Becoming a General Surgeon
Adapted from a chapter of From Ahmednagar to Africa: A Paediatric Surgeon’s Odyssey of Service, Leadership and Learning.
I left medical school on cloud nine. Becoming a surgeon proved far more difficult.
In 1982, I received the Best Outgoing Student award at B J Medical College, Pune. I had stood first in all three MBBS examinations, earned a distinction in Obstetrics and Gynaecology, and secured the highest marks in General Surgery. My name appeared on the achievement boards on every floor of the college.
I thought my hard work had prepared me for what lay ahead. Looking back, I had much to learn about the distance between passing examinations and becoming a confident surgeon.
Our compulsory internship comprised six months in an urban centre and six months at a rural health centre. I chose Nashik Civil Hospital, where my paternal aunt lived, and Jeur Rural Health Centre, near Ahmednagar, where my maternal grandparents were based. I was drawn more by family affection and home-cooked food than by opportunities for practical experience.
In Nashik, I missed valuable training. I hardly attended work during my Internal Medicine and Obstetrics and Gynaecology rotations. Supervision was limited, but that does not excuse my lack of engagement. I wonder whether I was experiencing depression after the high of my undergraduate achievements. I cannot be certain.
My interest returned during General Surgery rotation. I assisted an honorary surgeon in his private practice, sometimes at five in the morning. I went religiously. Somewhere beneath my uncertainty, the desire to become a surgeon remained strong.
The rural posting brought family warmth and kindness from the villagers. The health centre was quiet, however, and I gained less clinical experience than I should have.
By the end of 1983, it was time to choose a speciality. Naturally, I chose General Surgery. My marks gave me first choice of unit, and I joined Dr M J Joshi, renowned for his work in surgical gastroenterology and hepatobiliary surgery.
I entered residency with an excellent academic record but little confidence in a competitive environment. I am mild-mannered by nature and uncomfortable with cut-throat competition. At the time, I saw this mainly as a weakness.
Training comprised three years: junior, senior and chief residency. I was a sincere worker and a dependable assistant, but I struggled to develop the operative skills expected of me. My chief residents were dashing, confident surgeons. I admired them without acquiring their assurance.
There were encouraging moments. During my Obstetrics and Gynaecology rotation, I performed four caesarean sections and two abdominal hysterectomies. I enjoyed the posting, and the team seemed to enjoy having me. Elsewhere, I too often assisted mechanically rather than learning with purpose.
By the end of 1985, I was chief resident. I worked sincerely, yet I did not feel that I had the competence or confidence to exercise the authority the role required.
Three memories from those years have stayed with me.
The first concerns a retired Indian Air Force officer with a chronically infected diabetic foot. He spent months in our ward, requiring daily wound debridement. I remember his quiet endurance.
After discharge, he invited all the residents to his home for dinner. We enjoyed his generous hospitality and delicious food. In the early hours of the following morning, he returned to the emergency unit with a massive myocardial infarction. He died.
We were devastated. It felt as though he had been waiting to entertain us and express his gratitude before departing. That evening has never left my memory.
The second concerns a patient undergoing removal of a massively enlarged spleen. Severe bleeding developed, and the patient became unstable. The surgeon immediately called our head of unit, who meticulously controlled the bleeding and completed the operation.
I quietly absorbed a lesson that stayed with me throughout my career: recognise your limitations and ask for help early. A surgeon’s pride should never stand between a patient and the assistance they need.
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The third memory is more uncomfortable. Our honorary professor invited me to perform an open gallbladder operation while he assisted. I had assisted at the procedure several times. This was my opportunity to operate with the best available supervision.
I was petrified. My hands trembled. Soon after starting, I handed the operation back to him.
For a long time, I found it easier to learn by assisting than by having someone assist me. Observation, however, could not give me the confidence that comes from operating under supervision.
Our academic training also lacked structure. We were largely expected to study independently. I left too much until the final months, prepared poorly and barely passed the examination. I earned my Master of Surgery degree, but I did not feel ready to practise confidently as a general surgeon.
Alongside these struggles, my personal life was taking an unexpected turn.
Our Professor of Anatomy, a distant relative and my local guardian, enjoyed matchmaking. He wanted to introduce me to a medical student two years behind me. A friend of his, who interpreted horoscopes, predicted that we would marry, but advised him not to approach me in 1984. Our impatient professor did so anyway. I refused.
His friend also predicted that another of my proposals would be rejected in 1985, and that I would approach my future wife in April 1986. As luck or destiny would have it, events unfolded that way.
In April 1986, I saw her at a wedding reception. Something clicked. Soon afterwards, a family friend independently suggested the same young woman as a possible match. I took this as God’s signal.
Our Anatomy Professor invited us to dinner. Afterwards, we sat on a swing in his small garden. The third question I asked her was whether she would marry me.
She had three conditions: no smoking, drinking or flirting. I readily agreed. Forty years later, I am glad I have kept my word.
We became engaged in August 1986. She learnt to cook and brought me a tiffin of home-cooked food every evening for the rest of that year. We married on 9 June 1987. I remain grateful for her care during those difficult days and throughout our married life.
For years, I remembered my training mainly through its shortcomings. Two younger colleagues later helped me see it more fairly.
One had been my junior resident and became a medical gastroenterologist in New York. The other had been an intern in our unit and became a general and colorectal surgeon in England. Both are now close friends.
When we met separately years later, each told me how much he had learnt from my behaviour, teaching and treatment of colleagues. Their words surprised me. I had given so much attention to what I lacked that I had scarcely considered what I offered others.
I must have done something right.
Their recollections do not erase the gaps in my training. They remind me, however, that I was still learning what kind of surgeon I could become. The mild temperament I had regarded as a weakness also helped me treat people with empathy.
At the end of my General Surgery training, I hoped to specialise in urology. The training I sought was unavailable in Pune, so I applied for posts in Mumbai, where my parents were living.
It was time to leave B J Medical College and Sassoon General Hospital, my familiar world since August 1978. I carried a qualification, an uncomfortable awareness of my limitations, and lessons I would draw on for years.
Another major challenge awaited me in Mumbai.
ChatGPT has been used as an editorial assistant to polish and shorten this article.
