The ‘carpentry shop’ was up and running at full tilt. The Orthopedic emergency OR sessions were affectionately called the carpentry shop as fractures were nailed or plated and bolted just as a carpenter would do to his planks of wood. These patients had been seen in the outpatients in the morning or referred up from the Casualty. Assorted fractures were treated by closed reduction and cast, wounds were sutured and tendons and nerves repaired. It would start at around 5 PM and go on till past midnight. The conductor of the shop was the orthopedic senior registrar, a man mountain. Dilip was the University blue in wrestling. Most of us house surgeons looked puny beside him.
A small Nepali woman was wheeled in from the casualty. I examined her. She had fallen in the bathroom. There was no doubt about it. She had a supracondyler fracture of the humerus. X rays confirmed the diagnosis. “Guru, examine her radial pulse” was the shouted advice from Dilip. I felt for the pulse. It was absent. This is a well known complication of these fractures when the fractured fragment injures the brachial artery. “No radial” I yelled back over the din in the plaster room. “Shit, we have to reduce the fracture right away. Else she will have gangrene” Dilip told me. “When has she eaten? We need immediate anesthesia” The patient confirmed that she had not had anything by mouth from the morning. I noticed a curious thing: all the OR attendants seem to be very reverential to her and treated the woman with the utmost respect. As a matter of fact several actually touched her feet asking for blessings.
“Who is she?” I asked one of the attendants. “She is called Durga Mata Doc” said one of them. “She has meditated in the Himalayas for several years and has acquired several supernatural powers. If she blesses anyone, they prosper. If she curses you, misfortune is their lot. No one wants to displease her”
I took the x rays and went to speak to her. She had the most beautiful smile. When I told her that she would require urgent intervention for her fracture, her face clouded. “Beta” she told me “This period of time is inauspicious. Wait till morning do treat my fracture” I tried explaining to her that we could not possibly wait till the morning as gangrene would have set in by then. She was adamant. It was a No Go. She would not budge. I notified Dilip.
As mentioned already, Dilip was a wrestler and a short tempered one at that. He strode up to the patient. “You had better give consent, woman. Or else we will be forced to tie you down to the operation table and reduce your fracture” I tried to interrupt Dilip. But it was too late.
The woman’s face changed. Her lips peeled back in a snarl. Her face changed to become ugly and terrifying. Her voice sunk several decibels till it became guttural. “You dare to speak to Durga Mata in that tone, you worm?” she growled. “I will destroy you and your whole family. Be very afraid of my anger” The OR attendants were quaking with fear. Though in those days I was an agnostic, cold fingers of fear ran down my spine.
Then Baban, the senior OR assistant intervened. He asked Dilip to move away. He spoke to the woman in a placatory tone. After fifteen minutes of persuasion, her face changed back to its petite calm form. “Dilip Baba, She is willing for he procedure. She wants an apology from you” informed Baban. We convinced Dilip to say sorry so that we could get on with the job. “Dilip Baba, She feels that doing the reduction will result in a disaster. Please be very careful will you?” was Baban’s advice to Dilip who sniffed in disbelief.
She was wheeled into the OR. Sara was the Anesthesiologist. I sighed in relief. She was experienced and had handled difficult cases before. Pre-Oxygenate the patient…Connect to Pulse Oxymeter…Inject Pentothal…Give Scoline….Ventilate with the mask….Get ready to intubate….Standard anesthesia steps. And the lights went out!
It was very very rare for power outages in Mumbai. The last one had occurred several years back. The OR was plunged into pitch darkness. The anesthesia machine that worked on electricity fell silent. There was a stunned silence….
“I can’t see the vocal cords. The laryngoscope light is not working! Oh God! I can’t get the tube in” screamed Sara in panic. “I have to reverse her from the muscle relaxant” This would have been a disaster. The panic was contagious. For once even Dilip was lost for words. Someone had produced a torch. We could see in the faint light that the patient was getting cyanosed.
Suddenly the Professor of Anesthesia bulled his way into the OR. Prof Mehta was rumored to be genius. Stories about his managing patients virtually on their death bed and dragging them back to life were legion. He was also an avid Contract Bridge enthusiast. It was believed that during his free time, he would play bridge against himself!
“You with the torch” bellowed Prof Mehta. “Bring it here and shine it into the patients throat. Sara, move aside. Let me intubate.” Within seconds the tube was in. The patient stabilized.
“Close your gaping mouth, Dilip and get cracking. Can you reduce the fracture?” asked the Prof. Dilip and I sprung into action. Give traction to the forearm….Fingers on the radial pulse….Gently manipulate the fracture…Feel the click when reduction occurs….Gently bend the elbow while monitoring the pulse all the time…..Apply a posterior slab…Make sure that it is not too snug so as to allow for swelling….Whew! it went off beautifully. Dilip and I drew a deep relieved breath… Suddenly we were blinded. The lights had come on thanks to the power generator set that had been installed only that morning!
“Sir, how come you are around so late?” I asked Prof Mehta. “I didn’t realize that it was late. I was engrossed in a difficult bridge hand. Just as I was leaving, I had a strong sense of unease that some disaster was waiting to happen. So I walked around all the OR blocks. Your OR was the last” He explained. He patted Sara, who was ashen. “Anesthesia is like flying a plane. Induction and Reversal of anesthesia are most crucial just like the take off and landing of a plane. You have to be extremely focused and careful. Once the tube is in, we are on autopilot. I think this has been an excellent experience to all of you” Sara nodded weakly.
The next day, the patient was holding court with the ward attendants who were fawning over her. Her beatific look was back……..