The Story of a Heart Operation
in the Distant Past in a Distant Land

From Upper Toddman the Operation Theatre was just a few minutes‘ walk away, but on that day in October 1978 the passage seemed to be interminably long as Kiran’s cot was being wheeled out by a student nurse and an attendant.  From Upper Toddman ward we passed through a long corridor to reach an outer bay, took a turn to the right and went further ahead, got into a lift to take a short flight to the next floor and then continued the journey, in ominous silence, to the theatre complex at the far end of the passage.

As they slowed down in front of the outer door of the theatre, a matronly nurse in green overall came out to see the patient and ensure that the patient and the records matched.  She examined the identification wrist band worn by Kiran and checked the hospital records brought along by the student nurse.  She found everything in order and started to slowly wheel the cot into the theatre.

She then looked at me and benignly said; ‘Mr. Nayar, you may kiss  him now, if you want.’

Her words hit me like a bolt as all my preparations of the last nine months and the steely resolve and strength of mind I had nurtured all long had not readied me for this moment.  Suddenly I found myself face to face with a possibility I had not considered, deliberately perhaps, all these months.  The possibility of my son not coming out alive from the operation theatre in a hospital in the distant land of Australia, thousands of miles away from my home town of Trivandrum, Kerala.

As in a trance I bent down and gently kissed Kiran on his forehead.  And as though waiting for it, Kiran woke up from the sedative induced slumber and looked at me in an indolent, pensive manner.  Still looking at me that way he gradually disappeared into the theatre as the automatic doors closed in.

What was he trying to convey  through that look?  Was it a final ‘Goodbye, Father, ‘ or a comforting ‘Don’t worry, Father, I will come back.’

I couldn’t bear it any longer.  As the theatre doors closed all the pent up emotions that I had been stifling  all along suddenly gave way like a dam burst.  And I broke into tears, sobbing uncontrollably.

The student nurse, nearly half my age, rushed to me and held me close, saying ‘Don’t cry, Mr. Nayar, your son will be all right, your son will be all right,’ I was embarrassed  by my display of emotions, but however much I tried I could not regain my composure.  I felt weak, exhausted, drained. Unable to take  even a single step.

Dr. John Tharian, a Malayalee surgeon in the team of Prof Tim Cartmill who was going to perform the complex open heart operation on my son, saw me then and came to me.  He guided me to a nearby waiting room and seated me, saying everything was going to be fine.  He asked me to wait in the parents’ room near Upper Toddman where Dr. Cartmill would come after the operation to brief me on the outcome.

The student nurse remained with me throughout, trying to console me with a long narrative of the trauma she had felt when her own infant son had to undergo a major operation.
                   
Some time later when I found myself capable of walking, she accompanied me to the waiting room near my son’s ward.

Kiran’s was the second operation scheduled for the day, the first being that of seven year old Robert from Sydney itself. His parents were in the waiting room, their  faces revealing the immense relief in knowing that the operation was a success.  The surgeon had met them and talked to them and they were waiting for the child to be brought to the ward.

For me it was a wait for another three to four hours.  A time for intense, heart-felt prayers.  A time, also, when memories came flooding in.

~*~

Kiran, born on April 6, 1970, was six months old when the first signs of his heart ailment were detected.  He had a fever and was taken to a local homoeopath, Dr. K V John.  The doctor examined the infant and casually asked us whether there was anything wrong with his heart.  For my wife Radhakkutty and me it was literally  a bombshell.  Tense, agitated and with hearts throbbing we said we were not aware of any problem and asked him if there indeed was anything wrong.

Dr. John tried to pacify us saying there was probably nothing to worry about.  The child’s heart beat was a little fast.  “May be it is due to  the fever and will become normal once the fever is gone.”

But the shock that the doctor gave us did not go.  When the fever subsided we took Kiran to a noted paediatrician, Dr. T.P John, of the S A T Hospital, a leading government hospital at Trivandrum.  Dr. John  confirmed our worst fears and said there was some problem with the heart.  But he asked us not to worry as most such irregularities of the heart were surgically or otherwise correctable.

On his suggestion we took Kiran to Dr.K P Chandrasekharan, a well known physician who used to attend the paediatric cardiology clinic of the hospital once a week. Dr Chadrasekharan,a very good physician who was excellent in diagnosis, was reputed to have a foul tongue and fouler disposition.  He lived up to his reputation when he told me  and Radhakkutty, casually and callously: “If you want the child to live take it to Vellore or some other good hospital for surgery immediately.”  He did not tell us what was the problem with Kiran.  “I will tell Dr. John what is wrong.”

Radhakkutty was inconsolable. When we were alone she wept bitterly and asked what she had done to deserve such a fate.  Her world had come crashing down and there was only a feeling of desolation.

Our only source of hope then was Dr G Vijayaraghavan, Cardiologist,  who reassuringly told us that there was nothing to worry at all  and that the child need not be taken for any surgery at this tender age.  Such operations could definitely wait till the child was seven or eight.  The only thing for us to do till then was to ensure that every illness that the child had was promptly treated with antibiotics.

As it was decided to wait till Kiran was seven or eight for the operation, all that we could do was to see that he did not get an infection and that he had an otherwise normal and healthy growth.

But our wishes were belied when it became increasingly evident that the condition of the heart had seriously affected his growth pattern.  He was not a blue baby, but he was lean and was easily given to fatigue.  He grew up to be a handsome boy, but emaciated.  And even when he was in the first year of his kindergarten school, he had to be carried most of the time as walking even short distances became arduous.

In 1977, when Kiran was seven, I fixed up an appointment with the head of the Cardio-Thoracic Surgery Department of the Christian Medical College Hospital at Vellore.  The angiogram and other tests there gave the diagnosis of Tetralogy of Fallot, a combination of four defects, including a hole in the ventricular septum (VSD), pulmonary stenosis and a thickening of the heart wall.  Among open heart operations ToF was one of the trickiest, calling for a very high degree of competence on the part of the surgeon for total correction.

The surgeon met me after the tests and said Kiran needed to have operation only within a year and  that I could write to him in six months to fix up the date of admission.

Before leaving Vellore the one thing that I wanted to do was to see how many children with ToF had been operated upon in the hospital then.  I wanted to know their condition so as to reassure me that like those children Kiran too would be safe.

It came  as a shock to me, however, when I learnt that out of the three kids who had undergone ToF operations that week, one had died and the remaining two were in a critical condition, battling for life.

That disturbing information plagued me all through the subsequent months as my wife and I were mentally preparing to take Kiran for the operation at Vellore.  For us then there was   no other choice as Vellore in those times was reputed to have the best of facilities for such procedures in  south India.  The Sree Chitra Thirunal Institute  of Medical Sciences and Technology at Trivandrum had indeed emerged as a major cardiac surgery centre in the country, but even here ToF operations had not been started then.

It was about this time that I chanced upon an article in a Malayalam weekly about a hospital in Sydney that was reputed to be one of the best paediatric cardiology centers in the world. The writer of the article, a former deputy director of education, had taken his son to Australia for the operation in that hospital.

Intrigued by the article and fascinated by the prospect, I asked Dr. Vijayaraghavan about  the Sydney hospital.  It turned out that this boy was taken to Sydney on the advice of Dr Vijayaraghavan himself.

I got from him the address of Prof Tim Cartmill, Head of the Department of Cardio-Thoracic Surgery in the Royal Alexandra Hospital  for Children at Camperdown in Sydney.

I did not expect a positive response when I first wrote to Dr Cartmill explaining my son’s condition and asking if he  would be kind enough to do the surgery.  His prompt response, kind, gentle, accommodative and reassuring, was the best thing that could have happened to me and Radhakkutty for a long time.   We were happy beyond our wildest dreams as now we were confident of taking Kiran to a hospital for an operation that was bound to be successful, nay, perfect.

Dr. Cartmill had explained all aspects of the hospitalization and the operation, including the cost of hotel stay at Sydney, but the most significant point in his letter was his mention of the mortality rate for this type of operations.  That the mortality rate was “well below three per cent” was manna for us as we had learnt that in Vellore the mortality rate then was between 20 and 30 per cent, not to mention the high morbidity rate.

In subsequent correspondence Dr Cartmill fixed October 8, 1978 as the date of admission.  As much was needed to be done, including attending to minute health details like removal of the tooth carries of Kiran, the preparations were begun several months ahead.

One of things worrying us was how Kiran would take the journey to a distant land accompanied only by his father.  He had never spent a day away from his mother all those seven years.  To overcome this possible problem, I started telling Kiran stories of the pleasures of air travel, the sights and sounds of Sydney and of the big, big toy shops that he would be taken to in that city.  Kiran was so fascinated by all this that he could not wait any longer for that journey.

At last the day arrived for our voyage of unpredictable outcome.  At the airport all in the family, Radhakkutty, her parents, her sister, my parents, all were tense and apprehensive, but Kiran was in the best of moods.  He was so impatient to get into the plane that he caught hold of my hand and was pulling me along even before completing the goodbyes.  He was slightly disturbed only when he found that his mother and grand-father were wiping their tears.

Seated in the plane and looking out through the window at the terminus before take off, Kiran was silent for some time and then asked me why his mother and grand-father were weeping.  I told him it was only because we were going on a long journey.

It was indeed a journey into the unknown and the unpredictable and I did not know how I was going to cope.  My only consolation was that there was someone at the airport to receive us.  A family friend had asked his sister and husband, a professor at an engineering college, to come to the airport and receive us.

Though the arrival was smooth, our stay at Sydney was a problem as our hosts, the Devasahayams, had five grown up children and there was no spare room in their house. As a temporary arrangement till my son’s admission to the hospital, they therefore accommodated us in the house of a friend, Mr. Sundar Das, about 20 miles away.

For one week, then, the routine was like this: Mrs. Devasahayam would come in the morning, pick us up from the house of Mr. Sundar Das, and take us to their house.  We would spend the day there and after dinner, Mrs Devasahayam would make another trip, this time to deposit us at the Sundar Das house for sleeping.

Since the Devasahayams and Sundar Dases were from Tamil Nadu, they were only familiar in the Tamil circles and did not know any Malayalee.

I too did not know any Malayalee in Sydney.  Therefore it came as a pleasant surprise when one day I received a call from one Mr. Fernandez. He said he came to know of our arrival from the Indian Consulate and would like me to meet some of the Malayalees in Sydney.  He also spoke to Mr. Sundar Das and invited him and his wife to his house with us for dinner.

At Mr. Fernandez’s house it was something I had never imagined.  There were several Malayalee families with their children of different ages, from tiny tots to teens, and Kiran and I had the most pleasant time since our arrival at Sydney.

Apart from Mr. Fernandez there was Mr. V.K. Panikkar, Mr. V. Bhaskaran Nair Mr. Narayana Pillai, Mr. V.K. Kurien and many others, all with their wives and children.

It then turned out that the Malayalees came to know of our arrival from a letter that my college mate and friend T P Sreenivasan, later Indian Ambassador to Austria, had written to the then Consul General at Sydney, Mr.V.P. Singh.  Mr Sreenivasan had requested Mr. Singh to extend to me and my son all the help and assistance that he could render. Mr. Singh was, however, away in Pun/jab when the letter came and Mr. Panikkar, one of the officials at the consulate, took upon himself the task of facilitating our stay.

When Kiran was finally admitted to the hospital on October 8, 1978 I too moved out of the Sundar Das house since I got a bed in the Mothers’ Quarters attached to the hospital.

My room-mate, a French speaking gentleman from  Solomon Islands, had brought his son for a major orthopedic procedure.  I did not know French and he did not know English, but we knew each other’s predicament well through a silent but eloquent mode of communication that transcended linguistic barriers.

Kiran was in Upper Toddman, a ward full of children who had undergone or were waiting for heart operations.  Among those who already had their operations was Ho Li Ping , a  cute girl of my son’s age from Malaysia.  It  was  sheer coincidence that she too had ToF, now corrected.  And because of it I was constantly watching her improvement, with trepidation initially and with relief, later.  She was in very good shape, happy, jovial and without any apparent problem.

During all the months of preparation or during or after the journey I could not make myself tell Kiran that he was being taken for a chest operation.  I never knew how his young mind would take that disturbing piece of imformation.

In the Upper Toddman, however, nothing was easier.  A day before  the operation, the surgeon and his team and all the staff of the operation theatre came to meet Kiran.  Everyone came to say hello, some patted his back and through endearments made friends  with him.  Then came a group of nurses from the operation theatre, holding a one-foot tall doll that was dressed up like a theatre nurse, in green overalls and wearing a face mask.

The sister in charge slowly explained to Kiran what they were going to do.  “Kiran, you will be given an injection in the morning tomorrow and you will go to sleep.  When you wake up you will find all of us like this doll, in green overall and mask.  Don’t be afraid.  You will also find a bandage on your chest.  It is all for your good.  After some days you will be able to run and play with other children and you will have no problem at all.”

Back home Kiran had never been addressed to by anyone in English, but in the ward when the head nurse explained the whole thing to him in English, that too with an Australian accent, he appeared to have no difficulty at all in understanding. He listened to every word said and with a wave of his head each time she paused he expressed his full agreement.

When they left, he turned to me and said, perhaps with a tinge of pride: “Father, tomorrow I am having my operation.”

~*~

“Mr Ravindran Nayar, please  come to the room behind the IC Ward.”  The announcement made twice over the  public address system in the waiting room, woke me up from my reverie. I sprang up and, with heart beating fast, almost ran towards the room behind the Intensive Care Ward which was in fact one half of the Upper Toddman Ward.

Dr Tharian was waiting  for me. He said the main part of the operation was over and now the chest was  being closed. Everything had gone as per schedule. In another half an hour Kiran would be brought to the IC ward and then Dr Cartmill would meet me.

I sat there thanking  God for the life that had then been gifted to me afresh. With my mind at ease I waited, impatiently, for a glimpse of my son.

Half an hour later two nurses wheeled in Kiran’s  cot. He was awake and he looked at me though he was not fully out of the effects of sedation. They took the cot to the IC Ward, placed it at a corner and then connected a whole lot of leads and wires from different monitors to his limbs and chest.

Dr Cartmill then came to the ward and taking me to an adjacent room explained the operation in detail. He said Kiran had a classic case of  ToF and also had, by the grace of God, a classic correction. There was nothing to worry about him any longer. In three days he would be shifted to the general ward and in a week discharged from hospital. He would have to remain in Sydney for another month and come for check up for a day. He can then be taken back home.

I was so thoroughly engrossed in what the doctor was saying and what it meant for me and Radhakkutty to notice that he had stood up and was about to leave the room. Then only I realized that I had not even mumbled a ‘Thank You’ to the great surgeon who had given Kiran a new life and me and Radhakkutty a better life.

I sprang to my feet and went after the doctor who had by then left the ward. He had a fast pace and I followed him., almost running, but however much I tried I could not catch up with him. After passing through several corridors and going down some flights of stairs he finally came to the parking lot. Dr Cartmill was about to get into his car when I reached him. He turned and looked at me even as  I took his right hand in both hands and said  “Thank You, Doctor.” I could not utter a word more as all the anguish and the agony of the last eight years were by then washed out  in a cascade of tears.

Dr Cartmill was perhaps meeting a sobbing parent for the  first time. But he was full of sympathy and affection and kindness when he patted me on the shoulders for a along time and said: “Don’t worry, Mr Nayar, your son is now all right.”

~*~

Unlike in most Indian hospitals where the Intensive Care Unit is out of bounds for people other than patients, in the Upper Toddman one parent was allowed inside the IC Ward to attend on the child. The only precaution that was insisted on  was to wash the hands with disinfectant at the wash basin kept outside the ward.

I was beside Kiran when he was gradually coming out of the sedation. Perhaps it was natural to have hallucinations at this time. He called me to his side and pointed his finger at a corner of the wall. “Remove that beetle,” he said. There was no beetle anywhere, but I just made a wavy motion with by hand and told him that the beetle had been removed. He did not say anything further on it.

In the evening when I was sitting beside Kiran, a nurse came to me and said  there were some visitors for me. I went outside the ward and was surprised to see  a veritable crowd. There were all the Malayalee couples I had met as also the Devasahayams and the Sunder Dases. Some had brought flowers for Kiran and one couple a get well card. I sincerely thanked them for their concern.

For the one week that Kiran was in the ward, it then became  a routine for them. Most of them came to the hospital every evening.

The nurses of Upper Toddman were a wonderful lot, guided by their super efficient head nurse, Mrs Philomena Clifton. There never was an idle moment for Mrs Clifton who used to flit from one bed to another, giving a thousand commands to her staff. All the doctors, Dr Cartmill, Cardiologist Dr Celermejer, Dr Hawker, Dr Lee and Dr Tharian, had the highest regard for her and respect for her thoroughness. She knew the condition of every child at any given moment. When the doctors came for the rounds, at every bed she would reel off data as though from a computer.

On week-ends there used to be only a skeleton staff in the ward, but Mrs Clifton always made up for the shortage.  This was  so not only in the case of nursing, but also in the case of the cleaning.  Every two hours or so she would herself bring the pail and mop to the ward and clean the floor thoroughly as was usually done by the cleaning staff.

As the day neared for Kiran’s discharge from hospital, I knew  I had to plan for his  month-long stay at Sydney.  I had to find a suitable accommodation for me and Kiran as I did not want to tax either Mrs Sunder Das  or Mrs Devasahayam  any longer. Moreover I was aware that Mrs Sunder Das was expecting a niece and her husband from Singapore.

So one evening I requested Mr Narayana Pillai to fix for me accommodation in one of the lodging houses in the vicinity of the hospital.  I had heard that rooms with kitchen were available nearby.

Late that night I was called to the nurses’ post to receive a telephone call.  It was from Mr. Bhaskaran Nair.  He said he had beard from Mr Pillai that I was in search of a lodging house. “You do one thing, You just look after Kiran, Don’t worry about anything else like accommodation.  We will do what  is needed.” The next morning Mr Nair and wife Rohini came to the hospital and told me that on discharge Kiran and I were moving into their house.

Mr. Nair, hailing from Aranmula in Kerala, is a genuinely warm person, a person who is to me one of the most unforgettable characters in life.

Mr Nair, who retired from Australian Customs some years ago, had a large six bedroom villa in the beautiful Sydney suburb of  Benson Town, but all the rooms were occupied, by the couple  and their children, three sons and two daughters.  He therefore converted his drawing room as our bedroom.  He readied a cot, bought a new bed, new blankets, new pillows and new everything for  Kiran and reserved the only bathroom inside the house exclusively for his use, after  cleaning it up thoroughly with disinfectant and doing up the painting.  He told the family  that everyone had to cooperate to ensure that Kiran did not get an infection during the post-operative phase.  All his family, including the youngest son, five year old Jyothi, were asked to use the toilets outside the house even during nights.

With so much of affection and goodwill from Mr Nair and wife, as also their children Sathyan, Maya, Thampy, Mini and Jyothi, Kiran had a wonderful period of convalescence.

In fact when the time came for us to return, Kiran was a little sad.  He was so fond of the people and the surroundings that he asked me if we could stay on for another week or two.

We  had a nice farewell at the Sydney airport.  All the people we had fortuitouly come across in Sydney and who all had helped to make our stay pleasant and memorable, were at the airport to see us off.  With many of them, especially the families of Mr Nair  Mr Panikkar and Dr Tharian, it was going to be a life long bond.

A crucial aspect our Sydney sojourn was that the entire  hospitalization came to us free of cost.  About sixty per cent of the cost of hospitalization and operation was met by a medical insurance cover that Dr Tharian had taken for Kiran.  The remaining forty per cent, by way of surgeons’ fees and similar charges, was waived by Dr. Cartmill as we were coming all the way from a far off country.  The Foreign Exchange that the Reserve Bank of India had released for me for the treatment was therefore taken back to Trivandrum and refunded in toto.

~*~ 

A pleasant surprise awaited me and Kiran when we entered the Malaysian Airlines DC-10 on our way back to India.  Among the passengers were Ho Li Ping and her mother, returning to Kuala Lumpur.

Ho had been discharged from hospital much ahead of Kiran and it was pleasant to see her again.  I took some photographs of Ho and Kiran in the aircraft.  Ho’s mother, who did not speak English, made me note down her address from a diary and through signs requested me to send copies of the photographs to her.  I agreed to do so.

Some how word spread in the aircraft about two young kids returning to their countries after open heart operations in a Sydney Hospital and many passengers came to say hello to Kiran and Ho and extend  good wishes.  A group from Indonesia also came to me to know more about the hospital where Kiran had the operation.

Though I had promised Ho’s mother that I would send her copies of the photographs soon, I could not do so as her address was misplaced.  It was over two decades later, in 1999, that I accidentally came across that address when I was searching for some papers.  I asked Kiran to send the photos to Ho with a letter.  Ho, in her late twenties, naturally had the surprise of her life when she received the pictures in the plane after so many years.  In a two page reply, she thanked Kiran for taking her back to a long distant past and  brought us up to date on, so to say, her life after Sydney.