Chikitsa Ratan award 2022
Conferred by the Delhi Medical Association to Dr Ravi Shukla
Chikitsa Ratan award 2022
Conferred by the Delhi Medical Association to Dr Ravi Shukla
Healing Touch Legacy Honour 2024
Presented to Dr Ravi Shukla by the Delhi Medical Association - Healing Touch Legacy Honour 2024 for more than four decades of service, lifelong dedication and contributions to the medical profession.
THE EVOLUTION OF ANAESTHESIA
Then & Now..
"Dr saheb, kisi ko behosh karney ja rahey ho ?" was the snide comment of one
of the smart-aleks of the colony. Sizing him up and slightly irked by his remark
the Anaesthetist answered "main acchey acchon ko hosh mein bhi laatey hain !"
Well, Anaesthesia has changed quite some since I joined the Branch of
Medicine as a new PG student 40 years ago.
Forty years. Yes almost half a lifetime. "Balanced Anaesthesia" was recognised.
The then used muscle relaxants like Gallamine and Tubocurarine are history
now. Monitoring is at it's glorious best today with gadgets always assisting us
infallibly. Safer techniques lead to safer surgeries allowing the Surgeons from
various disciplines becoming safely bolder with enviable success rates in
hitherto untried fields. So many developments, so much water under the
bridge.
But still, it's the Man behind the Machine who counts.
Yes, on a scientific level we Anaesthetists are contemporarily more comfortably
placed. Still, as I have always maintained an Anaesthetist dies a thousand deaths
whenever a serious medical threat faces our patients. "Eternal vigilance is the
price for safety". What may result from our OT decisions may not always be
reversible. The grace-time granted in case of a cardiac arrest is just 3 to 4
minutes. Injections given cannot be pulled back unlike a repair job a surgeon
might successfully institute if he were to erroneously send his knife on
undesired forays.
It's not only a science, a lot of it is the Art of Anaesthesia also.
40 years back, standing on the "other side" sans the gown and gloves adorned by Surgeons et al, gave me an inferiority complex. Having worked till then in Surgery (with all it's brag and bluster) I felt somewhat downgraded having to "watch things from across the divide rather than being in the "midst of action". Two days after joining I was thoroughly pulled up for not concentrating on Anaesthesia ; instead, rushing off to the surgeon's vantage point and being more involved there.
Gradually, I learnt to conform to the rules of my new calling.
Then unprecedentedly came an Anaesthetic accident. A middle-aged patient with diabetes, hypertension and a few other co-morbidities was undergoing surgery for a stab injury. Though - in view of the patient's condition - the surgeon had been advised to be precise and quick, he took nearly 3 (+1/2) hours fiddling around the abdomen. Instead of heeding advice the surgeon was operating with utter disdain towards the patient's condition. On reversal the patient had a cardiac arrest.
This is where I was introduced to the risks Anaesthetists face. The skill and patience, the precise knowledge of the subject, the drill, the acumen, the respect which is the Anaesthetists' lot unfolded by just watching my Seniors resuscitate the patient.
The Surgeon's brag and bluster was replaced by anxiety, nervousness and dependence and utmost gratitude for the rest of their Surgeon-Anaesthetist interactions in future.The patient made it without any (brain) damage. He went home on the seventh postoperative day.
Things could have turned out bad for the team and the Anaesthetist if we had lost the patient. The blame-game might have been played out, accusations of oversight and neglect could have been levelled.
In this regard - even till today - two pieces of advice have stood by me over time :
Firstly, ALWAYS do a proper record keeping before, during and after Anaesthesia. Calculate the total risks involved, take proper consents and at the end make a proper written handover of the patient to the postoperative team ......
and, secondly :
Always sound out the patient's attendants about the possible prognosis of and related to all of the following : patient, procedure (surgery) and anaesthesia. After making the above clear without any confusion .........
Then REASSURE the patient and the attendants.
Well, Anaesthesia being a new terrain, I slowly learnt to negotiate through it. The basic theories of the subject were learnt as days went by, my teachers were good but I was always made aware of the surgery background I came from. However, it was more in tone of coaxing me to apply myself to learning the knowledge and the "tricks of the trade" than to ridicule me or to put me down.
There were bloomers aplenty - some outright comic, others instantly pointed out and corrected by my teachers or my more experienced colleagues.
Sample these :
After induction-intubation the patient underwent surgery and extubation was done after it finished. The patient was being administered Oxygen through a facemask. Suddenly the patient folded his hands and said "Doctor sahab aapp hi Mai-Baap hain" ..... Simultaneously he poked his tongue out of what seemed like a rent in his upper gums. I froze, thinking I had caused the tear in the gums during laryngoscopy-intubation. Upon being urgently summoned, my SR gave me a backslap and asked me to remove the patient's upper false denture from above which the patient was sticking his tongue out.
For the rustics amongst my patients there were a few who did not quite understand who this rookie doctor (Anaesthetist) questioning them exhaustingly, during the Pre-Anaesthetic Checkup was I convingly introduced myself as the "Sunn and Tunn" department doctor. This they most readily understood and most urged me to make them "Tunn" (unconscious) during the surgery rather than "sunn" (local analgesia) !
During my post-graduation a new muscle-relaxant "Pavulon" (Pancuronium bromide) was launched by the drug company Organon. The Anaesthesia department was invited to a launch-dinner at the premiere hotel of Jhansi -- Jhansi Hotel. The ampoules were dapper in appearance and the muscle-relaxant was promptly taken up by my friend Dileep Saxena as the medicine around which his MD thesis was based. The knowledge - about a week later - that Pavulon was being used occasionally as a combination administered to death-row convicts (alongwith sodium pentothal and potassium chloride) as an alternative to the electric-chair did scare Dileep and made him wary of telling others what his Thesis was about for a few months to come.
As one wades through or slogs out during his post-graduation one picks up myriad lessons, advices, comments and observations from teachers and colleagues. I remember clearly Professor B C Joshi's advice to always do prompt and precise record keeping. He would intone it is necessary to do the right things in Anaesthesiology but even more important than that is the need to record everything promptly and correctly.
Prof Joshi would also urge us to maintain a diary of Anaesthesia-related news, happenings, accidents published in newspapers and magazines. He showed me his "Anaesthesia Scrap Book" - it was an interesting and engrossing collection.
Then there was the brainiest of my teachers Dr U C Sharma, who would never never accept our lame-duck excuses regarding why a Lumbar Puncture had failed or an Intubation not succeeded. He would always announce - much to our chagrin - that our technique regarding the procedure was not correct. He would then point out exactly where we had erred and he was right ! "Things are not so simple" were his famous words of 'encouragement'.
Dr U C Sharma would ALWAYS come over to the OT for night-emergencies .... always sitting in the Senior Doctor's Room. "By the time you will send me a call at night and I will arrive it would be late" he always said. We always got a free hand but were reassured of his availability at night ; in day time there were many seniors present to help if required.