Monthly Archives: Jan 2008

The Impact of a Vision

Last night I was very tired. Not just physically tired, but mentally exhausted, emotionally weary.

But I couldn’t sleep. For an hour, I tossed and turned, tortured by a haunting question:

Is It Worth Sticking With This?

For the first time in over 10 years the question hit me with force and persistence. I kept contrasting ‘what might have been’ with ‘what is’.

I could have chosen ease and comfort instead of struggle and frustration.

I could have been an adult heart surgeon instead of opting for the more demanding and delicate choice of treating sick children.

I could have joined the staff of a corporate hospital, enjoyed a steady and substantial paycheck, and made the occasional donation to charity. Instead I chose to try and build a structure that would be centered around charity and use creative ways to get funded.

I could have turned a blind eye to the financial problems faced by most families who had kids with heart defects and delivered my services to the 5% who could afford treatment. Instead I went about finding a solution, raising funds from various efforts.

I could have enjoyed a career built around academic achievement, professional recognition and surrounded by a network of peers who are admired and respected. Instead I opened myself to criticism and even ridicule by getting involved in online selling and writing ebooks.

I could have made stature and status my primary goals. Instead I answer questions that ask how I am different from the slew of scammers and con artists that rip off gullible victims on the Internet.

Suddenly, I’m tired of it all!

  • Tired that progress is so slow.
  • Tired of feeling like I’m always holding out a ‘begging bowl’ for contributions.
  • Tired of having to ‘defend’ what I’m doing – because it’s so counter-intuitive.
  • Tired of the risk that a decade’s hard work and goodwill could easily be destroyed – by gossip and innuendo.
  • Tired of being perceived as being ‘less of a doctor’ than someone who spends all day in a clinic or hospital.

After restlessly agonizing over these realizations, I must have dropped into a slumber.

When I awoke early this morning, the first words that came to mind were ones I had heard spoken by an accountant at a fundraising workshop for non-profits that I had attended a few years back.

He said:

“When I look at the rows and columns of figures on a spreadsheet, I do NOT see numbers… I see the faces of the children I am working to help!”

What a powerful vision! To see the purpose of your work in the day to day drudgery that makes a dream come true.

My sub-conscious must have dragged that vision statement out from the cob-webbed attic of my mind, presenting it as the inspiration and encouragement I needed to get up and going today – and for as many days as it takes to achieve my ambitious goals.

All of a sudden, I’m not so tired any more!
 What’s your vision?


How Can a Heart Surgeon Blog for Influence?

Today, I’d like to tell you a story.

It takes you behind the scenes of a heart operation, reveals a secret and teaches a powerful lesson in the end.

It’s a story about a little boy. He’s 7 years old. He had a heart birth defect.

Ranjith lives in a little village. His father is a farmer. He was diagnosed with his medical condition many years ago. Because the expense of treatment was high, nothing was done about it.

Until a social worker told the family about a charity that could help the little boy.

The family travelled over 300 miles to our out-patient clinic. Our team of doctors examined the boy, reviewed his medical reports and ran some tests. They confirmed the diagnosis. Surgery was necessary to fix his heart.

I spoke to the family. Explained everything about his proposed surgery, the risks and benefits of having the defect repaired, the long term consequences and precautions needed… and then answered all questions the anxious parents had.

We talked about the cost of the operation, and what limited financial resources Ranjith’s family had. After learning about the role generous donors halfway across the world would play in their son’s treatment, both parents left the room teary-eyed after scheduling a date for the operation.

Over the following days, complex logistics of organizing the schedules of many team members, ordering an array of disposable materials to be used in the operation, and arranging for operation theater personnel and supplies kept everyone busy.

Open heart surgery requires blood to be banked against emergencies that may make transfusion necessary, and that is a completely distinct set of activities to be co-ordinated. Ranjith also needed to be reviewed by medical specialists like a neurologist, pediatrician, physiotherapist and anesthesiologist.

On the day before surgery, Ranjith was admitted as an in-patient and a detailed medical record was prepared. All his lab tests were recorded on his case sheet. A complete medical history was taken and physical exam repeated. All investigations were reviewed, so that anything missing could be repeated.

Every piece of sensitive electronic equipment was tested to ensure perfect functioning. Nurses ran down a checklist containing around 150 items – a series of actions that contribute towards the safe performance of a complicated operation. It’s similar to preparing a jet airliner for take-off! This potentially stressful procedure is made streamlined by repetition and having a system to follow.

In the operating room…

Sterility of a high order is necessary for heart surgery and the operating room is sparkling clean and carefully disinfected the night before.

The cardiac surgical operating room becomes a beehive of activity a good hour before the actual time of surgery.

Racks of drugs, syringes, tubing, catheters and cannulae line the walls. Disposable material for use during the operation pile up on the trolleys like mini-mountains. Sheets, drapes and sterile gowns are in their bins.

Heavy machines are wheeled into the theater. The heart-and-lung machine which will take over the work of Ranjith’s vital organs during the conduct of the operation takes center stage.

Heat exchangers to warm and cool the blood that circulates during surgery, ventilators and anesthesia apparatus that will keep the patient ‘under’ and pain-free, and surgical equipment like a sternal saw and diathermy are also brought in.

The preparation of the operating suite is the joint responsibility of the OR manager and head nurse. Together these highly skilled specialists perform a job that is by and large overlooked when you think about heart surgery – but critically important to the safe conduct of the procedure.

Ranjith enters the OR…

At the scheduled time, a nicely sedated and drowsily smiling Ranjith is wheeled into the room. The anesthesiologist takes over. Deftly slipping a needle into a vein in his forearm, he gives the little boy an anesthetic. Within seconds, Ranjith is deeply asleep, his pain centers totally numbed, all muscles paralyzed into a relaxed stupor.

A tube is slipped down his windpipe and hooked to the ventilator. The machine will now ‘breathe’ for him until the operation is over.

Lines are inserted into his artery (to monitor blood pressure) and neck (to measure central venous pressure). Electrodes hooked up to his arms and legs will display his heart’s activity on the EKC monitor. Another probe will tell the medical team how well his blood is saturated with oxygen.

In half an hour, the patient is ready for the surgeons to begin operating. The chest is prepped and draped with layers of clean sheets. A transparent adhesive is applied to the site of the incision. The three surgeons – myself in charge – bend over the patient. Surgery will begin.

A sharp, smooth stroke of the scalpel down the middle of his chest. A buzz as the electric saw separates the breast bone, exposing the shiny pink pericardium – a bag that surrounds and protects the heart. Scissors make a neat cut in the bag, and the throbbing, pulsing heart comes into view.

Ranjith’s heart is swollen almost to twice the normal size because of a hole in the walls between his upper chambers (atrial septal defect). Working in practiced unison, the three of us slip tubes (cannulae) into the main artery and veins of the heart and hook the little boy to the heart-and-lung machine.

“Let’s go on bypass”

My command is the cue our perfusionist has been waiting for. He turns on the machine that will become Ranjith’s heart and lungs for the next hour or so while the operation is carried out.

This is a critical and tense period, as hundreds of things could potentially go wrong.

“Everything’s fine. We’re on full bypass.”

The reassuring words from the perfusionist is the signal to proceed with the operation. The heart is stopped. The right atrium is opened. A large hole comes into view. It will need a patch to be sewn into the gap to seal off the abnormal opening.

With swift strokes the repair is completed in 10 minutes. After the atrium is sewn closed, the heart-and-lung machine is gradually turned off, leaving Ranjith’s new heart to take on once more the burden of pumping blood to his body.

The tubes inserted into his blood vessels are removed. All areas are carefully inspected for any bleeding. Layer by layer, his chest is closed and a clean, white dressing applied to his chest.

Open heart surgery is over. Ranjith’s atrial septal defect has been closed. A delicate, complicated maneuver involving a multi-disciplinary team of highly skilled and experienced specialists has successfully come to an end.

What’s amazing is that the entire operation, one that involves tens of man-years of training and preparation and practice to learn and master, took just an hour and a half to perform!

Leaving the recovering patient in the able hands of our anesthesiologist, the surgeons take a refreshing break. I talk to the family, explaining how the operation went, and reinforcing the sequence that we will follow over the next week as Ranjith recovers in hospital.

The Intensive Care Unit and beyond… 

Some time later, the little boy drowsily smiles up at his relieved parents as he is wheeled into the intensive care unit where he will be closely monitored for the next 24 to 48 hours by a team of personnel including an ICU nurse and a cardiac surgeon.

For a week, Ranjith stayed in hospital. Gradually he recovered from the extensive procedure carried out to repair his heart defect. Tubes and catheters were removed. He got out of bed the next day, and was walking around the room a day later.

Every morning, I visited him to check on progress. It never ceases to amaze me how quickly kids bounce back from a procedure that would leave most adults bed-ridden and groaning for weeks! It’s also why I LOVE pediatric cardiac surgery.

8 days from the date of his operation, I wave goodbye to Ranjith as he returns home. His scintillating smile is my biggest reward for all the intense, tiring and sometimes frustrating effort that went into making this whole thing possible.

What has this story got to do with my blogging for influence?

Nothing. And yet, everything.

Some people have wondered how I find the time to do all that I manage online while being a heart surgeon. Some ask if I really AM a heart surgeon! And others can’t figure out WHY I do it.

Many people have an imaginary concept about heart surgery that’s based on fiction and TV serials – and some personal experience with friends, relatives or contacts who are (or know) heart surgeons.

Did you notice that some bits of this post are in a different color? Wonder why? It’s because they refer to the only bits of the process where my personal involvement is required. Yes, I do not need to be around for the rest!

How is that possible?

Just the same way a business is managed. By letting other people have their clearly defined roles. Being responsible for them. It leaves me to handle one part of the process – while having to only oversee and co-ordinate the rest.

  • I can’t do heart surgery without my team.

  • And I can’t fund heart surgery without my donors (and that’s the reason WHY I bother doing all these things on the Web, incidentally!).
  • I also can’t manage my online business without automation and virtual assistants.

Yet, because of them, I can handle so many more things than I can do all on my own. By myself. As a solo-preneur.

That’s the lesson.

Manage your business or your hobby or your life in a way that it doesn’t overwhelm, consume and drown you in work and responsibility.

Delegate bits and pieces. Outsource some. Automate others. Manage the process, not the individual minor parts.

The trite aphorism is true. When you want something done, give it to a busy person.

The busy person KNOWS how to get things done – efficiently, and more important, effectively.

The busy person does not need to hang around all the time micro-managing.

The busy person does more – and takes more time off to relax, enjoy life and do meaningful things.

Be a BUSY person.

It’s fun.

It also leaves you with more than enough time to do other things that you love and enjoy!


Lessons from Barack Obama

Barack Obama won the Iowa caucus. He delivered a ‘Victory Speech’.

Ignore the politics, if you wish (as an Indian, they matter little to me). But listen to the message.

It’s a powerful message of hope, and applies to many people and things far beyond boundaries of nationality, creed or political beliefs.

These are words that influence and empower.

You can watch the video on YouTube here.

The part I liked best, which seemed just as relevant to my work with congenital heart defects, was this:

 Hope is not blind optimism. It’s not ignoring the enormity of the task ahead, or the roadblocks that stand in our path. It’s not sitting on the sidelines or shirking from a fight.

Hope is that thing inside us that insists, despite all the evidence to the contrary, that something better awaits us if we have the courage to reach for it, and to work for it, and to fight for it.

Hope is the bedrock of this nation. The belief that our destiny will not be written for us, but by us. By all those men and women who are not content to settle for the world as it is. Who have the courage to remake the world as it should be.

Together, ordinary people can do extra-ordinary things.

Words with influence.

Spoken by a man with influence.