The surgical fisherman

There is a 53yearoldfisherman in the ERrdquo 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 ldquoHe has no sensation in his legs and is numb in his groinrdquo I was informed ldquoBladderrdquo I asked to check if he had developed urinary retention a condition that makes it difficult or impossible to empty onersquos bladder ldquoUp to his nipplesrdquo I was told thatrsquos slang for lsquohugely distendedrsquo ldquoWersquove put in a catheter and drained over a litrerdquo the duty doctor announced happy with the promptness of his actionsldquoWhat does the MRI of his lumbar spine showrdquo I asked expecting a clear surgical emergencyldquoThere is a massive disc herniation at L3L4 that is squishing the nerve roots completelyrdquo he described ldquoIrsquove never seen such a large disc prolapse in my liferdquo 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 ldquoBahut badaa diks hairdquo he said with a straight face as I laughed I requested he show me the badaa diks on the computer and indeed it wasI 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 roadldquoDonrsquot worry about the moneyrdquo he told me in chaste English ldquoI want a single roomrdquo 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 manrsquos circumstances had been instantly beheaded Hook line and sinkerldquoYou can go ahead with the operation but what are the chances Irsquoll recoverrdquo he asked ldquoThe sooner we do it the earlier yoursquoll recover but to what extent is difficult to predictrdquo I explained knowing that it was impossible to determine how much damage was already doneOften times even in patients who have lsquobadaa diksrsquo 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 dysfunctionWithin 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 hadnrsquot improved nor did his sensations recover ldquoThe sweetheart we have to make our peace with again and againrdquo famous writer Pico Iyer wrote ldquothough she is surely as impossible and contradictory as we are is the one called lsquoRealityrsquordquoI 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 normallySurgeons rarely remember the patients they have healed we most often recall the ones wersquove 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 ldquoI want your home addressrdquo 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 ldquoYou gave me my livelihood back Today I went to sea and got such a good catch that I want to give you somerdquoldquoI was only doing my jobrdquo I said albeit ldquofishingrdquo slightlyMost 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 prawnWithin 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 ldquoI lost several lakhs of rupees recentlyrdquo he told meas he handed me the ldquocatchrdquo I offered to pay for the fish in the hope that he wasnrsquot going to ask me for larger financial help He politely declinedldquoWhat happenedrdquo I asked concerned ldquoMy employees were travelling in a bus in South India it overturned All of them are in hospital and I have to pay for them ldquoWhy do you have employees down south when your fishing business is in the cityrdquo the detective in me surfacedldquoI run a call centre which makes me a lot of moneyrdquo he told me ldquoDonrsquot ask me howrdquo he continued before I could ask him if he was scamming people which is what Indian call centres are famous for ldquoI will take care of all my employeesrdquo he told me while showing me pictures of the new bungalow he had bought in Alibaug Morality is a luxuryldquoOkay I have to go Let me know how you liked the crab and lobstersrdquoWhile walking away he turned ldquoIf you need help with the underworld let me knowrdquoA 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 availableThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazdaturelmiddaycom