She had been pounding the corridors of the final destination of all sick men and women in India, specially the East and North East India of the seventies. Apollo hospital has just arrived but not so reliable. As the lady neared the door of the Chief of head & neck Surgery, she overheard one of the Sr.assistant informing the Professor; Sir! the 'nut case' woman with the head ache has come, what to do with her? Send her to the 'nut cracker' was the order.

As she heard, she made her final decision, turn back to the Rail Station-Katpady.

Two years back she had noticed a swelling over the back of her neck, growing rapidly, few good doctors of Assam later she went to; Barbari, i.e Assam Medical College in Dibrugarh, a place she knew well. Her husband, a very important officer of the central Govt was once posted in that city. She was a VIP and was operated by the Head of the dept of Surgery. A very good surgeon whom I knew well as his junior for, I was an ex student of the college and before going abroad I was Registrar of the same unit. Every thing was fine, the professor was happy, the patient was discharged.

She felt some annoying pain over the back of neck, dismissed as normal post operative pain by the Surgeons, and so was sent home. The pain was excruciating, radiating to the back of whole head and neck. she went back to Barbari, pain killers were prescribed in increasing dose but nothing happened. She went to all the renowned doctors in Assam, then doctors in Calcutta [it was still called Calcutta, Kolkata came much later]. Her husband was then posted in NewDelhi- so Safdarjung, AIIMS were visited nothing happened - it was stronger painkillers for her. It was nearly 2 years by then, the pain killers had their own side effects, and she was persistantly 'groggy'. Then the final destination!! CMC Vellore!

As already mentioned, She moved around the departments, pounding the corridor carrying Kilos of Xray plates,CT Scan reports,MRIs and bunch of prescriptions.&, became quite  a familiar face in the hospital when the above episode in the Head and neck dept.occured. She jumped into the first train moving towards Calcutta crying all the way, from Calcutta she caught the next morning flight to Agartala, and she wanted to see her childhood pal who she had heard was posted in Agatala after obtaining his FRCS.

Lot had happened in the meantime. The husband, being fed up carrying around a sick wife had thurst a fat cheque book on her face and left, he could not miss his promotion anymore. She was in addition to her physical misery facing a divorce. It was me whom she wanted to see for help.We were neighbours and pals, when toddlers, my dad was Bacteriologist in the Pasteur Institute in Shillong [then capital of Assam].We lived in a hired house in Jail Road for 5/6 years, the next door girl Khuku and me were great pals, but when Dad got his Govt.Quarters in Pasteur Institute our hearts broke. But not too bad- Upper Jail Road and the pasteur Institute were seperated by a deep vally, Umkhra river valley [now a dry nullah]-on the pasteur side it was thick forest, a 20 minutes heroic slide down the thick pine needle covered stoney path, cross the kneedeep river, beyond the rainy days and a steep climb of 155 uneven stairs for us [me and Chordi one year older than me] and play on the Jail road ground. As we became preteen, Khuku was in Saris [uniform for school, her friends were girls, I had boys as friends for the football in polo ground.

We met after 30 years, hesitent and then the hug.We were past 40 yrs then. I was then the Chief Surgeon and the Medical superintendent of the GB hospital VM Hospital [now IGM hospital & the KB TB hospital and had my OPD clinic on Monday and thursday, it was on a monday morning that she arrived. I called my no.2 to kindly attend the clinic for I was expected to be couple of hours late, two childhood pals had lot to exchange and catch up. I examined carefully and thoroughly. It was an occipital neuralgia ie pain over the area of distribution of Occipital nerve, both greater and lesser occipital nerve causing irregular paraesthesia over the area exactly fitting the description in the books.She was later admitted in a paying cabin & in the OT a test dose of local anaesthesia was given leading to relief with in a minute- that was Occipital nerve block which confirmed our thinking that the Occipital nerve was under constant pressure. Next morning the pain was back as the anaesthetic block wore off.

My clever Assistant surgeon on his own mapped out the area of pain-it was a fan shaped area on the back of neck and head, an area shown in the books as the area covered by the occipital nerve, both greater and lesser.It was like maths ie one plus one is two and we thought we found the exact spot where the nerve was compressed which was the spot where the nerve emerged from two slips of the back of neck muscles before proceeding to cover the back of head & neck.

Compression of the nerve at this point was the cause of pain, we assumed. Next day in the OT the assumed area was explored.It was not easy. Khuku was then past 40 was nearing menopause and being a rich man's wife was well fed accumulating enough fat [adiposity] to make the approach difficult as we approached through a very short incision. Rana bijoy was confident about the location of the compression, so was I. We did not want to fail because  we did not like to fail and come out of the OT to say 'sorry'.I was mentally preparing to enlarge the incision and approach from the other side when suddenly our anaesthetist screamed , he can see a black silk thread from the other side hidden from our side by the flap.

Next, was easy, two black silk threads in knots were found around a thick cord which had the occipital artery, vein and the two nerves tied together in the two knots, when the two knots were released.  The previous surgeon had obviously tried to stop the bleeding from the artery and vein, the nerve being close by got entangled, an accident not uncommon when an over careful surgeon especially in VIP patients commit. Khuku was certainly a VIP. Khuku was completely free from her misery. I called the professor of Surgery who was then posted in Guwahati medical college; he found it difficult to accept, so one of the knots was sent to him. The second knot was given to Khuku, to hand over to her husband [he was incidentally my class mate in college in the St.Edmund's college with a word of warning never to threaten my childhood pal.

This case illustrates the impotance of good and intelligent planning which Ranobijoy did, which about couple of dozen very senior doctors all over our country failed, obviously none had applied the simple rule of anatomy and physiology that is one plus one is two A few words about Dr. Ranavijoy Chakravorty MS: he was the most brilliant young surgeon that I had seen. He went through my private library, literally combing throughly & just walked through his MS examination. His examiners were known to me & all vouched. A teacher, when surpassed by his student is the happiest person. With Ranavijoy I became the happiest teacher & surgeon. He is dead, addiction to tobacco. Smoking killed him with Cancer of lungs, too early in the life- Ranovijoy with out a stick between his lips would be a rare sight that killed him.

Dr. Rathin Datta, FRCS (England, Edinburgh & Glasgow).FFIMS (Athens) 

Surgeon & Sports Medicine Specialist

Padmashree Awardee, winner of the Bangladesh Liberation war honour 

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