The Surgical Mentor

Each of us is guided by an outer force that teaches us to think, and makes us the people we become

“How do I continue to improve upon my craft?” I asked my professor and mentor Dr. Ari Chacko over dinner. He was retiring from the Department of Neurological Sciences at the Christian Medical College in Vellore after having served it assiduously for over three decades. “You have to repeatedly watch your surgical videos,” interjected his teacher, Dr. Mathew Chandy, who had helmed the same department for several years and whose home we were at for the feast. I used to do that with my father, himself a neurosurgeon, I reminisced. Ari, as everyone fondly calls him, continued the conversation: “You have to go back to every surgery and analyse every movement, and you’ll decipher for yourself how many of those steps were unnecessary. I’ve realized that with this approach, over the years, my movements, which might appear to be slow, have, in fact, become very purposeful.”

Revisiting him after several years of leaving his nest was a separate education in itself. When I first joined my training as a surgical toddler, it was he who taught me how to pee in the proverbial neurosurgical pot. Wetting one’s feet was equivalent to burning one’s fingers. Precision was key. Rigor in examining a patient, exactness in studying the scan, definiteness in preforming the operation, and meticulousness in postoperative care and preparing a patient’s discharge summary were constantly imbibed every single day for every single patient. “Any time you try and cut corners, you’ll land up in a mess,” he used to say. And if ever he got away with it, he was reminded of what his witty mother used to tell him: “You have more luck than sense!”

When you train under someone, whether it be for a few months or several years, you tend to absorb more than the craft. Ari taught us to be kind and caring. He was strict when he needed to be but had mastered the balance of treating residents with a perfect mix of firmness and gentility. He also inculcated the habit of listening to the right music and exercising daily. He was universally loved and admired, and with the demands of our work environment, that’s not an easy feat to achieve. When I finished my training with him, people began to notice that I spoke like him, my hand gestures were like his, and I even incorporated his swag. “And all I wish for is to be able to operate like him,” I told all the people who pointed out these similarities to me. Emulating him became such an integral part of my DNA that a few days ago, while talking a stroll in the garden, I noticed that even my daughter walks like he does.

In recent years, after having moved back home, my father has taken the responsibility of mentoring me. Even though we don’t work in the same hospital, whenever I’m lost inside someone’s brain or spinal cord and need to be bailed out, he’s just a phone call away. I tell him where I’m stuck, he provides the unfolding. I discuss the complication, he dispenses the clarification. I go to him with the arrogance and brashness of youth, he receives me with the wisdom and grace of experience. He has taught me what textbooks cannot – about neurosurgery, living, and knowing.

“I still find it very hard to deal with complications, they just drain me physically, mentally and emotionally,” I spoke over dinner. “It just means that you are concerned about the patient and that is exactly how it should be,” he said as we dug into some roast chicken prepared by Mrs. Chandy. I was being continuously badgered with phone calls from a colleague who was finding it exhausting to deal with issues being faced by our patients. “Despite so much experience, I continue to tremble with a staggering degree of doubt and confusion,” I confessed. “You just have to move intuitively and do the next right thing with conviction – and with the technology available today, we can seek help and guidance from anywhere,” he finished, dropping pearls of wisdom over a meal.

Borrowing from what Atul Gawande, a famous surgeon-writer, once said, we spoke about how it would be useful to get a teacher into the operating room to silently observe the surgeon; over a cup of coffee, the surgeon and his observer could then dissect how one could do the same operation better the next time around. All professionals at the highest level have someone to coach then, then why not a coach in the operating room?

It was an ethereal experience to dine with my teacher, Ari, and his teacher, Dr. Mathew Chandy. Beautifully enough, his teacher was his father, Dr. Jacob Chandy, who started the first department of neurosurgery in the country at the Christian Medical College, Vellore, in 1947. Time has a funny way of collapsing when you go back to a place you once loved and so deeply cherish until the present day.

I returned home on my first flight since the lockdown. Isn’t it strange that at every checkpoint at the airport, one is requested to lower their mask rather than keep it up?

When I returned, I messaged Ari that all the patients who had niggles while I was away had recovered completely, and just as I was hoping for an easy week, I mentioned to him that another patient had returned with a collection of fluid in his head 2 months after surgery. He wrote back, “My mother used to say, ‘The wicked are never at peace!’” Did I mention he had a devilish sense of humour?

This New Year, may we all be guided by an inner light and outer force. May we remember those who taught us and continue to do. Each of us has a mentor we revere, who has made us a little bit or a whole lot of who we have become. And like a friend of mine recently told me, “May we always pay it forward.”