A New Beginning, or is it?

A company of twelve Doctor’s (Plastic Surgeons) stood in front of Vikram’s (all names changed) bed. The majority of them were residents, a couple of them were working there post-residency and the rest were the bosses. They seemed to be discussing his case very enthusiastically.

Vikram had an accident outside the same hospital, wherein a heavy truck ran over his foot, while he sat with his legs outstretched on his bike, parked by the side of the road. His toes were dangling and his forefoot was crushed. The enormity of the trauma had left him disabled. Vikram was immediately admitted to the Plastic surgery ward, prepared for surgery and operated upon, that very same day. 4 of his 5 toes were amputated. He was placed on a regular dressing schedule to wipe out the infected portion of the wound and allow the healing process to take effect.

2 weeks hence, after the healing process had initiated, Vikram was operated again. This time around, to cover the exposed areas and provide function to the limb. Something that had seemed improbable when he was wheeled into the casualty, after the accident. The graft over his foot had taken up exceedingly well.

Vikram, however, had a problem. He was extremely intolerant to pain. No dressing was complete without Vikram’s screams. This was the way of a public hospital. Sedating every patient for dressings wasn’t an option, due to the abundance of patients in the ward. Vikram just bore the pain, as the dressings were done as gently as possible.

My first taste of my new life as a plastic surgery resident.

At the other end of the spectrum was Rohan, a 25 year old mechanic, who had been burnt by petroleum over his torso and neck, three years ago. Rohan had developed contractures over his axilla (arm-pit), as a result of scarring in the wounds over the burnt area and had undergo surgery to release those contractures. The procedure would allow him to move his arms freely. The restriction in movements due to the contractures had caused him a great deal of social and economic harm.

Rohan, as opposed to Vikram, was extremely tolerant to pain. Burns to 50% of his body and the daily dressings that followed had given him a heart of steel. This was just one of the countless surgeries he’d require to regain full function of his arm. This is the nature of plastic surgery. No single surgery will suffice. It’s a process which requires months, if not years to correct something that had ruined the persons life only in minutes.

Lying on the beds next to Rohan were Ghulam and Shaikh. Both victims of oral cancer, the commonest malignancy in the country. Both of them chronic tobacco chewers. Both of them had undergone surgery to remove the tumour, leaving their face disfigured. Both their faces had been reconstructed using skin, muscles and bone from their legs. Both had a tube running down their nose into their stomach to feed them.

But, while Ghulam had recovered fantastically and was to be sent home soon, after removing the feeding tube, Shaikh had a more tumultuous recovery. Infections, bleeding requiring transfusions and poor healing of the wound over the leg had hampered his recovery.

Lying on the bed opposite them was Mr. Thamim, a elderly male, who also suffered from cancer of the oral cavity. His mandible (jaw bone) had been excised along with the tumour and a similar flap, consisting of the fibula (non weight bearing bone in the leg) had been placed over the facial defect. It had been 2 years since his surgery. The result was remarkable. This was the work of a genius. No ordinary man could’ve guessed that this person had undergone a reconstructive surgery.

Mr. Thamim had been admitted for removal of the plate placed over the grafted bone, in order to stabilise it. Plates were usually removed after two years. The same man who’d hide his face from the world, was now walking around the hospital with the same confidence, he had so cruelly been deprived of, due to the tumour.

Besides him lay Mr. Jagannath, another elderly male with a tumour of the teeth (ameloblastoma) which had been excised. The bone over the left side of his face had been excised along with his teeth. The attempted reconstructive procedure had failed, as the flap placed over his defect had blackened, due to a clot in the blood vessels supplying the flap. The flap was not salvageable and had to be removed. The defect looked ghastly, with the left side of his face depressed inwards and asymmetrical.

On just my second day, as I stepped out of the ward to dine at the canteen, I ran into Mr. Jagannath. He had a scarf covering the left side of his face. He didn’t escape the attention or the ridicule of any passerby. “Doctor, this is quite normal for me.” He said.

“I feel most comfortable in the plastic surgery ward, as I don’t have to face society. No one understands our plight. Everyone stares at us, making us feel abnormal.”

Jagannath was a teetotaller, had never smoked or chewed tobacco and had a very frugal albeit healthy lifestyle. 3 months back, the dental surgeons had diagnosed him with a cancer of the tooth.  One which requires a mutilating surgery. The cruel irony of life. The plastic surgeons had given it their all to salvage his flap post-surgery, but had failed.

“I’ll now leave this ward and hospital only after the reconstruction.” Jagannath vowed.

Armaan, a perky sixteen year old, came to the out patient department, the next day, with a broad smile over his face. 2 months ago, the story was very different. Armaan was born with a depressed nose tip. Only the tip of his nose had a cartilage defect. He had just entered Junior College and was the object of ridicule amongst his peers. Unable to afford private care, Armaan pursued his luck with the Plastic Surgery department at our institute.

A minor procedure under local anaesthesia was all that he needed. Fat was injected into the depressed part of his nose with a strapping placed over his nose for a few days.

2 months post-op and Armaan’s nose was as good as new. He couldn’t stop smiling. Armaan had become the cynosure of all eyes in college. He could now concentrate on enjoying his time in college and studies. The attention on his nose and its defective shape had been diverted to more meaningful things.

This was the impact of plastic surgery on people’s lives. When I decided to pursue higher education in the field of Plastic Surgery, I was scoffed at.

“Why do you want to specialise in surgery on the skin?”

“It’s a frivolous profession, one which requires very little skill”

“What satisfaction will you achieve in this profession”

These were some of the many questions asked of me.

And the first day in the Ward 25 answered all these apprehensions that people had planted in my mind. Plastic Surgeons may not save lives, they may not even perform emergency procedures, but they create magic. They allow people to lead a normal life. They allow patients to feel comfortable in their own skin. But, beyond all that, they play such an important role in the lives of patients scarred by previous experiences, be it burns, acid attacks or malignancies.

They rid their bodies of the physical scars related to the traumatic experiences. Once the body is rid of the scars, which are a sequela of such trauma, the mind is more willing to shelve those ghastly experiences and focus on opportunities that lie ahead. Plastic Surgeons heal not only the body, but also the mind.

As newer and more exciting opportunities present themselves to me, I may not pursue Plastic Surgery in future. My mind, nevertheless will always be inclined towards this sub-specialty. Whatever the case may be, I have developed a new found respect for all Plastic Surgeons. One that’ll never wane.

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