In continuation of last week’s article that explained the scientific basis of PM Modi’s fitness and energy levels with four hours of sleep and ability to avoid jetlag, and altitude sickness, this article explores this surgeon’s fitness in his fifth decade in a high-stress profession, with its own unique demands. Surgery demands steady hands, sharp vision, stamina to stand and operate for hours continuously without a break, handle wounds, blood, pus, live human flesh, and sometimes excreta, and be available 24×7, dedicated to patient care. Also, continuously reskill and relearn to avoid obsolescence, and most importantly, have excellent communication skills to manage emotional patients, their family, and friends in an emergency, when you may be exhausted, sleep deprived, hungry, and desperate to visit the restroom. Convincing a patient to accept elective surgery and risk his or her life in your hands demands another set of unique communication skills that are not taught in medical college, and are essential for a surgeon vis-à-vis other doctors. I do high-risk, complex, and redo surgeries, many with a definite risk of death, and it requires extraordinary convincing skills to get the patients’ consent for such a potentially life-saving procedure.
MANAGING STRESS: In a highly stressful five-decade-long career, including the need to do risky, complex cancer surgeries on my 90-year-old father and a very sick first cousin, both of whom were considered unlikely to survive surgery by other surgeons, stress management and mental health have been vital. As in charge of AIIMS emergency services during the Delhi riots in 1984, I had to manage hundreds of patients over three days and nights, and also coordinate between chiefs of various specialities, who were double my age. It was a war-like situation except that our lives were not at risk, unlike our colleagues in the armed forces medical services. Though I advise my patients to adopt meditation to manage stress, I have managed stress by positive thinking, problem solving, exercise, and multiple hobbies, such as gardening, art, photography, and listening to soothing music. Exercise suppresses stress hormones, enables sound sleep, strengthens muscles and bones, and burns fat.
MANAGING BODY WEIGHT: An essential aspect of good health is keeping body weight at the ideal BMI, or just below it, and waist-hip ratio within limits, as explained in an earlier article on body fat. I check and record my weight every morning, and advise my patient to do the same. This simple method has helped many self-regulate and reduce 30 kg or more, without fancy diets or drugs. I have managed to maintain an ideal weight since 1972. Any day your weight increases by half a Kg or more, you can identify the excess calories you consumed, or the exercise you skipped the previous day. It takes me three days or more to reduce weight if I gain more than a kg after a festival or celebratory binge. Self-discipline is necessary to consistently stick to a healthy diet, avoiding tempting high-calorie junk food, addictions, and peer pressure.
MANAGING SLEEP DEFICIT: As mentioned in my previous article, adults generally need 7-9 hours of sleep per night. In this author’s experience, 5 to 6 hours of good sleep, including the peak hours from 12 to 4 am, is sustainable in the long term and compatible with intense intellectual and physical activity. After a short, sound sleep, one gets up fully awake and alert compared to a long, disturbed sleep that leaves you drowsy afterwards. Exercise, stress and anger management with a humble and positive attitude, ethical behaviour, a passionate pursuit of socially beneficial tasks, avoiding stimulants like coffee and alcohol, a light early supper, reading a book instead of watching a blue light emitting screen, a calm mind, a quiet, dark, cool, safe and comfortable place to sleep, all together ensure a sound uninterrupted sleep. Tryptophan-rich food can increase sleep-inducing hormones, serotonin, and melatonin in the brain. In a 24×7 profession like ours, you get so exhausted that you sleep quickly, in less-than-ideal conditions, whenever and wherever you get an opportunity. Disturbed sleep leads to lower melatonin and elevated cortisol (“stress hormone”) levels, making it harder to fall asleep and stay asleep. The benefits of power nap, cat nap, and siesta have been covered in an earlier article on sleep. When I gave up coffee, tea, and cola drinks as a school child to successfully force my father to give up smoking, I discovered something new. I was able to completely control when I have to wake up, even from a nap, without an alarm. With the discovery of the hibernation gene in the fat mass and obesity (FTO) locus in humans, a day may come when we are able to switch it on and sleep or even hibernate at will.
STAMINA: Prolonged surgery needs stamina and good lung vital capacity to manage breathing in a closed environment with a mask, with air often lower in oxygen, and contaminated with anaesthetic gases. As mentioned last week, “Swimmer lungs” refers to the larger lung capacity and broader chest found in competitive swimmers, which is even more than athletes and other sports persons. Aerobic exercise, particularly regular and vigorous swimming, leads to the development of stronger respiratory muscles from water immersion and breath control, improves heart function and oxygen delivery to the body’s tissues, and encourages the release of erythropoietin (EPO), a hormone that triggers red blood cell production and increased Haemoglobin. My participation in 5 and 10 km running events, and 1.5 km swimming events in my youth, and simple daily exercise of the neck, arms, back, abdomen, and legs against my body weight and gravity, at home, keeps me fit and with good stamina. Avoiding alcohol, substance abuse, tobacco, and caffeine (energy drinks, coffee, tea, colas, chocolate, and products made with guarana, kola nuts, or yerba mate) helps prevent fine tremor of the hands, a major concern for surgeons operating with high magnification on delicate structures like the eye, brain, and very fine nerves and blood vessels.
BE A SELF-LEARNER, DIY ENTHUSIAST, AND POLYMATH: To remain relevant in an ever-changing world, you need to self-teach yourself, be physically and mentally active, and independent. When I joined the surgery department of CMC, Vellore, in 1979, my mentor emphasised that a surgeon went through three stages in his training and career: first, how to do a surgery, next, when and what operation to do, and finally, when not to do surgery. He stated that most surgeons remain in the first stage, and few reach the difficult third stage that requires the rare qualities of wisdom and self-discipline. I soon realized another important step: learn from others’ mistakes, how not to perform a surgery. Later, as a teacher and speaker, I dwelt upon the importance of doctors, healthcare workers, and mothers to take care of their own health to be able to take care of others, and to avoid becoming healthcare receivers. A DIY (do-it-yourself) person is resourceful, independent, creative, and a persistent problem-solver who embraces learning and isn’t afraid to take risks or make mistakes to achieve a desired outcome. Such persons are often meticulous planners who budget carefully and value the satisfaction of completing a task themselves rather than relying on paid professionals. Polymaths exhibit intellectual versatility by pursuing mastery across diverse fields, driven by relentless curiosity and a commitment to lifelong learning. Key qualities include associative thinking to connect disparate concepts, a flexible, sceptical mindset open to new evidence, and the ability to innovate by applying knowledge from different areas.
BE POSITIVE AND ETHICAL: A positive attitude means maintaining an optimistic outlook, believing in positive outcomes, and focusing on solutions rather than problems in life, even during challenges. It involves a mindset that is hopeful, resilient, and finds something good in difficult situations, rather than dwelling on negativity. Ethical behaviour refers to actions and decisions guided by principles of morality and integrity, which align with societal values of fairness, honesty, and respect for others. It involves making choices that are not only legally sound but also morally right, fostering trust, a healthy work environment, and positive societal impact. Examples include professionalism, punctuality, accountability for mistakes, and respect for dignity and diversity in relationships and actions. Arrogance, delusional thinking, greed, extreme passion for someone or something, uncontrollable libido, jealousy, anger, violence, revenge, and associated negative energy destroy the person, family, institution, and society.
STAY MOTIVATED: Dedication to humanity, keeping up with the times, acquiring new skills, teaching, and caring for Mother Nature have helped me stay motivated all these years. Ancient Indian wisdom, cultural diversity and heritage, spiritual values of tolerance and compassion, oneness with nature, and simple, sustainable, nature-preserving lifestyles have been a great inspiration. From cancer and disabilities to profound grief and depression, spirituality helps increase acceptance and decrease negative emotions. It tempers unrealistic ambition and impatience. A daily diet of raw and whole foods like fresh fruits, vegetable salads, anti-inflammatory herbs and spices, natural probiotics like curds and fermented foods (not alcohol), and whole grains like millets, in discrete amounts, fuels good health, energy, motivation, and delays aging.
Dr. P.S.Venkatesh Rao is a Consultant Surgeon, Former Faculty CMC (Vellore), AIIMS (New Delhi), and a polymath in Bengaluru.
