Thursday, October 25, 2007

The head bone is connected to the neck bone…

This past two weeks I’ve been going to Sarodev Orthopedic Surgical Hospital run by the Dr. Haresh Ratanpal, a very good friend of Samir Mama. Dr. Ratanpal is a quite friendly and intelligent gentleman who is a fount of information, orthopedic or otherwise. It has been great fun to talk with him not just about his experiences in his 15 years of practice, but also the human aspect of practicing medicine. He also maintains a very friendly relationship with his patients, one reason being that his patients will often remember his instructions better if they are given as a joke rather than an order.

Dr. Ratanpal was one of the first orthopedic surgeons in India to become qualified to do laparoscopic spine surgery after training in the US with some of pioneers in the field. He also came to the US for training in joint replacement surgeries, which he continues to perform at his hospital in Kandivali. During his OPD, as Dr. Ratanpal is examining his patients, he also explains to me what symptoms he looks for in his clinical exams and how he comes to a diagnosis about his patient’s condition. I’ve learned quite a bit, like how to differentiate the symptoms of rheumatoid arthritis from osteoarthritis, or how to determine if the back pain is neurogenic, muscular, or skeletal in nature.

The most common symptoms his patients present with are back and neck pains, also known as PC syndrome because they are usually office workers who have to sit in front of a computer for several hours every day. The treatments are often quite simple, first relieve the pain with pain relievers and muscle relaxants, and then prevent future pain through physiotherapy and posture adjustment.

I also got to see Dr. Ratanpal perform a couple of internal fixation operations. One was on a mother who received a compound fracture of her tibia when a delivery boy hit her with his bike as she got down from a rickshaw. Using screws and a surgical steel plate Dr. Ratanpal properly realigned the bone with no complications, which was great for the mother since her daughter was getting engaged that weekend.

The other operation was much more difficult, with the patient being an 86 year-old woman with a fracture in the neck of the femur that also extended down to the shaft of the bone. She had further complications of anemia and diabetes, and the hip fracture had left her completely immobilized. If the fracture was not repaired then she would never be able to get out of bed. The operation began well, but as Dr. Ratanpal began to screw in the plate, the brittle bone began to chip badly. Eventually he and the doctor assisting him were able to get a good fixation, but it will still be at least two months before she’ll be able to get out of bed.

Orthopedic operations are a quite an experience compared to the other surgeries I’ve seen, with the OT often resembling a mechanic’s workshop. My anatomy professor once told me that orthopedic surgeons operate with a tool belt, and he is quite right. In addition to the scalpels, forceps, and clamps used by all surgeons, Dr. Ratanpal’s bench had a variety of screwdrivers, pliers, wire cutters, and of course a drill. If you only looked at the doctors’ hands and not at the patient on the table, you could almost believe it was a machine they were repairing and not a human being.

1 comment:

Sapana said...

So what do you think? Still keen to don a belt and go into orthopedics? Has this experience helped you narrow down what you'd like to pursue, or does it all look fascinating?