The call came at six in the evening, and it carried a hurry to it — a third-year surgery resident’s voice pitched a little too high, the way young doctors sound when they need someone senior to say yes.

“Sir, we have a young man in the surgery ward. Acute appendicitis. No previous illness. But his eyes are heavy, and he seems drowsy. We need a physician’s clearance before we take him to the theatre.”

“Hold on,” I said. “I am coming.”

Kasturba Hospital is a ten-minute walk from my quarters. I crossed Gandhi Ashram Road, came out at the square, passed Gulabsingh’s shop, slipped by the iron gate that never opens, and was in. I climbed to the first floor of the surgery ward and found him on a steel cot — a 25-year-old farmer from Anji, fifteen kilometres away. His younger brother stood beside him, one hand gripping the bed rail.

“He was fine yesterday,” the brother said. “He slept on the floor, like always. At dawn he woke up crying, his stomach tearing him apart. The local doctor gave him pills for pain and acidity. Nothing worked. We put him on a motorcycle, one of us on each side, and he groaned the whole way to Sevagram.”

I examined him.

His abdomen was soft. No tenderness on the lower right side, no guarding, no rigidity — none of the signs appendicitis leaves behind. And yet he was slipping, minute by minute, into a stupor. His eyelids sagged as if weighted from within. A thread of saliva ran from the corner of his mouth; he could no longer swallow it.

I put the pieces together, one at a time.

A young farmer. The floor he slept on. Sudden, savage pain at dawn. Eyes that would not stay open. A throat that would not swallow.

Something older than appendicitis stirred in my memory. A Krait.

The Common Krait hunts at night, slipping into village homes after mice, and a sleeping man is only an obstacle in its way. Its bite leaves nothing behind — no mark, no swelling, no pain worth waking for. Its fangs are as fine as an insulin needle. The venom bypasses the skin altogether and goes straight for the nerves.

Dr Himmat Bawaskar, GMC Nagpur class of 1968, has treated snakebite and scorpion sting his whole working life, and one line of his has stayed with every doctor who ever heard him lecture: early morning paralysis in a rural patient is a Krait bite until proven otherwise.

“This isn’t appendicitis,” I told the resident. “This patient belongs to Medicine. I’m taking him.”

The surgeons did not argue. They handed over the file, and an attendant wheeled the stretcher three hundred metres down the corridor to the Medicine ICU.

By the time we reached it, his breathing had turned shallow, his pulse was racing, and his oxygen was falling by the minute. My residents passed a tube down his throat and put him on a ventilator to breathe for him. Every blood test came back normal — kidneys, clotting, platelets, all clean. Krait venom does not touch the blood. It goes straight for the muscles that move air in and out of the lungs, and leaves everything else alone.

We gave him anti-snake venom, atropine, neostigmine — knowing, even as we gave them, that once the venom has locked onto a nerve ending, no antidote unlocks it. The nerve has to grow a new ending of its own. The antivenom buys time. The ventilator spends it.

For twenty-four hours the machine breathed for him while he lay still as the dead.

On the second morning, his eyes opened on their own. The stupor had lifted. His pulse steadied, his pressure held, and the abdominal pain — the pain that had almost sent him to the operating table — was simply gone. We drew out the tube.

Forty-eight hours later he walked out of the hospital on his own two legs.

“Sir, you saved his life,” the resident told me in the corridor. “If we’d taken him to theatre, the anaesthesia on top of the paralysis would have killed him. He’d never have woken up.”

“I didn’t save him,” I said. “A small drawer in my memory opened at the right moment, that’s all. His body did the work. We only kept the air moving until his nerves found their way back.”

That was decades ago, and the lesson has not aged a day.

In Sevagram, when a villager arrives at dawn with abdominal pain no one can explain, heavy eyes, and saliva he cannot swallow — do not reach for the CT scan or the operating list. Think first of the creature that hunts in the dark. Keep the airway open. Support the breathing. Give the body its time to heal.

Every so often, a WhatsApp message finds me — from some former resident who trained in our department, now posted in a district I have never visited. It tells me of a patient who arrived at dawn, unable to swallow, marked down for a stroke. He remembered the story from Sevagram, skipped the CT brain, put the patient on a ventilator instead, and sent him home on his own legs. The rest of the ward, he wrote, was still marvelling at the diagnosis. They didn’t know whose drawer he had borrowed.