Sunday, May 28, 2017

Operation Theatre: The Life and Times of Dr. Subhash Munje


Reproducing this dated piece on the request of a few close friends. Hemant, Sai and Akhilesh - this one's for you:


Dr. Subhash Munje, renowned surgeon and stanch humanitarian, firmly believed in sharing his life stories to the tee. Insight or indecision, accomplishment or astonishment, delight or disappointment; he was keen to lay open his mixed bag of experiences for public dissection. A film on his life will go a long way in restoring the credibility of the medical profession in the guiding light of Dr. Munje’s example.

Dr. Munje’s memoir “Behind the Mask”, an honest and humorous account of his umpteen surgical trials and triumphs in the course of his momentous but largely unsung career – a great window into the mind of a sensitive surgeon who breathes the patient’s sigh of relief every time his treatment works and feels deeply wounded each time he falls short.

Dr. Munje narrates such diverse tales – real-life stories of human courage and conviction, frailties and failures, insecurities and inhibitions – that both enrich and endanger the medical profession in copious ways.

Dr. Munje began his career at age 26, as the youngest civil surgeon of Alibaug near Mumbai. This place in the 60-70 decade was bereft of electricity to safeguard the world’s purest magnetic observatory situated in this sleepy beach town. Unfortunately, the global distinction came at the cost of the general public welfare and community development as the town was left groping in the dark while most of its neighboring regions basked in the glory of lights.

So, Dr. Munje had to operate aided by his hunting light in a deprived district hospital equipped with 12 beds and only two medical officers. Needless to say, he played multiple roles in catering to diverse situations – surgeon, physician, obstetrician, gynecologist, pediatrician, ophthalmologist and even psychiatrist. Had Dr. Munje been in the US, his chronicles would have traveled far and wide as glittering case studies of innovation amidst abject deprivation but here he was in far-flung Alibaug, far-away from the mainstream, oblivious from the glamour of sprawling labs and spacious hospitals and yet, neck deep in the flowing stream of every-day strife that he took by its horns. His manifold trials and tribulations would make the best of surgeons gasp for breath. Let’s take a look at a few:

• The insecure outgoing Civil Surgeon of Alibaug, the one preceding him, had the impudence to mislead unsuspecting patients with a ridiculous assertion (Dr. Munje is only an MS, I am an MBBS) and worse, once he recklessly went ahead with the draining of an abscess only to please his bloated ego. The abscess was a rare case of aneurysm of the Aorta and he was forewarned by Dr. Munje against the drain for the potential blood deluge it would cause (which did happen in full force)

• Dr. Munje successfully managed a surgery of acute appendicitis on a furiously swaying makeshift operating table. Reason? The patient was a notorious sea pirate and the surgery happened at gun point in a rocking boat floating in the middle of the sea.

• On one occasion, he faced a queer request, a tempting surgical challenge, but one he downright refused for ethical reasons. The request was to make yet another invisible “pocket” in the inside of a person’s thighs to help smuggle diamonds. Dr. Munje however was all praise for the dexterity of the anonymous surgeon who had made the first pocket leaving only a thin 1-inch scar that invariably escaped the custom guys’ attention. Just because the surgeon was no more, the designer task had been “referred” to Dr. Munje.

• Guided by his impressive track record of quite a few thoracotomies in the district hospital, the incredible doctor performed a phenomenal surgery for the widening of a narrow heart valve on a complex case of Mitral Stenosis, on a patient with Situs Inversus (major visceral organs mirrored from their normal position). In hindsight, he admits it was a risky proposition at a small place like Alibaug. This feat won the admiration of India’s best known cardiologist who was vacationing in Alibaug at the same time. He was intrigued by the blood packs in his Alibaug-bound motor launch and decided to discreetly observe the “village surgeon” in action. Thrilled with what he saw, he offered Dr. Munje a lifetime opportunity to join his privileged team in Mumbai. No doubt, Dr. Munje would have scaled new heights with specialized training in cardiovascular surgery but he decided to stay put in Alibaug. The glorious sense of achievement amidst all the adversity was more precious than any professional recognition.

• Once he traveled all the way to Murud fighting rain and thunderstorm to attend to a bleeding pregnancy crisis but even before he could go about his job, the patient expired. For the sake of an old woman visibly frantic about the child in the womb, he decided to examine the dead body and actually felt a foetal movement. In a miraculous development, he delivered a badly asphyxiated but revivable child through a postmortem cesarean – a girl child after seven boys – who was named after the mother and grew up into a healthy woman and mother of three children herself.

• In one chapter titled “A dose of his own medicine” he recounts his own horrifying first-hand experience of awareness in anesthesia, having woken up in the midst of a routine operation to find him paralyzed, yet aware of every single surgical procedure from incision to retraction to dissection. It was only a miracle that he survived that near-death experience – akin to a blaze of spiritual enlightenment.

There are so many such instances – unbelievable but true - but the most astonishing feature a drunken ward boy called Mr. Sandey who regularly helped the doctor with such ingenious “Eureka” remedies that would find no mention in medical journals but they worked wonders when all medical possibilities had come to a screeching halt.

Here’s an account of one such Sandey solution:

A seven-month pregnant woman was attacked by a wayward bull causing a goring abdomen injury. The wound had perforated the abdominal wall exposing not only the intestinal loop and the protective abdominal fat (called omentum) but also the uterus which clearly showed the baby’s protruding forearm. Dr. Munje successfully opened the abdomen and fixed all injuries save for the baby’s hand. Even as desperate thoughts like amputation or a forced delivery crossed the doctor’s mind, our Mr. Sandey suggested a mild shock with a red hot needle. The suggestion seemed outrageous but Dr. Munje decided to pursue it. Heating an injection needle on a burning spirit swab, he placed it on the hand – and wonder of wonders, the child instinctively pulled its hand back. The birth two months later was perfectly normal and more important the hand had no tell-tale signs of the pre-birth mishap. And Dr. Munje had no qualms in unconditionally accepting Sanday’s genius as also proclaiming him as his most trusted advisor. Quick to express gratitude wherever it was due, he never sought attention or did his own promotion. Else, his world record of performing as many as 400 Tubal Ligations in a small village called Ainpur (that found mention in the London Times) could have easily entered the Guinness Book of World Records.

In the concluding chapter, Dr. Munje reminds us of Hippocrates, father of medicine, who remarked “I would like to know what sort of person has the disease rather than what sort of disease the person has”.

In the pursuit of medical advancement like genetic engineering, heart and kidney transplants, coronary bypasses and laser angioplasties, Dr. Munje laments, we have lost track of the human mind. Corporate entities have turned modalities like C T Scan, MRI, Sonography and nuclear studies into a profitable business. Doctors, he reflects, don’t feel the need to strike conversation with the patient any more. The diagnostic tools, which are only for the sake of confirming diagnosis, dictate the treatment instead.

In one instance, a patient was advised surgery for suspected cancer following a CT Scan which revealed a doubtful shadow in one of the nasal sinuses. Overcome with grief and stress, the patient had lost considerable weight which was linked back to the suspected cancer. When Dr. Munje examined him, he found the patient’s uncontrollable diabetes pointing towards diabetic neuropathy. The patient was taken into confidence and treated for diabetes. He had a full recovery in good time.

Despite his single-handed humanitarian work in remote areas, Dr. Munje was never adequately recognized by the government. Worse, he was repeatedly victimized and cornered by the powers-that-be – by peers and adversaries alike. Thanks to the supremacy of his conviction, he emerged unscathed every single time. And amidst all the strife, he never lost his zest for life. A wildlife enthusiast, he was fond of pets and as the pages of the book reveal, lover of poetry and shayari too. His striking sense of humour makes him a P L Deshpande among surgeons. He narrates many jokes and anecdotes in the book including this one popular in medical circles on the needless but rampant ordeals like Appendectomy: “A pretty nurse was called Appendix. Why? Because every surgeon wanted to take her out”

Whether at Alibaug or later at Thane, the doctor continued his practice largely on the goodwill he generated from his good work. Donations poured in from grateful patients but the doctor ensured they were always in kind – whether x-ray machines, refrigerators, cots, lockers, stretchers or even linen. In this context, Dr. Munje narrates one telling incident which reflects the sorry governmental practices in the name of rules and regulations. At some juncture, he had some of the worn-out instruments replaced with genuine stainless steel ones to sustain the hard water and sea shore proximity of Alibaug. Since the purchase exceeded the Government rate contract, he was questioned for the “exorbitant” expenditure. (He was never congratulated for the good work) Dr. Munje silenced the nuisance makers with some irrefutable logic “If you were to be operated yourself, which instrument would you prefer?” Obviously, there was no answer from the other side.

Dr. Munje’s will and skill in establishing a candid dialogue with his patients as also his unwavering commitment to the larger cause of medicine is a life lesson particularly for those medical professionals who choose to play safe at the cost of human life, and who treat their fraternity as nothing more than an elite club of the chosen few, consciously placed way above the reach and comprehension of the common people.

To put his profession in perspective in his own words “Surgery is a performing art, just like music, dance and stagecraft. But there are no retakes or replays. And as much an art, it’s a science and sacrament too.”

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