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The Rediff Special/ Sheela Bhatt

In an exclusive interview to rediff.com, Dr Harish Bhende, a member of the medical team which operated on Prime Minister Atal Bihari Vajpayee on Tuesday morning, provides a glimpse into what went on during the surgery.

October 10, 0600: The morning was not exactly like any other day. I had a job to do. My duty was to prepare the operation theatre for the prime minister's surgery and along with Dr Laud, assist the chief surgeon, Dr Ranawat, in one of the most publicised surgeries to date. I live in Dadar, central Mumbai. I had woken up at 0530 so that I could visit patients in my own joint replacement centre. I made my rounds at 0620.

O645: I, along with Dr Nandu Laud, drove down to the Breach Candy hospital. I have seen Dr Chitaranjan Ranawat operating at least 400 times, but of course, you don't operate on a prime minister every day! Dr Ranawat operates 400 such cases every year and for the last two decades, he has been performing 20 such operations in India every November.

I know Dr Ranawat well and I know what a superb doctor he is. He is like the painter Raja Ravi Verma. He is so easy with his knife as if he is holding a brush and not a knife! In 1997-98 I had gone to Lennox Hill hospital in New York to study joint replacement surgery from him. So I know about his perfected art. I am quite familiar with his team too. Clifton Icea, who has been in Dr Ranawat's team for many years, has come from New York. He has been present during almost all of Dr Ranawat's surgeries. And his staff nurse C Bagley is here too. She has been in Dr Ranawat's team for 15 years now.

0715: We reached the hospital and went straight to the operation theatre on the second floor where the prime minister's surgery was scheduled to take place. Three of us started laying the table. It took us 45 minutes to arrange around 800 instruments in six open trays. We were not apprehensive because Dr Laud and I perform around 150 operations every year. But we never forget that patients are not machines, every patient is a human being and humans can be unpredictable. That is why that tinge of anxiety is always there before a surgery.

0845: Dr Ranawat is sitting in an adjoining room. The operation theatre is nearly 500 square feet in size and has no windows. It has the Laminar clean air system which filters air in the room and keeps it bacteria free. I would like to emphasise the fact that this OT is as good as the OT at Lennox Hill hospital. I have been witness to 400 knee replacement surgeries performed by Dr Ranawat at Lennox Hill. Breach Candy's OT is absolutely world class and the staff here is really very good.

It is expensive, yes, but the good things come with a price attached, don't they? Since we were operating on the prime minister, besides Dr Subhash Gupte we had Dr Goyti Zolo, an anaesthetist from New York. Dr Gupte has been working with Dr Ranawat for 20 years now and has 40 years of experience behind him.

0910: The prime minister was brought down from the seventh floor. I was thrilled to see him in person. He had been requested not to eat anything before the operation.

Patients are advised not to eat six hours before and after the surgery. As soon as the PM was wheeled into the OT, Dr Gupte's work began. The surgery as such does not vary much from patient to patient. The steps are the same for everyone but the work of the anaesthetist varies. A patient's diabetes, blood pressure, his cardiogram and all other factors have to be taken into account before the anaesthesia is administered. Normally, in knee joint replacement surgery, we don't keep many monitors but, this time, throughout the surgery, we monitored the patient's cardiogram, blood pressure and sugar level. The anaesthetist's job is the most important during pre-surgery.

0945: I went to clean my hands and make them bacteria free. I rub my hands together for two minutes while cleaning them and this is the time when I pray. Dr Laud has always told me to pray thus: 'God, let this operation be the last operation this patient has to undergo and he should never have to come back to me during his lifetime.'

You see, even though doctors always do their best, things can go wrong. Some things are beyond our control and this thought makes you humble.

0955: The patient is ready. Dr Ranawat always ensures that the OT is not crowded. Once Dr Gupte's work was over in around 40 minutes, the chief surgeon, Dr Ranawat, joined in. The operation began. All of us were thoroughly briefed a day before. Present at that meeting were Dr Ranawat, Dr F Udwadia, Dr Laud, Dr Gupte and myself along with Dr Ranawat's assistants from Lennox Hill. We examined the X-rays, discussed and debated various points and planned our course of action. Frankly speaking, there was nothing unusual about this case.

Dr Ranawat operated on two more patients the same day and is scheduled to perform 14 more such surgeries in the next three days. In New York, he takes up to six patients a day. He starts at 0700 and ends his day at 1800.

It took us 43 minutes to operate on the PM. Most doctors take 60 to 90 minutes for a surgery like this but, when you have the experience of more than 3,000 operations behind you, I guess things are different.

0955 to 1040: The doctors hardly spoke to the prime minister when the surgery was in progress. Dr Gupte kept the PM engaged. He was given some sedatives. He was a model patient. The best part of the whole event was that the prime minister never behaved like a prime minister. None of his gestures indicated he was a VVIP patient. There were no airs, no tantrums, no nagging relatives, no complaints. The only thing which affected me was his chaste Hindi. We speak Bambaiya Hindi whereas he converses in shudh Hindi. I was afraid to reply to him in Hindi.

The operation began when Dr Ranawat cut the skin and opened the joint. The knee cap was on the lower side. He checked the joint. He did the shaving with the help of an instrument. He then took the trial joint from the tray. Just like we try out different shirt sizes till we find one that fits, surgeons try out the different joint sizes on the patient's knees. There are standardised joints available and we keep all the sizes ready before an operation. Dr Ranawat put the trial joint in between the bones, moved the patient's leg and then tried again. He corrected the size and decided to go for the final operation. He took up the regular size from the tray, the real joint. He put it between the bones and secured it with white cement.

The carpentry work was now over and the tailoring work began. He checked the bones, joints and the cement work and decided to wind up. He stitched up the open knee. It was all over in exactly 42 minutes. I would in fact say that things went even more smoothly than we expected.

When Dr Gupte spoke to the PM after the surgery, we saw his sense of humour was intact. He asked, "Doctor, main to teek hoon, mere dono pair hai na? (Hope both my legs are still there?)" Dr Gupte replied, "Yes, they are there and one of them is 10 years younger too!" This may sound like a cliche to you, but the fact remains that he took the operation very well. For his age, he behaved well.

Regional anesthesia was administered. But he was a little drowsy during the operation because we had given him anti-anxiety medicines. We were impressed by his courage and tolerance, but we didn't want to take any chances. The anxiety felt during the operation by the patient can raise his blood pressure. To avoid this, we gave him some sedatives. Yes, he did complain once during the operation -- "Mujhe thand lag rahi hai (I am feeling cold)," he said. He was wearing the hospital gown which all the patients wear. That gown covered his body except the knee. This gown is not warm enough to bear the temperature of 18 degrees in the OT and many patients do complain of feeling cold.

During the operation, no bleeding takes place because we put a tourniquet on the thigh which blocks the blood vessels and the circulation. This holds good for two-and-a-half hours.

Once the new joint is in place, the plastic tube is inserted in the knee which is connected to a plastic bowl where blood drips.

1315: The PM was sent back to his room on the seventh floor. His large room has a beautiful view of Mumbai's skyline and the Arabian sea. Now his physiotherapist's work begins. Mrs Wagle is in charge. She too is very experienced.

1700: He began exercising in the afternoon. Mrs Wagle will help him move his legs. That is the first exercise. It will be done with the help of a machine fixed to the PM's bed. It is called 'Continual Passive Mobiliser.' For two to three days, this machine will help him exercise without his having to get up from bed. Sirf pair hilana hai (He has to only move his legs). The machine is a kind of platform. The thigh rests on it and the legs have to be rotated with the help of the machine. Once he is sure of having control over his leg, he will be asked to stand with the help of a walker. I don't think this will happen before the fourth or the fifth day.

Everything depends on the patient, some of them recover faster than others. It normally takes a person six weeks to walk after this surgery, but there are some enthusiastic patients who surprise us by beginning to walk by the fourth week. The PM will be able to walk on the sixth or the seventh day with the help of a walker. In three to four weeks' time, he will be able to walk with the help of stick. Considering his age and weight, I think this is normal and fine. At Lennox Hill, Dr Ranawat relieves the patient on the sixth or the seventh day after the surgery.

On the eleventh day, the PM's stitches will be cut. He will be shifted to Raj Bhavan after he is able to walk with the help of a walker. All the facilities available at the hospital will be replicated there.

(According to Union Minister Jaywantiben Mehta, the prime minister told Maharashtra Governor Dr P C Alexander, "I am absolutely fine. Let me go to Delhi straight from Breach Candy hospital."

The governor said, "Nahiji, aap ke swagat ki khub taiyariya ki hai, aap Raj Bhavan padhariye aur hamare mehman baniye (No, we have made arrangements to welcome you. So come to Raj Bhavan and be our guest).

After the operation, the PM's foster daughter Namita Bhattacharya requested visitors not to insist on meeting the PM to avoid danger of any infection, adds Mehta.)

1930: By now, all the senior doctors had checked on the PM again. He was fine.

2000: Dr Ranawat, his assistants, Dr Sancheti, Dr Gupte and I left for the Taj Hotel. We had one marathon meeting in Dr Ranawat's room. We discussed many cases.

2230: After the discussion, all of us went to have dinner in Dr Ranawat's chambers. Dr Ranawat rarely drinks. He is married to an Australian and they have four children. Mrs Ranawat generally joins him on his India tour. She is a nice lady and a good housewife. But this tour was unscheduled, so she could not join him. His two sons are also doctors. He has a business interest in a pub-restaurant in Manhattan. His talent lies in fixing a problem in the shortest time and he gives his solution in an unambiguous manner.

He was a general surgeon in India. He learnt everything in America. Here, he wanted a job in Bombay Hospital but didn't get one. He went to study FRCS in Canada with 25 dollars in his pocket. Now he might be earning more than four to five million dollars a year. One of his hobbies is playing golf. By the way, he told us today, "I don't know a single song in any language. I simply do not have the brain for music."

The Rediff Specials

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