Dr. Ashok Koul

"I met him at PGI in 1991. Ashok Koul came to our department as part of surgical rotation. He immediately struck me as a very inquisitive and unusually bold and opinionated person.He had the habit of questioning everything! Which at times may even be considered rude! But then that is how he was and after a while we understood him. He showed diligence at work and a good knowledge base. At that time he was a JR in surgery. Fast forward 15 years and when i met him at APSICON, he had become a very well known figure in microsurgery and later in brachial plexus. I listened to his presentations in many later meetings and one cannot but admire his abilities, confidence and skills. I listened to him in Lucknow at the ISPNS where he also did live surgical demos. A great teacher and a critique, he spoke with conviction and from his considerable experience. He was at the acme of his career and could easily have risen to far greater heights. I came to know about the tragedy just a few days back and am still in grief. At a loss to understand what drove him to this! Tragic loss of a great surgeon and teacher, a loss to the nation, to APSI and to the plastic surgery community at large. ASHOK, YOU WILL ALWAYS HAVE A PLACE OF RESPECT in our hearts. You will be missed at every meeting. "

My journey with Ashok Sir: My Bangalore visit this time was much different than usual… Usually, (other than the times I was working in Bangalore) I would get down on Hosur Road, wash up in duty doctors room in the emergency department, have breakfast in Narayana and by quarter to eight I would be ready waiting for “Boss”. Whether I came from Cochin, Chennai or Pune… the schedule was almost the same. As soon as ‘Sir’ arrived he would say “Chalo yaar, phatafat change ho jaao, OT main baat karate hain” then you will be part of the system in minutes… even when I did not know the place intitally, he would make things comfortable, would carry me all over the place from Cancer center, to Netralaya, to Hrudayala and wherever he goes…. and I would realize only in the evening that I haven’t discussed anything….but if it was a minor thing, he would have sorted it out himself… if something further is needed, he would sit with me in the evening and address the concerns. This trip was most difficult one, I had heard the news about him 36 hrs ago, and could not believe it. I had discussed things with him just a couple of days before that. From airport to the hospital and back, I did not know, what to do, what to say, all the faces around were familiar, but as if I did not know anyone. There was no life, there was no communication… what I had there in ‘Sparsh’ and ‘Bangalore’ was ‘him’, I knew people, hospital and Bangalore through him… without him there was nothing… and then I saw him, my ‘Sir’….there was no one to talk to me… no one to listen to me…. ’The reason we cry is…. because sometimes the words are not enough to tell one’s life story!!’ My journey with ‘my Sir’ started in 2004, 14th Jan 2014 to be exact. I had travelled over to Cochin Searching for a PG seat in Medical Trust Hospital. I was interested in Neurosurgery direct 5 year course and was told that there is a vacancy. This was a time when centralized counseling was not there and there was a lot of confusion regarding 5-6 years courses. The Communication was not as good as it is now and by the time I reached Cochin, the seat was taken by someone. I was told that there is a seat in Plastic-Surgery, if I am interested. I had worked in Neurosurgery before and had assisted a few plastic surgery procedures but had no clue what to do. As there was no other choice, I decided to meet the professor and then decide about the future. As I reached the K ward (plastic Surgery Ward) of the hospital, Sir was busy with his morning rounds, with another doctor. He was very young, simply dressed, short and fair and very pleasant person. After finishing his rounds there he saw me and asked about me with a pleasant smile. I told him regarding my interest in Plastic Surgery Course. I was asked to follow him. The rounds continued in I, H, G wards and , H annex, on the way most of the dressings were opened, wound conditions were assessed and my future colleague Vinoth Philip then was asked to do the dressings. He was also talking to me regarding my whereabouts and checking my interests. Following rounds we came to clinic where he asked me, ‘why plastic surgery?’ and I remember telling him ‘though I had come for neurosurgery, I have assisted a few plastic surgery procedures, and found it quiet interesting’. Following tea, Vinoth was asked to finish ward work, and I was allowed to stay around to see the cases in the clinic. It was interesting to see variety of cases from hand injuries to facial fractures to burns in the clinic. Soon Vinoth Joined the clinic and he took charge of the minor procedures, dressings/suture removals and so on. By now I knew that he had joined around 8 months before. The ease with which he was doing things both in the ward and in clinic instilled me with confidence to join the department. The passing rate of DNB then was dismal and I remember Sir explaining me, ”Its a long (6 years then) course and your passing cannot be assured, though I am reasonably sure that you will see whole spectrum of plastic surgery procedures, and will be skilled enough to perform most of them by the time you complete your course.” I had seen already Dr. Vinoth working fluently and he had been taking independent duties, and had no second thought regarding joining the course. I took his leave to return back for formal joining, completed official formalities and started long (36 hrs) journey back to Pune. Though most of my colleagues back home and seniors scared me about 6 years course and the future, I was determined and returned on 25th Jan. Thinking that 26th will be a holiday, I reported on 27th of Jan 2004 in the department, just to receive my first warning “when you are in the town, it’s a working day.” Since then, I have never missed the ward rounds, when I was in town, irrespective of the place I have been working. Medical Trust was a closely Bonded family, where all consultants were gelled together very well. The routine used to start at 7-7.15 in the morning and we as residents, typically spent 36hrs in hospital and 12 hrs at hostel to return back for another 36hrs duty. Though he was very strict regarding the patient care, we had times when after nights case we would get up only by his call, ”where are you?” he would ask, and I would just answer “coming Sir” to divert his attention from the fact that I was still sleeping but he used to be quiet understanding. Unfortunately, I could not be part of the team replanting Reshma’s bilateral upper limb, but had heard about it and saw her later on. One day just couple of weeks after joining, when I was still getting oriented, I arrived in the hospital little late and found that there is no one in the morning meeting area, called ward, even they had no clue. Confused; on my way to the ward, I peeped in Operation theater, A 16 years old boy was being reused to OT, most of the consultants (ortho, Plastic, Anesthesia) were around arranging a well co-ordinated show. I was the only confused person. The history recollected then was quiet shocking. A 10th class boy, on his way to the examination center accidentally fell over a railway track and train ran over both lower limbs. The right one was amputated at the level of mid thigh while left leg was amputated through the upper third. In a marathon surgery, the right lower limb was attempted first and was successfully revascularised. Due to homogeneity instability the limb later had to be removed sometimes late in the evening. After stabilizing the patient again the left leg was replanted, successfully. We finishes early morning next day. It was great to see him working. He would work with passion and whatever in the best interest of the patient will be done. I have seen him doing difficult replantations and as a long vein graft is exposed he would cover it with a flap in the same sitting. His patients, stamina and hunger to deliver the best were unmatchable. For a microsurgeon, may be that is most essential quality. I remember him coming over for every single case during my emergencies. He would sit opposite and help me learn things, till he was sure that I can handle things on my own. Still for any doubt, we were allowed to call him, anytime, anywhere he was. He would guide us precisely over the phone... where have you reached... There will be a vein just next to you... As if he is dissecting himself and he always used to be right. One day I received a patient with hand crush injury sustained in a sugarcane juicer machine. The vascularity was doubtful; he asked me whether I was confident handling the case. I told him that I will manage, and if needed will ask for help. By the time the patient was ready it was past midnight, after debridement, irrigation and fracture fixation, as tendons were partially injured but in reasonable continuity. The tourniquet was released. Distal perfusion was somehow maintained. As tourniquet was released looking for anything further was difficult. So I just tacked the loose bits of skin and dressed it up. Next morning when sir asked, I told him that the nerves were repaired in an attempt to get the credit when I had not even looked for them. As I had finished early morning, case notes also were to be written, so the same was entered in the notes (one more lie to cover up previous one). He was a keen observer; he noticed that the tinnels is not progressing as expected. The patient was scheduled for re-exploration within 3 months and I was summoned to assist him. In his hand the dissection seemed so simple, he found most of the common digital nerves lying apart, with no evidence of even an attempt to repair them. He did not say a single word, but I was totally ashamed of myself for having done it. While the next case was being taken in, he calmly told me to write down “what all I had learnt from the case” and give it to him... I wrote over and over, initially to justify myself, then to explain the situation and then accepting the mistake and further all the things I learnt… But ultimately he never asked it again... But without a word, he had taught me the lesson that I will keep in mind for rest of my life… I have not closed a wound without looking at all the important structures in any given area that is injured since then. He was more of a parent or guardian at times when he would come before all of us, call us for the morning meeting, come well read and explain us a topic a day. When after repeatedly telling us to keep the measuring tape, rulers, lint cloth and scissors in the pocket at all the time for planning and measurements, and seeing our reluctance to follow the advice, couple of times he just jumped across the road to a stationary shop to get us those things. Seeing our meetings, Ortho department started morning meetings and their consultants used to present topics and journal clubs in the beginning. Dr. Asha madam was once mentioning it to him “see the ortho department; the consultants have to prepare and present while residents do nothing.” I remember boss smiling and saying ”my students are much better.... they don't need spoon feeding (by now both me and Vinoth are looking at each other n keeping quiet... and then the bouncer comes)... they believe only in bottle feeding.” Laughter spread all across the theater. He never ignored anyone. From a cleaning person to the liftman, always was given the respect and they reciprocated, he was loved by each and every one in both the hospitals. When I joined, within a few months there was Kerala Plastic surgeons associations annual meeting. He had prepared his famous videos on eight common flaps in plastic surgery that was part of the welcome kit, which people are still using and following. Then I was actually deputed in Cardiothorasic surgery with Dr. Jose Chacko, but was covering the duties with Vinoth to relieve him for the meeting. During his thanksgiving speech he mentioned each and every individual starting from the ward staff with names to have done their bit to make the meeting a success. I haven’t heard a better thanksgiving speech since. When I joined in 2004, he had already had won two best free paper awards for practicing plastic surgeons in 2002 and 2003, he won it in 2004 and repeated the feat 4th time in 2005. Then onwards literally he stopped presenting a free paper in KPSA meetings, though he used to be the faculty. Actually I have not seen him presenting a free paper after that anywhere else. The same thing was for the Free prize paper for postgraduates. Initially he used to help us prepare presentations (arranging pictures, matter, sequence and so on), and would make us rehearse before him. Vinoth, my senior colleague, won the best paper Prize for PG students in 2004, 2005 and 2006 KPSA meetings, then onwards he Stopped helping us. He always felt that others should get a fare chance. He had a magic of changing a simple presentation into a eye catching one. I am sure that only a person with his stature could do this thing. He was always eager to learn new things, assess each of his result and try to do better next time. I evidenced the transformation, from variety of V-y flaps straight/oblique that he used to do with passion, and had his own way of doing. We gradually moved to perforator and then propeller flaps. Sensate laretal arm that used to be his favorite for the heel and sole defects, of which the donor site scar always used to make him unhappy. Over a period of time we changed over the ALT perforator flaps with long tedious dissection of perforator to finally groin which became his favorite over last few years for a small to medium sized defects. He categorically had his indications for choosing flaps and still preferred scapular and parascapular flaps in children when possible. Working with him and listening to him when he was operating was pleasure too and we never felt the time passing when he was around. My senior colleague Dr. Vinoth Philip was his favorite resident. Vinoth was from Thirunveli (Tamilnadu) and had picked up fluent Malayalam soon after joining. He used to spend lots of time in the wards and was always helpful to anyone who approached him. Boss was always impressed with Philips communication skills and used to say that “If Philip Says, Cutting your neck would cure your disease, Patients would be happy even undergoing decapitation.” Vinoth always had a habit of swelling up and filling them with stuffing when he used to describe things. Boss funnily used to say that we take only 10% of what Philip says , if he says ”He saw a big, long, black snake crossing the road and it was thiiiiiiiiiis big, I think 10 feet,” you rest assured that it was only 1 feet long. He would always plan things in advance, along with his own arrangements. He was behind all of us to complete our Dissertation and even wanted us to attain certain proficiency before he left Medical Trust and joined Sparsh Hospital. Even from there he had a close eye on our progress. I remember spending 3-4 weeks in Sparsh a couple of times, working with him even during my training. After completing my training I worked with him for 6 months at Sparsh. This was the time when I got to know him even better. He helped me in so many ways as I was getting adjusted to Bangalore. I was surprised with the amount of faith and responsibility he had laid on my shoulders just after passing. I remember him calling me and allowing me to do many free flaps independently during that time. Unfortunately my wife got a PG seat and my Sparsh stay had to be curtailed, but he encouraged me even for that. Even from Jubilee Mission Thrissur, we were in constant touch and I remember him coming over for meeting arranged by Ellite Mission Hospital, where he used to be a regular faculty. He visited our burns unit and my home that time. My parents had only heard about him till then, they were very happy to see him and interact with him. He was so nice and simple. I remember, he sat with them all afternoon discussing different things. We spent the evening together and then he traveled overnight to Bangalore. By then had got a great assistant Dr. Sushil Nahar for those three years when I was away and he had all praises for Shshil. It had to happen that within 6 months of his visit, as my wife completed the course, we shifted to Pune, my native, where I always had dreamed of settling down. I tried free lancing type of practice for 4-5 months but did not succeed. I had decided to go back to Thrissur. When I discussed with Boss regarding this, he immediately offered me a Job at Sparsh. Sparsh was expanding and they had come up with a branch within the city. I was stationed there and boss used to visit that place once a week. It was great working with him again. His spectrum of work had completely changed. He was doing a lot of complex microvascular reconstruction, was into breast reconstruction, was a part of liver transplant team in narayana and a lot of Brachial plexus reconstructions. Fortunately the emergencies were taken care by Dr Sushil. I used to shunt between the places as needed. Unfortunately for me, the Infantry Road Plastic surgery work did not pick up well and I had to leave Sparsh again, when I Joined Ministry of health, Oman. Boss was always cautiously encouraged me to go only for a short time. During my interview, after seeing my C.V. the only question asked to me was ”Oh! So you have worked with Dr Ashok, is he aware of this interview?” I had already informed sir about the interview, so told them the same. They offered me Senior Specialist post without asking any second question. He even introduced me to a few people working in Muscat, during ISRM 2014 in Kolkata and APSICON Mumbai 2013, which made my journey pleasant here. He was proud father and used to discuss about the achievements of his daughters. Parul was studying in Pune, my native, when I was in Bangalore. He used to visit her regularly. He was impressed with her work, her command over English as she used to write articles on various topics on the internet, later she moved to US for further studies. He was always proud of her achievements. Actually Whenever I Insisted about writing up or publishing something he would say, “after so much work, I have to spend time with my family, you will understand it only when you have kids.” He was a loving father and a complete family man. Even from here (Muscat) we were communicating regularly and he used to share interesting cases that he had done. He had recently switched gears and wanted to grow further in the association. He had arranged “Brachialcon 2012’ and “Brascon 2014’. His interest in brachial plexus was growing and his ‘Plexus defined Course 2015’ co-organized with Rammayya medical college for the lack of facility at Sparsh was very well attended. I met Him during the Course, he was all energetic as usual and had started doing ‘Wong transfer’ (All in One reconstruction for global palsy as he used to explain it), and had visited Professor Wong and was impressed by his results. After the APSICON 2015 (Mumbai) he expressed his interest about contesting for the Presidents Post in coming Cochin meeting. Since then he had become busy visiting as many places as he could and attending most of the conferences. During this time he got the responsibility to write a chapter on ’Thumb reconstruction’ in the Textbook of Plastic Surgery edited by Dr Karoon Agarwal. Having written a few things with him, I was given the responsibility of writing by him. I remember keeping on disturbing him every time I was ready with a draft or I did not know how to proceed. With his busy schedule it used to take time for him to respond to my e-mails. I remember sending him a message, ”Sir, sorry to disturb you with all these e-mails, I am aware of your bust schedule.” The reply I got was “Rahul, you are always welcome, I don’t mind your messages and e-mails. It’s because of you it is progressing, otherwise I don’t have time and patience to do it. I am going to practice for another 20 years, I am looking forward to work with you, together we can do so many better things.” Those words keep haunting me still. I always wanted to go back and work with him, even the moment I think of going back to India, the first thing on the agenda was to go back and do a crash course with him (to re-learn doing things his way). This news was so sudden and so shocking, that no one of us had expected. I had talked to him in details just a week before the incidence discussing about a case and other things. We exchanged message on 18th when he told me to discuss something with Dr. Bhatia. When I heard about the incidence on 20th afternoon, I was shattered. He was not the kind of person who would take such a step. He would have taken any issue ‘head on’ and solved it to conclusion. I still cannot believe that something like this can happen. I still suspect that there is something wrong in the information that's out. But whatever sudden done we have lost a legend. He was simple, godfearing, modest man who followed his dreams with so much passion and perseverance and rose against all odds and struggles he faced to become a renowned Microvascular and reconstructive surgeon that he was. He was very meticulous surgeon and had profound knowledge of anatomy and solid basics. He always used to think out of the box and would have a very interesting plan for any given patient. He had the ability to foresee the results and plan stages accordingly. All over these years I always wondered why I could not think and plan like him. He was par excellence. He had touched many lives and had rehabilitated many back to their routine. His skills and vision were surely needed for many more years, where he would have trained so many young surgeons and served the society in many ways. ”Words are not always enough to express what we really feel…… One must be enough eligible to understand what the heart feels and the eyes speak” We all will always miss him, but personally I feel like I have lost my elder brother. He was so close to me that for any of my concerns I would pick up the phone and call him.... He was always there, for all those who were close to him.... helping and guiding... We always approached him when we needed help... May be, we failed to ask ‘whether he needed some help?’.... He was all alone, doing those fantastic reconstructions that no one would match in near future. I feel that God has taken away his hand from my head. Dear Sir, You will be always there in our memories, your principles will always keep guiding us... Still nothing can replace your cheerful, energetic, ever encouraging presence around all of us... You will be greatly missed... Greatly missed.

I can't believe that I cannot visit u again. I can't believe I cannot hug u any more. I'm sorry I didn't know about ur pain. I'm sorry I didn't stay in touch wid u. I'm sorry I presumed that everything is OK, when inside u were hurting. I wonder what u thought as ur life ended. Did U know ur life mattered to us all, especially ur own family. Tears roll down my eyes as I write these final words. Good bye my friend.!!! Have peace in ur soul.........!!!!!!!!

No words to express. A loving father, loving brother, caring son, loving husband, helping hand and simply matchless personality. We will never forget the image of his gentle and bright face. May God give him eternal rest and family the strength to bear the great pain. He was loved by all of us and he will be cherished in our memories forever.