I grew up in Indore which is in central part of India in a family of doctors. As a child, I keenly observed my father, and grandfather treat patients. Thus, becoming a doctor was in the blood. Medicine as a career was the obvious choice. As I grew, my passion for observation and thus clinical signs brought me close to Internal Medicine. However, destiny had something else written for me. I opted for a surgical branch and that too Orthopaedics!
Dr. Chitranjan Singh Ranawat, (New York) was a regular visitor to Indore to meet his parents and family and also to visit our school, The Daly college. Even as an orthopeadic trainee I made it a point to meet him regularly as frequently as possible. I would arrange his lectures in the Department of Orthopeadics, M.Y. Hospital, Indore. I recall having picked up ten technical tips when he operated on my father’s hand in the year 1983. He was an inspiring figure and invited me to New York after my post graduation. During my final months of residency, I happened to listen to a lecture by Late Dr. BB Joshi, who was a pioneer in Hand Surgery. The lecture was the turning point in my life. I decided to pursue hand surgery as a career. That was year 1985.
Introduction to hand surgery:
Soon after my residency in orthopedics in Indore in central India, I joined services of Dr. B.B. Joshi in Bombay, now renamed Mumbai. Each day with him, was a learning experience. That was during the period 1985 to July 1987. Every day it was something different to learn and there was absolutely no monotony.
On the shoulder of the giants:
With his encouragement and recommendations, I went to France in services of Prof. Michon and Dr. Michel Marle in Nancy, Prof. Narakas in Switzerland, Prof. Raoul Tubiana, and Prof. Alain Gilbert in Paris, Dr. Guy Foucher in Strasburg. At Nancy, I met and studied under Dr Michel Merle and had my first exposure to microsurgery and replantation. With Dr. Algimantas Narakas in Lausanne, Switzerland, was exposed to not only Brachial plexus but to one of the greatest human beings.
Following my great European experience, it was time to cross the Atlantic Ocean. I joined Dr. Ranawat in New York at Hospital for Special Surgery. Thereafter, I joined the services of Dr. Alfred Swanson in Grand Rapids, Michigan, USA, a gold mine for small joints replacements. So much to learn including how the world moves.
With recommendations from Dr. Al’ Swanson and our countryman Dr. Chitranjan Singh Ranawat (USA), I did a clinical fellowship at Kutz and Kleinert hand surgery and microsurgery institute in Louisville, KY in the USA. With eight consultants and almost 30 fellows from across the world, I was exposed to a Tsunami of knowledge. While the fellowship mandated 5-night duties, the desire to learn more, I took 11-night duties! These additional duties gave me more opportunities. Access to mortuary gave me more opportunities to hone my skills. At the end of my clinical fellowship in Louisville, I got a travelling fellowship which brought me in touch with Dr Kirk Watson, in Hartford, Connecticut, and Dr Julio Teleisnik in Los Angeles, Dr Robert Acland in Louisville and Andrew Weiland in New York, to name a few.
The whole western world experience was terrific. I had never bargained this will ever happen to me in my life.
Back home and setting up the practice:
Come 1991, I returned home and considered to practice in an industrial city of Pune which is about 100 miles from Bombay. Brimming with enthusiasm, full of energy, determination and confidence, soon I was into practice.
For the city it was a relatively new super specialty. Successful re-implantations 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 cervical issue. The solution was found in the carpal tunnel. Similarly, arthritic and painful small joints had alleviation of pain through surgery. Past trauma which had left hand presumably permanently crippled 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 there. Soon a splint workshop cropped up in the back yard of the house. Hand surgeon by the day and splint fabricator by the night! This would be probably unheard of in the western world.
Rehabilitation. Pretty soon, I could make dynamic splints and innovate quite a few of them. That too at a cost, too low, to be imaginable. The 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 and straight forward. Transparent.
The next focus was updating the knowledge and skills. Conferences and purchasing as many books as possible was closest I could get. I built up a huge personal library at personal expense. Travel was the next thing .This took me to east. Dr. Fu Chan Wei, Dr David Chuang in Taiwan, Singapore, and Dr. PC Ho in Hong Kong. Brachial plexus, wrist arthroscopy added to the list of my practice.
Introspection. Documentation and review of the results helped in constant self-assessment and critical appraisal to enhance future outcome.
Today, when I look back, I feel destiny played in my favor to make me a hand surgeon. Today, when colleagues, who watch me operate on intraarticular phalangeal fractures, nerves and artery are awestruck at the ease and finesse with which the tissue is handled. All thank to my teachers and training programme of different countries and different centers. All on the shoulders of the Doyens who molded my carrier.
No other specialty treats so many varied structures as a hand surgeon does, Vascular Surgery, Neurosurgery, Orthopaedics, Plastic Surgery, all bundled together. The wide scope, the spectrum, the plethora of ever-expanding knowledge, the refinement in techniques keeps the spark of life in the super-specialty. 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’m blessed to be a hand surgeon. Thanks to my teachers. Thank to my parents. Thank Almighty for molding my destiny.
- Undergraduate degree: Gujarati Science College, Indore, MP, India(B.Sc. part1. 1976).
- Medical school: Mahatma Gandhi Memorial Medical College, Indore, MP, India (1982).
Post graduate Residency:
- Department of Orthopaedics, Devi Ahilya Vishwavidyalay (University of Indore),
Maharaja Yeshwantrao Hospital, Indore, India. (Master of Surgery, Orthopedics, 1985).
- Hand Surgery Residency, Dr. B.B. Joshi, Mumbai, India (Nov 1985 – Jun 1987).
- Prof. Algimantas Narakas, Lausanne, Switzerland (October 13 – 31, 1987).
- Profs. Raoul Tubiana and Alain Gilbert, Paris, France (November 16 – 25, 1987).
- Dr. C.S. Ranawat, Joint Replacement Service, New York, USA (Nov. 30, 1987.-.Jan. 29, 1988).
- Travelling fellowship: Dr. Kirk Watson, Hartford, Connecticut (April 16 – 20, 1990).
- Dr. Julio Taleisnik, Los Ángeles, California (March5 – 16, 1990).
- Visiting Scholar, Drs. Fu Chan Wei and David Chuang,Chang Gung Hospital, Taipei, Taiwan(Mar 1999).
- Visiting Scholar, Dr. PC Ho, Prince of Wales Hospital, HongKong (October 2011).
- Hand Surgery Fellowship, Profs.J. Michon andM. Merle, Service Assistance Main, Nancy, France (July 1 – September 30, 1987).
- Fellowship in Hand Surgery and Research, Dr. Alfred B. Swanson, Grand Rapids, Michigan, USA (July1- December 31, 1988).
- Christine M Kleinert Fellowship in Hand Surgery and Microsurgery, Drs. Harold Kleinert and Joseph E Kutz, Louisville, Kentucky, USA (March 1,1989 – February 28,1990).