UPSURGE UPSURGE UPSURGE 2020

UPSURGE

PresidentDr Vikram Desai

SecretaryDr Atish Bansod

EditorsDr Dinesh Sarda, Dr Gopal Gurjar

Association of Surgeons of Nagpur

VOLUME 1

JULY

UPSURGE - 2020S

ecretary’s Message

Greetings to all respected Senior ASN members and friends. Hope you all are doing well in this COVID-19 pandemic era. Though our 2020-21 tenure started with lots of depressing words like pandemic , COVID-19 , lockdown , quarantine , isolation , we as a team ASN 2020-21 have tried to convert this un-favourable situation to a favourable one and continued with our zeal of academics as well as social activities which our association is known for. It gives me immense pleasure to present the activities conducted by ASN in this year's first E- UPSURGE and hopefully you all will enjoy reading it. In this lockdown we have conducted the following activities which have received a very good response from all our members.Different activities done by ASN 2020-21 till date are -a) 44 webinars by our local ASN faculties as well as faculties of National and International repute.b) 5 Online Post-graduate classes.c) 2 Online clinical meets in which variety of cases were presented.d) Special activities like

Ÿ ASN lockdown home walkathon on 26/4/2020 in which many ASN members participated from their homeŸ ASN Masterchef on 3/5/2020 in which ASN members enthusiastically displayed their culinary skills by preparing nearly

95 dishes and the Judge was Mr Vishnu Manohar , an Nagpuri Chef of National repute. We selected 6 winners who got a fruit basket delivered at their home.

Ÿ ASN along with Seven Star Hospital celebrated Nurses Day on 12/5/2020 during which they were taught various activities like Yoga ,Meditation ,COVID safe practices and also were felicitated.

Ÿ ASN celebrated World Family Day on 15/5/2020 to celebrate the brotherhood and bond between ASN members in which members posted different photographs of fond memories.

Ÿ ASN celebrated Anti-Terrorism Day on 21/5/2020 by felicitating the Police for protecting us all and they were taught hand hygiene ,measures to protect themselves from COVID-19 during their duty and were made aware regarding the symptoms of COVID-19 and provided with cold-drinks and refreshments.

Ÿ ASN members enjoyed Lockdown 4.0 Home Karaoke Singing Contest on 24/5/2020 in which members posted the videos of their singing talent.

e) ASN held its first Executive Committee meeting on 31/5/2020 on online platform to discuss the various issues.

f) ASN has added 8 new life members and 21 new PG members to its family.g) ASN as a part it's social responsibility has donated 160 PPE kits ,100 liter hand sanitizer and 160 N-95

mask to IGGMC ,Nagpur and 100 PPE kits and 100 liter hand Sanitizer to GMCH ,Nagpur.h) ASN has got an dedicated broadband high speed internet for its office.I) ASN has updated and upgraded its website. I want to thank all EC members and Editors Upsurge Dr Dinesh Sarda And Dr Gopal Gurjar for taking

special efforts out of their busy schedule to bring this first edition of E-Upsurge and doing an excellent work in Upsurge.

Dear all , I had taken the charge of ASN under the able leadership of ASN President Dr Vikram Desai and with an committed team of EC members ,I had a wish of Taking ASN from one height to another. Hopefully the ASN team 2020-21 is able to meet up-to its member's expectations. Suggestions if any are welcome.

Thank you all.Happy reading.Long Live ASN.

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Warm greetings and wishes from ASN. Dear Past Presidents, Esteemed EC Members 2020 and my dear colleagues, I hope all of you are taking good care of yourselves and your families in these unprecedented times. It is indeed an honour and great privilege to be at the helm of affairs and lead ASN for the year 2020-2021. We took virtual handover from previous team led by Dr Wilkinson on 1st April 2020 and installation of the new team was scheduled on 5th April, only to be postponed due to Covid 19 pandemic and subsequent lockdown. We started our tenure in right earnest and hope we are keeping you busy and enlightened with webinars on different topics as well as clinical meetings. We also conducted our first EC meet online on webinar platform. We also conducted many virtual activities during lockdown like ASN walkathon, ASN masterchef and Karaoke Singing Lockdown 4.0 to name a few and received tremendous , overwhelming response from our esteemed members . I must take this opportunity to thank our hardworking , sincere and efficient honorary secretary , Dr. Atish Bansod and of course all past presidents, esteemed members of EC and each and every member of ASN for their wholehearted support in all activities of ASN. I wish to have your enthusiastic participation and support in all our future endeavours. Hoping to greet and meet all of you in person as soon as possible, take care and stay safe.

With regards and love , your trulyDr Vikram Desai

DR. VIKRAM DESAIPre

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DR. ATISH BANSODHon. SecretaryASN 2020-21

Asso. Professor & Unit HeadDept. of Surgery

Indira Gandhi Medical College , Nagpur.

Hon. PresidentASN 2020-21

Consultant Surgeon Director

Kalpavruksha Hospital ,& Desai Hospital

Nagpur

UPSURGE - 2020

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Outg

oing

Pre

siden

ts M

essa

ge At this juncture I have mixed feelings of happiness and sadness. Happiness that a young new team is taking over

and sadness of requilinshing the post. Nothing is constant but change and with change comes new ideas and new ways of functioning, literally a breath of fresh air. The style of functioning this year with the COVID-19 Pandemic is going to be very different and a challenge to the new team. A challenge they have proven up to the mark to face. Our installation was a Grand affair, Dr. Ashish Satav head of the MAHAN Trust and noted social worker in the Melghat region, was the Chief Guest and spoke on why Technology should not take over Compassion and Passion and Patience from a Surgeon. Dr. Ramesh Ardhanari, head of surgical gastroenterology, Meenakshi Mission Hospital, Madurai, gave the Silver Jubilee MASICON Oration and spoke on the importance of Surgeons doing endoscopies.Dr. Sunil Agarwal, Head of the Vascular Surgery department, Christian Medical College and Hospital, Vellore, spoke on the Vascular surgeries relevant to a general Surgeon. Unfortunately Dr. Sunil Agarwal died in February this year in a tragic car accident. Reminding me of the transitory nature of life. The Mitra Memorial Quiz in our term could be considered the crowning glory of our tenure. We attempted to make maximum use of the available multimedia to make it a grand visual affair. I can still remember the first Mitra Memorial Quiz, where Dr. Abdul Qureshi was the Quiz master, he had phoned me for ideas as I had organized a quiz in our college, NKPSIMS. Those days slides had to be prepared and projected on the screen making it a tedious process. Despite that it was a grand affair with the available technology. I also remember Atish Bansod, the present secretary as part of the winning team from our college. Technology since then has advanced and democratized, as it's now available to everyone. We did our part of returning our debt to society by conducting an operative camp in the MAHAN Trust Hospital in Melghat. We had regularly clinical meetings and CMEs where there was a healthy discussion and exchange of ideas. The team strived for perfection during their tenure but complete perfection is impossible. I wish the incoming team all the best for a successful year ahead.

DR. TRV WILKINSON

Outgoing Secretarial R

eport

DR. RAJEEV SONARKAR

Dear all ASN Members, Change is the constant law of nature. Today’s present will be tomorrow’s past, so all of us travelling from today’s to tomorrow’s journey. I am sincerely thankful to ASN, NAGPUR to give me an opportunity to work in this prestigious organisation as a secretary for year 2019-2020. Its a privilege to me to present a brief annual report of the various social and academic activities carried out though the year 2019-2020.1)GBM WITH SELECTION OF NEW TEAM: DATE : 10TH MARCH 2019 Welcome by President Dr.Singhania. treasurer report given by Dr.G. Chude and Dr.A.Chaudhary for year 2018-2019Election officer Dr. Wilkinson s conducted process of new team formation and he declared new ASN team for year 2019-2020.In GBM Dr.Qureshi Member of Central ASI, brief about the ASI working and he welcome Dr Raghuram president elect of ASI in GBM. Dr Raghuram address the meeting regarding mission if ASN in future Dr.Rahate address the GBM regarding in coming up international conference AMASICON in Nagpur, which will be held in November 2019 2) BREAST CANCER AWARENESS :10TH MARCH 2019 In presence of Dr Raghuram president elect ASI, activity of breast cancer awareness done by ASN and Seven Star Hospital in morning 6am by organising PINK RIBBION WALK. 3) HANDS ON BASIC LAPAROSCOPY WORKSHOP:23 RD MARCH 2019 ASN with Zenith Hospital in collaboration of Olympus organised one day basic laparoscopy training and ultrasonic technology in basic laparoscopic procedure. Six postgraduate student participated . Faculties were Dr. M. Thakur..Dr.AbhayChaudhary and team. Dr Wilkinson and Dr Sonarkar also guided the students.4)GATHERING OF ELECTED NEW OFFICE BEARE :26 TH MARCH 20195)PRE INSTALLATION FACULTY DINNER:6TH APRIL 2019 ASN arranged a faculty dinner at CP Club where Dr.Wilkinson along with the past presidents, executive members and chief guest Dr. Ardhanari, DrAgrawal, Dr.Biswas for installation were present.6)INSTALLATION OF NEW TEAM AND 17 TH SILVER JUBILEE MASICON ORATION WITH CME: 7 TH APRIL 2019 At Hotel Center Point,Nagpur,9.30am the new team of office bearers of ASN was installed on with Dr.T.R.V.Wilkinson,as President and Dr Rajiv Sonarkar, as Honourable Secretary for year 2019-2020 at the hands of chief guest Dr. Ashish Satav .MBBS, MD (chief functionary of MAHAN trust) and guest of honours were Dr Ramesh Ardhanari, Head Surgical Gastroenterology Madurai, Dr Dilip Gode Past president ASI and Dr. Sunil Agrawal, Head Vascular Surgery Department, CMC Vellore. MOC were Dr Divish Saxena and Dr Gayatri Despande. In installation programm Dr Ashish Satav and Dr Gode addressed the gathering, Dr.Singhania gave his presidential speech. Dr.Bisvas (ophthalmologist) from Calcutta introduced new President Dr Wilkinson. Dr Sushil Lohiya gave his Secretory Report for year 2018-2019. Dr. Rajiv Sonarkar gave vote of thanks. Mr Ashish Sharma gave motivational talk on running, jogging to keep healthy life. The prestigious 17th silver jubilee MASICON oration was delivered by Dr Ramesh Ardhanari on the topic “WHY SURGEONS SHOULD LEARN ENDOSCOPY .”Chairperson were Dr. Raj Gajbhiye , Dr M. Akhtar, Dr Prashant Rrahate. Dr P. Rahate gave brief introduction regarding MASICON oration followed by citation was orated by Dr.Akhtar. Dr Sunil Agrawal gave key note address on topic “ABC OF VASCULAR TRAUMA”. Chairperson were Dr Sunil Lanjewar, Dr. S Dasgupta, Dr R. Singhania. Guest lecture was delivered by Dr AshishSatav on topic “TRIBLE HEALTH PROBLEM AND SOLUTIONS. HOW ASN CAN HELP.” Chairperson were Dr. B.S. Gedam, Dr B.B Gupta, Dr R. Singhavi. This CME was credited by MMC one point . MMC observer was Dr. Avadush Ray. This programme were attended by 250-300 delegates 7) SOCIAL ACTIVITY:15TH APRIL 2019Blood donation camp in tribute to birth anniversary of CHHATRAPATI SHIVAJI MAHARAJ, MAHATMA JYOTIBA FULE, BR. BABASAHEB AMBEDKAR in LMH Hospital, inaugurated by Dr.Kajal Mitra (Dean NKPSIMS and RC and LMH Nagpur) along with Dr BS Gedam, Dr Nitin Wasnik, Dr Sonarkar. About 46 blood bag were donated by students and faculties.8)VIDEO CME ON “ DIFFICULT CHOLECYSTECTOMY”: 27 th APRIL 2019 SPEAKER/PRESENTERS were Dr Raj Gajbhiye, Dr Mukund Thakur, Dr Prashant Rahate,

Cont....

Professor & Unit HeadDept. of Surgery

NKP SIMSNagpur

Hon. SecretaryASN (2019-2020)

Asso. Professor Dept. of Surgery

NKP SIMS, Nagpur

UPSURGE - 2020

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CHAIPERSONS were Dr. Subodh Gupta, Dr.B.B. Gupta, Dr. Wilkinson welcomed all 56 delegates & Chairpersons. 9)SURGICAL MEGA OPERATIVE CAMP AT MELGHAT : DT.16 TH JUNE 2019ASN along with Rotary Club of Nagpur supported by FDCM CRS TRUST organized a free operative camp in village Utavalli in Melghat on 16/6/2019. The area is predominantly tribal area and is one of the most backward regions in Maharashtra. A team of surgeon, gynaecologist and anaesthetist travelled 300km to reach the remote village. A total 38 patients were operated which includes major surgeries like Thyroid, Thyroglossal Cyst, Oral Malignancies, Parotid Gland and Hysterectomies. The efforts of our associations were highly appreciated by the locals for providing surgical care in such remote area. Dr Wilkinson, Dr.Gedam, Dr.M.Thakre, Dr.U. Ramtani, Dr.Ashish Satav, Dr Mrs.Satav gave their services.10)SYMPHOSIUM ON LIVER SURGERY AND TRANSPLANTATION : 23RD JUNE 2019 ASN with Liver Transplant Unit of Alexis Multispeciality Hospital organised a symposium. Faculties were : Dr.Rajashekhar Perumalla,Chennai, Dr.Rajashekhar Perumalla,Chennai, Dr.Ajitabh Srivastava, Dr.Niraj Kanchankar, Nagpur. Panel Discussion was done by Dr. Amol Dongre, Dr. Prakash Jain, Dr. Rajesh Mundra, Dr. Rahul Saxena, Dr.Abhijit Deshmukh. Symposium attended by 60 delegates.11)FIRST CLINICAL MEET WITH GUEST LECTURE : DT. 5TH OF JULY 2019 1)A case of irreducible femoral hernia by TEP. Dr Kaushal Kulkarni , Dr Unmed Chandak Dr. ArtiMitra 2)Transficsation suture site hernia repair by IPONG: Dr. Prashant Bhowate 3) Interesting case of ventral hernia Dr. Nilesh Junankar Guest Lecture by Dr.Pawanindra Lal Prof. and Head Dept. of Surgery MMC, New Delhi. Topic : TEP in bilateral hernia. Chairperson : Dr. B. S. Gedam, Dr. Arti Mitra Dr P.Lal. About 56 delegates were present. 12)LIVE OPERATIVE WORKSHOP ON LAPAROSCOPIC SURGICAL ONCOLOGY : 26TH JULY 2019. ASN , NAGPUR AND DEPARTMENT OF SURGERY, GMC, Nagpur organised live operative workshop on LAPAROSCOPIC SURGICAL ONCOLOGY Faculties were Dr .Shailesh Puntambekar, Laparoscopic Oncosurgeon, Galaxy care Hospital, Pune. Dr. Raj Gajbhiye Prof. and Head, Dept. of Surgery, GMC Nagpur. Total 6 cases operated in workshop like Lap. Esophagectomy for Ca. Oesophagus ,Lap Anterior resection for Ca Cecum, two cases of lap radical hysterectomy for Ca ovary, lap APR for Ca anal canal and Lap. Right Hemi Colectomy. About 100 delegates were present. This workshop credited by MMC. MMC observer was Dr. Mahesh Kriplani and 2 credit point with certificate awarded to delegates. 13)CME ONRECENT TRENDS IN PROCTOLOGY:1ST AUGUST 2019ASN organised CME on “RECENT TRENDS IN PROCTOLOGY”REFINING THE SURGICAL SKILLS” by Dr. KUSHAL MITAL, MUMBAI. About 70 delegates presented for this CME14)FIRST EC MEETING ON DT.10TH AUGUST(SATURDAY) AT CP, CLUB NAGPUR15)STATE LEVEL SURGICAL QUIZ :25 TH OF AUGUST 2019Association of surgeon ,Nagpur organised 22 nd Late Dr. Indrajit Mitrastate level Surgical Quiz. It is for the undergraduate medical students, to inculcate an interest in subject. This year a record number of 18 teams from all over Maharashtra and one team from Chhattisgarh (AIIMS Raipur) took part .Dr. P. Arora, Dr.D. Saxena, Dr.P. Bhowate, Dr. G. Deshpande, Dr. A. Deshpande, Dr P. Bansod were the quiz masters. Chief Guest Dr. P. K. Deshpande an eminent Surgeon, spoke on the occasion. Dr S. Dasgupta, Director RST Cancer Institute, Nagpur and the patron of the event spoke on the history of event. Dr. Mrunalini Borkar was the MOC and Dr.Bhutani, Dr.Nirmal Patle, Dr. B. Tirpude were instrumental in managing the whole event successfully. Dr TRV Wilkinson, President of Association of Surgeon gave the prize asWinner: Jawaharlal Nehru Medical Collage Sawangi, Wardha, First runner up: NKPSIMS and RC, Hingna ,Nagpur, Second Runner up: Mahatma Gandhi Institute of Medical Science, Sewagram. Dr Wilkinson, Dr P. Arora, Dr V. Desai, were the Chairman and Dr R Saoji, Dr R. Singhvi, Dr. Sudhir Deshmukh were the Co Chairman of Quiz Committee. Dr. Rajiv Sonarkar conducted the proceedings. About 150 students and doctors were present.16)SECOND CLINICAL MEET WITH GUEST LECTURE : 5TH OCTOMBER 2019 Four cases presented By: Dr Tanushree, Dr.Atish Bansod, (Two Cases Dr. Neha Awachar, Dr. Khushboo Gandhi), Dr. Shreyas Sonawane (Dr. Wilkinson, Dr. Sonarkar) Guest Lecture : Dr Prashant Bhandarkar, Topic :ACAHASIA CARDIA. Chairpersons : Dr. Sudhir Deshmukh, Dr. Wilkinson. About 54 delegates were present17)THE BREAST CANCER AWARNESS PROGRAM : 14 TH OCTOMBER 2019ASN in association with RST HOSPITAL organised the BREAST CANCER AWARENESS PROGRAM. DR WILKINSON gave a talk regarding awareness in Ca BREAST to gathering. 18)CME AND PANEL DISCUSSION ON CA RECTUM :19 OCTOMBER 2019ASN with American Oncology Institute with Nangia Multispeciatity Hospital organised panel discussion on CA Rectum Panelist were 1) Dr Mukund Thakur 2) Dr Rajiv Shreevastava 3)Dr Ramakant Tayde 4)Dr Atish Bansod. Moderator : Dr. Naresh Jadhav, Dr Rajesh Singhavi .About 45 delegates were present19)ASN PARTICIPATION IN AMASICON : 7TH TO 10TH NOVEMBER 2019 AT SURESH BHAT SABHAGRUH NAGPURAll the members of the association whole heartily participate in AMASICON at each level from beginning to succeed the conference.20)DIAGNOSTIC CAMP AT ARNI: 7 TH OF DECEMBER 2019 ASN participated in exclusively women diagnostic camp at ARNI with NARCHI. Dr.Deepa Jahagirdar, Dr.Mansi Dalvi gave their services in diagnostic camp and about 70 patients were examined 21)THIRD CLINICAL MEET : 4TH OF JANUARY 2020Four cases were presented1) Abdominal lump: Diagnostic dilemma : Dr GirirajGgajendra ,Dr Wilkinson,DrSonarkar2) A case of laparoscopic excision of patent uracus: Dr AshishBansod, Dr.Premlatha3) A rare case of spontaneous nephrocutaneousfistula : Dr Atish Bansod, Dr GirishMirajkar4) Spleen sparing laparoscopic distal pancreatectomy for a case of SPEN : DR UNMED CHANDAK DR ARTI MITRA,DR KAUSHALCHAIRPERSON : DR VIKRAM DESAI, DR. DEEPA JAHAGIRDAR. About 40 delegates were present22)SECOND EC MEETING AT CP CLUB NAGPUR : DT.29 TH JANUARY 202023)THIRD(EMERGENCY) EXECUTIVE MEETING :13 TH MARCH 2020At Paithankar hall IMA, NAGPUR TIME 5 PM TO 7PM. As per Principal Agenda of meeting, regarding directives of ASI, PRESIDENT like all gathering of association will be postponed till further information from ASI in view of COVID 19 pandemic effect. In meeting all members agreed in favour of postponing all activities of ASN, to maintaining social distancing to control the Corona virus spread. The forum also agreed upon hand over of new body of year 2020-2021 without any gathering or grand function .So digital or informal hand over will be applicable from date 31 march 2020. DR VIKRAM DESAI elected president of ASN announced the new ASN office bearer with honarary secretary Dr Atish Bansod for year 2020-2021. I owe to all past presidents, executive members ,ASN members for there constant support and timely guidance in this continues learning experience. THANK YOU ASN!!! I congratulate Dr Vikram Desai, President and Dr Atish Bansod, Honourable secretary and whole team of ASN for year 2020-21 and wish them all the best. Thank you all!!

UPSURGE - 2020

EDIT

OR

IAL

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DR. DINESH SARDA

Dear Senior Colleagues and Friends, We are going through the Covid pandemic and the resulting lockdown and social distancing. This has unfortunately stopped our customary clinical meetings, scientific CMEs and operative workshops. Not to mention the most important event of installation of our team under able leadership of Dr Vikram Desai and ever enthusiastic Dr Atish Bansod. Traditionally, we also launch the Upsurge during this event. But as it is said the darkest of the clouds have a silver lining, we have emerged with new ideas and innovative technologies. The webinars, online singing contest, culinary contests and walkathon have ensured that we all stayed connected through these troubled times. We now take pride in launching the very first E-UPSURGE with all its customary content and the ease of online reading and even mobile phone access. Its indeed a great initiative of this team to go green and avoid hardbound copies, not to mention the better quality of photos and layout in the e- format. It was a great privilege to interact with Dr R N Methi sir and know more about his life. We thank Dr Methi Sir for that. We would also like to thank Dr Qureshi Sir for his motivation and guidance. Two special columns need mention. One is DEBATE. Opinions were invited for and against two topics. We extend our thanks to Dr Prashant Rahate and Dr. Rajesh Singhavi for proposing the topic of debate & judging the entries. Another is WEB-I-CROSS. It is a crossword made from questions derived from various webinars conducted by ASN. Hence the name. We thank all the faculties who contributed questions from their presentation for this crossword. We also express our gratitude to all our past presidents, office bearers, all the members for their contribution. We request you to send your feedback and suggestions on atish6267@gmail.com, dksarda@gmail.com or gopalgurjar@yahoo.co.in With reverence we pay homage to Dr Arvind Joglekar sir through the eyes of Dr Dhananjay Kane, may his work keep inspiring all of us. We promise to bring the second volume of e-upsurge in coming months to accommodate the articles and write-ups which have not featured in this edition. We would like to all the authors who contributed for the UPSURGE.

Happy reading ! Dr Dinesh Sarda Dr Gopal Gurjar

DR. GOPAL GURJAR

FOREWARD

DR. RAJESH SINGHAVI

InCoviddayswheneveryoneisre-thinkingthemeaningoflifeandpeoplegoingbacktobasicsandadoptingminimalisticapproach,it'sgoodtimetodiscussthewaywepractiseSurgery.It'sgoodtimetodebatewhetherafreshlyqualifiedsurgeonshouldjoinaCorporateHospitalforfixedworkinghoursandsalaryorstarthis/herownhospitalwhichneedsalotofinvestments,timeandhasbecomedifficulttomanagenow. SimilarlyCovidhasgeneratedlotsofdiscussiononhealthinfrastructureinIndia.Canthegovt.makeabeginningsomewhereinasmalltowninIndiaamodifiedBritishstyleNHSsystem?InthissystemletallcitizensbecoveredbyInsurance(privateorbyGovt).LetallprimaryandsecondaryHealthcarebefreeofcostatpointofdelivery.Letalldoctorsinthissystembesalariedbygovernmentandprivatepracticebephasedout.Ifthissystemissuccessfulinthissmalltown-let'sreplicateitslowlyalloverIndia.Radicalidea-butweneedtodiscussinthisforumthewayforwardforIndiashealthcaresystem. So,welldoneEditorialteamofASNtostartthisdebate.Let'sdiscusshereandforwardtheconclusionstoappropriateauthorities.ThepresentASNteamhasdoneaverygoodjobbyorganisingWebinarsformembers.Ihopethesocialdistancingnormsarerelaxedsoonandweallmeetliveasbefore.Avirtualgoodbyetillthan.

Pediatric Surgeon & Pediatric Urologist,

Sarda Child Surgery & Child Urology Centre,

Dhantoli , Nagpur.

Consultant OncosurgeonHead of Surgical Services

NCI ,Nagpur

Consultant SurgeonNagpur

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ASN TEAM -2020ASN TEAM -2020ASN TEAM -2020

UPSURGE - 2020

First Row: President : Dr. Vikram Desai, Secretary : Dr. Atish Bansod, Immediate Past President: Dr. Raju Wilkinson, Immediate Past Secretary : Dr. Rajiv Sonarkar, President Elect : Dr. Sudhir Deshmukh, Vice President : Dr. Nilesh Junankar, Treasurer : Dr. Nitin Sherkar.

Second Row: Hon. Jt. Secretary : Dr. Prashant Bhowate, Editor Upsurge :Dr. Dinesh Sarda, Dr. Gopal

Gurjar, Co-opted Members : Dr. Dhananjay Kane, Dr. Pradeep Arora, Executive Members: Dr. Rahul Saxena, Dr. Abhinav Deshpande

Third Row: Executive Members: Dr. Ghanshyam Chude, Dr. Yogesh Bang, Dr. Vikrant Akulwar,

Dr. Abhay Choudhary, Dr. Mrunalini Borkar, Dr. Unmed Chandak, Dr. Bhupesh Tirpude.

Fourth Row: Executive Members: Dr. Gayatri Deshpande, Dr. Prasad Bansod, Dr. Harshal

Ramteke, Dr. Raj Kanthawar, Dr. Divish Saxena, Dr. Sushrut Fulare

UPSURGE - 2020

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"Action, heroism, certainty and optimism", are some of the key tenets of surgical culture all across the world.However, in today's times surgeons have been compelled to cope up with, "inaction, fearfulness, uncertainty and some degree of pessimism". To say that COVID-19 pandemic has disrupted the very foundation of healthcare would probably be an understatement. These are uncertain times and "fear" is the dominant emotion, ruling the minds of people across the world. In the absence of a precedent and adequate data to rely on, decision making is one of the most challenging tasks today. Most governments across the world chose to freeze, as did most of the big businesses. However, the only profession, where decisions cannot be deferred is medicine. As doctors we do not have the luxury to defer and have to take split second decisions all the time. Decision making during Covid 19 pandemic is probably one of the biggest tests that all of us have had to face. At the beginning of the pandemic, surgical associations across the world were quick to act. Guidelines were drawn and circulated at a lightening pace. However, at the ground level, each of us have had to grapple with taking decisions on a daily basis and it has been a lonely exercise. Along with clinical dilemmas we have also had to dealwith moral and ethical dilemmas. Should we be focusing on what could go wrong or refocus on what could go right? Would it be smarter to be pessimistic at this time than being optimistic? Could being optimistic be a liability at this time? How should we think about the future? What are the implications for patients and for surgeons? I have personally struggled with many of these questions over the last few months.

A Dose of Realistic Optimism for SurgeonsGUESTCOLUMN

DR. APARNA GOVIL

BHASKARMBBS, MS

Bariatric and laparoscopic surgeon, Mumbai

Taking a decision to get a surgery done is not an easy one. Patients and their families derive a lot of clues from the surgeon's demeanour and body language which helps them to take these decisions. As I mentioned earlier, even the smallest of surgical procedures can lead to grave complications and rarely can even lead to mortality. As the complexity of the operation increases, so does the chance of having complications. Most patients and their families suffer from optimism bias and despite being informed about complications during a consultation, they tend to filter the information related to bad news. Hence the onus is on the surgeon to drive the point home. In an increasingly litigious environment, surgeons have to tread carefully on the fine line between being optimistic and being brutally honest. Well, the solution to this conundrum may probably be found in realistic optimism. I have always believed that surgery is a very humbling branch. While surgeons may be vested with the power to cure many diseases, all of us are well aware that however skilled and experienced we may be, we can never get to a hundred percent. We all know that failure can strike us at anytime. Sometimes it could be because of an unintentional mistake and at other times we just lose to the forces of nature. Law of averages eventually catches up with all of us some day. Despite this awareness, most of us choose to go on. We take all risks into account and perform new operations every day. Should we attribute this to heroism? I guess our non-surgical colleagues may agree to that. However, being a surgeon myself, I know that what drives us is not heroism, but optimism.Not just optimism, I would say that it is actually realistic optimism that drives most surgeons.

Unrealistic Pessimism - Realistic Pessimism - Realistic Optimism - Unrealistic Optimism

So, what is realistic optimism and how do we apply it to the surgical practice? How is it even more relevant in today's times? Optimism is a necessity. However, unrealistic optimism can sometimes be misconstrued as having a nonchallant and uncaring attitude. In worst case scenarios, unrealistic optimists may be treading on waters of denial. When it comes to surgery or taking surgical decisions this would translate into ignoring possible risks and complications and focusing only on the positives. In a scenario where things may not go our way, it comes as a shock to the patient and their family. Despite the good intent of the doctor/surgeon, this forms for a perfect setting for a litigation. During the Covid-19 pandemic not taking the added risk into account would border onto sheer foolhardiness. On the other end of the spectrum is unrealistic pessimism. Unrealistic pessimists would go on to highlight the negatives much more than the positives. They would downplay the possible benefits of a particular procedure and focus a lot more on the side effects and complications. While it is important to keep our patients informed, it is also necessary to have some perspective. Treatments and surgical operations only come into common practice when their benefits are significantly more than the risks. No doctor deliberately wants to harm their patients but sometimes in trying to be honest we may tip over the scales to being too pessimistic. An over defensive doctor may unknowingly take away hope and push the patient into denying treatment. I would not shy away from saying that during this pandemic many of us have veered into the realm of unrealistic pessimism which may have unknowingly affected the disease outcomes for our patients. Only time will tell whether this was for good or bad. This finally brings me to the middle ground and we all have to ultimately choose between being realistically pessimistic and realistically optimistic. Being realistically pessimistic is considered as a safe zone for certain professions and surgery is one of them. It is said to prepare patients and their families better for any eventuality. It also takes the onus of liability away from the doctor/surgeon. As surgeons we are an integral part of the tragedies of our patients and their families. Being realistically pessimistic helps us to maintain a certain degree of detachment which is necessary for our own survival. It prevents over involvement and protects surgeons as they venture into the unfamiliar territory of taking high stake decisions. Realistic pessimism is the sentiment which is ruling through the Covid-19 pandemic across all surgical specialties. There can be no arguments against it and in the present times, it is probably the most sensible way to proceed. All said and done, doctors are human too. What ails the world today, ails us too. However, we also have to move forward and rise to the occasion to do right by our patients. We have to take the risks into account but ultimately, we have to move towards resilience. As we do this, we have to take our patients and their families along with us on the road to realistic optimism. While personal impact of negative outcomes can never be compared to statistics of complications, as doctors/surgeons we cannot take away hope from millions of patients. Just as patients must be made aware of all possible negative outcomes, they must also be made aware of the tangible benefits of the treatment being offered. Risk taking is a part of the journey towards a better life. As surgeons we become a part of this journey alongwith our patients. We have to help them to be able to objectively weigh the pros and cons and reach to a decision taken mutually for their betterment. Being realistically optimistic helps to ease the tension for a patient and their family and clear a partially cloudy disposition. At times carefully chosen words of optimism may be just the ice-breaker that was needed in order to reach to a life-saving decision. Covid-19 pandemic is being considered as the Black Swan of 2020. Healthcare is at the forefront in this battle. As we wade through these troubled waters the need of the hour is to move away from panic and paranoia. We have to approach this challenge with increasing resilience and realistic optimism. We have no option but to become comfortable with ambiguity. None of us will be a hundred percent right or wrong in our decisions but ultimately whatever happens, in our hearts we must know that whatever we are doing is in the best interest of the people that we are serving.

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As we all know, Dr. RN Methi sir does not need introduction. It was my privilege and opportunity

to interact and chat with sir over a cup of coffee. I was amazed to know different perspective of sir's

life.

Dr. Methi Sir – a Meticulous Surgeon, a Mentor for many, Master in academics, Mesmerizing in

surgical skill and Motivators for many surgeons is a well known personality not only in surgical

society but other fraternities as well. Sir is one of those who has been longest associated with Indira

Gandhi Medical College. His passion for teaching in rounds, clinics, postgraduate activities and on

operation theatre has been witnessed by many of us.

Born on 5th April 1944 at Achalpur in Amravati district, sir had a very simplistic beginning.

Coming from lower middle class family sir had to face all the troubles of those days and he never left

any opportunity unturned to progress in life. No wonder, Sir's academic career had been always

brilliant. He entered Government Medical College as undergraduate student in year 1962. He did his

post graduation from GMC, Nagpur in year 1970. He worked as Lecturer and then Associate

Professor for 4 years in GMC, Nagpur and then 1 year in JJ Hospital, Mumbai. Then he joined IGMC,

Nagpur. He had delivered his services as Honorary Professor in IGMC for 28 long years. He got

retired in year 2009. He is practicing at Methi Hospital, Central Avenue Road since 1975 and is still

practicing with same vigor, enthusiasm and passion. Let us know more about this sincere, punctual

and disciplined surgeon.

Question: Sir Tell us something about your early life and family

I was born in lower middle class family in Achalpur. My father used to have a small ration shop. My

childhood was similar like any other who has to have those days. I would like to mention major

incident in my childhood. At nine years of age I became so sick that I was bedridden and even could

not speak. My room where I was kept was next to Puja room. Those were navaratri days when “jyots”

used to be lightened up. On one of the day of navratri, I felt like jyot is coming closer to me and

suddenly I spoke our loudly “Jai Mata Di” and then my illness improved. I studied HSSC in Marathi

medium with mathematics subject. Then I did BSc 1st year and then got admission to MBBS in GMC

Nagpur.

Question: Sir, what inspired you to be a doctor?

As I told, at 9 years of age, when I was ill, doctors treated me passionately. At that point I felt like to be

a doctor. No one inspired me. I am the only doctor in my family. Now my daughter is also a doctor.

Question: Sir, Tell us something about undergraduate days

Since I missed preuniversity and did not have Biology as a subject, I had a tough time in first year. I

studied day and night and catched up with the course and passed in flying colours. In undergraduate

days I developed deep interest in Anatomy, then in Pathology and then in Surgery. That is how my

inclination turned towards surgical career. In those days, we were group of 8 to 10 students who used

to take evening rounds in wards of units who had admission day. It was routine. It was a golden time.

In 3rd MBBS, I used to do minor operations like gland biopsy in Minor OT.

One incident which I will never forget is about a patient who had intraoperative cardiac arrest

during strangulated hernia surgery. He required internal cardiac massage. He had been kept on bed

no. 1. I had been allotted that patient for history taking. He was absolutely reluctant to give any

history. I had been very kind, patient with him and finally on day 3 he gave history and became very

loyal to me. He used to come to meet me in follow up visits.

In internship I used to attend the discussions of those time very sincere postgraduates Dr N K

Deshmukh, Dr Satish Kale, Dr. Joharapurkar. In gynaecology posting Dr. Shastrakar, a very strict and

senior lady assisted and taught me tubal ligation procedure during internship. Similarly, in medical

ward posting I used to do all procedural work like lumbar puncture, sternal puncture, muscle biopsy,

gland biopsy etc.

DR R.N. METHI

Cont....

Consultant Surgeon Methi Hospital,

Nagpur

HUMBLE INTERACTION WITH A REVERED TEACHER DR R N METHI

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Question: Sir, we would like to know about your postgraduation days

Since I used to attend discussions of surgery postgraduates in my internship days, all of them knew me well. I had good time

with them. I had one jobs in orthopaedics. Dr. Satish Kale was my Registrar. I was previliged to do many lecturer level

surgeries during my house job. Souttar's Hip Release operation is one of them which I still remember. Feeding gastrostomy

was my first surgery I performed in my surgery housejob.

Question: Who was your guide?

Dr. Chikodi was my guide. And my thesis topic was “Regional chemotherapy by Internal Mammary Artery cannulation in

advance Breast Cancer”

Question: Can You recall some interesting episode in OT

In 1976, I was operating a case of hypernephroma. Dr. Magan Ostwal was assisting me and Dr. Shrirao was the anesthetist for

that case. There was a growth in body of kidney. I was separating kidney with my fingers and suddenly entire kidney came in

my hand. There was rent in aorta. Entire fossa got filled with blood. I immediately immersed my hand in pool of blood and felt

tap like gush and pinched on aorta. I sucked the blood. Very calmly and patiently I sutured the aorta with mersilk using

clamps, Luckily that worked,. Patient survived and was discharged. This is one occasion which I remember. Coincidently I

never required intraoperative call to another surgeon for help.

Question: what is your message for surgeon in OT?

“If you respect the tissues, tissues will respect you”. This is what I learnt from my boss and this is what I taught to all my

students. I would also like to say that there should be adequate rather extensive teaching on operation table. Knowledge, skill

and experience should get percolated to young surgeon. Good teacher is one who goes to the level of student and brings

him up from that level.

Question: what is your experience as a salvage surgeon?

I had gone to good no of surgeons for helping them during surgery. I have done about 1500 LSCS, about 1000 abdominal

hysterectomies, about 350 thoracotomies. In 1975, in a nearby very busy maternity home, once I was called for intraoperative

help for inadverant bladder injury while starting LSCS. Gynecologist being in very panic mode that time, she asked me to also

proceed with taking out baby from uterus. This is how I started doing LSCS. Then many gynaecologists started calling me for

LSCS, intraoperative difficulties, ureteric injuries, surgically difficult problems etc.

Question: Tell us something about your family

My family includes myself, my wife and three daughters. Eldest daughter is gynecologist and is practicing in Amravati. Middle

and younger daughter are nonmedicos and are settled in USA. They are now citizens of USA and doing all well.

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Before the Corporation Medical College (CMC) started in 1967 clinical teaching was going on for RMP courses. Dr. V. G. Diwan was then Civil Surgeon and he became First Principal (Dean) of the institute. He was really (Civil) Surgeon. considered to be daredevil, short tempered surgeon, used to do Cardio-thoracic surgeries in form of Mitral Valvotomy, Pneumonetomy, Decortication along with all other general surgeries. During those days, financial support to hospital was poor, and investigations were at the rudimentary stages, only clinical signs used to dicate type of surgery. He once opened post - thoracotomy chest in ward for evacuating clot haemothorax and salvaged patient without developing infection. Whenever he used to get time from administrative work, he used to operate morning / afternoon. He was so strict in his work that he was considered to be terror both as an Administrator & as a Surgeon. He himself to do postmortem to know the cause of death in post operative death events. Then in 1968 Govt. posted full time Professor Dr. Nisar Siddique. He was very particular regarding time, strict slience, methodical, interested in administration & Neurosurgery. He hosted International Surgeons Conference in 1971. He along with his team used to do cisternography, ventriculography and double contrast myelography. They used to tie 4/5 cassettes and pull rapidly (innovative method to today’s rapid casstte changer) to record carotid angiography. He influenced Dr. H. Deshpande and Dr. A. M. Bhole for developing interest in neurosurgery. At that time two units of Govt. Medical College used to function from Mayo Hospital. Dr. M. L. Gandhe, Dr. R. N. Das, worked here in capacity of Reader. Dr. V.D. Chaudhary & Dr. Paliwal were honoary surgeons at Mayo Hospital. Dr. V. K. Divekar was first lecturer posted at CMC. When Dr. Siddique was transferred to Mumbai, Dr. V. S. Gowardhan was promoted as professor and HOD of surgery in 1973. Dr. Diwan had asked him to prepare U G Teaching Programme in 67 only. He worked at Mayo on very meager resources. His interest was Gastroenterlogy and also thoracic surgery. He warked as professor till 80. He started surgical camp at remote place at Hemalkasa & he helped renowned social worker Dr. Prakash Amte & Dr. Mandakini Amte regarding medical care of tribal population of Bhamaragarh. In 1976 Dr. Satish Kale joined as Pool Officer and started definitive orthopedic treatment to trauma pts. From that period onward orthopedics started separating from General Surgery. Dr. A. M. Bhole was first Reader of CMC and later on he was Professor. His dissertation started experimental surgery in form of endothelisation in Terrilyn vascular graft in dogs. He is the only Professor who worked as HOD in CMC and then IGGMC and continued HOD of surgery till 94 ( except for short duration Dr. M. T. Rewale.) Dr. Bhole was interested in Neurosugery. Dr. Rewale was also daredevil surgeon who had done pituitary tumor excision. After Dr. A. M. Bhole was transferred to super specialty hospital, Dr. B. Deshraj took Over as Professor & HOD. His main interest was urology. Later on Dr. A. T. Kamble started thoratic surgery. Dr. Raj Gajbhiye was instrumental in giving boost to Laparoscopic Surgery. Beating heart is a mesmerizing organ which attracted Surgeons Dr. V. G. Diwan, Dr. V. S. Gowardhan, Dr. R. N. Das, Dr. M B. Shende & Dr. A. T. Kamble. Four surgeons need special mention. Dr. A. M. Joglekar (Kaka), a silent, real craftsman surgeon, very good teacher having very god presence of mind. He use to draw diagram using both the hands simultaneously. Dr. M. B. Shende was noncontroversial person who used to give free hand to his juniors so as to build self confidence among his PG student. Dr. R. N. Methi who was Honorary Professor initially later on appointed as associate professor on contract basis. He used to teach and look after his unit as a full timer and Dr. N. K. Deshmukh who was posted as Dean but used to find time for surgery and for teaching post graduates. Postgraduate Students :First batch of Post graduate student admitted were alumni of GMC, Nagpur. Dr. Chaturvedi was the first PG student. First student of CMC of 67 batch was Dr. Hemant Deshpande, He was registered during his internship but due to certain circumstances left for Mumbai, to get Superspeciality in Neurosurgery. Later on he was the first degree holder neurosurgeon of the orange city. Dr. M. Daga fo 68 batch was first student of CMC who had done M. S. from CMC and then M. Ch. Pediatric surgery. In 1972 Corporation Medical College renamed and Indira Gandhi Medical College. M.S. General surgery degree was recognized by MCI by order MCI - 81(22) 2008 / MED 5960 Dt. 01.05.2009 yr. Even through the house jobs of Mayo were recognized by Royal College of surgeons, UK long that, After JR & SR pattern was implemented, no. of post graduate intake admissions were diminished to 4 till 13 & then 5 since 13. When there was affiliation to Nagpur Iniversity, PG admission ranged from 3 (in 1972) to 9 (1990). Till today more than 200 students passed out from this institute with M.S. General Surgery degree Dr. Vivek Saoji is the first postgraduate who is a vice chancellor of K.L.E. Medical institute Belgaun, while Dr. A. Adhao was National IMA President. Department of surgery was deprived of one time increase in seats by Central Govt. Seats due to deficiency in faculties of Assistant & Associate Professors in the department.Infrastructure:When CMC started at that time, then emergency & routine OT used to function from same premses. Later on

DEPARTMENT OF SURGERY, IGMC, NAGPUR :

DR. SUNIL LANJEWAR

Cont....

Journey Revisited

Prof. & Head Dept. of Surgery IGMC , Nagpur

This feature will include some interesting light reading from the field of urology. Urology revolves around Pee. The urban dictionary defines the Pee Corner as:'the area designated for urination upon immediate adverse survival situations for sanitary purposes and disease prevention. Typically a corner. This literary pee corner serves the same purpose as the original i.e to provide 'relief'. Remember “Pee sets you free”.

Pecunia non olet‘Pecunia non olet' is a roman phrase which has found usage in modern times and has a materialist or philosophical meaning.The story of the origin of this phrase goes back to the time of the Roman emperors of 68-68 AD. This time is labelled by the historians as the year of four emperors. Rome was recovering from the down fall and suicide of Nero ( Nero playing fiddle, when Rome was burning notoriety). There was a civil war and emperors Galba, Otho, Vitellus and finally Vespasian came on the throne. Titus Flavius Vespasianus or Vespasian established the Flavian dynasty. Nero had left the coffers of Rome empty by his extravagances. Vespasian wasfaced with the empty treasury and needed to fill it up urgently. He did that by levying additional taxes. He taxed pretty much everything in sight. This came to him naturally as his father was a tax collector and he had humble beginnings rising from the ranks,. One of his infamous taxes was the VectigalUrinae or urine tax.The launderers called 'fullers'in those days did not have soap. Fullers had found a unique use for urine as a cleaning agent. The urea on exposure to air forms ammonia. This ammonia is used for removing recalcitrant stains from Roman togas and as a whitening agent The alkaline ammonia could get rid of the acidic dirt and grease from clothes. The tanners used it for softening the raw leather to remove fat and hair. So the humble pee was much in demand. The urine was collected from the giant Roman sewer called the 'Cloaca Maxima' (remember the embryological cloaca!) or it was collected from giant vats kept at street corners. Taxes were collected from the collection agents manning the vats. This tax was known as the 'VectigalUrinae' or the 'urine tax'. Gradually the treasury started filling up again and Vespasian could rebuild Rome. In fact the Roman Coliseum one of the Wonders of the World was built during his time. But as is seen even nowadays, the children do not approve all the ventures of the parents and are their main critics. Vespasianseldest son Titus protested against this tax and called it disgusting. Vespasian is said to have picked up a handful of the gold coins and profferedthem to Titus asking him to smell the coins saying “Pecunia non olet”. This means that the coins do not carry any stink. Money earned that way is indistinguishable from money earned from any other sources.money is not tainted. This phrase from Vespasian is the most famous phrase surviving till now. It was later used in various ways to even mean 'money earned from any source is justifiable' or 'money is money'. The term is used nowadays to downplay the questionable or outright illegal sources of financial gain. It does not matter how you got your money because it has the same value. Vespasian was the first to start public pay toilets in 74 AD. Thus the concept of 'Pee for Fee' originated from him. Toilets in Roman were called Vespasianos. In France and Romania they are still called vespasiennes.

DR. VASUDEO RIDHORKAR

when two hundred bedded building started 1976 routine OT got separted from EOT.Ortho OT was also functioning with General Surgery till it got separated in 1996.2016 Was Eventful year as new 30 bedded casualty, new Emergency OT started functioning above new casualty & new OPD block of Surgery & Ob Gy started functioning.In 2017 new surgical complex started functioning in “Surgical Sankul”. In one complex General Surgery, Orthopedics, ENT, Ophthalmology & Burn having wards as well as OTs. Wards were constructed as per MCI norms with bed strength of 33 each. General surgery and orthopedic depatment are having one modular OT each while all OTs in this complex are having separate Laminar air flow, with central colling, with hepa filter facilities, to decrease infection rate. Burn ward is centrally air conditioned and having state of art facilities in a form of rhapsody for cleaning burn wounds.

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Consultant Urologist Kingsway Hospital

Nagpur

PEE Corner PEE Corner PEE Corner

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Dr. Mrinalini Hardas

Dr Prachi Mahajan

We all learned the definition of a hernia in our first clinical posting in med school. We remember it as ' the abnormal protrusion of a

viscous from the walls of its containing cavity'. Figuring out the 'containing cavity', the ' viscous', the ' protrusion' was literally and

figuratively Greek and ' Latin' to us as we tried to understand it for case presentation in the viva! The nomenclature about the various types

of hernias seemed to be as complicated as the condition itself.

All these years later, after operating on many different types of hernias in different stages of simplicity, complexity and

complications, I always ponder on what a hernia teaches us in the form of life lessons!

A simple reducible hernia is like a curious intruder with not much courage, who tries to break in and peer into prohibited windows, but

withdraws of its own accord, having understood the implications of violating one's anatomical boundaries.

A hernia is always an opportunist. It tries to get into others' spaces without permission and literally spreads its tentacles as it tries to gain

foothold into uncharted territories. It holds on to anything it can lay its hands on, draws in more of its kind within and becomes an

unsightly and intolerable guest. It occupies space to no avail.

Reducing contents of a hernia while gently tugging on the loose ends gives us an insight into the complexities of our lives, the

various attachments we cling on to for dear life! Life situations are sometimes extremely sticky ( read adherent) and trying to solve one

problem may bring forth a longstanding interconnected maze of intricacies, each one of which needs to be addressed and' reduced' with

utmost care so that we don't cause collateral damage to anybody or anything. Any mishandling may cause more damage to the already

friable circumstances. Hence, one must proceed with caution and courage in order to reach the desired conclusion without inadvertent

consequences that may not reveal themselves immediately. Sometimes as we pull to reduce, we may get a pseudo feel of having brought

The Philosophy of Hernia - Dr Prachi Mahajan

A ' not so humble' hernia taught me that!

Asst.Professor,Dept. of Medicine

I.G.G.M.C,Nagpur.

Consultant SurgeonMahajan Hospital

Dhantoli, Nagpur

MR.COVID.. ……IT IS TIME TO LEAVE!!!!!!

The year 2020 is sure to find a place in textbooks of all subjects.We are learning the various aspects of COVID-19 disease namely etiology,epidemiology,diagnosis,clinical features, complications and management simultaneously with the emergence of the disease.Information is overflowing,much more than doubling rate of the disease itself!The fact remains that ,as of today, no definitive treatment is available. Covid positive patients' initial reaction most often is fear; but over a few days, as realization dawns that most of them are asymptomatic, other queries arise-regarding quality of test, facilities of the hospital, nature of treatment and so on, thanks to tonnes of information available on social media-most importantly Prof.Whatsapp! As of today,clinical scenarios requiring prolonged hospital stay are definitely less with advent of medical and surgical advances. So it is a tough task for the doctor to convince an asymptomatic case to remain in hospital for 14 days ,now reduced to 10 days.The patients who are ill ,are plagued by exhaustion and fear, worsened because of absence of family members.Mobile phones do contribute positively and ensure connectivity with the outside world. The doctor has to overcome his/her own prejudices in order to work efficiently and calmly in the covid wards..Treating a highly contagious disease with no definitive antidote is quite a daunting task.The possibility of getting infected,chances of spreading the disease to family members and others often haunt the doctors' mind. PPE kits definitely are physically exhausting .Communication between doctor and patient is through barriers ;it makes the patients' uneasy .The courage and tenacity of consultants and residents have saved many lives across the globe.Rounds in asymptomatic wards are taken with thermal scanners and pulse oxymeters.Chest xrays are a routine .Various oxygen delivery systems are available.The drug treatment guidelines get frequent updates.How does one inform `poor prognosis' ?;the immediate relatives are either quarantined or admitted. Yet, hope is eternal.The entire team of health-care workers and the patients are source of optimism and strength to the ill.Our city has done well till date. Covid19 management involves many agencies; the local governing body and administration is entrusted with quarantine,contact tracing and notification.The hospital administration ensures regular sanitization of wards ,security ,drug purchase and provision of food for covid patients (breakfast,lunch and dinner). The health system is managing a viral infection which is of pandemic nature ; at present, the therapy is oxygen,oxygen and oxygen.Resident doctors of all the deparments are doing courageous and awesome work.Faculty members of various departments have pitched in their might.The task of setting up a covid hospital is tough.The instruments required are identified;their procurement consists of price bids,necessary sanctions,routing through proper funds,installation and compliance with directives from govt.authorities and health ministry which is an exhaustive process .Telephonic and personal interactions demand patience and persistence.It is a matter of pride that the excellent covid hospital setup at our institute is the fruit of untiring effort of professor and head ,department of surgery and his team.Some reassuring findings have emerged in the field of covidology: a) oxygen therapy is sufficient in most cases and has saved many lives; ventilators are not the mainstay. b) anosmia is associated with early recovery. c)asymptomatic or mild cases comprise about 85% of positive patients.d)physical distancing,hand hygiene and face mask can safeguard us.It is true that the show must go on.Life with covid has brought various perspectives of life to the fore.Let noble thoughts prevail. Every pandemic has a medical end and a social end.Medical end occurs when new cases and deaths become negligible.Research is on at great speed all over the globe.Social end occurs when the fear associated with the disease ends and community learns to surge ahead.The social end is almost achieved .Let us work towards a social end and a medical end is sure to follow.

everything back, but loosen the traction and things go back to where they were! Then we need to start all over again, possibly through a different angle.

Once the contents are in their proper compartment, we are confronted with one or more gaping holes that solemnly stare at us, waiting to be effectively and

permanently closed. We started initially with use of indigenous tissue, only to realise later that an external administrator could prove to be more influential. Our early

tendency was also to 'sweep the problem under the carpet' by ' patching' it! Experience, maturity and dexterity gradually teaches us that just patching it up may not be the

best way. The patch may actually shrink or cave in under strenuous pressure! So we learn to do a fine darn and then use a cover! That is likely to give more breathing space

and without the invading enemies like fat, flab or force, may stand strong for long. Some hernias are too overbearing. They easily overcome weakened defences and take

charge of other domains. They then need to be tackled with ' brute force' and inside out to contain their scheming nature.

Through decades of improvisation and refinement of tactics ( techniques), we have realized that Nature is supreme, tough, yet yielding and if we make use of natural

planes, dissect them adequately, they actually give us more space and support by accommodating the required 'solution'! The gentler we are, the better the desired effect.

The problem at hand gets easier to quell, while adhering to one's basic approach of calmness, tenacity, patience, persistence and accommodation in solving life's many crises.

We probably all like to operate on a hernia because of the different challenges it presents with.

We must also remember that unpleasant situations may 'recur' in real life too and every problem has a solution if we think calmly , make a strategy and take appropriate

action.

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Scrolling through some posts in social media. I came across a few uploads on the above mentioned topic by one very renowned & highly talented senior surgeon, well known for his intellect, skills & administrative capabilities. Being in the field of medical Education for a fairly long time in my professional career and a man who has delved in relatively all areas like teaching, training, evaluating and also administration I thought of putting in a few thoughts of my own on this topic.· Quality of Training· Deficiency in Skills· Lack of Clinical Reasoning· Poor Communication· Lack of Empathy· Lack of Administrative knowledge & skills.Training of Skills & quality of TrainingVolumes have be written & spoken on the content & quality of teaching & training in our Medical schools. Medical Council of India under the leadership of Doyens in the field with input from the best brains in the market have experimented with multiple cocktails of syllabus & training programmes & hours of medical teaching. One of our very own & highly decorated personalities in this field had in his lecture in an International forum said that India has one of the best teaching models in the world. We expose our students to 36000 hrs of training in 4 years of undergraduate programme. What was this chest thumping for ? If we had a such an excellent programme then why are we lamenting ? about inefficiency & lack of skills ?Let us face some glaring facts.Let us accept the we, our policy makers, our custodians in universities & the government all areplaying the number game with emphasis on quantity and not quality. There seem to be a mad race as to how to increase no. of P.G. seats in every medical college. True, that we need more specialists & skilled surgeons but that does not mean we sacrifice quality at the alter of quantity.When we were post graduate students we had the good fortune of having a couple of excellent teachers (there were equally bad ones too) So the equation remains that when you purchase a basket of mangoes you get quite a few bad ones too and you accept it.Batch after batch as the manufacturing units keep on churning out specialists (Surgeons) in the market you keep on getting qualities which carry the label of export quality, Good Indian Quality, Average Quality & below average quality.I am sure this must be happening in the most of the countries worldwide including the developed ones. Even today with all this lament of poor training we have a good no. of highly efficient & skilled surgeons who fit the bill in all respects.Lack of Communication Skills & Administrative SkillsYes, I fully endorse the fact that our graduates & postgraduates lack communication skills to a great extent. The reasons are many. Right from their mother tongue, to quality of schooling they underwent, to total lack of emphasis on this vital aspect has led us to this situation. MCI has woken up to this problem very late and has now stressed the need to include English language & communication skills in the undergraduate curriculum. It has been inducted but what has it yielded is yet to be evaluated. The great language divide in the country and non acceptability of one language theory in the country has also added to the problem. I am witness to students answering in Hindi or Marathi to question asked in English. It is a huge challenge to face as our books and teaching all are in English but our students are poor in it. Every students in medicine should be taught some basics of Administration, Medical auditing, Health Economics, and manpower managements. Importance of Medical auditing as a basic tool for self improvement can't be overstressed.Training of TrainersLast I would wish to talk on this very important topic. If today we blame the younger generation of lacking skills, communication & other expertise, the trainers are equally to be blamed. The quality of undergraduate & post graduate teaching in most of the medical colleges in the country are far from desired. Added to it is the lack of interest among students in attending classes & clinics. Bedside teaching is becoming a rarity. Demonstration of clinical signs is a puzzle to the students. Patients walk in CT Scans & MRI in hand and the attending doctors looks at the diagnosis even before asking the complaints of patients.Concluding I would say that we already have a continue to have quite a few diamonds but we wish to have more with some fine tuning in our teaching & training programmes and this can happen only when knowledgeable experts in the field are given the authority without being override by political & regional compulsions. So let us look forward to a real revamp in the true sense.

Dr. Subhrajit Dasgupta

Looking for diamonds are we digging stones.

DirectorRashtrasant Tukdoji Regional

Cancer Hospital, Nagpur

Page 13

United Kingdom after winning the World War II, realized after losing over a million men and after taking a beating

on the economy, (The UK had just lost its cash cow colony- India) that healthcare was a responsibility of the

government. So, they took it upon themselves to deliver and maintain their healthcare by socializing it and called it

the National Health Service or NHS. To elucidate the working of NHS in short- the Government bears the cost of

running the NHS, which it pays from the taxpayers' money. Nobody directly pays for their visit to the GP or the

hospital. It has been running so since the 1950's and it has been more or less a smooth journey to say the least.

Prior to 1991, India used to have the License Raj wherein the necessary permission to start a major business lied in

the all-powerful hands of the government. Slowly, after 1992 many private businesses entered the market and started

dominating it, partly due to the fact that it provided better products and services and secondly, due to lack of

innovation in the then licensed companies. This effect was seen in many sectors ranging from making pins to palace

hotels.

It is not possible in India due to the democratic system & population. Further it is financially not

viable system for Indian government. Instead if government tries to maintain & upgrade the present

system it will be boon for Indian health care. If a proper salary, ambiance, scientific platform,

support, resources opportunity ,incentives , perks are given to full time health worker & doctors

it will go in long way to improve the health care system. The doctors will be more than happy to

serve government full time. Indeed the government & teaching institute should have full time

doctors without NPA .

Stance – NO

DR RAJESH SINGHANIYAConsultant Surgeon & Director

VIMS Hospital, Nagpur.

Somewhere in between was the healthcare sector. Till 1991, healthcare in India meant government hospitals basking in their former glory were headed

towards their demise (mostly located in cities and health care facilities in the rural areas) and family owned small nursing homes by the private

practitioners. But then in the early 2000's there was a boom in the development and expansion of the corporate private hospitals that changed the game

with better facilities albeit at increased costs. This satisfied the healthcare needs of the growing middle class. These were the institutions owned either by

those in power or by businessmen that lobbied the former in their elections. Health is considered to be recession prone. Hence many investors chose to

grab a slice of this cake and converted this into an industry (a word that irks many of our yesteryear seniors).

Now one might think that UK was a developed country and could afford to do so. But as a matter of fact, we are emulating the health system of the

United States, health as a priority is subjected to a decision made by the individual. The individual has to choose between getting into debt or pay for

insurance. The downside of this system is that only the 'haves' are insured and can afford to pay for healthcare whereas 'have-nots' become bankrupt

whenever a disease strikes them. In India, one might say- what about the government hospitals, where healthcare is free? Many schemes exist, but only on

paper. Added costs are never counted. As many of us have encountered, a poor man can't afford to pay the Rs. 2000 bill. Who knows how he/she manages

to get necessary money. And the benefits of the health schemes made for the poor are rarely used by the poor themselves.

The benefits of having an NHS like institution are manifold.

1. For the nation- It is a national program wherein all the primary care clinics, secondary and tertiary hospitals are under a national system and are

centrally controlled. The uniformity in all these institutes would be better ensured under a single umbrella. Nowadays, we hear many politicians are

lobbying for an AIIMS in their constituency. But if all hospitals are standardized under the purview of the NHS, would this gimmick even exist? Also having

a nation-wide network of hospitals helps in maintaining a national registry of the diseases and can carry out nation-wide clinical trials and audits, helping

plan for realistic budgeting- instead of getting mere peanuts of 1.2% of GDP.

2. For the patient- A normal delivery in the US costs around $9000. Whereas under NHS it costs nothing- in any hospital. There are many such

examples wherein having universal healthcare helps the family to take care of their health because the last thing they have to think about is the money.

Having an exclusively private healthcare depends on insurance, whereby the cost of delivery of healthcare increases tremendously. Truvada, an HIV drug

costs about $1000 a month whereas in Australia, (having a universal healthcare system) it costs $8 a month. This because the when the cost of drugs is

borne by the government, it has the power to negotiate the pricing of the drugs. So, there are no copayments, no additional burden on them for

medications.

3. For the Doctors- Yes, having an NHS means that all doctors are on the payroll of the government. But that does not mean that all doctors would

be paid the same ie. having the lazy ones and hardworking being paid the same. Doctors are paid according to their specialty and added qualifications

and incentivized to work more, research more and work in the remote areas. The general practitioners are paid according to the number of patients seen

and treated by the government. So, it is purely up to the doctor as how much he wants to earn. Plus, on the other side it is such a relief that his clinical

decision is not restricted by the size of the purse of the patient.

4. For the Tax-payer- Yes, having universal health care would mean added taxation. In addition to the multiple taxes that we already have why

would one chose to pay more taxes? Directly, it means not having to pay for the health insurance premiums every year or worse paying out of pocket for

health, which in total costs far more than paying for the NHS. Having an NHS keeps majority of people from bankruptcy due to diseases. It saves lives

which are lost due to lack of insurance.

So, we see that the benefits of having a universal healthcare system far exceeds the disadvantage of not having one which is staring us in our face right

now in our country. None of countries which have adopted having universal health system have ever reverted back on having a dual or private healthcare

system in the history. In fact, NHS is celebrated worldwide and is studied around the world with many countries having adopted the system as is or after

some modifications.

It is but a matter of political will, the nations need and lobbying on the part of the corporate industries for whom the welfare of the patients and doctors

comes second to their profits. The choice is ours as a nation to adopt this wonderful system which is changing the world as we know it.

UPSURGE - 2020

Should India have NHS like system where in every doctor is salaried?

Topic - 1

Debate

Stance – YES

DR GIRISH MIRAJKARJunior Resident,

Dept of General Surgery,Indira Gandhi Government Medical College, Nagpur.

JUDGE DR RAJESH SINGHAVI

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UPSURGE - 2020

DR GIRISH MIRAJKARJunior Resident, Dept of General Surgery,

Indira Gandhi Government Medical College, Nagpur.

This is a very complex topic. The opinions and views are bound to be varied. However to discuss this is all the more

essential in current times of uncertainties, in times of growing grudge and depleting faith against doctors, ever

increasing competition amongst doctors and unending expectations from ourselves. These are only some of the

myriad problems we are facing as medical professionals.

Why did I become a doctor? Well… that's the basic question.

As children, many of us dreamed of becoming a doctor. Why? It was because of the respect and recognition a

doctor gets from the society. We never understood the financial aspects of the profession during childhood. As we

grow and graduate the medical school we develop passion for our speciality. That very passion keeps driving through

all odds to excel in our field. To me passion is priceless. It can neither be quantified nor can it be adequately

compensated.

That was at the individual level. Now let's see the bigger picture… our national healthcare system.Stance – NO

DR NIRMAL PATLE Consultant Surgeon

Aureus Hospital, Nagpur.

We are a 138 Cr population. We have a doctor population ratio of 1:1800. The WHO recommendation is 1:1000. Almost 70% of healthcare is provided by

private sector. Now, to have a NHS like health system this 70% of the infrastructure has to be transferred to the government. With 3.6% healthcare

expenditure of the total GDP, this is most unlikely to happen. So the very topic is hypothetical.

Suppose this happens and all the doctors get employed on salary basis. Salary, according to me, is a word which signifies limitations. It also signifies

slavery (NAUKARI). We feel insulted to be called a 'Naukar'. The greatest incentive in salary is a regular (although limited) and secured income. This very

sense of security brings about complacency. It minimizes the risk taking tendency. It's akin to investing all your savings in FDs rather than mutual funds.

Another aspect is human psychology. We like to work for incentives. We work day and night for the patients. We don't count our 'shift' hours. We don't

exchange our duties. We don't see the calendars and plan our holidays trying to club weekends with public holidays. The passion to work and excel keeps us

going.

On the contrary, there are no incentives in fixed salary. Assured income brings about 'KAMCHORI'. There is general lack of accountability in fixed salaries.

The drive to work hard and progress gets diminished and that is the death of the very passion for which most of us became doctors.

So, for me, the idea of having a NHS like health system is neither practical nor acceptable.

The views expressed are totally personal and may be debatable. They are not intended to hurt anyone's sentiments.

Placement of New Young Surgeon in Corporate Hospital OPPORTUNITY OR EXPLOITATION

Topic - 2

Indeed it is opportunity for young doctors. Considering the new government regulations, ever growing

technology, finance involved in having the equipments, legality, insurances, stringent rules & harassment

from Local authority, expectations & demand of patients, finances at stake, it is blunder to have your own

setup initially. Corporate will be the future in city.

If one choose to work for corporate, after certain time and experience he can leave the corporate and may

get involved as director of some corporate group which is now a trend in many cities. It depends upon

financial background, risk appetite, mindset whether to have your own corporate with a group of light

minded people or to be employed in corporate set up. It is always better to have a group practice in a

multidisciplinary setup for broad specialty like general surgery,

Yes the corporate have their own strategy to replace you or tame you according to their needs. Exploitation of oneself depends on individual attitude &

mindset. If one proves his skills, ability, knowledge and once you develop your own clientele, then it is not possible for corporate to exploit you. Then

corporate also depends on you & you may have your terms then, but if you feel uncomfortable there, you will always have offer from other corporate with

more incentives & salary. Corporate are paying more than the salary in government job

Days of one man army is gone, days are of team work. Not only in medical profession, but even advocates, chartered accountants, architects are going

towards corporate culture.

For young doctors corporate is the best place.

There are many advantages of working in a corporate hospital, especially for a freshly graduated, wet behind the ear

surgeon. These are better exposure to clinical material and technology, a highly competitive environment and an

excellent compensation package.

Corporate hospitals continuously bring in newer technology. The young surgeonbenefits from thisexposure,

improving the future job opportunities for them in India and abroad.

Corporate hospitals are referral hospitals and the patients visiting these hospitals are suffering from complicated

diseases or need emergency intensive care.The young surgeons get to operate and manage patients which they would

not have been exposed to otherwise, adding an extra feather to the surgeon's hat.

Corporate hospitals provide more encompassing benefits than other hospitals in terms of cafeteria, parking facilities

and doctor's lounge. The compensation packages are also excellent which means that young surgeons will earn more

than their counterparts working elsewhere.

In these times of increasing violence against medical professionals by disgruntled relatives, the corporate hospital

provides a safe working environment, providing a great sense of security to the young surgeon.

Stance – Opportunity

DR. ANUPAMA KASHID Junior Resident

Dept. of Surgery NKPSIMS

The sanitation, ventilation and air conditioning are excellent, providing comfortable and healthy working environment.

The human resources department takes cognizance of any small complaints and attempts to solve the issue. Therefore ensuring safe, secured working

environment where an employee's problems are timely addressed.

The workpattern of a corporate hospital is a team approach. Working with others, who are typically dealing with the same things professionally, can lend

a support system to fall back on when things get tough, reducing the stress a new young surgeon goes through.

These are only few of the many reasons why I feel a new young surgeon should consider working in a corporate hospital as an opportunity.

Stance – Opportunity

DR RAJESH SINGHANIYAConsultant Surgeon & Director

VIMS Hospital, Nagpur.

JUDGE DR. PRASHANT

RAHATE

Page 15

UPSURGE - 2020

Placement of New Young Surgeon in Corporate Hospital – OPPORTUNITY AND EXPLORATION

That's my view on this topic. And I would like to put my views in detail explanation below.

1- Surgical training at MS level –

With increased number of seats in each and every residency programme overall exposure and hands on cutting which a

resident gets these days is not good. with increasing hospitals opting for MJPJY even work load in GMCs is not very high as it

used to be earlier. In private medical colleges too getting ample of exposure and hands on cutting is not possible. So with raw

teaching a new young surgeon can never start practice on his own. He still needs surgical exposure to get good confidence.

This can be achieved by SR post in GMC or Clinical associate post in corporate hospital under any big name in surgical field.

As each and every passed out person cant get SR post, working in a corporate setup under any big boss is next best option

for a new young surgeon to explore and learn surgery. In today's scenario this is quite normal and should be an accepted

norm by all surgeons that one cannot start or should not start working on our MS training. Rigorous hands on training and

work should happen before coming into practice.

2- Trend of Specialization –

I personally feel Mch or DNB SS is not super speciality. Its Basically SUB-SPECIALITY. Speciality is GENERAL SURGERY. Then

DR YOGESH BANG

Stance – Opportunity

Consultant GI Surgeon Midas Hospital,

Nagpur

we SUB SPECIALIZE in one of the branch of GEN SURGERY. Be it Urology, Neuro-surgery, GI Surgery etc. With current trend of everyone wanting to get treatment from

Specialist most of the Surgeons after passing out MS enter into Mch programme to SUB SPECIALIZE. I consider this SUB SPECIALITY training as an excellent

opportunity for young surgeons to enhance surgical skills and learn from teachers finesse in surgery. It completely changes the perspective and knowledge of a

budding young surgeon. The rawness in ones hand gets into fine art with this SUB SPECIALITY training. But one big problem here is inadequate Mch seats. So many

opt for DNB which are in corporate setups. Even I have done my Sub specialization in a corporate setup. And my experience shows its not at all an exploitation. In

nearly 75-80% of DNB seats or DNB institutes we learn things equivalent to CURRENT MS or Mch Residents. So, as Sub specialization is need of hour so we cannot

ignore importance of corporate setups who provide excellent DNB training programmes.

3- Outside world in not our Training Institute –

After finishing all the training, joining a corporate or starting own practice, free lancing or one's own hospital is the issue. For a new, young surgeon Corporate

hospital provides exactly what he needs in early days of his surgical career – Patients. One can get ample of patients and work efficiently under one roof. One has

backup of multidisciplinary team like Anaesthetist, Intensivist, Radiologist which are integral part of surgical decision making and recovery of a patient. As patients

volume and number increase, confidence and surgical hand also keeps on getting better. That slowly improves ones name too. Many would contradict on this saying

corporates don't pay and exploit. I beg to differ. I would say, if one wants work and needs to improve individual's performance then money should not be the first

thing in his or her mind. For first 3-5 years getting number of patients and curing as many patients as possible should be the aim. Once that happens and surgeons

name or popularity increases, money from corporates also increase. If we look at free lancing as start of ones practice, its not at all worth it. Even in free lancing small

hospitals or nursing homes don't pay appropriate amount, they don't pay on time. And they even expect surgeon to do case in compromised setups. Many setups

expect to get your own instruments, laparoscopy sets and operate. And end of the day, that patient operated is never Surgeon's patient. He is the patient of that

Nursing home where he got operated. So, getting into these things can cause more harm than any help to one's career. And lastly own setup at the start of your

career is big risky game. Even if one has lot of money to start it, lack of adequate skills is going to let that surgeon down. 5-7 years of practice, good patient flow and

then considering own setup is fine. But for new young surgeon its big NO.

4- Corporate vs Work under Senior Surgeon –

One of the way young surgeon can start his surgical practice is to work as assistant or fellow to a Senior Surgeon. Its good option to learn, get skills, and if lucky get

ample of hands on training (if the consultant is generous). And baring few most of these senior members don't teach or let juniors do cases. We have seen these type

of fellows a lot in Orthopaedic side of ours. Fellows in spine or joint replacement just slog without any recognition or hands on exposure. I think that is bigger

exploitation of young surgeon. Another big difference is, under a senior surgeon one can never ever get or let his name grow. Junior surgeon will never get his own

OPD, his own name as attending surgeon. So even after learning everything once he comes out he will have to start fresh to build up his practice.

5- Nagpur, it's Time to Evolve –

Of all major cities Nagpur is the one with least number of corporate setups. We are still the followers of Nursing Home Practice or Single surgeon based hospital

practice. Recently we have got change of trend where Big names have come together and formed Good Multi-speciality hospitals. Good thing about these hospitals is

its just like a corporate hospital but run by our own Doctors(so these are more sensitive towards patients or doctors). This evolution in practice is very good and

welcome change. Next step should be these hospitals hiring young surgeons as full timer consultants so that new budding surgeons learn and get platform to start

their journey.

We have seen how much progress Hyderabad and Pune have made medically as compared to Nagpur. Of-course these are far bigger cities than Nagpur. But if we

look closely, lack of good multispeciality setups is the reason why patients with bigger problems choose Mumbai or Hyderabad ahead of us. Situation has changed a

lot with recent good setups. As these senior surgeons or doctors choose to leave individual practice and come together to work for betterment of patients, even a

young surgeon should choose such multispeciality setups or corporate setup to start his career. Once he gets good confidence or good patient flow, he can think of

becoming a boss or forming his own setup.

6- Important things which Corporate Hospitals teach –

I have been a resident in medical college and then in a corporate setup. I have learnt one big thing which Govt college never taught. COMMUNICATION with

patients. This is the most important thing for any doctor and these skills are never ever taught in residency. But once you enter corporate setup, it becomes an

important tool. Convincing a patient for any procedure, dealing with number of relatives, google patients, explaining complications, even working efficiently and

saving money of patient as well as hospital can be learnt by working in corporate setup. These important things can never be learnt directly in your own setup or in

free lancing. That is also one reason I feel corporate is good for a young surgeon.

Only PERMENANT thing in LIFE is a CHANGE. As we are seeing Change in type of practice of many of our senior members, the juniors too will follow. I am not saying

they should come together and start Hospital as soon as they come out. But they should definitely look out of any good setup – corporate or multispeciality to gain

experience, learn, gain confidence, get name and then decide about future.

Dr GORLE SURESH KUMARJunior Resident

Dept of General Surgery IGGMC and Mayo Hospital Nagpur.

Stance – Exploitation

Any budding surgeon with bubbling enthusiasm within will be eager to grasp an opportunity to kick start his career or his journey to be a successful surgeon of repute from a well established corporate Hospital. Denitely , these young hands mastering the art of scalpel work , join these seemingly alluring positions under the big heads with a intense hope of mastering the surgical craft in all its nuances and sophistication. Some even join, just to derive the joy of rubbing shoulders at work with masters of great repute. Irony is , baring few , many realize they are just serving in mere apprenticeship of some false hope. As days pass by, they realise, they are but masters of drudgery with meager nancial returns for their dragged out daily chores. They bear the burden of handling the work place donkeys work. Nevertheless , with time determined hands will nd means to hone their skills before they can replace the old shoes at work, paving their way to fame and success. Alas ! The story repeats again.

Sex reassignment surgery (SRS), also known as gender reassignment surgery (GRS) and several other names, is a surgical procedure (or procedures) by which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble those socially associated with their identified gender. It is part of a treatment for gender dysphoria in transgender people. In the International Classification of Diseases (ICD-10)“transsexualism”is described as a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to undergo surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex. Feminization surgeries are surgeries that result in anatomy that is typically gendered female. These surgeries include vaginoplasty, feminizing augmentation mammoplasty, orchiectomy, facial feminization surgery, reduction thyrochondroplasty (tracheal shave) and voice feminization surgery among others.Terminology: Gender Confirmation Surgery or GCS, gender-affirming surgery, sex change operation, genital reconstruction surgery, sex realignment surgery, and sex reconstruction surgery.Ethical considerations: surgeons require two letters of recommendation for sex reassignment surgery. At least one of these letters must be from a mental health professional experienced in diagnosing gender identity disorder (now recognized as gender dysphoria), who has known the patient for over a year. Letters must state that sex reassignment surgery is the correct course of treatment for the patient.

Legal issues: � An appropriate period of hormone therapy � specific consent form � Change of Name Change of Name and Sex in various certificates and identity cards through court � Waiver of Liability, spousal release and parental consent forms � affidavits from a Notary or Magistrate. This means that now the state is a witness.

Hormone Therapy For secondary sexual characteristics, such as body hair, muscle mass, and breast size. Hormone therapy is necessary during all stages of the transition, before, during and after the sex change surgeries. Hormone therapy in male to female transition is important because it helps change the physical appearance to more closely resemble a woman, reducing the male aspects. Hormone therapy also aims to make the taker more comfortable about himself / herself both physically and psychologically. In someone who is undergoing hormone therapy with a view to male to female transition, hormones start the process of changing the body into a more female one.Surgical procedures The array of medically indicated surgeries differs between trans women (male to female) and trans men (female to male). For trans women, genital reconstruction usually involves the surgical construction of a vagina, by means of penile inversion or the sigmoid colon neovagina technique; or, more recently, non-penile inversion techniques that make use of scrotal tissue to construct the vaginal canal. For trans men, genital reconstruction may involve construction of a penis through either phalloplasty or metoidioplasty. For both trans women and trans men, genital surgery may also genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy, penectomy, mastectomy or vaginectomy. Involve other medically necessary ancillary procedures, such as orchiectomy, penectomy, mastectomy or vaginectomy.

Post Surgical Considerations:Quality of life and physical health Patients of sex reassignment surgery may experience changes in their physical health and quality of life, the side effects of sex steroid treatment. Hence, transgender people should be well informed of these risks before choosing to undergo SRS Overall, transsexual people have rated their self-perceived quality of life as 'normal' or 'quite good',Trans women have reported higher satisfaction in different aspects of their quality of life, including their general physical health

Psychological and social consequences After sex reassignment surgery, transsexuals tend to be less gender dysphoric. They also normally function well both socially and psychologically. Anxiety, depression and hostility levels were lower after sex reassignment surgery. They also tend to score well for self-perceived mental health, which is independent from sexual satisfaction.Persistent regret can occur after sex reassignment surgery. Regret may be due to unresolved gender dysphoria, or a weak and fluctuating sense of identity, and may even lead to suicide.

UPSURGE - 2020

DR. PRASHANT

RAHATE

Sex reassignment surgery (SRS),

Consultant Surgeon Seven Star Hospital,

Nagpur

Page 16

UPSURGE - 2020

Sexuality Looking specifically at transsexual people's genital sensitivities, trans men and trans women are capable of maintaining their genital sensitivities after SRS.Erogenous sensitivity is measured by the capabilities to reach orgasms in genital sexual activities, like masturbation and intercourse. Many studies reviewed that both trans men and trans women have reported an increase of orgasms in both sexual activities, implying the possibilities to maintain or even enhance genital sensitivity after SRS.The majority of the transsexual individuals have reported enjoying better sex lives and improved sexual satisfaction after sex reassignment surgery.

Our experience of sex alignment surgeryStarted since 2009, All male to female surgeries, 140 surgeriesAge : 25 t0 30years – 120 surgeries, 30-35 years –18 surgeries, 35 – 40 years—2 surgeries

Complications: Bleeding (3 cases), Infection (6 cases), Shape not satisfied (2 cases), Meatal stenosis (6 cases—all needed meatoplasty only), Stricture urethra (3 cases)

DR. LAXMMIKANT LADUKAR

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ही नाटके चालाया मी पा�े शोधाया आलो .

िवकास सधारणांचा मी अथ� शोधताना ,ुपिव� सिंवधानास मी तड व�या िनघालो.ू

yksduk;d----

DirectorLadukar Surgical Hospital, Bramhapuri

PO

EM

Page 17

UPSURGE - 2020

Page 18

Disclaimer - This blog is purely work of my thoughts. any resemblance with a person

dead or alive is what this blog wants to make!

'NEPOTISM' few months back I did not know meaning of this word and what it stands

for? Thanks to Bollywood we learn a lot from it. Next, I checked it on Google and learnt its exact

meaning. I thought, whether 'Nepotism' works or influences Medico's life? Well of course it does. At

least that's what a doctor from a Non-Medico family says or thinks of. But I am going to speak on Other

side of Nepotism, which everyone knows of, but never will speak.

Let us begin our story from first year MBBS. Mr A, son of a Medico (Parent is a practicing and well

settled Doctor) and Mr B, son of Non-Medico or belonging to Non-medico Family (No family member is

a Doctor). Since first year, no one will consider or appreciate the fact that Mr A studied hard and cracked

the CET to get into Medical college. But everyone in class especially Mr B will always say, 'Uska Father

bada Doctor hai.' For Mr A many of the teachers in Medical College are his parent's known or friends,

but that doesn't mean those teachers favor Mr A over Mr B. But overall perception about Mr A is same

everywhere. 'Uske Parents Doctor hai, Master k pehchan k hai.' Why is it so? I am not denying that Mr A

might get some extra or occasionally special attention, but that's a natural thing. What's Mr A's fault in

that? Mr B and his friends always link Mr A's marks, his performance in internals, university exams to his

parents being Doctor rather than giving credit to his own Hardwork. After suffering this for whole MBBS

as he sits, studies and cracks PG-CET and gets into Post Graduation, people don't say He studied and

earned it. They simply say, 'Uska kya, nai hota to Father paise de k seat dilwa deta'. As Dr A and Dr B

enter residency, one complaint about Mr A is always there from most of theCo Residents or from Dr B.

They crib that Dr A doesn't work, 'Boss ka friend hai uska Father, sara kaam apne ko hi karna padta'. Dr A

works hard. Dr A never takes advantage of being Medico's son. Even HODs in medical college never ever

favor but Dr A has to listen to this and bear these taunts. Even for final exam Dr B always says, 'Tera set

hai re, padhna to humko padega.' 2 students, studying, working hard, doing all things necessary for

residency, How come Dr A being son of a Doctor changes everything? Believe me, it doesn't. It might

help Dr A for first week or first month of residency, but then everyone in the Unit, Department watches,

talks and then judges whether Dr A deserves to pass or not. It's not and never based on Dr A being

Doctor's son.

Nepotism Rocks?

Real exam for Dr A starts in outside world. It starts when He lands up in practice. Not just Dr B, but patients or all the people

associated with Medical fraternity (Medical shop owner, Medical rep, Nurses in hospital and every dam person) keeps close track of

Dr A. Scrutiny of each and everything he does is followed at multiple level. Any slight change in protocol, behavior, attitude with

hospital staff by Dr A is labelled as Rudeness and is compared with his father by his own staff. And outside, Dr B as usual cribs, 'Uske

Father k setup me baitha ja k wo, pehle din se patients. Ghisana humko padta.' But that's not at all true. What Dr A goes through No

one can understand. Even his medico Father won't understand or won't realize. Dr A has to carry on the legacy, he has to keep up to

expectations, maintain that and in fact it's expected from him that He should outgrow his Medico Father. On the other hand, Dr B has

initial days of struggle but there is not one for him to compare, he has nothing to prove. He with his hard work develops his name, his

patient base and his practice. Dr A has patients on day 1, but to maintain the same feel which his father had, to give same or even

better results is very big burden on Dr A from day 1. Patients come to clinic, ask for Senior doctor, even if Dr A talks nicely, gives same

or even better medicines, patients say 'Hamare bade sahab ki dawai achi kaam karti.'

Sometimes Dr A has to prove even to his Father that whatever treatment he has started is as per recent protocols and is correct.

But Dr B or outside world will never speak of these things. They just feel, 'Uske father ka bada support hai.' Of-course Father is going

to support, its not Dr A's fault that he was born to a Medico. Why his hard work, his study, his mental burden or his state of mind of

carry forwarding his Father's legacy is never talked of? Why its always one thing, 'Uska Father Doctor Hai.' Being medico's son surely

helps in initial days, but in long run, Life of a Medico's son is far more struggling than Dr B. If you look into rest of the fields, same

thing happens. A President of a political party can never match the Aura which The Supremo once had, an Actor is always compared

with his His Megastar Father, Cricketer from age of 15 in his under 17 games is compared with his Master blaster Batsmen father. This

burden or this stress level which Dr A has to carry is never looked after or talked of. And what if Dr A is far ahead of his times and is Far

more better clinically ? Very few will appreciate that. Very few will make a note of that. But then that's the way our society is. Dr A will

never be judged on his own merit.

So ,my Dr A friends and My Sweet Dr B friends, give a deep thought on this. In the end my request to all the Dr As, never ever let

your Kid be a Doctor. In case he / she becomes, never ever let him / her pursue same branch as yours, (If Dr A is physician, his kid

should be surgeon) so that outside world never compares, never makes hell big thing for the new up coming Doctor and Dr Bs would

crib less. Even after reading this many Dr Bs will say, 'Uske Father ka bada kaam hai, usko kya tension, Baithe baithe likhta hai kuch.'

But then, Dr A is listening to this since MBBS days, so now it Hardly matters.!!!

DR. YOGESHBANG

Consultant GI Surgeon Midas Hospital,

Nagpur

UPSURGE - 2020

Page 19

Women are looked upon as fragile ,faint hearted and delicate. Men are perceived to have the time

commitment ,aggressiveness ,and rapport while women are often considered to lack them. Success is

OK for a woman if it's in an area that is not seen as off limits to them. There has been inadequate

accommodation of women's unique physical ,identity and work-life balance needs in the society.

Most successful women are viewed as selfish ,manipulative and untrustworthy. This is a reaction to their

violation of stereotyped norms. People can eliminate stereotypes from their thinking only if they admit

the stereotypes exist and make a conscious effort.

Until the beginning of their professional lives ,most men aren't taught to shake hands with women inside

their family ,let alone outside of their family. I have seen men unsure of whether to shake hands at the

beginning of a meeting when there's a woman in the room.

Many times women are made to take on the role of the pleaser. Getting someone coffee in the board

room isn't part of a woman's job ,let it be done by someone in an appropriate role.

Women needn't have to be “like the guys” to succeed in what has historically been their line of work.

Women shouldn't have to break out the whisky and cigars (unless they want to) to fit into the club. They

need to pursue their passion wherever it leads ,even if it means doing something few women have done

before.

In the year of 1960 ,when women had a very little role to play outside their homes and were striving hard

to come at par with men and break the mould they were put into ,there was Dr.SnehlataDeshmukh with

great determination and grit ,who broke typecasts for women and took up surgery as a choice of

specialisation after completing her MBBS. Having the conviction in her ,she ignored all the jibes made at

her and went on to become one of the pioneers of paediatric surgery. She stood against all storms and

became an eminent paediatric surgeon ,served in the neonatal department of KEM hospital ,Mumbai for

close to 35 years.

Even today ,when women are battling with inequality and trying to erase the lines of distinction of gender

in educational institutes ,workplaces ,there was this valorous woman who managed to make her mark. I

can only imagine what this pre-eminent personality must have gone through back then.

Olympian women wrestlers Geeta and BabitaPhogat are icons of women empowerment-quite literally.

Their solitary struggle in the face of social resistance to make a name in a field which is all about male

power is well known to us. In one of their interviews the Phogat sisters stated how every woman who

tries to storm a male bastion faces to some extent the social pressure thesisters had to bear when their

father ,Mahavir Singh Phogat ,decided to train them as wrestlers. They attributetheir success to their

parents who had to face far more social shaming in a village where men and women have rigidly defined

roles.

One of the young female surgeons had narrated a personal experience of how the society still views

men at a superior spot.

'In healthcare ,there tends to be an omnipresent sentiment (from both other men in the field ,and from

patients) that when you step into an operating room ,you will be seen by a male. She further added ,the

most frequent words she getsto hear are ,“Well ,I've never seen a female surgeon before.” Especially as a

young ,female surgeon ,patients tend to think you're the assistant. Although by now ,I take this with a pinch

of salt ,there is the constant feeling that you need to prove yourself in this male-dominated field ,and earn

the same respect as your male colleagues.'

Women must not view other women as competitors. In some industries ,it's easy to fall into this because

there are very few women while all are trying to get to the top. Most of the time this means that women

see a finite number of spots at that level for them ,so the automatic feeling when they meet a new

female colleague is that they are threatened. Harbouring this antagonistic feeling towards a colleague

will absolutely do no good to anyone. Instead ,focus on supporting women counterparts. Some of these

women may turn out to be each other's biggest advocates and supporters.

Right now ,women are sweeping into fields historically dominated by men. Work zones are getting

gender-neutral and aregiving importance to characteristics like passion ,consistency ,and authenticity

over gender.

It's a welcoming change that there are so many women taking action to change the balance of the

workplace. They are paving the way so that future generations of women don't have to work so hard at

it. Women have ample space in every field to make it big for themselves if given a well-deserved chance

and credit for their hard work.

Dr.Anupama Ashok Kashid

It's about hard work and not gender

DR. ANUPAMAKASHID

Junior Resident

Dept. of Surgery

NKPSIMSsurgeon.anupama@gmail.com

UPSURGE - 2020

Page 20

Down1. What is also known as 10% tumor (16)2 . M i n e r a l o c o r t i c o i d r e s p o n s e

phenomenon is mediated by (3)6. Name of robot used mostly commonly ,

inspired by artist who painted Monalisa (7)

7. Jorge Daes just added a vowel to produce a new technique (4)

9. Clinical condition characterised by 46XY, externally absolutely normal female, testis seen during herniotomy. (4)

13. Treatment of recurrent pancreatitis caused by pancreatic divisum (4)

16. Acronym for recent minimally invasive method to do pancreatic necrosectomy through retroperitoneal route (4)

Up19. Commonest association of carcinoma

gall bladder (4 5)

Across1. Who must be informed in event of

unexpected death on operation table. (6)

3. Name o f c l osed t echn ique o f haemmorroidectomy (8)

5. Seeking permission of the patient for surgery is called as (7)

8. Delay-Drain-Debride is the philosophy of which surgical condition (12)

11. Acronym of uorescence dye , now used in open laparoscopy and robotic surgery. (3)

14. Acronym of technique of instillation of chemotherapeutic drugs at heated temperature directly into abdomen after complete tumor resection is known as (5)

15. Triangle dissected during chole -cystectomy (5)

17. Cosmetic used in AWR (5)18. Name of technique of treatment of

hemorrhoid with arterial embolisation (10)

Across reverse1. Landmark trial published in 2020

stating stepup approach is better than open necrosectomy. (6)

12. Investigation of choice to diagnose biliary microlithiasis (8)

Diagonal up 4. Majority of functional adrenal masses

secrete which substance? (8)10. Procedure involving head coring with

lateral pancreaticojejunostomy is known as (5)

3

2

4 5

8

10

13

15 16

14

17

18

19

6 7

11

1

9

12

WEB- I -CROSS

Kindly solve this and send entries to atish6267@gmail.com in next 10 days

to avail attractive prize. Answers will be displayed on ASN website after 10 days.

UPSURGE - 2020

asn activities ASN Family Day

ASN Family day was celebrated on 15th May 2020. Members of ASN Family sent their collection of

photographs of ASN Members and rekindle the memories. Few snaps were even more than 30 years before.

International Nurse Days

International Nurse day was celebrated on 12 May

2020. Felicitation and Yoga classes for nurses

were arranged

Anti Terrorism Day

Antiterrorism day was celebrated on occasion of Death

Anniversary of Hon’ble Ex PM Rajiv Gandhi, date 21 May

2020. Police staffs were felicitated , made aware about

COVID safe practices during their daily work and served

refreshments.

Page 21

UPSURGE - 2020

Lockdown could not knock down the exercise spirit of surgeons. Virtual Walkathon was conducted.

ASN Masterchef Activity was

organized on 26th April 2020. Large

number of surgeons exhibited their

extraordinary talent in culinary skills.

Winners of Contest were Dr Vikram

Desai,Dr GS Butani, Dr Sumeet Gathe,

Dr Abdul Quereshi, Dr Rahul

Naikwade, Dr Prasad Upganlawar and

Dr Neha Awachar.

ASN Walkathon

ASN Master Chef Activity

A unique activity was conducted on 24/5/2020 as an attempt to hunt

out talent of singing. Surgeons in large number participated and showed

their melodious voice by singing songs and ghazals

Singing Activity

Page 22

UPSURGE - 2020

Page 23

Abstract of Clinical Case Meeting

Total Laparoscopic Spleen Sparing Distal Pancreatectomy In A Case Of Solid Pseudopapillary Neoplasm Of Pancreas(a case report)

Spleen sparing distal pancreatectomy is often performed for benign tumor of distal pancreas. It has an

benefit of avoiding immunodeficiency and thrombocytosis. 15 year old female with chronic abdominal

pain has been diagnosed to have solid heterogeneously enhancing lesion with nonenhancing few areas.

Total laparoscopic spleen sparing distal pancreatectomy was done. Histopathology was suggestive of

solid pseudopapillary epithelial neoplasm. Postoperative recovery was smooth.

CONCLUSION: pancreatic pseudopapillary tumors are rare neoplasms with malignant potential.Timely

resection on diagnosis provides long-term survival. A laparoscopic approach is technically demanding

and time consuming ,but it can be performed safely thanks to accumulated experience. Such a minimally

invasive approach would help to improve patient quality of life by minimizing treatment-related

discomfort.(Congratulations Dr. Unmed Chandak and team. Video of this case was accepted for SAGES 2020)

DR UNMED CHANDAKAssociate Professor,

Department of Surgery, Government Medical College,

Nagpur

Retroperitoneoscopic drainage of psoas abscess.

Purpose: Nowadays , endoscopic techniques are widely used i n surgical procedures.

Retroperitoneoscopy has been an extremely valuable tool for a wide variety of urologic disorders ,

whereas ,it has limited use in orthopaedic procedure.

Methods: We performed a retroperitoneoscopic drainage of psoas abscess with tuberculous

spondylitis. The procedure was done under general anesthesia and in lateral decubitus position.

Psoas abscess was evacuated during procedure and postoperatively drainage was continued through

a large silastic tube. The definitive diagnosis and treatment were made based on results of culture

antibiogram and PCR testing.

Results: complete clinical and radiological remission was observed in 3-6 months. The complication was

not observed postoperatively.

Conclusion: Retroperitoneoscopic drainage of psoas abscess gains advantages in term of rapid

recovery ,minimal invasiveness ,absence of radiation ,and shorter hospital stay. This procedure can be

used not only for cold abscesses but also for other pathologies of lumbar vertebral area.

DR. KAUSTUBH SARDA

Department of surgery.

Dr. PDMMC

Hospital

Hemosuccus Pancreaticus: A Masquerader in GI Bleed

Hemosuccus pancreaticus (HP) is a rare albeit life threatening cause of upper gastrointestinal (GI) bleed

through the main pancreatic duct. Due to unfamiliarity of this condition ,it remains diagnostic challenge.

Presentation may vary from intermittent occult bleed to massive hemorrhage. We pen down a unique

case of a 35 year-old-male who came to our emergency room with a recent history of malena and mild

abdominal pain. He was severely pale with no other obvious clinical findings. He had severe anemia with

elevated serum amylase and lipase levels on hematological investigations. Upper GI endoscopy could

not find the cause of upper GI bleed. Radiological investigations had features of chronic pancreatitis ,a

dilated main pancreatic duct and a pseudocyst in the head of pancreas with communication to another

pseudocyst in the mediastinum. The cause of malena was still unresolved. On reviewing the radiological

films and having a high index of suspicion we did a mesenteric vessel angiography which finally revealed

a pseudoaneurysm in the pseudocyst of head of pancreas causing hemosuccus pancreaticus. The

coiling of anterior superior pancreatoduodenal artery was done from which pseudoaneurysm was

arising. Unfruitful endoscopy and radiological investigations in a case of upper GI bleed should ring a bell

in the diagnostician's mind and possibility of hemosuccus pancreaticus always to be considered in such

cases.Co-Authors: Dr. Kushagra Singh, Dr. Yogesh Bang, Dr. Rajesh Mundada

Dr. MEENAKSHIYEOLA (PATE)

Professor and Head,

Department of Surgery,

JNMC, DMIMS (DU),

Sawangi (M), Wardha.

UPSURGE - 2020

Page 24

OBITUARYOBITUARYOBITUARY

In the early part of year 2019 we lost a gem in the medical fraternity of Nagpur. Dr. Arvind Joglekar, fondly known as “Kaka” left us for heavenly abode on 20th February 2019 in deep sleep while he was holidaying at Bharatpur bird sanctuary. He was a keen birdwatcher, a nature lover and breathed his last amidst the jungle.

All of us know that he was a Surgeon par excellence and a master craftsman. It always used to be a treat to watch him operate, as his hand movements were very swift, precise yet very gentle with great respect for the tissue. He would make any complicated operation look very simple to any observer. It had the finesse of an artist like a painter or sculptor. Anybody watching him operate would aspire to do like him.

His initial Surgical career blossomed at Mayo Hospital/ Indira Gandhi Medical college. He was a student of the same college, 1968 batch, when it was run by Nagpur Municipal Corporation. He graduated & later did his MS in General Surgery from the same college. He was selected for MCh in Cardiothoracic Surgery but chose to forego the opportunity for family commitments and to take care of aged parents. Later he worked as Lecturer & Reader in Surgery at IGMC until 1990 when he decided to quit & start his private practice. He was a very popular teacher, used to draw beautiful diagrams on the blackboard. Those of us who have seen him later, will not believe that most of his students used to be afraid of him for his short temper, yet nobody ever liked missing his class. For the early morning lecture at 8 am, he would be seen in the canteen door at 7.45 am with a cigarette in his hand and then… many of hostelites would skip their breakfast! He was a no nonsense man, always aiming for excellence & expecting the same from his students & co-workers which was probably the cause of his short temper. He was always updated in recent advances in the field of Surgery & used to pass on the knowledge to his students. Those days we had very few international journals in the college library and in the absence of internet at that time, his skill of acquiring recent information was amazing.

He was the most sought after Surgeon in the college & there were rumours then, that there was a waiting list of three months for anybody wanting to get operated by him. In his residency he used to do emergency duty for five days in a week. Even while he was unit head on one particular day of his emergency, he did five laparotomies back to back all through the night until dawn. There are many stories of his subtle sarcastic comments, his scolding, his precise incisive questions in PG seminars etc. Many of us who were trained at IGMC during that period would testify & each one will have many anecdotes to share!

In private practice, it was very natural that he was busy from day one as Dr. Joglekar was a well known name all over the region. He was a major part of the team doing first renal transplant in Central India, along with Dr. Acharya & late Dr. Vijay Shrikhande. He never bragged about his achievements, never carried any attitude of being a super surgeon even when he was called in emergency for rescue by his fellow surgeons. He was careless about the fees he charged or received. He never gossiped about any other doctor & if someone initiated any such topic, he would skillfully change the subject. In any close group conversation, although he never criticized any person, he would certainly condemn any unscientific, unethical act. He was shy to be on dais & probably did not like to talk from the podium on any non surgical issue. Maybe that is the reason he kept himself from holding any posts in any professional association. But he participated in most of ASN (then ASI Nagpur) activities, particularly live operative workshops even until recently. He had passion for good quality surgical instruments & had many different, custom made instruments in his collection. Like many surgeons of his times & earlier times, he did not keep a logbook of the surgeries done by him. (I categorically enquired with Dr. Ketaki about any records he kept of the operations performed.) Considering the magnitude of Surgical work done by him in the college & in private practice, such data would have had immense statistical significance even today.

He was the main pillar of the Surgical Camp at Padmshree Dr. Prakash Amte's Lokbiradari Hospital at Hemalkasa, right from the first camp initiated by Dr. V. S. Govardhan in 1986. He rendered his services for 33 long years until this year of his demise. Late Baba Amte was very fond of Kaka & used to insist Kaka to operate on his VIP patients, some of them for vasovasotomy at which he was very good.

He had very beautiful handwriting & used to draw linear sketches of the procedure performed in the operation notes. In his first year he had drawn anatomy sketches which were displayed in the Anatomy museum. He had affection for almost all branches of science from anthropology, physics, photography to astronomy. He was very proud of his father who was a renowned physicist of his times & had worked with the legendary Prof.C.V. Raman.

He was very simple in his personal life with a minimalistic attitude for material things around him. I doubt if anybody ever saw him clad in suit or a neck tie! As one of his old friends recalls him being told,” if you have seven sets of trousers & shirts in your wardrobe, it's more than enough & you need not buy clothes any further”. He liked to be with nature, had developed keen interest in bird watching, and was fond of Indian classical music. He admired the younger generation of classical singers like Pandit Sanjeev Abhyankar, Ms. Kaushiki Chakraborty. He himself used to sing Marathi natyagit very well in a small group of friends. Many of us are not aware of his personal friendship with best seller writer & software genius Shri. Achyut Godbole, actress late Smt. Reema Lagoo & many others from different walks of life. This year on his first death anniversary I had written a short tribute for him in Nagpur's Marathi daily Tarun Bharat. I received several messages and more than two dozen phone calls from his patients, well wishers all across Maharashtra. Everyone had a story to tell about this great surgeon and a great human being! It's not an exaggeration to say he literally lived life, like what Lord Krishna said in Bhagwadgeeta, doing his Karma without expecting any rewards - A true Karma Yogi.

The life is not easy for his family to live on now although all his family members are accomplished in their respective fields. His wife Dr. Vrinda Joglekar, a gifted writer, poetess & an artist to the core, worked as Professor of Statistics in Hislop college, daughters Manjiri Sameer Deshpande, is a software engineer at Hyderabad & Dr. Ketaki Shashwat Magarkar, is a facio maxillary surgeon working at Nagpur. He has left a legacy of so many surgeons working all across the globe doing excellent work trying to follow his footsteps. As a mark of respect, responding to the proposal given by Dr. Vrinda Joglekar, ASN is starting "Dr. Arvind Joglekar Memorial Oration" during installation of new body from this year.

Dr. ARVIND JOGLEKAR

Lets all pray & wish his soul attains eks{k

Dr. Dhananjay Kane

deZ;ksxh Surgeon

UPSURGE - 2020

Page 25

Guy : Well yah see Doc the problem is obesity runs in my family

Doctor : No the problem is nobody runs in your familyMedical students watching surgery for the rst time

When a nurse takes up gardening

Prof : Can you show DNA and RNA visually?

Me:

Every intern's wish

Medical Humour Medical Humour

UPSURGE - 2020

Page 26

DR. ROHAN UMALKAR DR. SUMIT GATHE DR. PARAG INGLE DR. KISHORE JEUGHELE DR. DHIRAJ SAGRULE

DR. MAHENDRA KAMBLE DR. ANKIT AGRAWAL DR. ADARSH LALWANI DR. SAURABH MUKEWAR DR. ISHAN KALBANDE

DR. AKASH ASHOK GHOLSE DR. DANISH UYGOR DR. PRANJAL B. MESHRAM DR. SURESH GORLE DR. PATIL ISHWAR GOPALRAO

DR. VAISHAK M RAI DR. NEHA SANJAY AWACHAR DR. RAHUL PRASAD DR. PREMALATHA NADAR DR. PRATIK SINGH

DR. RAJESH AKULWAD DR. JYOTI GUPTA DR. SWAPNIL SURESH UGALE PRATIKA NAGORAO CHAVHAN

DR. MANASI UDAY DALVI DR. ROHIT KATE DR. ABHISHEK MANKAR DR. SANKET P DHAMNE

DR. SHALABH JANBANDHU DR. ANUPAMA KASHID

Others