T�� he official news letter ofT� he Association of Surgeons of India

Scalpel March 2017

Dr. Shiva K. Misra Dr. J W Ebenesh Bensam Dr. C R K Prasad Dr. G Laxmana Sastry Dr. Narayana Rao T. Dr. Sanjay Kumar Jain President Honorary Secretary Honorary Treasurer Head Quarters Secretary Website Secretary Joint Secretary

Message from President Esteemed member,

Greetings from ASI headquarters,

I am very happy to communicate with you through this very first e-newsletter of ASI in 2017. The Association of Surgeons of India has bounced back after a year of no activity apart from litigations, allegations and counter allegations.

You have proved once again that boss of the association is its member and not the office bearers. The non performers and miscreants were given theunceremonious exit.

E-newsletter is the platform to appraise the members about the ongoing activities of the association. ASICON Mysuru was a grand success on all fronts, be it the academics, camaraderie or in reviving the democratic fabric of the association. Team ASI at headquarters is working tirelessly to give a year to remember. Five ASI National Zonal Refresher Courses have been planned along with FAIS credentialing with intense teaching and learning program. New

peripheral skill centers in the centers of excellence have been identified to give golden opportunity to members to sharpen their surgical skills. I have attended annual conferences of the state chapters of Odisha, Karnataka, Chhattisgarh and Madhya Pradesh in the month of February and have witnessed renewed enthusiasm of members in the activities of the ASI.

Social Security Scheme has been reactivated and I appeal all full life members till the age of 65 years to join this noble scheme at the earliest. Communication is a key to success and I will keep you updated through this newsletter periodically. I welcome your comments, criticism or feedback on president@asiindia.org

Message from Hon. Secretary

Yours truly Dr. Shiva K. MisraPresident ASI-2017

Dear Esteemed Members,Greetings from the Head Quarters.I am very happy to know that a Newsletter of our esteemed Association is being published after a long time. It is indeed a long needed publication and I am very much confident it will go a long way to inform our members regarding all the activities of our Association.We have been regularly organizing academic meetings and events which are always very well attended at City Branches, State Chapters and National Level. Our State Chapters and specialty sections in conjunction with our National ASI provide a forum for our members to exchange ideas, views and information.This Newsletter will give ample opportunities to keep ourselves abreast about emerging advances in the field of our interest. It is really very heartening our membership has grown in large numbers during the past few years.

Apart from organizing regular CME programmes, we are considering Continuous education, fellowship programmes and many more activities which will take our organization to greater heights.

I am sure this Newsletter will be of immense benefit for our members in the future. Long Live ASI

Your's always in ASI Service.Dr. J. W. Ebenesh Bensam

Honorary SecretaryThe Association of Surgeons of India

Message from Editor

ASICON 2017- JaipurDear Friends,Jaipur is being privileged & honoured to hold the 77th Annual National Conference of The Association of Surgeons of India. On behalf of the Organizing Committee, we take immense pleasure in inviting you for ASICON-2017, to be held at Jaipur.

Jaipur, the 'Pink City of India' being part of golden triangle is famous for the Architectural designs including Hawa Mahal, City Palace and its exquisite forts. Jaipur is also the 'Shoppers Paradise' with its marble statues, exclusive jewellery, Sanganeri prints, beautiful handicrafts and colourful Jaipuri quilts.

Rajasthan is set as a jewel in the midst of Aravali hills studded with innumerable forts & beautiful palaces. So each city has its own series of exotic forts and palaces. The state also has world famous wild life and bird sanctuaries, hill resorts of Mount Abu, beautiful carvings at Ranakpur & Delwara temples to name a few. The world famous Pushkar Fair at Ajmer, Desert Festival in the sand dunes of Jaisalmer, the camel polo are some of the annual events that attract national and international tourist in large numbers.

With the weather being at its best, the timings is just perfect to enjoy the exotic city for its famous Rajasthani hospitality and breathtaking sights.

An ever memorable, loving, exhilarating, academic & cultural experience waits to welcome you in Pink City. Dr. R. K. Jenaw Dr. Prabha Om Dr. Bhanwar Lal YadavOrganizing President Organizing Secretary Organizing Secretary

Website: http://www.asicon2017jaipur.com/

We thank the president and ofce bearers for entrusting this job of bringing out our ASI e news letter. The scenario in ASI is changing at a rapid speed in sharing and improving professional knowledge / skill to all its members. The national conferences and zonal CMEs have gained immense popularity with very high standard of academic content.. More and more members are taking an active interest in the association matters as evident by the largest attendance, discussions and active contributions in the decision making during recent Annual General body meeting ( ASICON 16 ) at Mysuru. I sincerely thank my editorial team Dr.Shalabh Gupta, Dr.Sanjay Jain and Dr.Aravind Patel for their active contributions in giving this shape to this news letter.

Dr. Sadashivayya S. SoppimathEC Member, Hubballi, Karnataka

I welcome your suggestions and feedback at editornlasi17@gmail.comSelect feedbacks will be published in the next news letter.

Becoming ASI Life member is very easy now !!

Did you know?You can become

ASI Memberonline just by

clicks

Present fee is 7,700/- for life time membership.Can make online transferNeed to upload Degree and medical council registration certificates online.The link for applying online is;http://asiindia.org/member-application

Dr. Sadashivayya S. Soppimath, Hubballi, Karnataka.

Dr. Shalabh Gupta, Ghaziabad, Uttar Pradesh.

Dr. Sanjay Jain, Bhopal, Madhya Pradesh.

Dr. Dr. Aravind Patel, Bellary, Karnataka.

Editorial Team

EC Members, ASI

Andhra Pradesh Dr. Narayana Rao T Dr. Vakamudi Prakash Dr. Ramana Murthy P V

Assam Dr. Sarbeswar Bora Bihar Dr. Sitaram Prasad Singh Dr. Alok Abhijit Dr. Bindey KumarChhattisgarh Dr. Siddharth Tamaskar

New Delhi Dr. Srivastava K N Dr. Rana Anil Kumar Singh

Gujarat Dr. Bharat K. Panchal Dr. Gunvant H. RathodHaryana Dr. Bharadwaj S S

Jammu & Kashmir Dr. Fazlul Qadir Parray

Jharkhand Dr. Satish Kumar Midha

Karnataka Dr. Aravind Patel Dr. Sadashivayya Soppimath Dr. Godhi A S Dr. Siddesh G

Kerala Dr. Padmakumar R Dr. Fazil Marickar Y M Dr. Karthikeyan C

Maharashtra Dr. Abhay Narendra Dalvi Dr. Dilip S. Gode Dr. Jaisingh K. Shinde Dr. Manoj S. Jain

Madhya Pradesh Dr. Sanjay Kumar Jain Dr. Achal Gupta Dr. Mukesh Shrivastava

Odisha Dr. Sreejoy Patnaik Dr. Chitta Ranjan Das

Punjab Dr. Ujagar Singh Dhaliwal Dr. Chanjiv Singh

Rajasthan Dr. Raj Govind Sharma Dr. Raj Kamal Jenaw Dr. Shyam Bhutra

Tamil Nadu & Pondicherry Dr. J W Ebenesh Bensam Dr. Sai Krishna Vittal Dr. Srinivasan N T Dr. Subramaniyan S R

Telangana Dr. Kanaka Raju G Dr. C R K Prasad Dr. G Laxmana Sastry

Uttar Pradesh Dr. Janme Jai Prasad Sharma Dr. Probal Neogi Dr. Nikhil Singh Dr. Ashutosh SayanaWest Bengal Dr. Gargi Bandyopadhyay

West Bengal Dr. Gargi Bandyopadhyay Dr. Diptendra Kumar Sarkar Dr. Makhan Lal Saha

Sectional Representative (EC) 2017 Dr. M Velusamy Dr. V Sitaram Dr. B K C Mohan Prasad

Co-opted EC Members Dr. Jayant N V Bhandare, Goa Dr. Pradip Sarkar, Tirupara Dr. S Rajendra Singh, Manipur Dr. Ramesh Bharti, H.Pradesh Dr. Pankaj R Modi, Gujarat

Sectional Office Bearers 2017

1 ACRSI Dr. Kumkum Singh, President Dr. Niranjan Agarwal, Secretary

2 IAES Dr. A R Ramasubbu, President Dr. Anand Kumar Mishra, Secretary

3 AGUSI Dr. Anil Thakar, President Dr. Prakash Patankar, Secretary

4 AMASI Dr. Tamonas Chaudhuri, President Dr. Jugindra S, Secretary

5 IAPS Dr. S N Kureel, President Dr. K Ramesh Reddy, Secretary

6 ASRI Dr. M Velusamy, President Dr. G.S. Gnanagurusamy, Secretary

7 IASG Dr. V Sitaram, President Dr. Pradeep Rebala, Secretary

8 IASO Dr. B K C Mohan Prasad, President Dr. Rajendra Toprani, Secretary

9 ATVSI Dr. S K Jain, President Dr. Ashwani Kumar Dalal, Secretary

10 IATCC Dr. Winston Noronha, President Dr. Vineet Kumar, Secretary

11 AAFS Lt Gen M K Unni, President Surg Cmde C. Sudeep Naidu, Secretary

12 ABSI Dr. P. Raghu Ram Dr. S P Somashekhar, Secretary

Did you know?

ContactingHeadquarters & Ofce Bearersis made easy

The Association of Surgeons of India21, Swamy Sivananda Salai, Chepauk,Chennai – 600 005, INDIAPh: +91 44 25383459, 25385584Fax: +91 44 25367095www.asiindia.orgEmail: headofce@asiindia.orgPresident ASIEmail: president@asiindia.orgSecretary ASIEmail: secretary@asiindia.orgTreasurer ASIEmail: treasurer@asiindia.orgFor website related Queries:Email: webmaster@asiindia.org

“ The ratio of what we know to what we do not know in human history will always be almost zero because what we do not know is innite.”

Editorial....

Surgeon and the art of Surgery

Surgery has been considered as one of the best artistic talent. It is called artistic as it gives enough scope for creative ideas and making on spot decisions to improve the surgical outcome. But this is not a performing art like dance, painting, music or acting. A good performing art is exhibited to large number of audience at a time and evokes instant liking, appreciation and standing ovations from public. There is no scope for all these in the surgical performance. When you do a complicated surgery, sail through a very difcult situation, only you will be celebrating silently . The ecstatic feeling in such situation may rob you off from good sleep due to sheer happiness and immense satisfaction. This is the only art which is really exhibited in true sense to a very few select audience like anesthesia personnel, surgical assistants, assisting staff, and supporting staff in operation theater whose critical reviews / accolades are not amenable to common public. So do not expect the public to admire our surgical skills and give a standing ovation!!!!. The common public always assess a surgeon as good by the ou t look and communication. Now a days as more and more people are becoming aware about the outcome of an individual surgeon, the importance of surgical skill is being appreciated. Earlier the arrogance was wrongly considered as sign of competence. Now a good surgeon has to maintain good personality, good communication, good clinical knowledge and operative skill. It is apt to remember that 90 % of the common surgical procedures do not require extra ordinary surgical skill. But almost all require good nonsurgical skills. At one extreme a person with best surgical skills and best nonsurgical skills excels , whereas at the other end with poor surgical skills and poor nonsurgical skills, the person becomes a failure. It needs some effort to improve our surgical and nonsurgical skills and ASI has taken it as a big challenge.

Many work to earn so that they can to pursue

their hobbies. We can involve ourselves

completely in

providing surgical care like in meditation. We can

provide social service by providing sincere, good

surgical care. And we can make our profession

as the best working hobby. How lucky we are!!!!

- Dr. Sadashivayya S. Soppimath

Ignaz Semmelweis, savior of mothers. Ignaz Semmelweis was a Hungarian obstetrician who disproved the belief that post-operations deaths were caused by 'poison air' in a hospital ward. The work done by Semmelweis all but removed puerperal fever from the maternity units he worked in. His colleagues and superiors derided his work while he was alive but antiseptic surgery drastically reduced post-operation fatalities. Ignaz Semmelweis was born on July 1st 1818 near Budapest. His father was a wealthy wholesale grocer. In 1837 he studied Law at the University of Vienna before changing to Medicine in 1838. In 1844, Semmelweis was awarded a doctorate in Medicine. At the end of his training Semmelweis decided to specialise in obstetrics. His first medical position came in 1846 when he was appointed as an assistant in

A must know for all young surgeons....

a maternity ward at Vienna General Hospital.The number of young mothers who died in the ward after giving birth immediately struck Semmelweis. In the first month that he worked in Maternity Ward No 1, 36 women out of 208 died – a 17% fatality rate. He learnt that Maternity Ward No 1 had a poor reputation outside the hospital as the one in which you, as a young mother, had the greatest chance of death when compared to Maternity Ward No 2. Services at the hospital's maternity wards were free and they served the city's less well-off women. However, Semmelweis learnt that women would rather give birth in the streets around the hospital rather than be admitted to Ward No 1 and that they had a better chance of survival.The explanation he was given by experienced workers in the ward was that the women were victims of a 'poisonous gas' that had got into the ward. This was a very commonly held belief and one that had been around for many years. This 'miasma' was invisible and for some fatal.

Semmelweis was not prepared to accept such a belief and he spent time researching the issue. He found that in 1846, 451 women had died in Maternity Ward No 1 after giving birth but in the nearby Maternity Ward No 2 only 90 women had died. Semmelweis would not accept that somehow the miasma that was so destructive in Ward No 1 did not get to the corridor of Ward No 2 that was close by and more crowded. He believed that there had to be another reason.Semmelweis believed that cause of so many deaths in Ward No 1 was the nearby post-mortem room. Ward No 1 was the preserve of doctors and trainee doctors while Ward No 2 was where only midwives learned their profession. At the Vienna General Hospital it was very common for obstetricians to carry out autopsies in the morning and then carry on with their other work in Ward No 1 after that. Midwives did not do autopsies.Semmelweis believed that there had to be a link between the work done in the post-mortem room and the obstetricians coming into Ward No 1. On the one hand the hospital had a maternity ward next to a post-mortem room and in that ward post-birth deaths were high. On the other hand, the hospital had another maternity ward which was staffed by midwives who did not go into the post-mortem room and in that ward post-birth deaths were much lower.In 1847 a colleague of Semmelweis, Jakob Kolletschka, died from septicaemia. He had been cut with a scalpel during an autopsy. Semmelweis attended his colleague's autopsy and noticed that the lesions on his body were very similar to those on many of the women who had died in Ward No 1. Semmelweis believed that it had been the scalpel that had transferred the 'miasma' from the corpse to his former colleague.Semmelweis ordered that all medical staff in Ward No 1 had to wash their hands in chlorinated lime before visiting a patient and that the ward itself had to be cleaned with calcium chloride. The mortality rate in Ward No 1 dropped dramatically and by 1849, just 2 years after the death of his colleague Kolletschka, death from 'miasma' had all but disappeared.Semmelweis provided his evidence to the medical elite of Vienna. He stated that cleanliness was the way to defeat 'poison air' and backed this up with the statistics he had gathered. His views were not part of the general medical beliefs of the time and he was immediately attacked by most senior medical figures – three did support him but none of them had a background in obstetrics. Semmelweis was dismissed from his position at the Vienna Krankenhaus and went to live in Budapest.In Ward No 1, doctors went back to their old ways and fatality rates immediately increased to their level pre-1847.Semmelweis gained employment at the St. Rochus Hospital in Budapest and applied his findings there. The death rate in the maternity units there dropped drastically.

In 1861, Semmelweis published 'Die Aetiologie, der Begrif und die Prophylaxis des Kindbettfiebers' (Etiology, Concept and Prophylaxis of Childbed Fever) – “which stands as one of the epoch-making books of medical history." (History of Medicine by Roberto Margotta)The work was filled with a mass of statistics and proved difficult to read. It was met with hostility by the medical profession and many simply mocked its findings. It took another twenty years before his findings were universally accepted. For years many of Europe's leading medical practitioners believed that childbed fever was a disease of the bowel and that purging was the best medicine for it.

The years of rejection by his colleagues in medicine almost certainly took its toll on Semmelseis. He suffered from severe depression and may have suffered from premature dementia as he became very absent-minded and when in public invariably turned all of his conversations into ones concerning childbed fever. After the effective rejection of his 1861 work on puerperal fever he wrote a series of 'Open Letters' to his main critics in which he openly called them “ignorant murderers".In 1865 he was tricked into visiting a mental asylum. When he tried to leave Semmelweis was forcibly restrained and put in a strait jacket. The injuries were such that they became infected and he died two weeks later.Ignaz Semmelweis died in 1865. He was buried in Vienna. Very few people attended his funeral. In 1891, his body was transferred to Budapest. A statue was only erected to him and his achievements in 1894, nearly thirty years after his death.

- From editor’s collections

“A bird asked a bee, u work so hard to get honey & people steal it. Don't u feel sad?Bee said ‘no, because they can never steal my art of making honey!!’.”

a young doctor who sacrificed his life for many mothers’ safety !

“One Person With A Belief Is Equal To A Force Of Ninety-nine, Who Have Only Interests”

ASICON 2016-Mysuruth76 Annual National Conference of the Association of Surgeons of India.

For the first time national surgical conference , ASICON16 was held in a non-capital city of state Mysuru , a beautiful and princely city from

14th to 18th Dec 2016. The venue was a huge lush green combined area of world famous , Indias oldest Mysure university ( Manasa

Gangotri) campus and Karnataka state open university campus. This conference was attended by the largest number of delegates (4700

registrations, highest in the history) and was accompanied by equally large accompanying persons (2500). This was highest attended

national conference inspite of many uncertainties which kept away many leaders and delegates from attending. The palatial decoration of

the food court and rustic Karnataka village models at the entry of the venue were eye catching.

On first day live surgeries / Procedures of different specialties were relayed from Asian Institute of Gastro Enterology Hyderabad, GEM

Hospital Coimbatore and JSS Hospital Mysore . All the delegated were delighted seeing masters performing the procedures with live

interactions.

The event was officially inaugurated at 6 PM by symbolic lamp lighting ceremony by Hon. District In charge Minister Mr. H .C.

Mahadevappa. Dr.K.S.Shekhar, past president ASI was the guest of honor.

Many stalwarts in the field delivered orations and conducted symposias during which halls were packed. The invited guest lectures and

organ based sessions were well received and appreciated. Nearly 100 best papers out of 1500 abstract submissions were chosen for

presentation in different award sessions. The response for papers and posters presentation was phenomenal.

The PG master class and post op rounds were conducted by Dr.Santhosh John Abraham and Dr.Aravind K were huge success with lot of

learning points. The hall was jam packed with many standing audience.

Quiz masters Dr Ramanuj Mukherjee and Dr C.S. Rajan made the interactive national quiz session a very interesting one with 13 teams

taking part. In the final round Kerala and Maharashtra needed a tie breaker, paving way for Kerala to number one.

Laparoscopy and GI endoscopy skill development stalls were well utilised by delegates with hands on.

The annual general body was a history as it was one of the largest attended. The deliberations and discussions with active participation by

many, clarified few members doubts and paved way for a clear future for ASI with some bold decisions which were unanimously approved.

The welcome drinks and sweets were the initial punches in the lunch area. Variety of south Indian dishes to exquisite continental cuisines

with local delicacies, wide spread of fruits and deserts with different theme everyday were savoured by connoisseurs and others alike. The

icing on cake was live orchestra with old movie numbers which forced everyone zoom to the melody. The gala dinner was arranged at the

famous Lalit Mahal palace hotel, which many had seen only in movies. Everyone felt as special guest of Mysuru Maharaj and would be

cherished for long.

The accompanying persons enjoyed the parallel programmes arranged for them throughout day. Delegates and their family members

enjoyed visiting the Mysuru palace, Chamundi hills (with darshan of goddess Chamundi), roaming in the city and buying Mysuru silk sarees.

Dr.C.G.Narasimhan, Dr.Siddesh, Dr.C.P.Madhu, Dr.Balakrishna, Dr.Dinesh, Dr. Chandrashekhar S, Dr. Sarvesh Raj Urs and their strong

dedicated team left no stone unturned to make this wonderful event a great success.

Awards Asicon 2016

Best Chapter Paper Presentation

I Dr Hemanth Gn St. Johns Medical College & Hospital, Bangalore II Dr Azhagamuthu Re Svims, Tirupathi III Dr Pranay Kabiraj Bankura Samillani Medical College And Hospital, Bankura, West Bengal

Best Paper Presentation Session I

I Dr Sreeharsha Mv Columbia Asia Hospital, Mysore II Dr Mir Zeeshan Ali Yenepoya Medical College, Mangalore Dr Balaji Jayashankar Kasturba Medical College, Manipal III Dr Dibin Mohammed B Yenepoya Medical College, Mangalore

Best Paper Presentation Session II

I Dr Mohsina Subair JIPMER, PuducherryII Dr Subash C Subudhidy Patil Medical College And Hospital, MumbaiIII Dr Abhik Debnath Institute Of Medical Sciences, Banaras Hindu University, Varanasi Dr Shwetha Venugopal JSS Medical College And Hospital, Mysore

I Dr Khyati Melanta M.S. Ramaiah Medical College & Hospital, Bangalore II Dr M Vamseedharan Sri Ramakrishna Hospital, Coimbatore III Dr Seema Khanna Institute Of Medical Sciences, Banaras Hindu University, Varanasi

Dr C Palanivelu Best Post Graduate Paper Presentation I Dr Mario Victor Newton L St. John’s Medical College Hospital, Bangalore II Dr Kapil Dev Kidwai Insitute Of Oncology, Banagalore III Dr Karthik Prakash Jipmer, Puducherry

National Surgical Quiz - Asicon 2016 Winners Dr Anoop S Government Medical College, Thiruvananthapuram, Kerala. Dr Aravind S Ganapath Government Medical College, Thiruvananthapuram, Kerala.

Runners Up Dr Priyank Kothari Grant Medical College, Mumbai Dr Pankaj Kumar Grant Medical College, Mumbai

The Association of Surgeons of India had been awarding its Fellowship since couple of decades to its members with experience after a formal credentialing process during every National Conference.

From this year onwards the credentialing process is re-structured to impart

contemporary knowledge to its members before being admitted to the Fellowship

(FAIS).

Did you know?

FAISCredentialing

processChanged

Those of you with five years of membership in the Association of Surgeons of India desirous of being admitted to the Fellowship are requested to fill up the form with remittance of due fees to the ASI. The last date for submitting the application for this year is on 30th June 2017. Details of the Fellowship are available at ASI website www.asiindia.org/asi-fellowship.

Credentialing is a formal teaching process with assessment and is clubbed with Regional Refresher courses from this year onwards to have the best utilization of resources and faculty. This is a three day programme which needs to be attended by every candidate with a formal registration to it and the details are also available in the ASI website.

Do not miss this unique opportunity of intense learning and Fellowship

Just Smile......

The following quotes were taken from

actual medical records dictated by

physicians. They appeared in a

column written by Richard Lederer,

Ph.D. for the Journal of Court

Reporting. These and other language

gems will be featured in Lederer’s

new book - Fractured English, to be

published by Pocket Books in the fall

of 1997.

Read select few.....

The patient has been depressed

ever since she began seeing me

in 1983

The patient refused an autopsy.

The patient has no past history of

suicides.

The patient expired on the floor

uneventfully.

Since she can’t get pregnant with

her husband, I thought you would

like to work her up.

While in the ER, she was

examined, X-rated and sent home

Patient was alert and unresponsive.

When she fainted, her eyes rolled

around the room.

“Life is not about the people who act true to your face.... Its about the people who remain true behind your back”

Did you know?

ASI SocialSecurity Schemeis the best one

available

Social security scheme of ASIHighlights of the scheme:• It is a family benefit scheme, as an obligation of ASI to give security to families of surgeon • ASI Members can join below the age of 65.• No medical certification is needed to join the scheme.• Early settlement of death claim within a month.• Documents like Death certificate, membership identity and the City branch Secretary’s Recommendation are only needed for the claim.

• Admission fee is variable with age - Rs. 5000/- upto 30 years and Rs. 30000/- upto age 65 years.• Fraternity contribution is per death is very low comparing to any Insurance scheme.• Payment is to be done for 25 years only.• Benefit — Member's Family gets minimum 500 times of total number of members enrolled.e.g.Members in ASI SSS=1000Benefit Rs. 1000x500=500000If 5000 members in the scheme the benefit will be 2500000• The financial security is much more than any other commercial policies.• Substantial amount make you secured with happiness.• As membership increases the fraternity amount also increases but benefit increases many folds• Beside this amount other academic benefits and financial help as per GC/Executive Body decision in future.

For Details Contact : Dr Shalabh Gupta Cell : 9811965686 Email : drshalabhgupta@gmail.com

Heart tells the eyes: "See less, because you see and I suffer alot". Eyes replied, "Feel less because you feel and I cry a lot."

A Football Coach’s Advice to Surgeons

College of Medicine, Mayo Clinic, Rochester, MinnesotaMy dad taught me hundreds of pearls over the course of alifetime. He is a talented man, a loving husband, father, and grandfather, and an inquisitive human being. Being a footballcoach may not seem a grand profession from which to espouse advice and knowledge to a young surgeon, but it was, for meand my father. His triple option version of ‘3 yards and a cloud of dust’ mentality brought his NCAA Division III football teamsgreat success and a legendary reputation. They rarely turned the ball over, their defense bent but rarely broke, and the Falconsseldom beat themselves. . .and neither did their opponents.

As I mature into a General Surgeon that now has a couple decades of operating, teaching, and training behind me, I write to pass along a couple of my father’s favorite quotes and sayings that should resonate with surgeons of my era and, better yet, aidthose who follow in our footsteps:

“Repetition is the mother of learning.” Great football players are not born; they are created with blood, sweat, tears,and hundreds, if not thousands, of repetitions. Linemen block, receivers run pass patterns, and the quarterback throwsthe ball. Repeatedly and over again. Technique is important. Muscle memory is invaluable. Timing is critical. Those skills are worked on individually, in groups, and eventually as a whole team. Same with surgeons and surgical teams. Practice your knot-tying, rehearse the steps of a Whipple operation, spend time on the box trainer, and make yourself better by committing to the effort. The best way to get better is to just work hard and get better. There is no substitute for repetition and practice. It is how surgeons must learn.

“Preparation is when luck meets opportunity.” Are we ready for the on side kick? Do the opponents like to use screenpasses on third and long or do they throw deep? The scouting report is important in football and in surgery. Be meticulous indetails. Rehearse the steps of the procedure with your ORteam.For diabolical adrenal and renal cancers, scrutinize the CT scan and see the vena cava tumor thrombus preoperatively. Have the Satinsky clamp ready. . . and your cardiac surgery bypass team on stand-by. The harder you work to prepare for the task at hand, the “luckier” you get. An insightful mind sees much.

“Be quick, but don’t hurry.” The running back needs to accelerate to the outside but not so fast that he outruns his own blockers. The punter needs to get rid of the ball in a timely fashion, but not so fast that he shanks it sideways. Same for surgeons. Most hernias can be repaired in 30 minutes, but do not forget to achieve hemostasis, remove all yoursponges, and close the skin securely. Some of the fastest surgeons I have worked with move methodically and safely with rarely a need to backtrack on any step. They usually perform the procedure in a nearly identical fashion each time, efciently, safely, and they never have to hurry.

“The only thing I know is that I know nothing.” Attributed to Confucius, Socrates, and a few others, my father usedthis quote to teach humility and encourage young college-age men to keep seeking greater knowledge. Some on side kickbounces are unfathomable. Some dropped passes defy logic, and some wins AND some losses should not have reallyhappened. But they do. For surgeons, we know that our profession is indeed humbling. We never will know-it-all,but we should keep striving to understand medicine and the art of surgery. As we remain vigilant for trouble lurkingahead, we are reminded that there are no “little operations” for our patients, and if we indeed “know nothing” then weshould never be afraid to ask for help.

“Lead, Follow, Or get the hell out of the way!” Nike says to “just do it.” My dad was a leader and his actions generatedloyalty and passion among his players. Make your choice and move on. When it is time to transect the portal vein, do so.When in doubt, ask, but do not belabor the point. Move! Life is short. Operating room time is expensive and efcientteams render better care at lower cost. Do your part to make your team great.

“The team comes rst.” My father gave several talks a year at high school football banquets or regional football clinics asa featured speaker. The point of many of his talks was the wisdom of strength in numbers and shying away from individualaccomplishments. One thousand-yard running backs go nowhere without linemen blocking. Field goal kickers donot win the game without the snapper, holder, or protection. Same for surgeons. Rarely do surgeons do everything bythemselves (administering anesthesia, prepping, draping, sterilizing instruments, etc.). The team does the lap chole.The team reconstructs the breast. It is amazing what can be accomplished if no one cares about taking credit.

Contd... P9

ASI Zonal Refresher Courses 2017

Date Place Zone Convenor 7‐9 July, 2017 Hyderabad Andhra Pradesh, Telangana, Odisha & Chhat tisgarh Dr. Ramulu

21‐23 July, 2017 Chennai Kerala, Karnataka, Goa &Tamil Nadu &Pondicherry Dr. Vinayak Senthil

4‐6 August, 2017 Kolkata West Bengal, Bihar, Jharkhand & Nor th East Dr Gargi Bandyopadhyay

18‐20 August, 2017 Bhopal Madhya Pradesh, Maharashtra & Gujarat Dr. Sanjay Jain

25‐27 August, 2017 Delhi Delhi, Ut tar Pradesh, Rajasthan, Haryana, Punjab, Dr. Durga / Himachal Pradesh & Jammu & Kashmir Dr Deborshi Sharma

State Chapters Annual Conference 2017

Date Events Place Org. Chairman Org. Secretary 12‐14 May 2017 Kasicon 2017 Backwater Ripples, Kumarakom, Dr. Sam Christy Kot tayam Kerala

3rd Week Of August 2017 Annual Conference (apasicon) Guntur Medical College Dr. Subbarao Dr. N Srinivasa Rao Andhra Pradesh 27‐29 October 2017 Assam Annual Conference Kaziranga National Park, Assam 14‐15 October 2017 Rajasicon 2017 Sikar, Rajasthan Dr. S L Soni Dr. Mahesh Rao

Details Of Sections Annual Conferences-2017

Date Events Venue Org. Chairman Org. Secretary15 ‐ 17 September 2017 ACRSICON ‐17 Hotel Le Meridien, Coimbatore Dr. C Palanivelu Dr. S Raja Pandian

13 ‐14 Oct 2017 IAES‐17 Hotel Holiday Resor t, Puri Dr. B.N.Mohanty Dr. Arun K Mohanty

22 ‐ 24 Sep 2017 IAPSCON 2017 Hotel Hyat t, Kolkata Dr. Sumitra K.Biswas Dr. P. Gupta 5 ‐ 8 October 2017 IASGCON 2017 Jipmer Auditorium, Puducherry Dr. Biju Pot takkat Dr. R Kalayarasan & Dr Sandip C.A

26 ‐ 29 October 2017 AMASICON 2017 Le Meridien, Kochi Dr. C Palanivelu Dr. C J Varghese 10 ‐11 November 2017 ABSICON 2017 Hotel Clarks Exotica, Bangalore Other Events-2017

Date Events Venue Org. Chairman

2‐4 March 2017 VAICON‐2017 BHU, Varanashi, Prof. Ajay K Khanna

31Mar‐1April 2017 IASG mid term CMC Vellore

21‐23 April 2017 IFSO APC ‐2017

“When lizard is alive, lizard eats ants. When lizard is dead, antseat lizard. Things can turn any time. Don't neglect anyone in your life”

A Famous Inspirational Speaker Said “Best Years of my life were spent in the Arms of a woman who was not my wife”. Audience was in Shock & Silence. He added , “She was my mother” Applause & Laughter!A Top Manager tried to crack this at Home. Af ter good 3‐4 Drinks, he said loudly to his wife in the ki tchen, “Best Years of my Life were spent in the arms of a Woman who was not my wife!” There was sudden silence !

Standing for a Moment and trying hard to recall the 2nd Half of the sentence , he finally blur ted out “Forget i t , I can’t remember who She was”. By the time he regained his Senses, He was on a Hospital Bed recovering from Burns of Boiling Water. Moral; DON’T COPY IF YOU CAN’T PASTE.

Many journal articles are available for browsing and free download. In HPB Virtual Journal Club , nearly ten topics like pancreatitis, HCC, pancreatic anastomoses, cystic lesions of pancreas, biliary injuries, liver resection etc are extensively discussed with evidence basedarticles. Just take a look !!

h t t p : / / a s i i n d i a . o r g / c a t e g o r y / e d u c a t i o n

Did you know?

ASI websiteprovides many journal articles

freely for access & download

Please Contribute to next edition of this Enews letter

Editorial team requests members to contribute interesting articles, case capsules, etc. for publishing in this enewsletter.

Kindly submit at : editornlasi17@gmail.com

Chapter Co-Ordination CommitteeDr. Kanakaraju G, HyderabadDr. C.R. Das, BhubaneswarDr. Probal Neogi, Allahabad

Sectional Co-Ordination CommitteeDr. Kumkum Singh, AjmerDr. Tamonas Choudhuri, KolkataDr. Subramanyeshwar Rao, Hyderabad

Disciplinary CommitteeDr. Abhay Dalvi, MumbaiDr. Rana A.K Singh, New DelhiDr. Fazil Marickar, Trivandrum

Election TribunalDr.K.S. Shekhar, BangaloreDr.Satish Shukla, IndoreDr. Suresh Chandra Hari, Hyderabad

Internal Auditing CommitteeDr. Nikhil Singh, LucknowDr. Mukesh Shrivastava, JabalpurDr. Sitaram Prasad Singh, Sitamarhi

Building CommitteeDr. Subrammaniam S.R, ChennaiDr. Rathnaswamy A, ChennaiDr. B.K. Rau, ChennaiDr. Vinayak Senthil, ChennaiDr. G Chandrasekar, Chennai Committee for Protocol for ASI MeetingsDr. Ashok Godhi, BelgaumDr. Bindey Kumar, PatnaDr. Ashutosh Sayana, Haldwani

Program CommitteeDr. Srivastava K.N, New DelhiDr. Manoj Jain, SolapurDr. N.T. Srinivasan, Koilpetty

CME CommitteeDr. Siddesh G, MysuruDr. Raj Govind Sharma, JaipurDr.P.V.Ramanamurthy, VijayawadaDr. Dilip Gode, NagpurDr. Diptendra Sarkar, Kolkata

Committees for the year 2017

FAIS Committee Dr. Padmakumar R, KochiDr. Gunwant Rathod, AhmedabadDr. Jaisingh Shinde, PuneDr. Gargi Bandopadhyay, KolkataDr. Sreejoy Patnaik, CuttackSurgical Research CommitteeDr. Rajan Saxena, LucknowDr. M.J.Paul, VelloreDr. Adarsh Choudhuri, New Delhi

Membership Drive CommitteeDr. Bharat Panchal, AhmedabadDr. J.P. Sharma, DehradunDr. Dhaliwal, AmritsarDr. Bhanwar Lal Yadav, JaipurDr. Rupesh Mehta, AhmedabadInternational Affairs CommitteeDr. P. Raghuram, HyderabadDr. Saumitra Rawat, New DelhiDr. Jayashree Todkar, PuneDr. B Somashekhar, Dr. Dhananjaya Sharma, Jabalpur Trauma and Disaster Management CommitteeDr. Winston Noronha, ChennaiDr. C. Karthikeyan, TrivandrumDr. Arvind Patel, Bellary

Safe Surgery Initiative Dr. Arvind Kumar, New DelhiDr. Fazl Parray, SrinagarDr. Jyotsna Kulkarni, PuneDr. Ajay Khanna, Varanasi

Newsletter (Scalpel)Dr. Sadashivayya Soppimath, HubliDr. Shalabh Gupta, GhaziabadDr. Sanjay Jain, Bhopal

Social Security Scheme Committee Dr. Satish K Shukla, Indore (Advisor)Dr. C Khandelwal, PatnaDr. Vakamudi Prakash, NelloreDr. Kaushik C Shah, AhmedabadDr. C R Das, BhubaneswarDr. Shalabh Gupta, Ghaziabad

Committee for Liaison with GovernmentDr. R. P. Srivastava, BokaroDr. Vivekanandan Subramanianathan, ChennaiDr. Rana A K Singh, New Delhi

Committee for Surgical ProtocolsDr Pawanindralal, New DelhiDr Sai Vittal, ChennaiDr H S Bhanushali, ThaneDr. M C Misra, New Delhi

Director Surgical StudiesDr. Santhosh John Abraham, Kochi Ethical Surgical Practice CommitteeDr. Ashok Mehta, MumbaiDr. Achal Gupta, GwaliorDr. C. P. Kothari, Indore

Social Services / Public Awareness CommitteeDr. K. C. Dewani, JabalpurDr. Chanjiv Singh, JalandharDr. Satish Kumar Midha, RanchiDr. C Khandelwal, PatnaDr. H S Bhanushali, Thane

Grievance Redressal CommitteeDr. Siddharth Tamaskar, RaipurDr. J.P. Sharma, DehradunDr. Makhan Lal Saha, Kolkata

Professional Indemnity Dr. Satish K. Shukla, Indore (Advisor)Dr. Pramod Shinde, NashikDr. K Surya Narayana Murthy, BhimavaramDr. K N Srivastava, New Delhi

Peripheral Skill CentresDr. Rajan Saxena, LucknowDr. Ravi Kant, LucknowDr. Sanjeev Misra, JodhpurDr. V Venkatesh, CoimbatoreDr. Ashok Ladha, Indore

HQ Skill CentresDr. Suresh Chandra Hari, SecunderabadDr. Vinayak Senthil, ChennaiDr. M Kanagavel, Chennai

“Political language... is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.”- George Orwell

Just Smile......There was this guy that went to the doctor to get his sperm counted. The lady behind the desk handed him a jar and said, "Bring it back tomorrow, full." He says, "Okay, I'll be back tomorrow then."

Well he goes home and comes back the next day, and he hands the woman the jar. She says, "Nothing's in it." The man responds, "Well, I went home and I tried with my right hand and I tried with my left hand and nothing happened. I called my wife into the room, and she tried with her right hand and she tried with her left hand. Nothing still happened. Well, we called our neighbor and she came over, and she tried with her right hand and she tried with her left hand, and still nothing happened. And the woman behind the counter looked stunned and asked, "You asked your neighbor over tohelp you!?" And he says, "Yeah, we couldn't get the jar open."

A man walks into his doctor's office and sits down in the waiting room. While he is waiting his turn to be seen, a casual acquaintance walks in and sits down next to him. The newcomer asks "W w what are yyy you ddd doing here?" The man replies, " I am waiting to see the doctor." "W wwhy dd do yyy you wwant to sss see hhim?" The man replies, "Well, if you must know, I have a prostate problem. " A pp prostate ppp problem, wwhat's ttthat?" "Well, if you must know. I pee like you talk."

Did you know?

Your Social / Charitywork would be of

immense helpto ASI

Reporting charitable activities ASI has come into existence with an objective of doing charitable activities also, besides protecting the interest of the member in the field of education etc. As an entity exempted from tax under income tax act 1961 it is obligatory on our part to report the charitable activities to continue to be entitled for such exemption from tax. It is therefore required that the member of each branch report the charitable activities, like free surgeries, free health camps, awareness programs to prevent diseases etc. to the Head office. Such activities to be submitted to the Income tax authorities on yearly basis. In the interest of the ASI all the branches are once again requested to furnish the details of such activities along with the news paper /Magazine published evidences, if any.

Dr.K,C,Dewani organised a free health check up camp in MOCHA tribal area on 18-01-2017.He also organised free camp at Gwarighat, Jabalpur on 14 to 17-01-2017, in which 2050 patients were seen and 300 underwent free cataract surgery.

Dr.Sarbeswar Bora conducted free health camp with a cancer awareness meting at Mirza on 7th Feb2017. About 200 people attended the programHe also organised another free health check up camp at Majuli on 18th February 2017. Majuli, a greatest river island of the world, is in the river Brahmaputra. Majuli is known as cultural headquarter of Assam unfortunately with poor road communication, consisting of mixed population tribal and non tribal. The Assam chapter of the ASI rendered a free health check up, free laboratory examination and free medicine distribution . A public meeting was also organized to make people aware about cancer. A large number of people attended both

“The quality of a person's life is in direct proportion to their commitment to excellence, regardless of their chosen eld of endeavour”-Vince Lombardi

Contd from....P6A Football Coach’s Advice to Surgeons

A s I m o v e c l o s e r t o w a r d retirement, I realize that among the greatest pearls my father gifted me was his rendition of a poem written by a young woman from Tennessee in the 1800s. She was the daughter of a prominent senator who longed to have a son; so much so that Mr. Dromgoole named his daughter, “Will.” She became a prolic writer and poet. Her poem, The Bridge Builder, was rehearsed dozens of times by my dad in our 1971 Volkswagen Beetle on the 15-minute ride home after football practice; at the time, I tired of my dad’s renditions, but now I realize it is the stuff a loving father passes on to a son and for an educator surgeon to pass on to his trainees. It goes something like this:

The Bridge BuilderAn old man going a lone highway

Came at the evening cold and gray To a chasm vast and deep and wide

Through which was owing a sullen tide. The old man crossed in the twilight dimThe sullen stream held no fears for him

But he turned when safe on the other sideAnd built a bridge to span the tide.

“Old man,” cried a fellow pilgrim near“You’re wasting your time in building here

Your journey will end with the closing day

You never again will pass this wayYou have crossed the chasm deep and wideWhy build you this bridge at even-tide?”

The builder lifted his old gray head:“Good friend, in the path I have come,” he said,

“There followeth after me todayA youth whose feet must pass this way.This stream which has been as naught to

me,To that fair-haired youth may pitfall be:He, too, must cross in the twilight dimGood friend, I am building this bridge

For him.”

-Will Allen Dromgoole

Thank you, Dad. I love you and the advice you provided : both in your actions and in your words. Good stuff for football players; good stuff for surgeons. Many thanks to you and to all the other great mentoring fathers out there!

-David R. Farley, Editorial, Journal of Surgical Education • Volume 69/Number 5 • September/October 2012 573 journal of education 2012

Thanks to Dr. Laxman K, Bengaluru for this forward.

Be Expert in your eld

In 1972, Jim Cathcart was working at the Little Rock, Arkansas Housing Authority, making $525 a month, with a new wife and baby at home, no college degree, no past successes, and not much hope for the foreseeable future.One morning, he was sitting in his ofce listening to the radio, to a program called “Our Changing World” by Earl Nightingale, who was known as “the Dean of Personal Motivation.” That day, Nightingale, in his booming voice, said something that would change Jim’s life forever: “If you will spend an extra hour each day in study of your chosen eld, you will be a national expert in that eld in ve years or less.”Jim was stunned, but the more he thought about it the more it made sense. Although he had never given a speech, he had always wanted to help people grow in areas of personal development and motivation. He began his quest to put Nightingale’s theory to the test by reading books and listening to tapes whenever he could. He also started exercising, became better organized, and joined a self-improvement study group. He persisted through weeks of temptations to quit, just by doing a little more each day to further his goal. Within six months he had learned more than he had in his few years of college, and he began to believe he could turn his goal of becoming a motivational speaker into reality. All the hard work, the discipline, and study paid off. Jim now has delivered more than 2,500 speeches worldwide and has won every major award in the speaking industry. -From editor’s collections

The annual conference of was organised on 19th February 2017 by the Surgeons Chhattisgarh Chapter of ASIClubDurg-Bhilai. The venue was CCM medical college, Bhilai, Durg. Organising team Dr C S Kantharaj (Org. Chairman), Dr Manish Khare (org. Secretary) supported by Dr SiddharthTamaskar( GC , ASI), Dr R P Singh (State Chairman) and Dr Rajesh Sinha (State Secretary ) did a great job. The chief guest for the conference was Dr Ashok Chandrakar, Director Medical Education, Chhattisgarh. Guest of honour was Dr S K Mishra National President ASI. He delivered his speech and talked about his vision for the coming years of ASIGuest faculties were Dr Ajay Kriplani, senior consultant laparoscopic and bariatric surgeon from New Delhi and Prof. Arvind Kumar, Director, Robotic and Thoracic Surgery deptt, Sir Ganga Ram Hospital, Delhi. Dr ShaileshSrikhande from TMH Mumbai and Dr Anand Kumar from Hyderabad.The conference was well attended.

The 34th Annual conference of the was held at Guna, on 25-26 February 2017. Dr Shiva K Misra ASI MP ChapterPresident ASI inaugurated the conference, Dr Satish K Shukla Past President ASI was Guest of Honor, Dr Sanjay Jain Hon. Joint Secretary and Dr Achal Gupta Chairman MP Chapter and EC member were present. The first day was dedicated to the Orations and Guest Lectures followed by Gala dinner.

ASI Activities-2017

35th Annual Conference of Karnataka state chapter, was held 10-12 KSCASICON-17,feb2017 at KLE University's centenary convention centre, Jawaharlal Nehru Medical College Belagavi. On the first day we had live operative workshop relayed from KLE hospital includinglaparocopic as well as open surgeries by DrPuntambekar, Dr Ramesh M, Dr B R Patil and DrPrabhal Roy. CME included very informative topics by some of the best faculty of our country. Dr Shiva K Mishra president ASI was the chief guest for the inaugural function held on 10-02-2017. There were orations, symposias, video session and free paper sessions on second and third day.New team was elected during general body meeting held on 11-02-2017. The organising team Dr. S.S. Shimikore, Dr. Manoj D. Togale, Dr. Prashant Hombal supported by local senior staff /officials , state and national EC members did an extremely good job

Maharastra state conference, , was held from 09-02-2016 to 12-02-2016 at MASICON-17SGGS college of engineering Nanded. Dr. P.T. Jamdade was Organising Chairman and Dr. Umesh M. Bhalerao was Organising SecreataryFirst day CME was dedicated to Late.Dr.Shyam Motewar, included Presidential lecture by Dr.A.M.Quraishi, other lectures and symposias.Enodoscopic procedures from Dr.Nageshwar Reddy , Dr.Amit Maydeo and oeprative surgical procedures from Govt Medical college were relayed on second day meant for workshop. The day ended with the inauguration function. Chief guest for the function were Hon.Padmashri.Prakash Baba Amte , Dr.Mrs.Mandakini Amte and Dr,Dilip Mhaisekar (VC,MUHS)On third day and Fourth day various orations (The prestigious G.M.Phadke oration was delivered by Dr.Jaising Shinde, The prestigious K.C.Gharpure oration was delivered by Dr.P.T.Jamdade ) and symposia were the main attractions along with master videos & free paper sessions

“We always hear about the rights of democracy, but the major responsibility of it is participation”.-Wynton Marsalis

ASI Activities-2017

32nd Annual Conference was conducted by from 3-5-02-2017 at BubaneshwarOdissa chapter of ASI

The Association of Surgeons of India, conducted Live ASI Kerala ChapterOperating Workshop on Saturday 25th February 2017 at Muthoot Medical Centre, Kozhenchery. Majaor laparoscopic and open surgical procedures were demonstrated by Dr. Seon Hahn Kim, Dr.C.Palanivelu, Dr Santhosh John Abraham, Dr Praveen Raj and Dr Padmakumar B and other expert faculty. The meeting was inaugurated by former Supreme Court Judge Hon'ble Justice K.T. Thomas.On Sunday 26th February 2017, the conference had various topic Presentations, symposia and free Paper Sessions. The meeting was well attended by surgeons and postgraduates.

Annual State Conference Of was held at Saroj Gupta Cancer Centre and Research Institute , WBASI SASICON 2017Thakurpukur, West Bengal from 24th -26th February 2017.

A live operative workshop was held on 24th February, 2017 was held on 24th February, 2017. On 25th February. On 25th February 2017 a good Scientific Program was held . Orations, many lectures award sessions, debates, master videos and free paper sessions.

AGM was held on 25.02.17 followed by inauguration. Dr. Sashi Panja , Minister of State for Women & Child Welfare and Social Welfare was the Chief Guest and Mr. Shaheb Chatterjee , Film Celebrity and a singer was the Guest of Honour. PG master classes were also conducted. The team led by Dr.Somnath Ghosh, Dr. Gargi Bandyopadhyay did a wonderful job.

“Do not be afraid of making mistakes, but be afraid of making the same mistakes”

Republic Day Celebration at ASI Head QuartersThe Republic Day ag hoisting function was held at our ASI Head quarters on 26th January 2017. Our Honorable President Dr. Shiva K.Misra hoisted the National Tricolour in the august presence of Dr. B. Krishna Rau, Dr. S. Vittal, Dr. Suresh Chandra Hari, Dr. Sathish K. Shukla, Dr. Santhosh John Abraham-all Past President of ASI. Dr. A. Rathnaswami Past ASI National Secretary & Governing Council Member was also present. The function was graced by Dr. J.W. Ebenesh Bensam Honorary Secretary, Dr. CRK. Prasad Honorary Treasurer, Dr. R. Laxmana Sastry Hq. Secretary, Dr. T. Narayana Rao Website Secretary, Dr. Sanjay Jain Jt. Secretary and galaxy of ASI members from Chennai. Entertainment programmes were performed by a school. The Biography of Past President of ASI and father of surgical Gastroenterology Dr. N. Rangabashyam was released by our President Dr. Shiva K. Misra.

A man was granted two wishes by God,He asked for the best drink & the best woman ever. Next moment he got mineral water & Mother Teresa.Moral: BE SPECIFIC!!

There are 3 kinds of men in this world. Some remain single and make wonders happen. Some have girlfriends and see wonders happen.Rest get married and wonder what happened!!!

The rst ever clinical audit was undertaken by Florence Nightingale during the Crimean War of 1853–1855 in Scutari at Medical Barracks hospital in Turkey. Florence was appalled by the unsanitary conditions and high mortality rates among injured or ill soldiers. She and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment, and kept meticulous records of the mortality rates among the hospital patients. Following this change the mortality rates fell from 40% to 2%. Her methodical approach is recognized as one of the earliest programs of outcomes management. -Walshe KMJ. Principles for best practices in clinical audit. Qual Saf Health Care 2002;11(4):392

Did you know?The rst ever clinical audit

was not done bya doctor.

What goes through a surgeon’s mind after a complication

One of the hardest things about being a surgeon is the inevitability of complications. It’s true for any doctor; but with surgery, it’s as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big ones are there for lots of people to see: nurses on the surgical floor or ICU, operating room personnel when you have to re-operate. And of course, the patient. The family. My family, for that matter. Smaller problems might just be between me and the patient; but they still are painful. Carrying the responsibility for having done harm to people who gave me their trust can be nearly too much to bear. Thankfully rare, it’s never been easy. Nor should it be I don’t know the extent that I speak for other surgeons in this matter. I actually believe I took it too hard, and too personally; so what I say (which I’m sort of anxious to find out myself) may be fairly singular. But I got a specific request to tackle the subject, and I think it’s an excellent one. So here goes.There are two cardinal sins, in my estimation, for the general surgeon. The first, the sine qua non of a surgical screwup, is injuring the common bile duct. Nailing the bowel with a suture while closing an abdominal incision is the other. Each tends to bespeak carelessness, and I’m sorry to say I’ve done both. Only once each, thank God, in what I’d conservatively estimate to have been around ten thousand operations (not all, of course, subject to those particular errors.) Actually the cardinal error — more like the pope error — of bile duct injury is to do it and not recognize it at the time. That, I’ve never done. Unrecognized bile duct injury can lead to a tragedy for the patient. If you’re gonna ding it, at least see it at the time and fix it. That usually works out ok.In the community of my first job as a surgeon, each newbie was subjected to a monitoring process in which every other surgeon in town was to scrub with him/her at least once at to render some sort of judgment. So the first time I was able to do a case unmonitored, I had the referring doc assisting me on a very routine gallbladder removal. It was the classic situation for injury: The easy case — when the going is tough, you tend to have all the feelers out for problems.My patient was a tiny woman, with tiny ducts. Her gallbladder had practically no length of duct connecting it to the main bile duct, so I thought I was dissecting the cystic duct (normally much longer, it’s the tube that connects the gallbladder to the common duct), when in fact I was working my way down the common duct. Somewhere along the line, I discovered I’d cut it clean in half. As my heart sank and my hands got clammy with the realization, my forehead and armpits drenched themselves with sweat and I told the referring doc I’d be wanting to get my partner in to help at that point. He was only too happy to vacate. I repaired the duct — among the smallest I’ve ever seen — over a baby-sized T-tube, drained it, and closed up. And for the first time as a real doctor, I had to face my patient and tell her what happened.It’s excruciating. I hate everything about it. There is a very real temptation — to which, even in this age of attorneys under every rock, some people still succumb — to fudge it, not to tell it like it was, to protect oneself. In my case, I think, the urge is motivated less by fear of lawsuit than of confronting my own inadequacy. And the acute awareness that I’m telling a person things will not be as she expected; that her life could be very unpleasant for awhile. It’s not what she signed up for, and it’s my fault. Face to face. You’re screwed. My fault.I doubt I could successfully bullshit a person if I tried. My car got stolen when I was in med school. In the glove box was a small amount of what might be called an herbiferous stimulant. (That it was small and had been in my glove box for months bespeaks the extremely limited use to which it was put.) For what may be the only time in the history of the local police, they found my car, and called me to pick it up at the station. Finding the glovebox contents strewn about the car, I noted it was all there; except for the one item. To the query if anything was missing, I said no. Couple of days later, there were two cops at my door, holding badges at eye level (narcotics boys) and asking for me. Had they just graduated from cop school, had they never seen a guilty person in their lives, they’d have known I was as guilt-ridden as if I were holding a bloody dagger. They displayed (holding it by a string: no fingerprints) the Alka-Seltzer bottle which held the offending material, and asked if I knew what it was.“Well,” I said. “You guys being here and all, I suppose it’s some sort of drug …” Fortunately, they also knew that the car had been stolen and there was no way to pin the contents on me. A stern warning was what I got, as my future career and my father’s wrath passed before my forebrain: the one waning, the other waxing. I’m a lousy liar. (And since then [well, not too long after] a confirmed non-user.)I told my patient truthfully what had happened, but I was not above trying to put it in the best light. Her anatomy was unusual, I explained, with her gallbladder so close to the bile duct that removing it left the duct damaged. True. But passively stated. To my retrospective regret (because it was less than entirely forthcoming), I glossed over the fact that I hadn’t recognized the anatomy until I’d done the damage. I didn’t lie. Yet I didn’t resist the urge to sugar coat it. She was disturbed, but not beside herself: Ultimately she had to put up with a capped-off tube with no drainage for three of months, after which it was gone and she had no further problems. (Being just out of training, I wrote to my professor to ask his advice about how long to leave the tube. In doing so, I said “I was recently called upon to repair a bile duct …” It was not untrue. I hoped he’d assume it was someone else’s injury. He never said otherwise, but he was a very wise man.) It could have been much worse. As to the conversation I’d had with my patient, it’s weighed on me ever since, and it was a long time ago. So many issues are at play in such a situation, it’s hard to enumerate them, let alone fully understand them. I’ll try. The suture thing was quite different: The whole spectrum of terribleness, way worse for everyone. It had been a routine colon operation, and she’d gone home quickly, doing fine, only to come to the emergency a few days later, sick. My clamminess didn’t take over right away, because my first instinct was to try to fool myself, to convince myself it wasn’t what it was …Sid Schwab is a retired surgeon who blogs at Surgeonsblog and is the author of Cutting Remarks: Insights and Recollections of a Surgeon.Source: http://www.kevinmd.com/blog/2014/04/surgeons-mind-complication.html

Collected by : Dr. Sadashivayya S. Soppimath

“Handle every stressful situation like a dog. Pee on it and walk away”