“Hey Rupesh!” with his usual warming voice and a gentle pat on my shoulder.
“We did not see much of you recently. Oh no, it’s been so many years! Where had you been hiding?”. He was one of the organizers and held a position in the association.
“Ya. Been busy here and there. But you will see more of me from now on. Nice to see you after long!”
This was my first conversation on the first day of the annual conference of my professional body. I had an original paper to present the same morning at the conference.
The conference venue was quite a distance from my home, nearly an hour’s drive. I did not, this time, take a break in the way to fuel my nerves with nicotine, nor or a tablet of propranolol. With my clean breath, I exchanged greetings, talked, and laughed with my seniors and colleagues and took my seat. National and international faculties duly shared their knowledge in their allocated time. The number of participants was remarkable. In time, the fraternity did grow exponentially. My younger colleague from my hospital had already joined by my side and we exchanged comments on the presentations. Boy! I really have missed these academic bonanzas.
Then it was my turn to deliver my paper. I went to the dais. I knew I had a collection of interesting cases and a good take home message. It went as I expected, with an affluent flow, followed by a few questions from the floor.
I came back to my seat. Happy. Happy to celebrate my victory over my Panic Attack.
It was 2017, I was grossly involved in preparing for the conference of our society going to be held at one of the renowned hospitals in the country, which happened to be my alma mater as well. They had delegated me to moderate a session and be a panelist on the first day. I had prepared myself well for it. There were renowned faculties from neighboring country and our own. And I should deliver my best as I believed myself to be the part of the pioneers of that society.
I have presented or talked many times in academic conferences. Since my medical school days, during my residency and after becoming an eligible surgeon, I had presented quite a number of papers in academic forums. I had always made it a point to present rare, interesting or controversial issues and deliver them in my own style. Even though I had never been selected to be eligible for any mentionable prizes, I believed most of the time I delivered valuable topics as learned critics came and congratulated me most of the times, and I found my presentations being presented in foreign conferences by some and even turned into original articles by others. The challenges of preparation, imagination and delivery gave that impeccable special feeling which overrode any difficulties or aftermaths.
July 2017, early morning, as I was driving for the first day of the conference where I had to conduct a panel discussion and later chair a session, a sudden tightness on the chest and a feeling of despair took over. Just around the corner, after passing St. Mary’s school, I pulled my car over. The feeling that of hopelessness and of incapacity was so intense. I realized I did not remember anything; I did not know what I needed to do when I would reach there. I was momentarily blanked in my mind. I could feel my heart pounding like a horse. I got out of my car, tried to relieve the situation with some nicotine in the small shop nearby. Then got back to my car.
I was trying to assess the situation. Was it a heart attack? I certainly knew it was not. The feeling was similar to that of a situation which I faced while I was 14 years old, competing in the finals of the elocution contest in my school and suddenly I forgot the middle two lines of my poem. I tried to remember those lines, so intensely, but to no avail. It was just not possible for me to forget those lines as I had practiced them thousands of times. My mind went blank, and I could see the faces of my school mates and my Nepali teacher trying to help me out from the audience. Those lines never came back to me, and I even forgot the other remaining lines. It seemed as if ages passed in between before I left the stage without completing my poem. My heart was pounding hard, and I was literally anxiety stroked.
I was there in my car going through the same emotions. I picked up my phone and called two of the organizers of the conference and apologized to them that I could not come for the program and gave them a reason which I feel ashamed even to write here. I turned my car, headed straight back to the hospital, and did my usual job as before. When at home, I told my wife what happened. She suggested I see a counselor.
Since then, I voluntarily avoided conferences and especially coming-to-the-dais thing. Just the thought gave me goosebumps and facing my colleagues was very uncomfortable.
As an ardent medical student, I then started to dig into it. I wanted to know what, why and how to solve it. I never went to a therapist; however, it could have been an easier path as I look back now. I was a good student and liked psychiatry during my internship. If it had not been Orthopedics I would have certainly taken Psychiatry. I had spent many hours with my professors and patients during my psychiatry posting of one month during internship and had seen the patients recover so well that I was sure I had the capacity to treat myself.
In 2013, with the zeal of a young skilled surgeon, and an entrepreneur at heart, with some friends, I had the guts to open up a fifty-five bedded hospital in Kathmandu. I was literally giving decisive suggestions in every single situation from conceptualizing, planning, administrative, hiring, financing, procuring, marketing, promoting to gathering investments and you name it.
The initial days were beautiful, teamwork was remarkable, and things were coming to shape. However, the novicity soon took its toll coupled with difficult circumstances, loss of faith in health businesses by the investors, rampant corruption, brain drain from the country, disputes between the partners and mostly the urge for perfection by me brought tremendous toll on myself. I was multitasking vehemently and was under enormous pressure and stress. There were nights when I would be planning and days busy in the operation theater. At the late thirties, I was proud and pounding on my vision and thinking I would never tire. Then this panic attack happened, which made me stop. Stop for a while.
I realized, I was overworking with emotions rather than knowledge and skills. One fine day, while operating on a patient, there was a call that one of the lifts of the hospital stopped working. That was the time I felt the necessity for me to choose between Orthopedics and Hospital management. I enjoyed dealing with people, hiring them, training them, building things, providing services to patients, technical people, and others, learning finance, budgeting, reviewing audits, representing hospital in government and other forums, etc. But I felt at peace when I was in the surgery theater!
Then I decided I needed to focus on my original career, Orthopedics. I gradually handed over posts and responsibilities I was taking, and I started to train myself further into Orthopedics through different angles and possibilities. However, later, I realized even my own brainchild, the hospital, could not support or afford me in my complete technicalities. Which brought me again to the point where I had to come back to my original form of planning, creating, innovating, taking risks and all those characteristics of an entrepreneur. But this time, being a bit wiser and taking a step at a time. No wonder, my late bhinaju had cautioned me “Rupesh, your visions and energy are great, but you might be a bit “young” to open a hospital in Kathmandu”.
Coming through a full circle, but more experienced, I decided to go back to the life which I had dreamt of. Life on the knife’s edge. But that’s what I love most.
***
I stood up from my chair and went to the mic and asked the presenter “Thank you for your great presentation, I have two questions…”
RV
9th March 2024
Kuleshwor.