VS was hardly three months into his internship, having just recently cleared his MBBS exams . And was the junior most in the entire surgical unit . As he went into the operation theatre early before the first case started, he had no clue what was in store. All that he knew was the patients name , his hospital number and what surgery he was planned for . ‘ Where’s your head?’ thundered SD his boss , rather annoyed , to the anaesthetist JK who had just finished her post-graduation . ‘ Oh he’s in the office sir. He won’t be coming . This is not a major case, this patient is quite fit with no major medical issues , so I don’t think he would be coming into thea…’ ‘
‘ What do you mean ? Tell him that the HOD ( Head of the Department) of surgery is here, so the HOD of Anaesthesia better be here too , asap . ‘ JK the junior consultant didn’t say a word, but didn’t budge either . After a short gap, all she said was ‘ patient is already anaesthetised, and I can’t leave him and go elsewhere ‘ . SD was furious . VS was the junior-most in the unit , and was ordered to run to the anaesthesia office , and was given the impossible task of getting the ‘anaesthesia HOD into theatre ,RIGHT NOW’ . He looked at the PG registrar and the junior consultant . The consultant ran for cover out of theatre, the PG registrar decided she had to get scrubbed up for the surgery immediately , and I was all alone . As he was just walking out of theatre , wondering what he’d tell the Anaesthesia HOD , AB stormed into theatre , demanding to know what exactly was going on . Clearly , one of the nurses had called and told him about the commotion inside the theatre. ‘ Why so much confusion for the first case in the morning ‘ he asked JK who was at the head end of the patient, with a screen separating the surgical team that was not yet ready to operate , as SD wasn’t scrubbed up yet . And everyone there knew the PG registrar would dare not put the scalpel to the skin with SD in that kind of a mood .
‘ Well AB, you are the confusion this morning ‘ SD who was still-angry howled . ‘ Don’t you know that when the HOD of surgery is operating, the HOD of Anaesthesia should be giving the Anaesthesia ? Whether it’s a fit or a complicated patient ?’
AB didn’t agree . ‘ No , I don’t think so SD . Agreed you’re the HOD , and there’s no need to think you’re a big VIP here because ..’
SD cut him short ‘ I agree AB, I’m not a VIP because, you know, I’m a VVIP . What would you do without surgeons around ? Won’t you be jobless’ AB was quick to retort ‘ And what would surgeons achieve without anaesthetists ? If you are a VVIP then I’m a VVVIP’ . I met VS during my years as a post-graduate trainee , with both of us having graduated from different medical colleges . We are still very much in touch , though in different continents now . But he wasn’t prepared for this scene, to be honest . All the 5 1/2 years of training generally were aimed at diagnosing and treating patients correctly, not helping seniors to cool down and let go of their egos .
Almost 2 decades earlier, I remember being involved in a somewhat similar scene on a Sunday at church . As SP the senior pastor was halfway through his message, some local councillor walked into the church , with a few others following him . The local elections were just around the corner . SP stopped the sermon, introduced the councillor to the congregation , who walked up to the front, said a few words and just before he left said a big ‘namaste’ with folded hands raised above his shoulders, turning from the extreme left to the extreme right of the congregation, then briefly lowered both his hands , and did the same namaste to SP who was on the small stage behind him . And out he went, along with the same bunch of followers that escorted him in .
SP resumed the sermon by saying ‘ When VIPs come we should give them due respect ‘ Dad, who I was sitting next to , seemed extremely irritated with the whole scene . I wanted to ask him what was troubling him, but he whispered saying we’d discuss this over lunch at home . Before the service concluded, AP the assistant pastor said something like VIPs and VVIPs may come but we should not have to change the usual routine of the church service , which I felt was the equivalent of telling off SP for having halted the service . He seemed to be of the opinion that we could have waited for the service to get over before introducing the councillor . Dad seemed to agree with him and they both had a short chat at the end of the service .
Usually Sunday lunch was the only time we would all get to sit together as a family for a meal in the afternoon ( click here https://injablogger98.blog/mom-m-s-m-ch/ to know more about Sunday lunches , if interested ) and that day dad still seemed to be irritated . He was telling mom he could never understand why SP had to stop the sermon and sing praises to the councillor . He said he was glad atleast AP spoke about it, and didn’t hold back from criticizing the pastor for what he thought was wrong . Dad said ‘ what VIP and VVIP and all , we forgot the MIP ‘ My primary school brain didn’t understand much . But he explained it at lengths to mom and my elder brothers over lunch, and they all seemed to absolutely agree with him .
Being the junior-most in the operation theatre, VS was too scared to speak up like AP , the assistant pastor . VS said he himself was not sure who the VIP and VVIP here were . If he had to take a stand, obviously , he would take SD’s side, well , because ‘ he was my boss , and the boss is never wrong’ . But this was still early internship days , and whenever he went for his rotation in Anaesthesia , in all probability AB would finish him off. What should VS do ?
I remember Dad saying that day ‘ Agreed the councillor was a VIP. Or maybe even a VVIP . But we as a church should not have forgotten who the MIP is , and I think that’s where the SP let us down. He may not be seen , may not be sitting next to us , may not be making any announcements . None of us is perfect , none of us is without faults, and it’s quite possible that many of us won’t be able to see eye to eye on certain matters , but still we all go to church for the one reason – to collectively give thanks to the Almighty, to worship and sing praises to the Creator who we don’t actually see with our eyes . But we all need to be sensible enough to remember that undoubtedly unequivocally and undisputably , it’s HIM , it’s God who should always be the MIP – the Most Important Person .’
Even that day in the operation theatre , in the fight between the HODs and a huge clash of egos, the MIP was forgotten . He was there, lying motionless , intubated and put to sleep , and with not even the slightest idea of what was happening around him . Thankfully VS was not asked to take sides that day , and more importantly everything went off well , both the bosses cooled down , surgery went off without a hitch and the patient was shifted back to the ward , safe and sound .
I haven’t quite witnessed a theatre scene like that in my almost one and a half decades of practice as a surgeon , but VS and I have discussed this scene umpteen times , over and over again . VS said he didn’t know how to react . When he first told me about it , I could almost imagine myself in VS’ shoes , sandwiched between two warring HODs . I was very angry with them but to be very honest , i don’t think even I would have been able to open my mouth , being the junior-most in the unit , to give them my personal opinion . If I do encounter a situation like that , I hope and pray that like dad and AP, the assistant pastor , I would be able to say it out boldly , irrespective of how many VIPs and VVIPs I’m surrounded by , that once inside the operating theatre , none of the VIPs or HODs matter – all that matters is the safety and the well being of the anaesthetised unconscious patient , who needs all the attention , leaving the egos aside, and come what may everything that he needs should be done .
A patient seeks help because he needs help . It may be something minor, or major . Even the hospital I work in has different categories of staff with various levels of experience , some very good friends and some who can’t seem to get along at all . There is a mix of brilliant clinicians , super achievers, extremely skilled surgeons , and also the average ones . There are , deservingly , quite a few VIPs and VVIPs too . Maybe I need to constantly ask myself , in any given situation , who the MIP is . Whether inside the operating theatre , in the wards, in the OPDs , or just about anywhere in the hospital , I hope I would be able to remind myself everyday that ‘undoubtedly unequivocally and undisputably , it’s the PATIENT who should always be the MIP – the Most Important Person .’