Clinical practice is not the same at all ages. I have seen it assume different dimensions at different stages of my career. Many other things have changed too - the country, the laws, the patients and most certainly me, but the fact that my practice has meant different things to me at different times can not be denied.
Back from overseas, after what can be called a Rolls Royce of training in Microsurgery and Cranio-facial surgery, I was sure to get a University faculty position but destiny had better things in store for me. I started practice in full earnest. I was convinced that I will only do Plastic Surgery. I took pride in the fact that I was the only full time practicing Plastic surgeon in the state of Uttar Pradesh, a state with more population than Europe!
The first phase of my practice was 'phase of consolidation '. This was the time to assure the referring community that I could do anything remotely related to Plastic Surgery. Thus whether it was a replant or a free flap, a head & neck reconstruction or a breast reconstruction, extensive burns, non healing pressure sores, facial fractures, hand injuries or even vesico-vaginal fistula and urethral strictures everything was welcomed. We formed teams and we delivered results on a daily basis. This phase brought with itself two huge benefits - confidence and popularity. I was practicing in three large cities and this phase established me as a Plastic surgeon.
I do not know exactly when the first phase faded out and a new phase started but what I remember is that my practice was now in autopilot and I did not have to ask seniors and colleagues for references any more. This was also the time when I realized for the first time how lucky I was to be acknowledged by my patients as competent and dependable because they were now turning out to be my commonest source of referral. This was also the time when the children were growing up and I was truly working for my livelihood. This was also the time I realized that not only the patients but my family too needs my time.
Circumstances taught me to manage time and for the first time it dawned on me that working from 7 AM to 8.30 PM is not the true test of stamina, but coming back home from work and then taking the family out to dinner is. I will call this second phase 'the phase of earning a living'.
Once again I could not fathom when this second phase phased out and I landed in the most pleasant phase of my practice. Now earning a livelihood was not a high priority agenda anymore. The children had started leaving home and after acquiring requisite escape velocity choosing their own orbit and trajectory. We, I and Neeta, had an empty nest to look after. She chose to switch her practice to an even bigger tertiary level hospital and I am still working from 7 AM to 8.30 PM but now in only one city, Lucknow.
But my practice has changed remarkably. I now pick and choose my patients and liberally pass on the politically and socially volatile ones to my younger colleagues. I honour all referrals, attend to all emergencies but I am gradually settling into a comfort zone. To give you an example, after reading Phillip Blondeel's book on perforator flaps I tried my hand in almost every one of them but today I am a microsurgeon with 5 flaps only, those common five with which I am most comfortable, those which I can perform with almost effortless ease! This is also the phase when I am more available for camps and teaching programmes. I feel I am now practicing with two purposes - helping others and leaving a legacy! All the previous stimulants - fame, money, rewards, allocates have weaned off and only one feeling has survived - challenge, and one feeling has been newly acquired - satisfaction. I will call this 3rd phase of my practice, 'the phase of giving back' and I love this the most.
I now have a lot of time to do what I love most. I read a lot. I write a lot. I interact with my friends and school and medical school batch mates on a regular basis and I travel a lot but surgical work still brings the most satisfaction and brings the best out of me.
After I completed my MBBS in 1979 my father told me that my profession is uniquely blessed because it brings with itself 3 benefits or 'prapti' in Bangla - 'sukh prapti', 'yash prapti' and 'dhan prapti' (satisfaction, fame and money). But he also added a word of caution, the day I forget the sequence, Goddess Saraswati will desert me. Now if I go back to analyse my three phases of practice it is the last stage which is giving me maximum 'sukh prapti'!
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