hours now, he was unable to move his feet as well. "He has no sensation in his legs and is numb in his groin," I was informed. "Bladder?" I asked to check if he had developed urinary retention, a condition that makes it difficult or impossible to empty one's bladder. "Up to his nipples!" I was told; that's slang for ‘hugely distended'. "We've put in a catheter and drained over a litre," the duty doctor announced, happy with the promptness of his actions.

"What does the MRI of his lumbar spine show?" I asked, expecting a clear surgical emergency.

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"There is a massive disc herniation at L3-L4 that is squishing the nerve roots completely," he described. "I've never seen such a large disc prolapse in my life!" he almost trembled. Before seeing the patient, I went down to the radiology console where the MRI was done and asked the technician to show me the scan. "Bahut badaa diks hai!" he said with a straight face as I laughed. I requested he show me the badaa diks (on the computer) and indeed it was.

I walked across to the ER to examine the patient. He lay there in tattered shorts and a white shirt that had a few broken buttons and oil stains. His hair was unkempt over his wrinkled forehead, as he lay wincing in agony. He would not allow me to touch him. I asked him to flap his ankles up and down, and there was barely a flicker. He could just about bend his knees. When I ran my fingers over his legs to check for sensation, he shook his head. I tapped a hammer on his knees and ankles to find his reflexes flat. I told him in Hindi that he needed an emergency operation or else he may never recover in function. Looking at his tethered condition, I suggested he do it at the government hospital across the road.

"Don't worry about the money," he told me in chaste English. "I want a single room," he added, ordering his brother who was standing next to him to get R3 lakh from the glove box of his car and pay it as a deposit. I was a little stunned by how quickly the story I had created in my head of another man's circumstances had been instantly beheaded. Hook, line, and sinker.

"You can go ahead with the operation, but what are the chances I'll recover?" he asked. "The sooner we do it, the earlier you'll recover, but to what extent is difficult to predict," I explained, knowing that it was impossible to determine how much damage was already done.

Often times, even in patients who have ‘badaa diks' but no neurological dysfunction, we are able to manage the situation without surgery, but that is not an option if a patient has severe motor weakness, sensory impairment, or bladder dysfunction.

Within four hours of his arrival, I made a 2 cm incision in his back. Using a series of tubes, we dilated his muscles without cutting any of them, which is the beauty of modern minimally invasive surgery. A sliver of bone was drilled as the dust coming off it was doused by a sprinkle of water by my assistant. I took off some of the ligament in the way and identified the extruded, humongous disc. It was akin to sighting Mount Everest amidst the Himalayas. I held it with a forceps and milked it out, removing it completely. The nerves stretched over it were restored to normalcy, like a crying child soothed by its mother. He was elated to wake up pain free a few hours later. However, the strength in his legs hadn't improved, nor did his sensations recover. "The sweetheart we have to make our peace with, again and again," famous writer Pico Iyer wrote, "though she is surely as impossible (and contradictory) as we are, is the one called ‘Reality'."

I explained to him the next morning that healing takes time. The physiotherapist first got him to sit at the edge of the bed, and over the next few days, he began walking with a walker. He was beginning to feel the ground he walked on as he regained his strength. When he left the hospital a week later, he distributed chocolates to among the staff members who had looked after him. One month later, he was 80 per cent better; we were able to remove his catheter and he could now pee normally.

Surgeons rarely remember the patients they have healed; we most often recall the ones we've hurt. And so, like in the case of all patients who do well after surgery, I forgot about him. Until one morning, three months later, when he called me at 5 am. "I want your home address," he asked, after reminding me of his case and informing me that he had recovered completely. I was obviously a little sceptical and asked why. "You gave me my livelihood back. Today, I went to sea and got such a good catch that I want to give you some!"

"I was only doing my job," I said, albeit "fishing" slightly.

Most often, when patients get well, they bring along a box of sweets, while some present handmade cards or small gifts. This was the first time I would be showered with pomfret and prawn.

Within the hour, he was outside my building in a dilapidated Maruti van, once again making me question my judgement. Dressed in shabby shorts and a frayed tee, he offered me a big basket of fresh sea food, which I accepted gracefully. But he looked disheartened. "I lost several lakhs of rupees recently," he told me,as he handed me the "catch". I offered to pay for the fish in the hope that he wasn't going to ask me for larger financial help. He politely declined.

"What happened?" I asked, concerned. "My employees were travelling in a bus in South India; it overturned. All of them are in hospital and I have to pay for them. "Why do you have employees down south when your fishing business is in the city?" the detective in me surfaced.

"I run a call centre which makes me a lot of money," he told me. "Don't ask me how!" he continued, before I could ask him if he was scamming people, which is what Indian call centres are famous for. "I will take care of all my employees," he told me, while showing me pictures of the new bungalow he had bought in Alibaug. Morality is a luxury.

"Okay, I have to go. Let me know how you liked the crab and lobsters!"

While walking away, he turned: "If you need help with the underworld, let me know."

A few months later, I was craving sea food and thought of buying some fish from him, as the last meal had been so delicious. I dialled him. His phone was no longer available.

The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazda.turel@mid-day.com