Building a practice in Pune
Come 1991, I returned home and decided to practice in Pune. Brimming with enthusiasm, full of energy, determination and confidence, soon I was into practice.
I turned down a significant job offer abroad to return to India and build a practice defined by subspecialty depth, so families would not need to travel overseas for the level of care I had trained in.
For the city of Pune, hand surgery and reconstructive surgery was a relatively new superspecialty. Successful reimplantations brought accolades and self-satisfaction. Failures brought humility. Aches and pains which were considered only muscular pains were found to be compression neuropathy. Tingling in the hand was not a neck or cervical issue; the solution was found in the carpal tunnel. Similarly, arthritic and painful small joints had alleviation of pain through surgery. Hands left presumably permanently crippled by past trauma were brought back to function through surgery. One patient declared 100 percent disabled went on to become a computer engineer and will be found around San Jose! What can be more rewarding?
Hand surgery was not operating-room skill alone. Results came through post-surgery occupational therapy, which was unheard of. Within days of starting the practice, I knew the limitations. Soon a splint workshop cropped up in the backyard of the house: hand surgeon by the day and splint fabricator by the night! This would probably be unheard of in the western world. Pretty soon, I could make dynamic splints and innovate quite a few of them, and that too at a cost too low to be imaginable. Follow-up compliance was made successful by providing these highly economical yet highly effective splints absolutely free. Results were encouraging. Contractures and stiffness were scarce. Practice grew. Results were there for everybody to appreciate: honest, straightforward, transparent.
I opted for happy patients and not money. The USP works even today.
The next focus was updating knowledge and skills. Conferences and purchasing as many books as possible were the closest I could get. I built up a huge personal library at personal expense. Travel was the next thing. This took me to the East, and I worked for a short period with Dr. David Chuang in Taiwan, Dr. P.C. Ho in Hong Kong, and then to Singapore. Recent advances in brachial plexus and wrist arthroscopy were added to the list of my practice.
Documentation and review of the results helped in constant self-assessment and critical appraisal to enhance future outcomes.
Today, when I look back, I feel destiny played in my favour to make me a hand surgeon. Today, colleagues who watch me operate on intra-articular phalangeal fractures, nerves and arteries are awestruck at the ease and finesse with which the tissue is handled. All thanks to my teachers and the training programmes of different countries and different centres, all on the shoulders of the doyens who moulded my career.
No other specialty treats so many varied structures as a hand surgeon does. The wide scope, the spectrum, the plethora of ever-expanding knowledge and the refinement in techniques keep the spark of life in the superspecialty. No two major open injuries are similar. Planning and execution bring rewards which are often in the words but also in the eyes of the patients and their relatives, the beholders.
I am blessed to be a hand surgeon. Thanks to my teachers. Thanks to my parents for trusting me and letting me pursue whatever I thought prudent. Thank the Almighty for moulding my destiny.
Patients who changed hand surgery
Often people ask me to enumerate a few patient stories which I remember vividly and that have changed the face of hand surgery in the city and the country.
I designed an instrument for surgery of the hand. It is called JESS and is named after my teacher Dr. B.B. Joshi.
The first successful reattachment of a totally severed arm was done in Pune in 1993. The eight-year-old boy had his arm totally severed from the level of the shoulder. After visiting a few hospitals, the father arrived at the hospital where I was present, carrying the arm in a polythene bag! Neither mobile phones nor even pagers existed at that time. It was 7 PM. By 7.05 PM, the arm was in the operation theatre. The patient followed. By 6 AM, which was 11 hours of overnight effort, the arm had been put back. This required reattaching artery, veins, nerves, bones and tendons. Successfully. Today, after 30 years, he is a grown-up man and drives a motorcycle. Nobody knows about the severity of the injury he suffered.
Stories like this have been repeated many times.
I recall an instance of a boy who had undergone 14 surgical procedures which unfortunately failed one after another and ended up with a certificate stating he was 100 percent disabled. He was one of the earliest we treated, somewhere in early 1991. Today, after five preplanned surgeries, he is an international figure and can do rock climbing. From 100 percent disability to full recovery. Nothing can be more rewarding and gratifying.
Then there was this unemployed youth with a disabled hand, not able to carry out any work, staring blankly at his hut and a dark future, and a passing indifferent world. After a few surgical interventions, he is gainfully employed and owns a chain of houses. A landlord indeed!
There was this NRI whose child had four fingers and no thumb. A thumb was reconstructed. Yes, a thumb was reconstructed out of the four fingers. When they returned to the USA, the American doctors were amazed at the dexterity of Indian surgeons.
Diabetic patients often have a burning sensation in the feet disturbing their sleep. They are diagnosed as diabetic neuropathy. Research has proven that these nerves are severely compressed and surgically relieving the pressure eases their suffering.
This girl sustained a severe burn of the hand as it remained immersed in boiling water for a very long time. Fast forward, and surgery has given her a new lease of life, working hands. She can drive and write as well.
The success story covers over 30,000 patients. Their symptoms varied from pain, paralysis, spasticity, injury, fracture, deformity, contractures, tingling and numbness to burning sensation, to name a few. Each one had a story. Some had suffered for over 50 years before getting diagnosed. People have come from all parts of the country and other countries as well, and felt happy.
Service beyond the city
The bigger and most satisfying dimension of my service has been the free rural deformity-correction camps conducted in remote parts of the state. NGOs like Agrawal Club Pune, Rotary and Giants International have come together to organise and treat the rural population in places like Chalisgaon, Jalgaon, Shirur, Shahada, Shirdi and Waduj, to name a few. The rural population suffers from severe deformity following injury, burns and deformities since birth. They are surgically treated with the most gratifying results.
I remember a farmer with Volkmann's ischaemic contracture who could not afford surgery. I operated, and paid the hospital bill myself.
There was also a child with a severe burn contracture, referred through the Maharashtra state secretariat, Mantralaya. He arrived at night and had not eaten properly for days. I admitted the child, told the canteen to feed the family free of charge, and operated free of cost. The hand works today.
A patient does not travel to see an assistant. They come to see Dr. Jindal, and it is his hands on theirs when they are on the table.
The success stories can go on. But I owe it to some of the greatest teachers from around the globe who have groomed me over several years, and the patients who trusted me and my skills.
As if my teachers are operating through my hands!
The exhaustive training in surgery of the hand has been not for a few days or months but for over five years, and the training continues. This is one of the best in the world, I can surely and proudly state.
