Hektoen International

A Journal of Medical Humanities

The sweetest gift

Subramoniam Rangaswami
Karnataka, India


Viswan and his father with the gift, image courtesy of author

It was the mid-1970s. We were busy packing our portmanteaus and bags in preparation for leaving our campus residence in Calicut Medical College in Kerala1 where I had been working as an assistant professor of orthopedics. I thought I heard someone cough outside on our doorstep. Sure enough, I saw a man in a crumpled dhoti2 and faded green shirt approaching our porch. He held an even more wrinkled package in his hands. A young boy almost hidden from view was timidly inching his way behind him.

“You remember him sir… Doctor?” He nudged the boy. “This is Viswan, Doctor. You haven’t forgotten, I hope.”

“Of course, I haven’t forgotten; how can I? You have grown tall, Viswan, haven’t you, and big?”

“Yes, he has. He’s been eating better these days. Doctor, you saved his life.”


Viswan’s story had never left my mind. Three years earlier, we had treated the nine-year-old boy for tuberculosis of the spine. What made his condition critical was that the infection was destroying two of his neck vertebrae and there were early signs of paralysis of all four limbs. We had to operate on his neck, scoop out part of the diseased bones, release the pressure on the spinal cord, and fix the gap in the spine with bone grafts. We did not use metallic plates or screws to hold the unsteady spine those days. Instead Viswan was nursed in total immobilization in a tight-fitting plaster of Paris “shell” from head to foot. He would have to spend the next three months supine in the shell.

Viswan withstood the operation well. He was transferred to the ward with a tube in his windpipe connected to a “ventilator” that helped him breathe until he recovered fully from the effects of anesthesia. We had no intensive care unit or specially trained staff in our hospital to take care of such patients, so a corner bed was arranged close to the nurses’ station in the surgical ward. The “ventilator”3 was a portable contraption consisting of a concertina rubber bag that delivered air into Viswan’s lungs at a pre-determined rate.

I had to attend a meeting downtown that evening. Because I did not have a car or scooter in those days, I had to take the local public transport bus for the eight-kilometer ride to town. It was almost ten at night when the bus dropped me back at the bus stand in front of campus after the meeting. Viswan’s difficult operation and risky recovery were on my mind as I walked back to the hospital.

Bhoof … clunk, bhoof … clunk … … bhoof clunk … I heard the ventilator as I walked past the corridor of ward twenty-two. The place was quiet and cheerless otherwise. “Isn’t the noise uneven?” I thought as I hurried past the walkway. What I saw in the ward alarmed me. Viswan was struggling to breathe and was fighting against the machine’s set rhythm. “Thank God he is in the plaster shell.” I comforted myself with this thought, as tossing his head in a struggle to breathe would have spoiled our good work earlier that day. I rushed straight to Viswan’s bedside without stopping at the nurses’ station.

Bhoof..clunk … … … bhoof ..clunk … …. bhoof …

In the dim light I saw Viswan’s face turning blue. I switched on the suction machine nearby, picked up the suction catheter from the tray, and applied it to clear the mucus and secretions in the tube.

“I had applied suction just a minute ago, Doctor,” said the nurse who had hurried to the bedside.

“Get the duty anesthetist, Sister … right away,” I ordered and continued the suction. Viswan kept struggling. Clearing the tube did not seem to change anything. I could feel a solid block in the tube that stopped the suction catheter from reaching deeper into his airway.

“Good God! The boy is struggling to breathe, I’ve got to do something … no time to lose … I’ve to make sure he lives …. yes, I’ve got to do something.” I quickly pulled the tube out and started sucking inside Viswan’s throat, pressing his head against the shell. He stopped struggling; and I saw him take a deep breath. I kept on with the suction, clearing away the mucus and saliva from his mouth.

“Are you feeling all right, Viswan?”

The boy wanted to say something but could not speak. “You’re doing fine, Viswan, don’t worry… there was a bit of a problem with the tube you see, but I have taken it out. The tube has gone … you can breathe now. Try and take a few nice deep breaths, Viswan … you’re doing just fine.”

I was greatly relieved to see him breathe on his own, with no more squirming or wriggling.

I scrutinized the tube, trying to figure out the problem. It was an uncuffed endotracheal tube, the same type the anesthesiologists used while administering general anesthesia. I turned it this way and that, squinting into the lumen to see what was causing the block.

“Is he okay?” It was Unnikrishnan, the duty anesthetist. “I had seen him around five o’clock. He looked okay then. I thought he was kind of ready to breathe on his own then.”

“Yes Unni, he is breathing all right now.” I narrated the events. “I wasn’t sure, though, when I pulled the tube out. I happened to walk in and saw him turning blue. Have a look inside, Unni.” I handed the endotracheal tube to him.

Unni held the tube against the light and peered into it.

“Can you see?”

“Yes … yes, I can; there’s some kind of a block there. But I want to see what it is.” He pushed the suction catheter into the tube but could not steer it past the block. “Do you have a metal suction tube … you know the small stainless steel one?”

The nurse opened the bedside cupboard, took out the suction tube, and handed it to Unni on a tray.

Unni pushed the obstacle with the metal tube. “See, see … there it is!” A dark brown dollop dropped onto the tray, a malicious accretion of coagulated blood and mucus.

“So, that’s what was choking him, wasn’t it? Did you see that, Sister?” I exclaimed to the nurse. She nodded coyly.

“I’m glad you pulled the tube out, Ranga.”

“Yes Unni, I’m really. So, you don’t think he needs to be intubated again?”

“No, not at all, he’s quite okay now … aren’t you, Viswan?” He stroked Viswan’s brow. The boy was quiet now and sleeping; breathing easily, evenly. “See, he does look comfy, doesn’t he?”


“Please, can you ask your child to come out, Doctor?” The father and son walked stealthily to our porch.

I was not sure what Viswan’s father had in mind. “Malu …” I hollered and waited for our five-year-old daughter, Malathy.

“I heard you’re leaving the town, Doctor. Last week I had taken Viswan for a check-up to the hospital. I was looking for you. They said you’ll be leaving soon, going away to London. That’s why we hurried. We wanted to meet you at all costs before you leave. He’s your child, Doctor.”

He was right about my going away. I was to leave for Bombay (Mumbai) soon and from there to England in a few days.

Malathy appeared on the doorstep.

The father handed over the package to Viswan. “Son, give it to the child.”

Viswan advanced with slow and shuffling steps.

“Just a few oranges, Doctor, nothing more.” Viswan’s father spoke haltingly.

Malathy held on to my hand, shy and hesitant. “It’s all right Malu, you can take the pack.”

Viswan placed the small bundle on Malathy’s hands. It looked sizeable in her slender hands.

“It was so nice of you, Viswan … can I open and see?” I untied the jute strands around the newspaper package and uncovered the oranges in a towel casing.

“They are very nice oranges! Thank you so much Viswan; but how did you know my daughter likes orange?”

My wife Usha appeared in the doorway with Bubby, our one-year-old daughter in her arms. She recognized the duo; she had heard me narrate Viswan’s story earlier. “Nice oranges!” She commented almost in a whisper. “Very thoughtful of him wasn’t it, one for each of us.”

There were four oranges in Viswan’s parcel; greenish yellow, looking somewhat bashed and bruised, not very enticing.

But they were the sweetest oranges we have ever eaten!



  1. Calicut has since been renamed Kozhikode
  2. Dhoti or mundu is a loose piece of clothing wrapped around the lower half of the body, worn by men in Kerala
  3. It was a 1965 model Beaver Ventilator; a crude and noisy equipment kept as museum specimens in Anesthesia departments these days.



SUBRAMONIAM RANGASWAMI, MBBS, MS, MCh (Orth), had his medical education in Kerala and postgraduate education at the Central Institute of Orthopedics, New Delhi. During the five years he spent in the UK he acquired training in Trauma and Orthopedics in the University of Liverpool and the Robert Jones & Agnes Hunt Orthopedic Hospital at Oswestry. He secured M Ch degree from the University of Liverpool in 1979. He was the Dean of Gulf Medical College in UAE for six years. He has authored two books: E-sclepieion: Healing the robot way published in 2011 and Full moons many more in 2015. He lives in Bengaluru, Karnataka


Spring 2019   |  Sections  |  Surgery

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