The Countdown...

It happened a ‘couple’ of years ago – on November 29 2006 – when I turned 54. There is this ritual in our department, when residents dutifully cut a cake for my birthday and present me with a card (one of the rare mementos I preserve) which says all nice things about their ‘teacher’. So on this day, one of my lecturers said “Sir, how many more years before you retire?” That jolted me back into the realisation of the fact that I would have to quit this place I call home away from home in another four years. 
As days have merged into months and months into years, my countdown to November 30, 2010 has almost come to end...
And it all seems like just yesterday. Walking from the main road bus stop along the empty (yes it used to sparsely populated those days – unlike the chaotic traffic jams of today) Acharya Donde Marg to the college office and paying my MBBS fees. Those days it was just the kids who came alone to pay the fees – not like today where it done with “family and friends”. Come to think of it – by the time I retire  - I, like many GSites before me, would have spent more than two thirds of my life and all of my adult years within the four walls of these glorious institutions we call GS and KEM.  
The place grows on you and you become an inseparable part of its glorious edifice. The MLT, the dissection hall and corridors of the hospital and of course, the canteen become an inseparable part of your GSite life. 
For those of us that preferred the “full-time” life, life continues on in the campus even as, one with some luck or a lot of it – as in my case, rises up the hierarchy of academia and then you suddenly find yourself heading a department. 
Not all are so lucky.. and boy, have I been lucky..!!
From some great UG teachers - to master bedside educators - to some o the best minds in Medicine.  I have seen them all.. learnt from them and worshiped a few.. some continue to be life-long heroes. As I look up to my teachers, now walking along with me,, as I look at my colleagues both within and outside the department,I am filled with gratitude for the enrichment that they have brought me.
Students both UG and PG – from both within and outside Radiology, have been the ones that have driven me through these 30 years. Their enthusiasm to learn and work, and their subtle hints at my lack of knowledge and ignorance, their quizzing minds .. all make one’s day. 
And finally, the very purpose we are all here.. the ubiquitous KEM patient. They are all over the place trying to make sense of what appears to be a chaotic system. We try our best to help.. feeling sad, when we are unable to.. they are the foundation on which our institutions rest.
And so we have this axiom that we are students at all times and we owe our patients all that we know . And, in return, we must  share all we can - we live by them - for them. That has been the tradition of GS and KEM and it is for us to keep that flag flying high and I sure you will… remembering at all times that..


No written word, no spoken plea,
can teach our youth what to be,
Nor all the books on all the shelves,
It is what the teachers are themselves.


At yesterday’s farewells, they said all the nice things about me… I basked in the glory of the moment knowing only too well that both  the moment and glory are only evanescent - what remains are


the traditions we were given,
the traditions we tried to maintain and enrich and
the tradition that we hope will be carried on.


That tradition, dear friends and students, is now in your hands.


And, dear bacchus, live life beyond yourself;  for in life, it is possible to win the game and still be a loser and lose the game and still come up as a winner… it is not about winning, it is not about being better than someone else; but, giving the best that you are capable of ! And do not mistake reputation with character! If you do not believe me, listen to Coach Wooden.


They asked me why I teach,
And I replied
Where else could I find
such splendid company…


So, as  I write this line my throat fills into a  lump even as I thank you all for the "time of my life" these past 40 years.


So long and happy be but, say no more that no one envies thee..


Fondly,


Ravi.


November 30, 2010

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You can see more essays at this link

Sisters !!

“I am sorry to call you on your cell number, Sir; but, I am admitted in Ward 4 side room and I have been trying to contact you ….

“Sir, can you please come and see me in the ward….” and the sobbing started…

So, I marched off to Ward 4, met the Sister in Charge and asked, who was admitted in the side room.. I had imagined it would be a medical student or a former faculty.. but, to my surprise the S I/C said “Our sister D  is admitted there, Sir”

Of course, I knew Sister D; she had retired 6-7 years ago and she was one of the first persons, I had run into ward 27, the day I joined there as an orthopedic houseman in 1976. Like most sisters, she had a ‘motherly’ attitude towards me.. helping me cope with the ward work and learning the ropes.

Through days in junior and senior residency, we come under the ‘care’ of a large numbers of sisters - staff nurses and  the “laal patties” and so many of them become a part of our being at the hospital. With some you develop special relationships, one so close and yet indefinable, one born of joy of caring for the sick against all odds and odd times..

Needless to say, so many basic things we will learn from them from -how to load a syringe, to give an intramuscular injection, to preparing a saline sets (those were the good old days) or often the tricks for a fast and easy lumbar puncture which they themselves have learned from generations of residents.

As we switch wards and specialties and change from a resident to a faculty and with time, these memories fade and as faculty, one tends to get more formal in one's dealings with sisters.

 But, not really with those sisters that were with you when you were a bacchu.. The only few people who even today call me a “Tu” in Marathi are the sisters that knew me from my ‘young days” they are the only ones allowed all sorts of liberties with even the head of the department for they are ones like mothers have held our hands and taught the basics of “bed side manners and patient care”.

We outgrow them in rank, and when I see a staff nurse who was a staff nurse when you were a resident and continues to be a staff nurse when you are an assistant professor, And then, suddenly you see her on the corridor with a  “laal patti’ , you feel like shaking their hands warmly and saying” Well deserved sister, long overdue”

Unlike, many of you, I have know most sisters only as sisters, I do not think I  have ever addressed them by their names, but, still the warm bonds I share with them are absolutely unique. Many will drop in Radiology on the last day of retirement to often say “Do not forget me, hun.. you may be big boss today, but you were my houseman..” and we have a good laugh even as I wish them well.

Years pass and one day like sister D in Wd4, some of them will come calling - mostly for medical reasons, they will look around helplessly for a familiar face and then come calling in radiology “I knew you will always be here, I knew you would never leave KEM.. but, ah! ha!.. you seem to have put on some weight , at last”.

Residents look on unbelievingly.. “Who talks like this to their boss”; little do they know the fondness that we all share for our sisters.

And so dear sisters,  those that have helped shape my career and mind, here is my big Salute and a wish - that so many of you (like Sister D in Wd) have showered on me – ever so often - “May God Bless you, all!!

November 2010

Missed opportunities of the 'other' kind

I wonder what people think about, when it is time to retire…I wonder how many would want to continue to work at KEM - looking hopefully for newspaper reports of extension of the retirement age to 60, 62,65.. I know many do, but, I am not one of them. Not because I do not love this place, -  how can I not?  This IS my home, this has been my home, this has made me what I am, and I simply love it here. So what is that makes me so determined to move out of KEM at the stroke of 58, no matter what. Obviously, when I join a private hospital and do more of medicine and radiology, I would make more money,. a lot more money.. but had that been my top reason, I should have been out of this place 25 years ago,. Surely money is not all of it…  The reason has to do with me. Perhaps, as is the case with so many others who have retired and gone away. Some have continued to practice medicine full time… the same way they did in KEM. There have been others who gave up everything to do with medicine and followed a new path. I wonder what is correct.. I wonder if there is a formula here.. something that is “the right thing to do”.  Surely not. Each one of us is different,each one has to decide for ourselves and follow the path of our calling. You have read in these pages the story of my school reunion a little over two years ago, Since then, some of you have heard me talk animatedly of my school..this.. my school ... that…my school - so much so that the grapevine going around KEM is that if Ravi is not in the campus , he has to have done a “back to school thing”. Though exaggerated, there is some truth in this. Since that reunion, I have come in contact with people from varied walks of life, seen a world beyond medicine - admired intellect. incisiveness  and logic in my schoolmates that I have seen, but rarely, in the campus,, felt the warmth of childhood friends and the joy of being a school boy all over again.  Nothing is the same since that time, from foraying into Uapnishads to question “Who am I?” I seem to have gone “soft in the head” . I have seen a world that is very different - young people doing serious stuff for education at a fundamental level, NGOs that do yeomen service in education in all parts of the country, programs that are as rigorous and as vast as the most sophisticated controlled, multi-center clinical trials in Medicine. I have seen great minds and unbelievable commitment in education.. such as for the tribals of Gujarat And each time, I have felt, why so late?...why did I not look at these things, may be five or ten years ago..and, talking to others in the campus, I have realised how, not a small number of senior faculty, is into “one thing or the other”.  But, you are supposed to be doctor and your job is Radiology some would say..and why not practice it longer.. after all 58 is not ‘old”. Perhaps yes. Surely yes.. But, does that have to be Full–full time.. is there not the other path.. where we only slightly move the blinkers and look beyond at what others are doing in fields related or unrelated to us and see how we can come to bear our experience for the progress of each other’s fields.  I feel there is great merit in this.. in the cross pollination of people and ideas - of interactions across “cultures”. I am sure more of us doing this will surely enrich each of us and our students and medical education. and of course, the practice of medicine. Beyond medicine and medical teaching there are people and 'people who have ideas and ideas' we can imbibe.. if only we will look around.. before it is too late.  Take the advice of an old man, keep your eyes open for something beyond the four walls of the campus - jump at it at the first opportunity.. and see how the symbiosis of your two worlds  benefits all that inhabit it. Do it  - before it is too late!! We have but this one life to live.. to learn…to earn and to give. April 2010

When death strikes over a cup of coffee..

At least a couple of trips to the coffee vending machine outside the MICU is a daily routine for me. In the good old times, not so long ago, coffee-cup in hand, I would march into the MICU, looking for Dilip Karnad in his office. Not any longer. I just spend a pensive few minutes standing in the corridor looking at things and lost in my thoughts- sipping coffee. A couple of days ago, this reverie was suddenly shattered by an ear-piercing 'shreiky-cry' of a young woman waiting outside the MICU even as relatives gathered around to console her and, students and residents in white coats, squeezed their way past them, often with disapproving looks of “How could you crowd around and block the passage?”.

Common enough, you might say.. in fact, so common, that by the time you are a one or two-year-old in KEM, you would have developed psychological deafness to the sights and sounds of “death-wails’ that we not infrequently encounter on the corridors of our hospital. But, that morning’s shriek set me thinking – to that morning - some 25 years ago - to the medical ICU at the Sion hospital. That fateful day, death - without any warning whatsoever, had snatched away a 27-year-old doctor in the prime of life .. a close relative of mine  - leaving behind a wife and, a son who was about to have celebrated his first birthday. The three days and nights that I spent on the steps of the staircase outside the ICU at the Sion hospital, were my first introduction to life and death from the other side of intensive medical care.

Time heals, they say.. but, not always without scars. The scar that this experience ‘gifted’ me was an acute awareness about how callous we ever-so-often are as we go about our day to day ‘patient-care’ chores.

The first time I came face-to-face with communicating death was as an intern in surgery . I vaguely remember my registrar instructing me:

“Go, tell the relatives that the patient is dead”.

Obedient that I was, I went out and asked for “so and so’s sagewala” and said:

“Appaka patient gujzar gaya” or some such matter-of-fact words.

QED., right??

Shocking some would say.. how could you be so callous?

But, what could I do? At 24, I knew nothing better. No one had taught me how to convey death and why it was important that it be done right.

That was in 1976. Now 34 years later, we are no better. We are not “death-conscious”, worse still we are seldom “patient-conscious” Sadly, as a rule, medical students and interns are still not taught the need for and ways to be sensitive to suffering or how to convey death.  

“Oh! That’s not in the syllabus and there has never been an MCQ on that in the CETs, so why should we know” some would say.

Young interns not wanting to ‘study’ anything but the facts that get them marks is understandable; but, we as their teachers and mentors ought to know better. If treating human beings is all about life and death, don’t we need to be teaching these skills? Because these are skills that cannot be learned from text books or the internet, these are skills of experience - experience gained by oneself the hard, long way or taught by teachers who have been in the midst of suffering and death all their lives and have taken the oath to alleviate these.

How is that we are so insensitive to what we see around us each day?

Why should a sick patient ever have to stand whilst in a queue? Do benches cost crores of rupees?

How can we let the patients fend for themselves in the maze of our corridors with out a single sign board that says “May I help you?”

Why can’t we provide decent toilets to patients and their relatives? Do they cost crores of rupees?

How can we dare to fling out off the corridors - the clothes patients’ relatives leave out to dry when we do not provide them any decent place to stay?

How can be run a hospital that caters to the poor and destitute - people who often have no where or no one to go to when death strikes - without a system of grief counselling?”

None of this costs crores of rupees to set up; none of this costs dozens of employees to be appointed…all that this needs, is for us to stop and think and remember that we are here to heal sick human beings who often remain anonymous as “that case” .

We are not just ‘health care providers’. We are supposed to be doctors - healing human bodies and minds.

How I hope - we will wake up – soon!

February 2010.

Deepali!

The only thing I noticed unusual about her, when she joined our department in May 2004 as a resident registered for MD was that she seemed older than the others. That, I learned later on was because Deepali was an “in service” candidate. Over weeks and months, I found her to be a quiet and confident worker, timid sometimes, bold at others.. someone who gave no cause for me to complain. Everyone told me she was very hard worker; though on a couple of occasions I had to give some minor “bhatti” to egg her on to do her best. She apologized and then I never did have anything to pull her up for!

I am not one of those “hyper-friendly bosses” and as I have written here on these pages “I like to keep a safe distance” from residents. So, many residents’ goings-on and the internecine “residents politics” seldom escalate up to me - that privilege belongs to the Chief Resident or Deshi!!

So, one not so fine day, I heard from one of the residents that Deepali had been diagnosed as having a carcinoma of the breast and that she was to be operated. At this time, she was seven months old in the department. In all my years as Chief, I have never heard such a shocking news Deepali then underwent surgery and chemotherapy. In two weeks time she was back in the department.. she seemed none the worse.. except for the inevitable wig.

She had actually wanted to extend her leave; but I felt she would be better off at work and in retrospect both of us felt it was the right thing to do. Her inevitable leave of absence, on and off, was being adjusted; her co-residents were covering her calls and all seemed well till about one year later, another resident told me one morning “Sir, we have just done Deepali’s abdominal CT” and it looks like she may be having a carcinoma of the left ovary with peritoneal seedlings; ascites, pleural effusion and tiny lung nodules.

Around this time, her husband, Bhushan came visiting me. We talked a lot back and forth. He seemed to feel helpless and looking for advice. For me, being much older, it was easy to see things in a better perspective. I offered to have a long chat with Deepali. I think I gave her a bit of “pep talk” even as she started following up at the Tata hospital for one more surgery and courses of chemotherapy.

A surgery, several days of admission in the ICU, re-explorations, chemotherapy… all over, Deepali was back at work in a month's time. She continued to work with her co-residents stepping in to help with duties and calls whenever required. She had her MD exam coming. I told her that exams are a cake-walk if you have worked, there is nothing to worry about. At home, her husband and daughters encouraged her to study “Mummy, you have to complete what you have taken in hand” was the ‘advice’ from her 14-year-old Mansi.!!

Enthused by all this, she did appear for her MD exam and fared well and passed out the first time… even as none of her examiners knew of her medical history. All of us were joyed for her.

Post exam, nothing was easy, one or the other medical problem continued, there was fear of recurrence, transfusions, chemotherapy,., it seemed as if it would never end. Earlier this year, Deepali and I had one of our longest conversations, it was an emotional one. On routine examination, a mass (6 cms) had been found in the abdomen . she was totally distraught, her elder daughter was appearing for her the ICSE exam in a month's time. I brought to fore all my experience in dealing with human tragedies and resident problems and said what I really meant “Deepali, live life fully, the future is not in your hands.. do you not want to see your daughter come out with flying colors from the exams?” Tears of sadness slowly seemed to turn into a faint smile, and as Deepali left , I said “Never give up.. we all need you around”. Six cycles of chemotherapy later, her lesions had completely disappeared and there was no need for re-explorations.

And a couple of weeks ago, Deepali called up to say, she would like to visit me at home..

She came in one afternoon, all smiles and looking cheerful with her sparkling daughter, carrying a box of sweets to celebrate her daughter’s successfully completing of the ICSE course … as expected with a 93% marks..

In those precious moments that my son, wife and I were chatting with Deepali and her daughter, the idea for this piece suddenly hit me. The events of the past several years flew past me in super fast motion.. and I blurted out:

“Deepali, I want to write up a “Chairman’s corner on you”.. I feel others will draw inspiration from you.. I will need a couple of photos too”.. you can say “no”… if you do not want to…

Without a moment’s hesitation she said “ Sir, I do not mind…”

And friends, this is a the story of Deepali, one of my brave “bacchus” who fought two metachronous malignancies through several surgeries, and seemingly unending sessions of chemotherapy, fear, pain, anguish, anxiety and uncertainty. But she has stood on the strength of hope, girt with a love of life and the support of family and friends even as she continues to carry on with her professional and personal responsibilities. This a story of a husband and two young daughters (Mansi & Reeya) who supported their mother through times as difficult as life can throw up; of the caring of colleagues who stepped in for her at all times.. and the story of a few close friends who stood as pillars of her strength..

I am sure there are other ‘Deepali stories’ around.. many may have been influenced by them; but, this story of my Deepali is a special one for me…..an inspiration to celebrate 'every living day' of life that we are fortunate to have come our way.

Deepali and Bhushan!! I salute your courage and understanding in giving me permission to reproduce your life's story for the whole world - pictures and all!!

The torch has been passed!

I have been head of radiology for as long as I remember-well-almost like ancient history….officially, for over 21 years and, much longer – unofficially.

I was head when I was a registrar.. I was head as a tutor.. as a lecturer.. as an AP and officially, of course, as a Professor. For as long as I remember, I have been the ‘head’. That’s how my teachers and seniors treated me with care and compassion; with encouragement and enthusiasm and then stood by and watched as I “ran the show”.

So, being head came naturally to me. I did not have to work for it. I had become head by default and as I often tell my friends, the saddest part of my being head here for so long is that I do not know what is to be Number 2. That’s a tragedy for my long-suffering Number 2s.

And that is saying something. My poor number 2s. Even as they dream their time has come - as the old blighter will retire at 58 in a little over a year, there are rumors - the retirement age may be increased - the UGC be cursed!!

And, therefore being head has not gone to my head. My attitude.. So what’s the big deal.? You get to make the decisions, you also get to get the flak, you can’t break rules.. lest others follow suit. The Deans are screaming at you, the AMCs are after your blood, the Unions are gunning for you and the students curse you.. the faculty is never satisfied. And depending on the Dean, you end up spending 20%-40% of the time in meetings. In fact, it is even difficult to find someone who will join you for tea. – the bigger the gap, the more difficult it gets… no question.. it islonely out there at the top.

The wheels of time keep churning along.. giving way to new. The 5 star hospitals beckon and as faculty leave KEM in droves…. we seem to be getting more and more new heads. It is fascinating to see old friends transform from a Professor to a “Professor and Head”. Whereas, some remain untouched by power, most will don new robes - the emperor’s robes! And, when you have been a No. 2 for close to a ‘century’ and then take over as the head, it sort of plays all sorts of tricks with your limbic system. They are repressed energy personified. Most times, this stays within limits, sometimes it boils over as sheer arrogance and anger - ruining relationships - even at the start line.

Perceived as the “know-all in admin” (even if not in radiology), their steps will often lead to “No. 10” seeking advice on this and that and I am privileged to sneak previews of thoughts behind their actions. Being one who is always happy to dole out even unsolicited advice, I get into my elements when advice is actively sought… I am the “know-all guy”.

“No! that’s no way do it….”

“Why don’t you send that in writing....”

“Just do it, forget the dean….”

“In the BMC, the vulture is a patient bird….”

are stock sentences they will hear from me. But what I really enjoy, is lecturing to them about “this is our place”.

You see, I have no doubt at all, that however you look at it, this place we call home, is what we make it to be. Surely, a long chain of people - “small and big” - from the sweepers to the Dean - run the place. But the soul of the GS is us. Through generations of GSites, illustrious or not so illustrious, the torch has now been passed on to you and on you - the head - rests the great ‘burden’ of responsibility - of keeping that torch afire .. bright and shining.

But, no one head can do it alone. For, you cannot just hold it up and watch as it burns out.. it needs to be cared for- by each one of you holding it in turns.. doing all that it takes.. to keep the glow for ever.. brighter and smarter.

That’s not possible if you live in “first person singular”.. “I, me , my department”.. Surely your responsibility is to your patients and your students.. to your faculty.. your department… that is obvious in any organisation .. but not in institutions. In an institution such as ours, your responsibility goes well beyond the legal limits of your department. And, when you see it this way, you will surely think of the “other department”. And even as you make decisions that will enhance your own, you will think of the future as you try to enhance your present.. you think of “what is in it for us rather than just for me.

In these unbounded thoughts, there are no “that is not my job” - “that’s the Dean’s problem”. The Dean, after all is just one cog.. maybe the strongest one; but, what use a wheel, with just one strong cog?

So my dear friends- all of you bright and eager new heads, we have passed on the torch to you - the next generation, a generation which will preside over the Rs. 900 crore transformation of our campus.. a generation that will see GS and KEM being reborn. In your hands, is the future of this place we call “the campus”…a place which at one time boasted of “all firsts’ in the country.. a place which seems slowly to be losing the battle to the “5 stars” outside.

It is time for a war cry, a time for you to find time to shed your aprons and theater gowns.... a time to shed your departmental loyalty.. a time to huddle.. to breathe fresh air into this place.. to ensure that that the splendid, lofty edifices of five years from now, do not remain just buildings of cement, concrete and glass but temples of learning and towers tender care…and you are lucky you will have a leader who can lead you along that path.

So, what are you waiting for?

Teacher! teach thyself !!

“Please keep track of this patient – let me know what this turns out to be” is my common refrain to anyone who seeks an opinion on a difficult case.

We all follow-up our patients; we need to know. We need to know if we were right in making a diagnosis; we need to know the final outcome of a procedure or surgery, we need to know how well a patient came off a complication; we need to know because we need to learn to publish and to share our experiences with our colleagues all our the world .

Following- up patients, getting their feedback, knowing if we did right or wrong; knowing how we fared seems to be a done thing – after all, we are doctors, we need to get better all the time.

Sure we are doctors; but are we just doctors? I thought we were medical teachers too – after all - my appointment letter says “Full time Professor in Radiology”. So teaching, is supposed to be an integral part of our workday. It is not an “optional extra”…. we are doing no one any favour by teaching We are paid to teach and we need to do it well. After all GS is still the first choice of most toppers.

Assuming that we do all the teaching we need to do; do we know if we teach well? What do the kids think of our teaching? Have we gone around asking them ‘Tell us how we rate”. Today’s students are bold and forthright in giving feed back and we can benefit immensely from this - if only we do it right.

“If only we do it right” – that seems to be the key.. From my informal chat with UGs, I have realized that there is great scope for improvement in both the program and quality of teaching.

“We can count good teachers in GS on the fingers of two hands and great teachers do not even count for all the fingers on our one hand” a gutsy young lady from final MBBS said. Take for example the “integrated teaching” that we do for them. It seems to be a disaster because the timing of the lectures and the kids’ “knowledge level“ is all wrong. In fact, SVP has written up about this in one of his articles on this forum.

But how do we get this feed back – back to the teachers; how do we get them to accept the “testing time” - to accept the results and work on improving themselves. Unfortunately, neither the MET cell nor the Academic committee has been able to put in place a self propagating system of student’s feedback in spite of the fact that we have capable people in the campus in the MET cell, in the academic committee and of course the FAIMER itself.. I suspect that this is so, because we are afraid of a backlash from teachers who may feel hurt and let down on feedback that may be critical. We worry about chaos.

Some time ago, I was discussing this issue with a non-medical friend of mine who has been a career teacher and she had suggested several ways to improving acceptability of critical feedback by teachers. I do not believe much of that has being implemented in our college though our local experts in teaching research may all be aware of these.

Whatever be the truth, I am certain we need to intervene urgently if we are to prevent GS from sliding into double digits in Medical school rankings.

And should that happen, we will have no else but ourselves to blame.

ANS, Nimma, Pritha – are you listening?

January 2009.

Let them fly -away!

Stability is a good thing. 

Each morning, we get up and go to work secure in the feeling that this is just another day.. the only difference will be the patients and occasional ‘new’ residents. 

We set your goals and ambitions on this stability. We make our plans for patient care, education, research and publishing based on this secure assumption that ‘all’ will be there. 

It was not always like this before. Not at least in radiology. Like the matinee movies, it was a case of “daily change”. We never had more than two or three faculty in the department running the show with residents. Sure, the modalities were less, but the patient load was the same. Someone or the other ended up doing more work.. And then, after a few months, when things seem to have be somewhat settling down, there would be a change. Some one chose to leave KEM for greener pastures in a private practice or a private hospital. The wheels of this cycle never seemed to stop.…or so it seemed. 

I have, as head of radiology, seen this cycle for close to 20 years. My reaction to this phenomenon today is the same today as it was 20 years ago. A warm feeling of contentment, a sense of a job well done… one more of our own is stepping out into a world of his/her own   

“How can you be so unemotional when someone leaves” – many have asked me.

Sure it is possible - once you realize what it is all about to be a teacher and what a medical school and a teaching hospital are all about.

 

In the daily humdrum of clinical work, we seem to forget that we are all teachers.. may be we became doctors first,, but, our position today is that of a teacher and that is why we are here  in a medical school. As a teacher we teach all we know. We teach the basic formulas, what chemical reactions they decide to create depend on the individual talent of the taught. We do not have complete control over it. And from this cauldron of chemical reactions are born generation after generation of those that trained at GS and KEM…the legacy of our institutions and departments to posterity –

a few bad ones, a few great ones and most in-between. 

In a pyramidal system of staffing, there is never place for everybody; some will leave; others will have to - even if their hearts are in this place. 

As a chief or senior faculty, you will interact frequently with colleagues working ‘under you’ …. And, as they make their life’s decisions, they will turn to you for advice with implicit faith that you will take decisions which are in their best interests. You cannot misguide them. You have seen more life than them, you’ve seen the fate of those that have left before them… you are supposed to know.. you are the wise one. 

Making such decisions for others is not easy.. it never is. You, as their mentor, will have to bring to being a great deal of objectivity in advising them to leave or stay on. These cannot be colored by your personal interests or the interest of the department or, for that matter, even the institution.. All that matters is the best interest of the fledgling that wants to fly - you can neither let them fall to the ground below, nor can you keep them cooped up with the nest – in house arrest. At the right time, there is a need for a right decision. Some of these are most difficult decisions that you make as a medical teacher and a mentor. 

Pride in the people we train, gratefulness to those that have given their everything to run the show for us will always be your beacon - even as you advice them to take the ‘bold step’. 

And, as change is the way of this world, there will be new generations of fledglings even as the older ones are encouraged to fly - fly away - so that the seeds of learning that our institutions will sow through them will blossom into a million learning centers all over the world, treating patients and training doctors… bringing glory to these great institutions we know as GS and KEM. 

So let people fly --- fly away – towards the blue skies and the green pastures- even as you wait with bated breath……to see the fruits of the seeds they carry away from you -to seem  them to excel.... ...to see them outshine you. 

For, in the life of a teacher, few things can be as heartwarming as being completely outshone by his own former “pupil”!

 

 

 

All Rise

I cannot believe GS traditions can change so fast….

Not since school days , do I remember standing up when a teacher walked into a lecture hall; surely, not during my two years at Ruia, not the five years at GS and of course not after joining radiology.

May be in those yesteryears we were more concerned with truly having respect than just showing it.

But, these are different times…

When the Dean walks in for a meeting, most faculty and Chiefs stand up and this percolates all the way down along the line to our students. But, I steadfastly refuse to - even ignoring Nalini’s stern disapproving glance .. not because I do not respect Deans, but simply because, I do not see any reason to demonstrate that publicly. The only GSites who seem to blissfully unaware of the hierarchy are the native-bread, dyed in the wool, GSite packs of dogs. They seem respect only the hands that feed them and can even be trained to bark loudly and run after the Dean’s (new) car..

What? Do you want GS to got to the dogs?... – literally- should they set the tone for behaviour- they better stand to attention with heads bowed in veneration!

I do not think so, I do not think, standing up when some one senior walks in is a true show of respect.. may be a show, but not necessarily a true show… may be respect, but, not necessarily true respect. And, I should know .. what with the under-the-breath expletives that are uttered even as my colleagues stand to a senior faculty or administrator.

So, I find it exasperating when people stand up when I walk into our conference room for a lecture, or into the lecture theater for the occasional UG lecture I give. Thank God, they do not follow it up with a “Good Morning teacher…”

Students and residents standing up….. may be… just about may be OK, but what is most embarrassing is this.. You see, we have these inter-departmental clinical meetings several times a week. We have senior faculty from various departments coming into our conference room to discuss cases and teach. And, it embarrasses me no end, when they too stand up when I enter the room… and then their poor residents have no option but to follow suit..

Why do I loath this so much.. why do I not feel good when another professor calls me “Sir” and stands up in 'respect' for me. About senior faculty I do not know. No amount of persuasion seems to work; whereas some have changed to “Dr. Ravi” or “Ravi” over the years, others whom I consider great colleagues and respect a lot – some of them the finest faculty and we have on the campus today - insist and continue to call me “Sir”. One particular one is very candid and says says "I do not care what you say Sir, but, I will continue to call you 'Sir', Sir". So, after a while I leave these folks alone and admire their honesty and candidness at what they feel, say and do.

But what about the kids, the UG and PG ones?

I would like to believe that they really respect their teachers,, I would like to believe that their teachers live up to their expectations and deserve the veneration that the students seem to shower on them; but sometimes, I wonder if all that they do is just lip … err leg service as they “All Rise”

I do not know if you have noticed it lately, but the new generation of kids has no qualms about rushing into lifts, or sit all across the steps of the college stairs or walk 5 across along our long corridors blissfully ignorant of the inconvenience that they are causing others – junior or senior. I do not know about you, I have but rarely seen these kids, make way for others or for that matter even sick patients. Surely there may be exceptions to this.. but that is not “as a rule” as it ought to be. And , of course, it was not like this during out times. May be we did not stand up when professors walked into our classes, but we never hogged the staircases, the corridors or the lifts.

But as I never tire of saying this.. I am sure it is not the fault of the kids.. they have never been taught otherwise. They have never been told that true respect is respect for any fellow human being whether it is a poor patient in tattered closes or the Dean in his starched white apron. It is important to see who really needs respect. For, making way for a sick patient, or a ward-boy with a heavy load or a patient on a wheel chair is the true demonstration of caring, courtesy and hence respect for all fellow human beings , A way to show that we truly care…

So, show true respect by making way for a patient for the elevator, a trolley on the corridor or a ward boy with a heavy load. Let’s respect people for what they are rather than for what the signages outsides their offices or the name tags on the apron pockets proclaim them to be….

Let’s “All Rise” to people for what they are rather than to their titles that denote their “importance.”

So the next time any one stands up when I enter our conference room, he/she is doing it at his/her own risk of having to continue to stand.. for you will never again hear a “Please be seated" from me.

(This essay is inspired by Subroto Bagchi’s “The Missing I”

Giving....

I would have recognized that rich and deep voice any time-any where, though it must have been over a decade since I had last talked with that my teacher of mine – a blue-blooded GSite now in private practice.

“Ravi”, he started “I have a lady with me; she is the daughter of a patient of mine - who recently passed away -and she has expressed a desire to donate some money to medical charity. “I thought”, he carried on “the PBCF at KEM would be a good idea.”
“Yes sir, of course!” was my immediate response.
“In that case, can I send her to you - so you can guide her how to go about this?” he asked.

We agreed on a mutually agreeable time and there the conversation ended.

I am always game for taking for our institution. Though, if you have ever tried to donate some money to PBCF, you will realise that it is not easy. Once such time, they wanted to know why a particular sum of money was being donated. After much argument, exasperated, I wrote the reason : “… I wish to donate because ….I have too much money” The clerk read the note several times over with no change of expression whatsoever and very officially and with great flair pulled out a pen, underlined that phrase with red ink and readily accepted the cheque!!

Hardships aside, money is always desperately needed in KEM - what with the BMC interested in starting more teaching hospitals rather than take care of the existing starving ones. And, after 20 years of handling Deans and bureaucracy, I am always game for minor skirmishes with the powers that be. I know all their lines and my answers are always ready!!

A couple of hours later, the donor walks into the department at the pre-appointed time. I do not know how often it happens to you, but, there are times when you meet some one for the first time and, even the first few spoken words leave a deep impression on you. A lady in her mid fifties, our donor was one of the most pleasant and charming persons I have had the fortune of meeting. She had this genuine and sincere smile that reflected a pure heart and a lot feeling for life. Preliminaries over, we discussed how best the money could be donated and where it would most useful. Like most genuine givers, she left all the decisions to me saying “We just want to give”.

Over the next days, we exchanged several emails concerning the donation. I then learnt that she was motivating her friends and family to give and eventually all this will go into the PBCF. One thing lead to another and, she even ended giving a substantial amount money for the alumni fund that we were collecting for my school!!

First, a GSite , no longer in KEM, thinks of giving to his Alma Mater rather than to some other charity, and here is a lady, who has had nothing to do with KEM showing such great enthusiasm for the “task” on hand.

We move on from a 55-year-old lady to a bunch of 30-year-old entrepreneurs who spend each Sunday morning at a public hospital playing foster-relatives and taking care of patients’ needs - monetary and othe wise when they could have been “better off “ with playing golf or squash in one the plush Bombay clubs.

Or, this benevolent donor at KEM who has and continues to give crores and rupees to us – his only condition - anonymity for himself.

Closer at home, I can never express fully the gratitude I feel for scores of Alumni from our department who, over the years, have given lakhs of rupees in cash and kind. Often, with a ”Ravi, you do whatever you want with this”

Not that all the above are rich or famous, not all of them give money for 80G or for their names to be etched in gold on black granite.

They give - not because they have to, but because they want to.

After all, to give away in charity, you don’t need to have a lot of money – just a big heart …. in the right place.

Thank God, for such “small” mercies in this “mad-house” called KEM.

Back to School

Exactly at the stroke of 10, the school bell rang and all 80 of us – “boys and girls” - stood up as per usual practice, in rapt attention – and sang the National Anthem with full gusto. The “Jayahae…Jayahae.. Jayhae was followed by the traditional .. “Good Morning Teacher” in the inimitable SIES School style. The teachers in turn responded with a “Good Morning”. But the “children” from the “Good Morning” was missing. Because there were no children - only 55 year olds and about a dozen of their 75 year old teachers on a grand Golden Jubilee reunion, at the school that the “kids” joined in 1958 and left 11 memorable years later, in 1969.

The date was February 24, 2008 , a day I will cherish and savour as almost no other day in my life for the experience was all at once moving, enthralling, unique and unforgettable.

The idea was mooted by a GSite – naturally (not I, but a batch mate of mine) who modelled it on the now traditional silver jubilee (our batch had in 1996) and golden jubilee (will I be around then?) alumni get-togethers of our college.

It seemed an impossible task then in September 2007 when the idea was sown - but with cell phones, e mails and internet, a majority could be contacted and about a third attended.

It is difficult for me to describe my emotions as I entered my school today. Had we done a functional MRI on my brain then, you would have seen my temporal lobes on fire. A rush of memories and unique emotions is what I felt – and I said to myself “Why did we not think of this earlier?”

Those of you that have read my previous essays here, probably know that I always considered my school days as the best days of my life so far – well ahead of my GS career and the reason for that was not just my great school friends and those friendships devoid of politics but the almost “romantic” respect that I had for some of my teachers.

So, it was natural that when I saw my maths teacher enter school that morning, I rushed out to him to say “Sir, let me have the pleasure of welcoming you first” – not that he would have remembered me but because I was possessed by nostalgia.

Slowly, many other teachers trotted in - some walking straight and briskly, others slowly hopping in; but, all with radiant smiles on their faces.

Friends were a different ball game altogether; the boys from my class - I had no problem recognizing (I made a profound observation that day that madrasis, unlike others do not easily have temporal hair recession (unlike my balding GS classmates in 1996) – you see it is coconut oil we use ! – (may be I should write it up!) . There was a sizable number girls, some like a few boys, having come from outside town - I could not recognize a single one of them. But after brief introductions we back to old days chatting away like animated kids catching up on all that was left out in those 11 years at school (ah!, in our days, boys never talked to girls in school!!).

In vividly memorable moments, the assembled teachers were felicitated by their students and then we had the pièce de résistance – a full 15 min. lecture on Algebra and Geometry by our mathematics teacher – black board, chalk and all…. In his now familiar , inimitable style punctuated by wry humor he enthralled us for those golden moments and the best part – he certified us as being better in maths than we are at school.

I can go on and on with a compilation of the goings on that day - which like a normal school day ended at 4, but that is not point my writing this piece.

You see, that day I was not RR of KEM but Ravi R of SIES, I was not Ravi Sir, but Ravi Student, I was not asking the questions but answering them and then it suddenly dawned on me that there is the other side – the students’ side and when one of teachers in her emotionally chocked voice said – “the teacher student relation ship is eternal”, I couldn’t agree more.

I am so lucky to be surrounded by my students, I am lucky to have them stimulate me, I am lucky that one day, we will meet again and a tottering Ravi in an emotionally chocked voice will say, Dear Students “I happy that you have not forgotten that the student teacher relationship is eternal”.

And dear kids, these days if you see me a little more considerate and nice to you – you know why – it is “hang over” of the magic of the reunion!!

Now, go and have your own – it will change your life in ways that would have scarce imagined!!

March 2008

We are giving too much away….

“I think we should add this case up on the “Interventional Case records” section of the KEM website; - the images are beautiful.. I’ve never seen anything like this before” I said to one of my colleagues who with a little bit of prodding, diligently and periodically gives me cases to put up on the internet. A hesitant nod of the head rather than an enthusiastic “Yes, Sir!” somewhat surprised me. And even as I was wondering why, one other faculty who was standing by said-
“But, I think, we are giving too much away..”
Startled I said “Come again”
“You know” he elaborated “by putting these cases up on the net, we are giving away all our good interventional cases”
The full impact of what he said then dawned on me.
“You mean” I replied “others will flick these cases and show them as their own?”
“Exactly!” he responded - visibly relieved that this old man had at last understood the full meaning of what he meant.
Unfortunately though, I never did understand and perhaps will never fathom how doctors and teachers can “give too much away”.
This of course is not an isolated incident and I’ve repeatedly seen just how it can be very difficult for some to draw a line between giving and giving away..

Ever so often, when I am lecturing at meetings, I see the red focusing lamp from digital cameras on the images on the screen,. These are enthusiastic residents clicking away with their most recent digital cameras. You see, these “red lights” can get annoying and exasperated I would say
“For God’s sake! stop bothering with this “dark room photography:! At the end of my lecture, those of you who are interested can copy the lecture from my CD”
“Not mine” my colleague who followed me to the lectern said “You cannot shoot off the screen for my images nor will I give you my CD after the lecture is over”
On one such occasion, surprised at these strong words, I needled him “Why are you so possessive?”
“Oh!” he explained “I’ve collected these with such great difficulty. I don’t want to give it away to others on a platter”
“Why” I persisted
”Come on Ravi! it is obvious; they will show it off as their own”
“So? I retorted”
“But, that is wrong” he almost shouted!
“But, we sell CDs” with similar case material, I persisted.
“Oh! That’s different - its paid for – it’s perhaps OK then” he replied..
“On! Common” I mumbled noting the obvious “value” attached to the service and left it that.

Sure it is wrong. You cannot use others' material and show it off as your own. But, ever so often, we ourselves are guilty of such plagiarism, I am sure there are many of us out there, who when using other people’s material do acknowledge the source or say “This is not my case; I borrowed this from so and so or I got this from the net” . But for each one of us like that do that, there are ten others who pass off plagiarized material as their own - scant realizing that the audience is not fool enough not to be able to catch the lie.
But then just because there are people that cheat, does the internet shut down? We all know that we all would perish (well almost) without Google. Day in and day out, we scrounge the internet for information that will help us learn or treat patients. What would happen if every one thought that they were “giving too much away”? . There would be no internet, no blogs, no teaching files, no open access journals no free lunch... Is that right? – Of course not. Thus as far as the net is concerned, there is nothing like “Giving too much away” – QED.

As teachers we are constantly giving, teaching others what we know – reducing our exclusiveness at all times. As doctors we keep treating patients - each patient treated is one patient less for revenue. All this will not stand logic of materialism or ego. These are signs of a true “do gooder” – a supreme example of altruism.

And even as I conclude this piece, I scan through this morning’s headlines in the newspaper and here is this guy (an Indian) who has invented an “anti snooze” device for car drivers to prevent them from dozing off at the wheels. Asked by the reporter if he has applied for a patent for his new invention he said “No, not yet; I feel, the more it is copied, the more the lives that will be saved”

Teachers and doctors can never “give too much away”.
Let us be proud that being a medical teacher is probably the noblest of all professions.
Lets keep giving away so “more lives will be saved”.

August 2007

Behind My Back…

Within a week of stepping into the department, our new residents get an earful of my “Welcome lecture” which lasts a full one hour. This is in the form of the “Ten Commandments” (often many more)! The first of these commandments, that gets repeated several times in the course of that one hour is –
Thou Shall Not Cheat!
I would like to hope that the residents stick to all these commandments – well - at least the first of the big list -and do not cheat - I hope they will not cheat on their patients, their teachers and most of all do not cheat themselves. I wonder if you have noticed it lately, but it suddenly dawned on me one day that no matter how hard you try, you cannot cheat yourself!! (As my residents say this is RR’s latest ‘One liner’; “God knows, how he comes up with these stupid ones”).
So when I see them explaining things patiently to patients, writing and answering calls politely and doing what I tell them to do.. I feel great - glibly feeling that my residents really do listen to what I say. Not that, it happens all the time - once in a while, I catch them lying (most commonly about a patient’s history which they never asked) and admonish them for not following the “First Commandment”.
In the olden days, when I used to be younger and had stamina to run around the department and was not addicted to computers and digital images , I would walk around the department a lot – often at odd times. Some of my older residents had a nice name for me – “The Ghost who walks”. So, they were always on their guard about what they said and did. Not any longer – I am often in my den and residents can be care-free.
It is all fine in normal times. Every one has their best foot forward and best face towards you. Unfortunately, many of us manage to hide the real “me” from public view and especially from the chief. It takes difficult times to test people and bring out the “true them”. And it happens when their normal routine is disturbed.
And so, not infrequently when I am not in their FOV but within ear shot, I see their true colors. Residents screaming at patients… and just plain ignoring them or picking a fight with a fellow resident from – say - OBGYN… they would not have dared do had they known the ‘Phantom’ was around. So I call them aside – give them a lecture on how it is important to be polite. even though the situation may be exasperating “I know it can difficult“ I say, ”But you should always try to be nice to patients; they are here not because they want to be here, but because they have to be” And I am off on my way thinking… ,”This must be an aberration… may he/she had bad night on call last night” and I think no more about it….
And one day, usually towards the end of a term, I ask around with my faculty and Chief resident about continuing some of residents for the 3rd or 4th years as supernumerary residents. What I hear then is often quite shocking.
So and so.. (who I may have so far thought to me a great guy or a sweet girl) gets painted as demon incarnate. He/She is rude to patients and other residents – shouts at residents from other departments… does not follow patients-up .is truant on call, ‘bats’ calls…..the list is unending.. Some of these are universal observations, others though are colored by personal bias; some others are doomed in an faculty’s cussedness…but at the end of the day you see a pattern and …I am shocked and disappointed. “Oh! they have let me down” I lament …….
Not because they shouted at a patient or a colleague or refused a call but because they thought it necessary to lie about it; because they felt it is more important to appear to be right than be truthful and especially because they pretended to be what they were not.
But, then what do you expect from 25 year olds who are mortally scared of what his/her teacher would do if he knew the truth; what if teacher chose to be vindictive… what if …... the list is unending
As teachers therefore, it is important for us to impress on our students how it is important to be truthful when they deal with patients and peers; for, this is the springboard of academic integrity. Ignore this and we are grooming megalomaniacs who think nothing of fudging data or palgiarising text….
It is important for us to stress that even as you can cheat on your parents, child or spouse and teachers, there is nothing called as cheating oneself. For, if you do that, at the end of the day when you hit the pillow, the deceit and shame of it all will unfold before your own drooping eyes!
When trust is lost – everything is lost!

November 2007