Dr. Kumar was born in Kerala, grew up in Tamilnadu, graduated from Tamilnadu, post graduate from Karnataka and landed in UK shores in late 1999. He has just completed a six month job in Accident and Emergency. He was heading for a University town to start training in cardiothoracic surgery. The most difficult part of UK life as a junior doctor is the need to move from place to place. If you were a UK graduate or if you are a lucky International graduate or more importantly if you are an exceptional International graduate than your life in UK can be smooth because you will land a rotation in your preferred specialty and do not have to keep moving jobs and home every six months. Unfortunately Dr. Kumar was an international graduate who was neither outstanding nor lucky. So Dr. Kumar followed a trajectory that some of his lot follow in the career circus of NHS over many decades. We just have to satisfy ourselves with left overs.
Kumar however did not know that this is what will happen to him in Aug 2000. He believed he was good enough and luck had nothing to do with career progress. He was too excited about joining a premier cardiothoracic unit and an University teaching hospital in the oldest and certainly the most prestigious University in the world( apologies to Cambridge, Harward, Nalanda etc). He was joining in the lowest medical tier- Senior house officer in Cardiothoracic surgery. For people not used to the NHS training systems this is a job where you are the dogsbody of everybody in the department. You are essentially this automaton who answers only questions specifically targeted at you, you clerk all preoperative patients, you do your 24 hour on calls every few days, you will ensure the post operative patients are progressing in the right fashion and ready for discharge, you prepare their discharge summary on time and anything else that can make the life of your registrar and consultant smooth. In return for this you might occasionally get the privilege of entering the operating theatre to help with harvesting the vein and help close the sternotomy and thoracotomy.
Kumar was completely unprepared for this chastening experience. He was a qualified surgeon from India who has done the above shitty jobs as a first year resident in surgery in 1996 and had progressed on to being a respected and valued member of the surgical team during his final year as a post graduate resident in surgery. But that does not count here because "United Kingdom" does not recognise any of your overseas experience, unless you are from a "white country". Kumar had nobody else to complain other than himself. He chose to come here in spite of knowing about the discriminatory nature of "United Kingdom". Anyhow the first three months was a difficult experience and Kumar found it difficult to adjust to the the new environment. His main supporters were a remarkable "you can do it"Naik from Kerala and an ultra suave Srilankan "James bondesque" Ratnatunga. He could not have survived the job if not for the support of these two individuals. He was also well looked after by a Bengali Brain box Poirot like man, another brain box from Greece and finally a good friend in Nambiar who looked at Kumar as his own brother.
The department had five cardiothoracic thoracic surgeons those days. Each was an icon in his own way. There was one surgeon who was supposedly the youngest cardiothoracic surgeon in UK when he was appointed many decades back. He showed Kumar that it is not all about reaching a destination quickly. There was a swashbuckling all singing all dancing superstar in Westaby. He was not the most popular person amongst the team and it can be a bit difficult to get his attention because his enormous head and ego came in the way of any meaningful discussion. However Kumar thought he was a pure genius and his ability to think outside the box was legendary. He is a prime example of an extra ordinary genius being under utilised in the NHS. He can still remember Westaby's patient with the Jorvik mechanical heart device who was in the intensive care unit during his first night on call. He was clearly told that if there is anything to do with that patient he should NOT get involved and should instead immediately call the big boss himself.
Kumar's favourite surgeon was a Rajinikanth like Ravi, who was considered the best trainee ever under the great Mr. Yacoub. There were a lot of rumours flying around the department during this time about this fine gentleman and it made Kumar realise that as you rise higher you have to be more wary of un savoury individuals who will want to pull you down. Ravi rose through those difficult times like a phoenix. His surgical skill and decision making was unparalleled and even the great Westaby probably secretly prayed he could be like Ravi. The most quirky and misunderstood surgeon was a little Scottish man who even after a year kept calling Kumar 'Gupta'. It is possible that was the only Indian name this little genius had time for in his incredible brain. He had the right idea when it came to coronary re-vascularization, he had all the right data to support his decision making, his only handicap if any was he was not as supremely skilled as a Ravi or a Westaby. Finally to Kumar's own super hero Ratnatunga- not the illustrious Srilankan cricketer but the James bondesque Cardiothoraic surgeon. Ratnatunga would never make any extravagant claims to be the supreme surgeon or the greatest intellect but to me he was the overall package when it came to be a complete adult cardiothoracic surgeon and a well balanced human being. He was also the only person in the department with the right interpersonal and communication skills to lead what can be a very difficult bunch of supremely talented human beings.
Towards the middle of Kumar's first six months in the unit, he called for a meeting with the Ratnatunga. The senior house officer team came up with a variety of suggestions which would make the lower most tier part of the team and contribute more effectively to the team. The changes were sanctioned, a couple of Kumar's colleagues choose to stay on for a further six months. They were joined by four newer members in the SHO tier in Feb 2001. By the spring of 2001 the cardiothoracic anaesthetic team which worked closely with the surgeons made an open statement at a departmental meeting that they were the best ever team of senior house officers seen at the unit for a long time. Kumar felt the praise was justified because they were truly performing at the most optimum level. Soon it was time to leave Oxford because Kumar felt that he needed the experience at a different cardio-thoracic unit. Somewhere where transplantation programme was going on. This is what brought Kumar to Manchester on the first occasion and that is where Kumar fell out of love with cardio-thoracic surgery. More about that in the next blog.
Picture below shows a book published by the iconic Westaby.
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