Celebrating 50 Golden Years
of Hand Surgery in India

A tribute to my teacher......

"Mera toh Mali ka kaam jaisa hai.." (I am but a Gardener)

Aaj kya seekha tumne? (What did you learn today?)

For a student like me to come up with a unique and truthful answer to that question, every single day for nine years, puts into perspective the wisdom of one of the greatest teachers of our times. For him, the quest never ceased. He knew there was a way around every problem. And when he arrived at that solution, he was sure there was a better, more elegant and far more scientific and yet simpler way to get there. He was the eternal scientist who never gave up seeking.

I first met "BBJ" at MGM when I was his houseman in my third post. He had published extensively of his wonderful work with hand trauma and reconstruction. Every international journal in the 1970’s had published some of his path-breaking work. And some of his pioneering work continues to be cited in all landmark articles to date. The importance of his tireless work continues to be relevant even today. At that time, when our plastic surgery colleagues all around the country were loath to do the Chinese (reverse flow radial artery flap) flap, he did it with consummate ease and published his experiences in a large series. He only did it to reduce the morbidity of groin and abdomen flaps. While we attributed such lofty ideals to his efforts, simple thoughts like - "only one limb needs to be dressed, it leaves the rest of the body free", seemed to be able to drive him to devise startlingly logical solutions to vexed problems.

His unit at MGM Hospital, Parel, was never short of visitors. Every luminary in Orthopedics, General Surgery and Plastic Surgery from all around the country would drop in to witness and experience advances he made in hand surgery! When the likes of Pulvertaft, Bruce Conolly and Dror Paley began visiting him, we knew that the strides he took were also pushing the frontiers of international information on the subject. He was a world leader and was fittingly featured as a Living Legend of hand surgery in the Journal of Hand Surgery (Br). Although awards and accolades were regularly heaped upon him, they truly meant little to him. He carried on soldiering away in his pursuit of amelioration of the suffering of his patients. His care for his patients is legendary. Every one of his residents would come under fire from time to time on the rounds. He spared none. And yet, each one of us will readily admit that we were not blame free! He noticed the tiniest detail that was overlooked, he recognized every short cut we took, and he flushed out every excuse that we conjured up. He corrective actions were aimed to inculcate the quest for perfection in us; to become the best; to be committed and dedicated to our patients. I will never forget the day he held up the hand of a shabbily done dressing in the ward and asked, "who has done this?" When I owned up, sheepishly, I was handed down a pearl that shines brighter, each day I remember him. He said "doctor, take pride in your work, even if it is only a dressing. You should be able to turn around and point out to it and say "I did it". A simple tenet, so loaded with meaning, that it could serve as a guide for every action in our lives. That was the essence of BBJ.

After qualifying as an Orthopaedic Surgeon, I joined him in his private practice as an assistant. Here was the opportunity to learn a craft that needed no other investment (unlike arthroplasty, arthroscopy and spine surgery, in those days) other than your ingenuity, intelligence and a few simple instruments. Day after day, I saw him work his magic on crushed, deformed, painful and festering hands. Day upon passing day, I began realizing that the magic was only initiated in the operating room. The amazing results could only be accomplished by his untiring efforts in the post-operative period. His understanding of healing and rehabilitation was unmatched. He devised splints and orthotics from simple and available material. Strips of scrap metal, rubber hoses and spring wires with a little help from his trusted splint maker, Dattu (Late DattatrayLolum), took on shapes and functions as the most elegantly efficient static and dynamic splints. These were immortalized in a complete chapter in Rob and Smith’s textbook. Amongst innumerable publications and textbook chapters authored by BB Joshi, are no less than seven original techniques devised by him,that adorn the pages of Grabbs’ Encyclopedia of Flaps.

Being invited overseas to set up hand units in Malaysia and Indonesia, to lecture at Hong Kong and Singapore, to operate every year in Muscat and to grace International meetings and preside over sessions of great contemporary workers in his field are but some of the indications of how immensely sought after he was. At such international meetings, almost every important faculty member would be eager to attend his talk and later strike up a conversation with him. They were curious to know what he was up to and to pick his brains to help them overcome their own hurdles. These are hallmarks of a great thinker, a leader!

One often wonders whether such men are gifted or do they inherit these qualities? Whatever the contribution of these factors, undoubtedly such greatness comes only from single minded pursuit. BBJ trawled literature continuously and repeatedly. I have often referred to his library as the Temple of Hand Surgery (presently respectfully housed by Dr. S. RajaSabapathy at Ganga Hospital, Coimbatore). It was a treasure trove of books and journals relating to Hand Surgery and he knew what was written on every page of every book! At times when we threw questions at him, he would look up from the book he was reading and say "woh Zancolli ki laal wali kitaab lo, usmein jawab milega!" take that red coloured book of Zancolli, you will find the answer there!). And sure enough, we would find something that had eluded us in our youthful enthusiasm! At other times, when we came up with seemingly original ideas, he would point out to a book; and when we handed the book over to him, he would open the exact page where the procedure had been condemned! He wasn’t wrong by far when he wisely reiterated that research is re-search (to find something that was already found!). He always said, we never looked hard enough and in the right places! He converted his insomnia into reading time! He often read at around 3 a.m. He then scribbled notes and dog-eared the pages of the book he read and left it on the table for us to understand his flow of thoughts the next morning. He spent enormous amounts of money (that he could ill afford, especially during his days at MGM Hospital) in keeping records of his patients. He cared for his albums as a mother cared for a newborn. He kept meticulous notes and he always reviewed his albums over and over again. He spent time trying to understand his failures and that gave him the impetus to devise ways to overcome them in future cases. He had no other hobbies. He rarely visited a movie theater. Not one to socialize, Dr Joshi avoided the limelight and continued to toil away in his ‘den’. Only knowledge intoxicated him.

During his years at Laud Clinic, Mumbai, where he spent his mornings operating and conducting his outpatients, Dr. BB Joshi drew patients from all over the country and from every walk of life. He was compassionate and understanding. When he did not see the results he expected, he would be stern and extract compliance from his patients. He had to have the best outcomes. He rarely derived monetary satisfaction from his patients. They were the working class and they were poor. But they worshipped him, and they were ever indebted to him. How else can one explain the fact that one of his patients was named Joshi Mathew after him! Now, can any one of us boast of that, ever? Such was the impact he made in the lives of the families of his patients that they heaped him with gifts and sweets for years and years after they had completed their treatment. He was always punctual and never took a day off from work. He worked on holidays and worked through Diwali too! Work, for him, was worship.

The hand surgery workshops he conducted, ran over a week and attracted plastic and orthopedic surgeons alike, from all over the country. He lectured well into those nights and operated assiduously the next day. Many hand surgeons around the country owe their success, in no mean measure, to this legend who stimulated, nurtured and supported them in their careers.

He devoted the last few years of his life in creating a wonderful external fixation system to match and then outdo existing mini fixators. He expanded the spectrum of its applications and traveled far and wide to spread the utility of JESS (Joshi’s External Stabilisation System). He wrote, edited and published many articles, books and chapters on the topic. With its growing popularity and increasing acceptance, Dr Joshi will be remembered for all times to come, as a person who worked hard to earn the respect and admiration of his colleagues from all around the world. He made India proud.

None of that pride ever affected him. Neither did the fact that he had presided over every Professional Association that he was a member of (IOA, ISSH, BOS). For his patients, he was always the “mali” (gardener) who tilled the land, sowed the seeds and watered the plants with love and affection. He never promised them outcomes. He coaxed nature to bear the best flowers and fruits.The abundant fruits of his endeavors shall always remain sweet just as all the flowers from his garden will always remain fragrant.

Brij Bhushan Joshi

1928 -2009

A tribute to my teacher......

Sudhir Warrier