Dr. Anthony Dugald Dias
(1927–2018)
(Read at the Condolence Meeting held at the Lokmanya Tilak Hospital on the 6th February 2018 by Ravin Thatte)
Today is perhaps the saddest day of my professional life. And that life includes all
my successes and failures. In the past, there was Dr Dias to whom I would turn to
share my exultations and sorrows. In recent times, the meetings had reduced having
grown old myself, but there was that feeling that he was still around should I need
him. That situation has now changed forever. I have grown old myself, yet I feel orphaned.
He was the one who gave me support, succour and stability when I entered the portals
of these institutions under difficult circumstances in 1961. He was my philosopher
and guide, who expressly and also by example told me about the nature of our life
and the purpose of our existence. That was the backdrop in front of which his clinical
life played out and I used to be awed by the patience, persistence and perseverance
with which he went about his clinical work. Quintessentially, he was a ‘Yogi surgeon’.
There is an ancient verse which compares a yogi to the Sun which to our eyes appears
to go around the earth but which in fact is not orbiting but is steadfast. When I
read that metaphor, I was reminded of Dr Dias. His movements and his surgical skills
were an extension of his peaceful interior and that is why they were efficient and
artistic. It was he who once told me that there was no uglier sight in this world
than a person in a hurry. It was this peaceful attribute which starkly reminded you
of the difference between ego and ahankar on the one hand and confidence and self-assurance on the other hand. I remember him
telling me that we must not attempt to surpass others but to be good and useful in
our own way. The idea was not to impress the world but to satisfy your conscience
and to frame your practices to the conditions that confront us.
This attitude allowed him to contemplate in general and think about solutions to problems
then extant in particular. His work on the treatment of post-burn myositis ossificans
of the elbow by an excision arthroplasty through the physiological plane was invited
to be included in the yearbook of plastic surgery when we were not even a plastic
surgery department. He was perhaps the first one to move a muscle as a flap to close
a hole in an organ, the sternomastoid muscle for a laryngeal fistula. I should know
because I assisted him. The work on muscle flaps appeared in journals much later.
He lived in the present and moved by the plight of patients with urethral strictures
he adopted the urethroplasty described by Johanson, and his was one of the longest
series of successful treatment of that condition in those days. I know this information
first hand because I used to calibrate these urethras for their long-term follow-up.
Those reconstructed urethras were a cake walk when large metal dilators were used
for calibration. In an era when plastic surgeons removed the stitches of their cases
themselves, I remember him telling me then that the results of a surgeon must always
be evaluated by a peer. He was one of the earliest surgeons in India to adopt and
publish the results of the rotation advancement technique for a cleft of the lip.
After we evolved into a Department of Plastic Surgery, he described a new axial pattern
flap the superficial external pudendal artery (SEPA) flap based on the artery only
after undertaking anatomical dissections. Much much before the current hypothesis
that the end-stage velopharyngeal incompetence (VPI) be treated by bolstering the
posterior pharyngeal wall either by free tissue graft or an implant, this technique
was described by him in his paper on use of the stainless-steel mesh for a variety
of conditions in the body. I have never again seen and heard such dramatic improvements
in the speech of patients with VPI after the mesh was introduced behind the posterior
pharyngeal wall. He used to be the first volunteer to do cases which others would
avoid, for example, pressure sores. His work on the ‘shift of the pressure points’
after excision of bone in the treatment of pressure sores was proved by impressions
on a plaster cast. To supply post-auricular skin in cases of unilateral microtia,
he successfully carried that skin on a contralateral superficial temporal artery flap.
The then editor of the British Journal called it the PARAS flap. The man had vision,
but this vision was not born out of any divine qualities or a third eye but was born
out of a sustained painstaking clinical analysis followed by contemplation. His axiom
that a sinus or a fistula or an ulcer is like a star that guides us in the desert
called disease still rings in my ears. His questions such as what is the anatomical
diagnosis, what is the pathological nature of the illness, how will you confirm the
diagnosis, what is the apparent defect, what is or will be the actual defect were
like poetic mathematics. When regional anaesthesia was not even thought of for major
surgery, I remember him doing a partial gastrectomy under a regional block followed
by a prostatectomy in the same sitting because the patient was too frail for general
anaesthesia.
He spoke little and said things very softly but like in an ancient verse what he said
was like water, capable of breaking the tough resistance of a rock but was also soothing
to the listener's mind like water on the sclera. He was a proud Indian and the one
who advised me to go and see the frescos in the caves of Ajantha to know what Indians
were capable of. Those frescos were made by Buddhists an atheistic religion while
he himself was a devout Catholic Christian. When I was intrigued, he had told me ‘faith
can move and carve mountains’. In the sixties of the last century when the Eucharistic
Congress was held in Mumbai and his holiness the Pope graced the occasion, Dr Dias
in spite of an invitation from his parish opted to continue to do his work in the
theatre. In answer to an enquiry from an anaesthetist, he had said ‘this here is my
Eucharistic Congress.’ Yet, he was loyal to his parish and did a lot of work in the
blood and eye donation drives. Outside the unit, he was a devoted father and husband,
and before Loretta his wife passed away, there used be frequent get togethers at his
home where the whole unit would get invited for elaborate prolonged and sumptuous
dinners. The family including the daughters were gracious and affectionate hosts.
Dr Dias gave to this country a veritable chain of outstanding plastic surgeons though
he himself was a generalist because he allowed them to grow. Those of us who seem
to think that they are shining better remember from where the original glow came and
bow down with humility because humbleness is what he taught us by example.
Dr A. D. Dias retired as the head of the Department of Plastic Surgery at the Lokmanya
Tilak Hospital in Mumbai in 1985.
