Fatal Margin

by Umanath Nayak

Genres: Medical Thrillers

Synopsis

Cancer crusader or god-player? Dr Veer Raghavan, a dynamic young cancer surgeon, is in CBI custody, suspected of fraud, medical negligence and malpractice. A forerunner in the field of oncology, Veer?s reputation and credibility is at stake. Is he guilty of committing the alleged crimes against his patients? Or is this a ploy staged by the corporate establishment unable to come to terms with his popularity and unprecedented rise? Set in a bustling, modern cancer hospital, this riveting novel takes us deep into the heart of the crucial battle between medical science and the complex and unpredictable nature of cancer. The truth comes forth in a thrilling battle of wits in the final courtroom drama, raising vital ethical questions about the immense power doctors hold over us while they negotiate the thin line between saving lives and playing god.

Release date: November 1, 2014

Publisher: Hachette India

Print pages: 190

Sample

FATAL MARGIN

Umanath Nayak

First published in 2014 by Hachette India (Registered name: Hachette Book Publishing India Pvt. Ltd) An Hachette UK company www.hachetteindia.com

This ebook published in 2014

Copyright 2014 Umanath Nayak

Umanath Nayak asserts the moral right to be identified as the author of this work

All rights reserved. No part of the publication may be copied, reproduced, downloaded, stored in a retrieval system, or transmitted in any form or by any
means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover or digital format other than that
in which it is published and without a similar condition being imposed on the subsequent purchaser.

This is a work of fiction. Any resemblance to real persons, living or dead, or actual events or locales, is purely co-incidental

Print edition ISBN 978-93-5009-811-0 Ebook edition ISBN 978-93-5009-812-7

Hachette Book Publishing India Pvt. Ltd 4th & 5th Floors, Corporate Centre Plot No. 94, Sector 44, Gurgaon 122003, India

Cover design by Nitesh Mohanty

Contents

Prologue

Veer

Jenny

Varma

Nita

Rashee

Shastri

Nigar

Madhavan

Ritesh

Part II

The Trial

Postscript

Acknowledgements

To my patients, for their trust and confidence in me. Despite my shortcomings, I am what I am only because of them.
Prologue

A palpable shiver of excitement ran through the packed courtroom when he entered. The people, who had been waiting in restless anticipation, stood up and
craned their necks to catch a glimpse of their fallen hero. The sensational case, its grave medico-ethical implications, and his high- profile reputation as
a leading cancer surgeon had been getting non-stop coverage in the national dailies and the nightly news bulletins. Within a matter of minutes, press and
television crews had converged on him with their cameras and microphones and began firing questions. For the first time in his life he had nothing to say to
the press
the same press that he had nurtured and entertained for years and which in the past had been benevolent and indulgent towards him. Today things
were very different. The press was baying for his blood and all his charm, skill, influence and surgical brilliance could not win them over.

He managed to cut his way through the thick throng of the media and their equipment with the help of the policemen escorting him. Seemingly unfazed by the
presence of the two burly constables pressing against him, he strode forward purposefully, his head held high, with whatever dignity he could muster under
the circumstances. The expression on his face was inscrutable.

Once inside, he glanced at the multitude of people who filled every conceivable space in the courtroom, and for a moment he lost his nerve. He could
recognize many of them his colleagues from the hospital, influential friends who had stood by him all these years and who could do nothing for him now,
and many grateful patients whom he had treated in the past and cured of deadly malignancies.

The tumult of the present slowly phased out and his thoughts went back to the day of his arrest two weeks ago...

He had almost wrapped up for the day, finishing with a follow-up consult of a patient he had operated on three weeks ago, when his secretary Sunita had
barged into his consultation chambers and announced that there were half a dozen men ready to break into his room. She said she had tried telling them that
the doctor was busy, but they had just flashed their police badges at her and told her that they would give Doctor Sahib five minutes to wind up before they
marched in. He had calmly told his secretary to relax and then turned to his junior associate and instructed him to take the patient to the adjacent chamber
and finish with the rest of the consultation while he dealt with the intruders. He had been anticipating their visit for a while. Despite that, he was not
prepared for them swooping down on him like this.

Though outwardly composed, he had been troubled by the fact that the Assistant Commissioner of Police, a close friend, had not given him prior intimation of
their action. He later understood the reason for this when the leader of the team, Mr Madhavan, introduced himself as the Joint Director of the CBI and then
informed him that he had an arrest warrant against him. The fact that the CBI had taken over the case explained the speed and the secrecy of this late
evening swoop. By the time he was led to the waiting police jeep, a sizeable crowd had gathered outside the cancer hospital. There had even been a few
reporters and a television crew present. Someone had given him a handkerchief to shield his face, but he had curtly refused the offer.

The next two weeks had been spent in police lock-up as his case was filed and his bail petition reviewed. He had been forced to share a cell with four petty
undertrials. Three of them were small-time thugs and the fourth was a rapist. The men slept side by side in the tiny room. The cell was hot and stank of
urine. Sharing a toilet in the corner of the room was a humiliation he couldnt bear. The insanitary and primitive conditions were beginning to wear him
down. He had lost two kilos in the last fortnight.

Fleetingly, a mental image of himself in his cancer centre flashed before him distinguished in his trademark pin-stripe suit, the one which he exchanged
for his extra-long spotless white coat when doing his rounds and leading the surgical team.

His medical team was by far the most impressive and talented group in the hospital. Tall, handsome and dignified, he towered over his colleagues and
associates even as the rest of the doctors looked on in awe as he strode along the hospital corridors and checked on his patients.

Today, he appeared to have shrunk right in front of his own eyesboth in size and demeanour. As the case hearing droned on, his thoughts flashed back to the
events of the last few years, searching in his past for the clues, for the first signs and symptoms of an insidious condition that had culminated in this
final play-off of his life...

Dr Veer Raghavan took a deep breath, then looked up and scoured the crowd. He could not see Rashee anywhere and was relieved. He did not want his wife to
share in his ignominy. Being the wife of the accused, being subjected to the curious stares of the public, the snide comments of supposed well-wishers, was
not something he wanted to expose her to. He had been insistent last night, when she had come to visit him, that she should not come to the courtroom and
she had understood. The press would have been waiting to corner her, to subject her to their relentless grilling and her presence would have made things
more difficult for him. And what of his eight-year-old son, Nikhil? Children can be very cruel and it hurt him viscerally to think that his classmates might
be taunting his son about the fall of his once-respected father. Hopefully, he and his legal counsel Mohan Naidu, the best criminal lawyer in Mumbai, would
help end this nightmare soon, by getting his bail petition approved. Naidu had reassured him of his chances and said that he was cautiously optimistic.

Veer was seated in the chair next to him, staring down at his hands, when the court clerk announced: All rise.

Everyone stood up as Justice Chowdhary, the magistrate, made his entrance. He was a middle-aged man with a gaunt face and a close-trimmed white beard. He
looked sternly at the crowd before adjusting his robe and settling himself into his seat.

The court clerk announced:

Case no. 09 1 00042 7 The State of Maharashtra
versus Veer Raghavan


Veer

i

It is not very clear what past circumstances dictated the events ultimately culminating in the prosecution of Veer Raghavan. Coming from a well-to-do
business community background, money or rather the lack of it was never an issue and Veer had all the basic material comforts that upper-middle-class
affluence could provide. As the youngest of three brothers it was not incumbent on him to continue the family business of automobile spare parts that his
father ran. Wealthy, but frugal by temperament and upbringing, his parents were proud of their studious son but also mindful of the fact that too much
indulgence could result in more harm than good, thus resisting the temptation to cater to his every whim and fancy. His father drilled the importance of
money and social status into him all through his growing up years, and when he displayed a flair for studies, pushed him to strive hard for academic
brilliance. He saw this quality his son possessed not only as a formula for success but also as a means to compensate for his own lack of a formal
education.

While the high expectations and pressure from his business family ensured that Veer turned out to be academically very strong, it also created in him a
deep-seated craving for quick success and fame.

In the small town in coastal Andhra where he grew up and did his schooling, it had not taken much effort on Veers part to top his class and he had
consistently achieved this throughout his school years. However, one inexplicable phenomenon that regularly dogged him in all his academic pursuits was
that at every crucial stage, in the test that really mattered, his luck seemed to desert him and often his final academic score was not commensurate with
his abilities. This frustration simmered in his psyche for a long time, and he often brooded about his ill-luck.

He was, from his very childhood, led to believe that he was a cut above the rest and even though on more than one occasion his best friend Sivakumar, whom
he would later also go to medical college with, pointed out his tendency to complicate simple situations and problems, he rarely gave his well-intended
advice any serious consideration.

A prime example of this tendency was exhibited in his intermediate, when in his overconfidence he made a mess of his examination. He attempted to solve a
simple physics equation using a complex formula and in the process tied himself up in knots and lost valuable time. Because of this, he missed out on a
medical college seat in the state government quota by a small percentage and had to join a private medical college in Mangalore.

This curse repeated itself again when he applied for his postgraduate seat in general surgery in the same college. Despite having an excellent grasp of all
his medical subjects, a procedural glitch in his undergraduate admission process resulted in him forfeiting his seat by a whisker. The management of the
college had decided from that very year to give extra weightage to local candidates belonging to the same state in the postgraduate admission process.

Veer had to knock on the doors of the court to ultimately get his seat, but missed a term in the process. It was deeply mortifying for him to see less
deserving classmates get ahead of him while he had to languish for six months before he could join as a junior to them. Overnight, all his friends became
his seniors and Veer was forced to adopt a faade of superiority to ensure that he still remained their equal. Though some of them did understand his
behaviour, the majority thought him unnecessarily arrogant and aloof.

It was another such incident, which occurred during his postgraduate surgical exams, that left an indelible scar on him and dictated his actions throughout
the rest of his life

The postgraduate examination leading towards a masters in surgery consisted of both a theoretical and clinical section. What mostly decided the fate of
budding surgeons was their performance in the main case of the clinical section in which they had to examine a patient, and without the aid of any
investigations, come to a diagnosis of the particular disease and discuss its management to the satisfaction of the examiners. The examiners took a vicious
pleasure in proving to the students that they knew nothing.

The cases were distributed to the candidates by a system of lots and every once in a while they would include a case that would stump even the most
brilliant. Such cases were referred to as the graveyard of the PGs.

On the day of Veers main case, the expert (a junior surgeon responsible for arranging and distributing the cases to the candidates) had already dropped a
bombshell in the morning, declaring that one such patient had been picked for the clinical exam. As the expert led Veer to his case, he fervently hoped that
he did not land this patient.

When he approached him, Veers patient was lying on his side on a rusting metal cot, caressing his belly and moaning loudly. Gently, Veer made him lie
supine. Looking at his bulging belly, he had no doubt that this was an abdominal case. He noted down the patients name and age and asked him details of his
presenting complaints. But the chap seemed to be in no mood to cooperate. He looked at Veer balefully, grumbling that in these past few days more than a
dozen doctors had poked and prodded his belly and worsened his misery. He had also not had a decent meal in weeks now. Veer whispered to the patient that if
he cooperated he would give him some money after he was done with examining him.

Half an hour later, Veer had managed to gather some semblance of a history and completed his examination. The patient had a long, ugly scar running through
the length of his abdomen. He told Veer that he had been operated twice in the past, but the tumour kept coming back. Because of his pain, he was holding
his abdomen taut, clenching his muscles, and Veer had some trouble doing a thorough examination. Once he was finished, he pushed a fifty-rupee note into the
patients hand and waited for the expert to lead him to the examiners.

So, whats your diagnosis? the examiner asked Veer once he had presented his findings in the case.

There is a hard mass deeply located in the epigastric region and it is arising from the stomach.

Wouldnt you expect a stomach mass to move with respiration? As per your findings just now it is not moving. How do you explain that?

Normally in a difficult case, when a candidate is not on the right track, the examiners tend to drop a hint or two to help the examinee reconsider his
diagnosis. But Veer was confident.

I am sure it is a recurrent mass in the stomach bed, probably following a previous gastrectomy, though I do not have access to his previous records. I do
not expect, in this situation, for the mass to be mobile, he said categorically.

The external examiner was not convinced. How do you explain his distended abdomen?

I think the mass is infiltrating his small bowel and causing intestinal obstruction. His symptoms corroborate that.

In reality this was the graveyard case alluded to by the expert. The patient was a known case of a recurrent retro-peritonial sarcoma (a malignant tumour
of the abdomen), following previous attempts at surgical excision. That morning the four examining professors (two internal and two external) had seen the
patient and had agreed upon what diagnosis they expected the candidates to give. Though the external examiner had some difference of opinion to begin with,
once they had gone through the patients past records and ultrasound reports, he had also concurred with the others. It was also decided that those
candidates unfortunate enough to get this case deserved to get some hints, in case they went off track.

However, before the external examiner could drop Veer any further hints to point him in the right direction, the internal examiner leaned forward and asked
elatedly, So you are fully convinced that the patient has carcinoma of the stomach?

Yes, sir. Veer did not budge from his diagnosis.

All the four examiners made notes in the candidates sheet in front of them. They grilled him some more regarding his recommendations for the management of
the patient, but Veer started getting a sinking feeling that they had already made up their minds.

The internal examiner had a reason to be delighted. His future son-in-law was one of the candidates and his chances of getting through the exam would
brighten considerably if Veer failed. There was an unwritten rule that not more than a third of those who appeared for the MS surgery exams could pass and
qualify as future surgeons. The senior professors in the surgical department felt that this restriction was one way of keeping the examinations competitive
and ensuring the calibre of future surgeons.

Veer had already shown streaks of surgical brilliance during his three years of postgraduation. Unlike his other colleagues who were more focused on
presenting cases and studying for the exams, Veer devoted his spare time to honing his surgical skills. Luckily for him, the government hospital attached to
the medical college gave him ample opportunity to practise his craft. The members of the teaching staff of the medical college, who doubled as honorary
consultants at the hospital, were more focused on their thriving private practice than on taking care of the hordes of poor patients who thronged the
outpatient facility and its dark and dingy wards. Once they had completed their morning rounds, the patients were left at the mercy of the postgraduates and
the level of care was determined by the competence and enthusiasm of these PGs. Veer would hang around the emergency room once his work was completed and
lend a hand to the ER doctors in managing trauma and accident cases.

The variety and serious nature of the injuries he handled there not only helped improve his dexterity but also his surgical decision-making. Attention to
detail and speedy action were vital in the trauma unit to save lives and Veer mastered both these arts early in his surgical career. He was also the one to
whom the doctors on duty and night nurses in the wards turned to whenever they had a problem obtaining intravenous access. Veer was often seen walking the
hospital corridors late at night with his surgical kit, containing an assortment of cannulas and central venous catheters, visiting different wards and ICUs
offering his help in finding a vein. His ...