The Doctor Surgeon with the Magic Scalpel

As I was gathering articles for the book on personal accounts of Indian Peace Keeping Force in Sri Lanka (IPKF) operations, I came across the “Surgeon with the Magic Scalpel – Major Ashok Tyagi”. He was considered a lifesaver who had worked wonders, often conducting surgeries for 24, 48 and even 72 hours continuously.

I interviewed the “Surgeon with the Magic Scalpel”, now Colonel Ashok Tyagi, who has since left the Army and is settled in Dehradun.

Ashok Tyagi graduated from Armed Forces Medical College (AFMC), Pune as part of the ‘L’ Batch in 1977. He takes immense pride in his tenure in the Parachute Brigade where he was posted to 60 Parachute Field Ambulance and later The Para Regimental Centre Bangalore. He also went on to qualify as a paratrooper and a skydiver. He did his post-graduation in General Surgery from AFMC and was posted in Lucknow. In August 1987 he was sent to the medical set-up in Vavuniya, Sri Lanka, a place notorious for LTTE operations, as a surgeon, on temporary duty for three months.

The surgical centre was organised, in terms of equipment and manpower, to treat a maximum of 10 casualties in a day, of which four were stretcher-borne wounded needing life and limb-saving surgery and six were walking wounded requiring minor surgeries.

Surgeon Tyagi mentions how he was grateful to be able to be of service to the soldiers and treat them for a variety of combat injuries including mine blast wounds and gunshot wounds. They even treated the Liberation Tigers of Tamil Eelam (LTTE) cadre thereby earning their gratitude which was repaid by never knowingly attacking Indian Army doctors. An informant warned the doctors to be careful if they ever moved out of the camp as there were chances that LTTE might kidnap them to treat their own wounded cadre under duress. He jokingly mentioned that the LTTE might even weigh them in gold as payment for services rendered.

The Operation Theatre (OT) was located in a makeshift shelter built upon an abandoned and damaged civilian house. Often during surgery, they had bullets whistling overhead. Army combat engineers continued to build up the facility and had some air conditioning, refrigerators and blood bank operational in time.

When there were no surgeries he’d go for a run at the nearby military airfield. He’d also visit 9 Para Commandos Special Forces, which was located there. Dr Tyagi had a special affection for 9 Paras, being one of the finest special forces of the Indian Army. One day towards the end of his temporary duty, he bumped into Major General Goel, the General Officer Commanding (GOC) of the division, and a paratrooper to the boot. The General thanked him for the great job he was doing and said that he’d like to consider him for something special, hinting possibly at some award or medal. Tyagi told the General that he wasn’t doing his job for any recognition and that he wasn’t the only person there, but a member of a well-oiled unit where everybody contributed to their mission of saving lives. The General then, literally in passing, enquired if he’d be amenable to move on permanent posting to Vavuniya. He told the General that this was an opportunity for any young surgeon and he was more than willing to be posted to Vavuniya. He returned to his unit in Lucknow, India in November 1987 and a week later he received his posting order to Vavuniya, Sri Lanka. He thought to himself that he’d either excel or destroy himself or be killed in action.

Soon he was in the thick of things. There were over 30 occasions when multiple mine blast or gunshot wound casualties to the tune of 15 at a time arrived at the surgical centre, requiring the surgical team to work for more than 24 hours at a stretch without any rest. Thanks to the physical stamina and mental endurance that he had developed as a paratrooper he was able to shoulder his responsibilities and much more. He overcame the shortage of staff and surgical equipment by improvising. He split his surgical trolleys into three sets and developed a style where he managed with minimal instruments. Once the first set was used, he moved to the next set while the first was getting sterilised and became ready for use by the time the third set was in use. He had three trolleys ready at all times. He didn’t have a permanent anaesthetist but got all those who came on temporary duty to step up their style.

He trained non-medical staff, even one sweeper, to take on the role of operation theatre assistant. Ambulance assistants were trained to perform duties of Nursing Assistance and young Unit Regimental Medical Officers (RMO) were put through additional training to stabilise casualties in the operational field. The golden period for a casualty was six hours as was the period for infection to set in. RMOs and battalion medical staff were trained to stabilise and administer antibiotics to delay the onset of infection. Later his team trained innumerable infantry battalion soldiers as Battlefield Nursing Assistants (BFNAs).

He recalls one instance where he had to request the GOC to intervene to evacuate a gut-shot NCO (soldier) of Signals. The nights in Sri Lanka were very dark and it was very difficult for helicopters without night flying capability to land in small openings in thick jungles. The GOC however authorised a night helicopter evacuation where the helipad was lit up with headlights of 3 Ton trucks. Surgeon Tyagi operated on the NCO throughout the night and was able to save him.

There were multiple occasions when they had to perform surgeries for 24-36 straight hours. His toughest day was when they received 46 wounded casualties and had to operate on them continuously for 72 straight hours with one surgical team and with just one surgeon and one anaesthetist. He ensured that his entire team remained motivated during such marathon surgery sessions. Amongst these casualties was Major (later Major General) Bhupesh Jain of 9 Para Commando whose leg had been injured in a mine blast. His evacuation from the incident site had taken so much time that the leg was turning gangrenous and the only option to save his life was amputation of the leg below the knee. “Major Jain was a very dear friend of mine, and his amputation was a very hard decision for me.”

Surgeon Tyagi’s skills and management ensured that the combat surgical mortality rate was kept well below 0.06% as opposed to the world standard of 20%. Patients would be held for durations of 24-48 hours till they stabilised before they were evacuated to other hospitals in India via Madras.

Another major issue was the replenishment of oxygen which was done from Madras. In one case he had loaded empty oxygen cylinders along with patients being evacuated to Madras by air which was much faster than the normal replenishment by sea. It became a major issue when the empty oxygen cylinders were taken off the aircraft. It was wrongly assumed that the patients were being transported without adequate oxygen support. Promptly the medical hierarchy asked for his explanation for this ‘perceived’ serious lapse. It was only after he contacted the concerned officer in Madras, and explained the actual situation, that the wrong perception was cleared and the matter closed.

They started treating/operating on civilian patients at the Vavuniya Government Hospital as they didn’t have a surgeon. He then realised that it would be better if the surgical equipment of the civil hospital could be moved to his (Army) surgical centre and the civilians could be treated inside the Army camp. This was a war zone. One day he went and met the Registrar of the hospital with a request to loan the surgical equipment. He had also taken a party which had already started loading the equipment in the Army vehicle. The Registrar dithered about the loan till he saw that the equipment was already being loaded. He then acquiesced and signed off on the paperwork. This additional equipment greatly enhanced the capabilities of the surgical centre. Further, the medical unit started treating non-surgical cases with the anaesthetist doubling up as the medical specialist. Treating civilians generated a great amount of goodwill for IPKF and the doctors. This also resulted in the generation of lots of actionable intelligence. In OPD for local civilians and in the local Government Hospital he kept a close eye on suspected LTTE cadres having signs of ticks and mites bite marks prevalent in Vavuniya jungles, thus adding to military intelligence.

He learnt that there were orders to the LTTE cadre not to harm any IPKF medical staff. To the best of his knowledge, only one IPKF doctor was killed and that too when he was travelling in a convoy and was not directly identifiable as a doctor.

He did a full tenure of 22 months and was finally deducted from the division. In this duration, he did around 1800 surgeries on severe war wounded, both IPKF and LTTE and around 600 civilian cases including cesareans.

Dr Tyagi says that these were, by far, the best days of his life and he cherishes every memory of the tenure. He later met General Goel in India and when asked how many awards he received, he told the General that he had been awarded the Yudh Seva Medal (YSM). The General was surprised as he had initiated 13 citations and felt that the doctor should have been given more awards. Dr Tyagi replied saying that the best award was the love and respect of soldiers he'd saved, that he received. Wherever he went and if there were any officers or men who had served in Vavuniya they would take the trouble to meet him. He recalls one incident where he was examining a soldier, who suddenly pulled up his shirt to show him an old incision and happily told the doctor that he had been operated upon by him and saved from certain death, in Vavuniya. He feels that his best achievement was that all those who were operated on by him always remembered him with a lot of respect and gratitude. He says that the pre-mission briefings in 9 Para Commandos always included the reassurance that if anyone got injured Dr Tyagi was there to save them so don't worry.

One of his toughest decisions was during the period when he had operated for a straight 72 hours without a break. He was operating on an IPKF JCO when three LTTE casualties were brought in. One had been shot in the right chest and the bullet had exited from the side puncturing his lung and damaging his liver. He was gasping for breath and wouldn’t have lasted for more than a minute. Dr Tyagi asked for blood for the LTTE patient but there were no volunteers. As a surgeon, he always considered that all patients, IPKF or LTTE, were to be attended to, so he donated one bottle of his blood for the LTTE patient. Taking into account the condition of the IPKF wounded who were yet to be treated, he decided to operate on the LTTE patient before the more stable IPKF wounded. After finishing the surgery on the IPKF JCO he got the LTTE patient into the Operation Theatre and put out a request for five bottles for the IPKF patients for the IPKF JCO. There were more than adequate volunteers and he used this blood to save the LTTE patient. The LTTE patient stayed with the surgical centre for quite a while. Some IPKF soldiers were unhappy about how he had prioritised the enemy over their comrades. He had to explain his actions to the soldiers accompanying the wounded to assuage their bitter feelings.

There were 5-6 occasions when the first bottle of blood transfused into urgently needy patients was his own. He comments that as a rule no IPKF soldier ever refused to donate blood.

After a tough professional call, he had to decide how to extend the lifetime of a patient by infusing blood and IV fluids till he could operate on the more serious patient.

Many times a patient would be bleeding but the blood being infused would be keeping his blood levels up thereby extending his life till he could be operated upon. This was a big risk and a tough decision to make.

He recalls the day he received 12 serious casualties of an infantry battalion,12 JAT. While he was busy in triage he heard one of them, an officer, say, ‘Doctor please look after my boys’. He was seriously injured but refused to be shifted to the Operation Theatre till he saved the lives of his ‘boys’. That person was Col Resham Singh, CO 12 JAT. Such a show of leadership and sacrifice had a great impact on the doctor and his surgical team, and despite not having slept for 72 hours all tiredness disappeared. The team worked hard to save everyone and by the end, Col Resham’s condition had deteriorated but fortunately, his fighting spirit saved him.

Col Tyagi finally left the Army in 2011 to Dehradun and settled there. He remembers his IPKF tenure with nostalgia and with tears in his eyes. Great are the soldier doctors of the Indian Armed Forces. Jai Hind ki Sena.

– Major General KA Muthanna, Army Veteran