April 12, 2020
Once a surgeon always a surgeon. Yes, I operated on eyes many moons ago. And the first lesson was when a patient is bleeding, all courtesies are off. Clamp that bleeder right away. Ligate it. Cauterize it. Then you will have all the time to address details later. Save life first. If the patient lives, you will have the leisure for questions and explanations. Save the eye. We will be courteous later. A surgeon sees a world differently. No time for theory if there is an emergency. You need to act. Now.
I did not know then that I would be carrying my lessons from the Operating Room to real life 28 years later. I am not looking for a certificate or some recognition. I never cared much for it anyway. I had a job to do. And I did it.
The patient might feel the pain when you are ligating the artery without anesthesia in an emergency. He might even call you ill-mannered for hurting him or her. But you know in your heart that the real bad manners are to try to sugar-coat it now and make the patient suffer later. And yet, to do it with compassion. With humility. Knowing the sacred vocation, you are entrusted with. Therein might lie the secret.
And so, it is here that I find myself, COVID-IFIED. In Hernando, having lived here for 24 years, making it my home. Our children were born and raised here. We have grown roots and developed deep bonds here. The beautiful people of this community have accepted us and allowed us to thrive. An alien, with Indian accent, strange habits, and idiosyncrasies, love this as his land. That is the miracle of this country.
This is the greatness of its people. They honor ability. They are open, transparent, forgiving, honorable. I know of no other country in the world as spiritual as this. Even more than the land of my birth, India, which I love dearly as my mother.
My wife and I started practicing Medicine in Hernando in 1996. We had a little rinky-dink office next to a hardware store. Two exam rooms. One front office staff. One back office. A cubby-hole of an office. We worked hard putting all our energy and resources into that little practice. I rounded in 6 hospitals across two counties. Saw patients in three offices. Fell asleep in the car while driving. I locked myself out of the car in the hospital parking lot several times. My friend Armbruster used to look at me and laugh with those sparkling blue eyes and say, “Your employer is working you to the bone. But you will never be able to make as much money as I!”
Today, he is no more among us. I think he would have liked what we have tried to create here. We started our HMO, here in the boondocks, Optimum Health Care. Hernando’s first Accountable Care Organization, Integral Health Care. Our first Third Party Administrator, or first IT startup here, with limited resources. We had to scrounge for talent, train medical assistants to take BP properly, teach them coding, and get them certified, try to adjust to the new generation with its timelines and inclinations. We had to find the best talent across the globe so that we could create world-class products here, in Spring Hill, the hinterland. We hired specialists in Australia, in the UK, in Canada, in Malaysia, and, of course, India. We synergized operations across time zones and cultures.
I was made fun of. I was told I was creating “a pie in the sky”. Well the pie is here. For all to see, share, enjoy, partake.
Then came COVID. Perhaps, nothing else needs to be said. We all know and can see the national calamity that is happening as we brace ourselves for our surge. Pearl Harbor II.
And there is only one thing I know when I spot a bleeder. To clamp and stop the hemorrhage. It is not easy. This is not the time to walk on eggshells. As I ligate, I know many lives are affected. So many, who for no fault of their own will now be asked to sit out while we try our best to save the patient.
I know I have only one responsibility. Our patients. The rest all is secondary. And the only means we have to serve them is our most precious asset. Our caregivers, our doctors, advanced practitioners, our nurses, medical assistants. Our goal is to preserve them, to ride out this storm that may last 3 to 4 months if not more. We need to do this without the need for understanding or appreciation. Without seeking consideration. But with utmost humility and empathy.
There will be time later to critique and learn from this firefighting. Our doctors and nurses are risking their lives in the frontline and exposing themselves and their loved ones to possible contagion or death. Yet, they have marched on as loyal soldiers, knowing their adherence to only one thing. Their sacred calling. That of serving our patients without relief.
Hospitals are going bankrupt. Specialists are hurting as no electives are allowed. Hospitals are working at less than half the usual volume and are taking lines of credit to survive. In these times and conditions, I am humbled. That we are called to bear this enormous weight on our shoulders.
I know we will rise, Phoenix-like, from these ashes. With a lot of prayers and Divine blessings, we will overcome this too, stronger, more unified, and truly prosperous. We will do a hundred start-ups and HMOs and ACOs. And we will take care of many more families and community members as our contribution to these great people that have given us everything.
But first things first. We need to live. Survive another day. Hunker down and marshal all our resources. Be as tough as nails and yet gentle as a bloom.
In times of war, etiquette can be eschewed. But how to do so when your only weapon is compassion and empathy? That is our challenge today. To be able to take the hardest decisions but keep our heart soft and alive. And that is my invocation. That we all rise to the challenge and face this travail together, no matter what happens. No matter how hard it is.
But first. We need to live.
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