“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
Saturday, November 17, 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
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
Twelve years is a short time!!
“Sir, will you please fall in line”, the admonition that I was handed out at my son’s school 12 years ago as I stood in line (or not so much in line) to pay the Kindergarten fee still lingers fresh in my memory. And, just a few days ago was the passing out day for the batch of 2007 where the Vice- Captain of the school with immaculate deliverance said adieu to the school on behalf of her batch-mates, one of whom was my son.
These 12 years, have on several occasions, brought me to the school for reasons pleasant or unpleasant and have, on many occasions, helped me relive my own childhood and schooldays.
The one thing that has impressed and awed me year after year – open day after open day, in the kindergarten, junior school or high school is the care and concern of the teachers for their “children” and their dedication and commitment to the good all-round performance of their students.
Not surprisingly, they never referred to the student as “student” – it was always “this child” – that in it self set the tone for intimate bond between the teacher and the taught. It was not surprising therefore that almost every single teacher, whether it was the “class teacher” or a “subject teacher” almost always knew the child inside out – not just the academic performance, but even small nuances as talking and eating habits and characteristic behaviour patterns. The other facet that caught my attention, year after year, was the amount of effort and time the teachers put in for the “Christmas Concert” an annual extravaganza in which every child in the school participated.
The Open days – there were three each year – were great fun. I keenly looked forward to them and have attended almost all of them. Open days were also a veritable GS Alumni reunion – there were so many GS parents that we could have had out Alumni meets at school open days.
Even as I am in awe the school and especially the teachers, my son has very little good to say about the whole thing. All that he cared about was how rowdy his infamous X-D was and how their class “showed” the Principal by doing very well at the boards. He also remembers what great fun they had hassling teachers and the football games during the breaks.
What did the school make of my son? They provided every opportunity for academic and extra curricular activities. They taught him how to good this , good that… they taught him environmental education and how to be a useful member of society. They also taught the structure of the neuron and four pages on the menstrual cycle…all in standard IX. He was made half doctor, half engineer, half geologist .. half everything.
And what does my son think of all this ?– “Oh !Dad” he says utterly bored - all this is a whole lot of B***S****.
“How typical of these kids” you will say! At that age they scarce realsie the value of what they have learnt; what they owe their teachers, how they will never be able to repay the hours of labour the teachers poured on them ,, to make them learn how to wrote A, spell Bee all the way up to ‘Zee’ and how proud they felt when their ‘children’ did well at the boards.
And when he grows old and it is time for him to go back to school with his child, he will, I am sure,. as I always did , say” Son, school days were the best days of my life .. have fun”
Lest my memories of those wonderful days fade away, this piece is in tribute to the Great Unsung School Teacher. –professors of radiology can’t hold a candle to them!
July 2007
These 12 years, have on several occasions, brought me to the school for reasons pleasant or unpleasant and have, on many occasions, helped me relive my own childhood and schooldays.
The one thing that has impressed and awed me year after year – open day after open day, in the kindergarten, junior school or high school is the care and concern of the teachers for their “children” and their dedication and commitment to the good all-round performance of their students.
Not surprisingly, they never referred to the student as “student” – it was always “this child” – that in it self set the tone for intimate bond between the teacher and the taught. It was not surprising therefore that almost every single teacher, whether it was the “class teacher” or a “subject teacher” almost always knew the child inside out – not just the academic performance, but even small nuances as talking and eating habits and characteristic behaviour patterns. The other facet that caught my attention, year after year, was the amount of effort and time the teachers put in for the “Christmas Concert” an annual extravaganza in which every child in the school participated.
The Open days – there were three each year – were great fun. I keenly looked forward to them and have attended almost all of them. Open days were also a veritable GS Alumni reunion – there were so many GS parents that we could have had out Alumni meets at school open days.
Even as I am in awe the school and especially the teachers, my son has very little good to say about the whole thing. All that he cared about was how rowdy his infamous X-D was and how their class “showed” the Principal by doing very well at the boards. He also remembers what great fun they had hassling teachers and the football games during the breaks.
What did the school make of my son? They provided every opportunity for academic and extra curricular activities. They taught him how to good this , good that… they taught him environmental education and how to be a useful member of society. They also taught the structure of the neuron and four pages on the menstrual cycle…all in standard IX. He was made half doctor, half engineer, half geologist .. half everything.
And what does my son think of all this ?– “Oh !Dad” he says utterly bored - all this is a whole lot of B***S****.
“How typical of these kids” you will say! At that age they scarce realsie the value of what they have learnt; what they owe their teachers, how they will never be able to repay the hours of labour the teachers poured on them ,, to make them learn how to wrote A, spell Bee all the way up to ‘Zee’ and how proud they felt when their ‘children’ did well at the boards.
And when he grows old and it is time for him to go back to school with his child, he will, I am sure,. as I always did , say” Son, school days were the best days of my life .. have fun”
Lest my memories of those wonderful days fade away, this piece is in tribute to the Great Unsung School Teacher. –professors of radiology can’t hold a candle to them!
July 2007
Sir, can we … take…..?
For a moment I was lost. As far as I can recall, in 25 years of working with residents, no one had asked this question before. ..
"Sir, can I make a copy of our teaching files on CDs and take them with me?
It is creditable that not one but two residents asked me this question on successive days. Creditable because if they just made the copies and gone away, no one – not in the least I – would have known and everybody could have lived happily ever after. Couple day later, in an entirely different context, another resident told me "Sir, people will use this material to show them as their own…"
I have always felt that the human "hunter- gatherer" instinct comes back to haunt us when we join residency. We hunt and gather x ray films of patients – films which we think are "interesting".
Therefore, for this poor patient with hyperparathyroidism, 7 sets of x rays find their way into residents’ "collections".
The medicine guy - to whom the patient first came - has it, the endocrine fellow has one because he saw the patient on referral ..ditto for the ortho guy; the surgical resident couldn’t care a fig about hyper… whatever it is called – except that it means an opportunity to knock off the gland – but he still makes a set for himself and finally the radiology residents have the monopoly over the stuff – the registrar has one, the houseman another and lecturer the best of them all. And, at the end of all this, the patient has a distal phalanx of the middle finger missing due to radiation therapy!!
These "collections" used to provide great opportunity for the worst hunter-gatherer of them all – me! You see, there was a golden period in the 80s when I used to have friendly servant in the RMOs hostel, who at the end of each room reallocation would get a huge pile of films back to me in radiology – a pile that residents had left behind in or outside their rooms. Now that there were through with the exams, they had no use for them. Ask them how many times they saw their "collection" in the last three years – a big zero.
Scanners and digital imaging have made it all very easy - thankfully sparing the patient much radiation and endless visits to radiology.
But nothing else has changed. Only, we have graduated to "digital hunter-gatherers"
Off and on, because we seem to be always running out of disk space on scanner\radiology, I search for duplicate files in that folder. Not surprisingly, I find as many duplicates of some files as there are residents and the ironic part is not one of them is where the common department pool ought to be. I might be exaggerating a bit but this is often true. If this is true of residents it worse with faculty ..at least the residents do the hunting-gathering themselves; faculty do it by proxy - by making the residents do the hunting-gathering – talk of slave labour of yesteryears.
I never understood why we need to do this – it must just be the possessive urge we all have.
We need to get, we need to have. There are only "get" lists – no "give" lists.
Perhaps when you are out in private practice, it improves your stock when you give a lecture with good films .. may be that is why you need it then.
Which brings us the question of "image plagiarism" – something that is all too rampant. Articles and books are written with others’ images; lectures are delivered with other PowerPoint presentations – so often without due credit to the real source.. Not infrequently, the unfortunate "thief" feels all very good after the show is over. Unfortunate because everyone around him in the audience invariably knows where the images came from …. Of course, there are those really smart crooks will "gracefully" mention - "I borrowed this slide from the internet" – makes him look like a saint. Look harder, you will realize the rest of the 99 images are also from the internet!
It can all be made very simple- like these residents – who were decent enough to ask for permission – and feel good about what you have done and when you do use the stuff acknowledge the source.
I for one, have no hesitation is giving away material whether it is images or PowerPoint presentations – after all – teaching is all about giving… of course, there are the others who guard these possessions jealously. My logic is simple – you cannot fool everyone all the time. Sooner or later, if you use plagiarized material you will be caught and the balloon will burst. If on the other hand, you use them and behave like a gentle man acknowledging the source - your stock will only go up.
As for our own people taking stuff with them when they leave the department is concerned – how can anyone object? These are the same people who often toiled hard and long to run the department - who in their own small or big ways contributed to the teaching material, who will be the flag bearers of the department in the outside world. In their success lies the departments pride.
So take all you want – but also remember – give all you can – when you can.
And when you make a presentation, make sure the GS logo is somewhere there – flying high and sounding loud.
And not in the too distant future, when it will time for me to pack my bags and leave - I would be turning to Deshi and asking:"Sir, May I take…".
January 2007
"Sir, can I make a copy of our teaching files on CDs and take them with me?
It is creditable that not one but two residents asked me this question on successive days. Creditable because if they just made the copies and gone away, no one – not in the least I – would have known and everybody could have lived happily ever after. Couple day later, in an entirely different context, another resident told me "Sir, people will use this material to show them as their own…"
I have always felt that the human "hunter- gatherer" instinct comes back to haunt us when we join residency. We hunt and gather x ray films of patients – films which we think are "interesting".
Therefore, for this poor patient with hyperparathyroidism, 7 sets of x rays find their way into residents’ "collections".
The medicine guy - to whom the patient first came - has it, the endocrine fellow has one because he saw the patient on referral ..ditto for the ortho guy; the surgical resident couldn’t care a fig about hyper… whatever it is called – except that it means an opportunity to knock off the gland – but he still makes a set for himself and finally the radiology residents have the monopoly over the stuff – the registrar has one, the houseman another and lecturer the best of them all. And, at the end of all this, the patient has a distal phalanx of the middle finger missing due to radiation therapy!!
These "collections" used to provide great opportunity for the worst hunter-gatherer of them all – me! You see, there was a golden period in the 80s when I used to have friendly servant in the RMOs hostel, who at the end of each room reallocation would get a huge pile of films back to me in radiology – a pile that residents had left behind in or outside their rooms. Now that there were through with the exams, they had no use for them. Ask them how many times they saw their "collection" in the last three years – a big zero.
Scanners and digital imaging have made it all very easy - thankfully sparing the patient much radiation and endless visits to radiology.
But nothing else has changed. Only, we have graduated to "digital hunter-gatherers"
Off and on, because we seem to be always running out of disk space on scanner\radiology, I search for duplicate files in that folder. Not surprisingly, I find as many duplicates of some files as there are residents and the ironic part is not one of them is where the common department pool ought to be. I might be exaggerating a bit but this is often true. If this is true of residents it worse with faculty ..at least the residents do the hunting-gathering themselves; faculty do it by proxy - by making the residents do the hunting-gathering – talk of slave labour of yesteryears.
I never understood why we need to do this – it must just be the possessive urge we all have.
We need to get, we need to have. There are only "get" lists – no "give" lists.
Perhaps when you are out in private practice, it improves your stock when you give a lecture with good films .. may be that is why you need it then.
Which brings us the question of "image plagiarism" – something that is all too rampant. Articles and books are written with others’ images; lectures are delivered with other PowerPoint presentations – so often without due credit to the real source.. Not infrequently, the unfortunate "thief" feels all very good after the show is over. Unfortunate because everyone around him in the audience invariably knows where the images came from …. Of course, there are those really smart crooks will "gracefully" mention - "I borrowed this slide from the internet" – makes him look like a saint. Look harder, you will realize the rest of the 99 images are also from the internet!
It can all be made very simple- like these residents – who were decent enough to ask for permission – and feel good about what you have done and when you do use the stuff acknowledge the source.
I for one, have no hesitation is giving away material whether it is images or PowerPoint presentations – after all – teaching is all about giving… of course, there are the others who guard these possessions jealously. My logic is simple – you cannot fool everyone all the time. Sooner or later, if you use plagiarized material you will be caught and the balloon will burst. If on the other hand, you use them and behave like a gentle man acknowledging the source - your stock will only go up.
As for our own people taking stuff with them when they leave the department is concerned – how can anyone object? These are the same people who often toiled hard and long to run the department - who in their own small or big ways contributed to the teaching material, who will be the flag bearers of the department in the outside world. In their success lies the departments pride.
So take all you want – but also remember – give all you can – when you can.
And when you make a presentation, make sure the GS logo is somewhere there – flying high and sounding loud.
And not in the too distant future, when it will time for me to pack my bags and leave - I would be turning to Deshi and asking:"Sir, May I take…".
January 2007
Sorry? No way!
It’s a mad world out there.
There are cat fights and dog fights.
The only difference is that animal fights do not involve ego. And hence they can settle without much backlash.
Not so easy with humans; not- especially if you a 25 something resident in KEM!!
Resident warfare is nothing new – not to us in Radiology anyway, where we have had to interact with virtually every other department in the hospital.
In my times as resident, it was not warfare – just fights – simply because all residents were GSites, we were mostly from the same batch – most were friends. Even after a heated argument, most times, we were friends again. Not so today. There are major cultural and “ethnic” differences amongst residents, language barriers exist and misunderstanding of what is said, heard and meant is rampant.
So, we no longer have fights – just plain simple warfare.
There are many variations and uncertainties about these resident warfare – the only certain thing is that it will occur with alarming regularity.
It all started with a couple of phone calls (not one, but two) at my home on a lazy Sunday afternoon from a couple of residents from one of the superspeciality units complaining about the “rude and threatening” behaviour from a radiology resident. I listened politely to the outpouring on the phone and as is usual, I said, “We will sort it out tomorrow”.
Tomorrow came.
I have learned from experience, not to open my mouth without listening to both sides… and as happens always, the versions from the radiology side and the “other” side were quite and significantly different – I got a distinct impression that some blatant lies were being let loose. All this is old hat for me, so I did not bother to counter or argue since I have always held that in matters such as these “The truth is always somewhere in between.”
And the exact truth is impossible to ascertain and in my opinion, no energy and time needs to be wasted on this.
As is my won’t, I gave philosophical lecture to the residents from the other department (my own resident must have had enough of this just being a radiology resident)… I thought things would smoothen out. A couple of hours later, the five of us sat to round to put one more “L'affaire des residents” behind us.
The concerned department Chief, each, the two concerned residents from that department, the radiology resident and I sat across.
“I do not want to go into details” , I started off to my resident – “What you said seems to have hurt them”. So I suggest you just say “Sorry” to them, if what you said has hurt them.
The poor radiology resident had no option against my request, which must obviously have been seen as a command.
“I am sorry, if I had hurt you” promptly blurted the radiology resident.. I felt great. The resident had lived up to my expectation and “ideals”
“Now why don’t you say sorry” said the other department chief to his residents.
A few tense, silent moments passed and out came the shocker.
“We do not think we have done anything that we should say sorry for” was the startling response from them
I was aghast, taken aback as this what I had least expected.. From there demeanor, it was clear that there was defiance and no remorse. I saw no pint in pushing the matter further.
I politely thanked my contemporary and along with my resident left the room.
On the way down, I could hear sobs from my resident. That too didn’t shock me – it always ends in sobs and tears.
“I do not want you to feel bad about having to say an unilateral sorry; I said to my resident who was walking along, “In fact, I am proud that my resident has the courage and sensitivity to behave in a civilized manner. That they did not want to say sorry is their problem, It in no way reflects on you.”
With that I left the resident to personal thought and sobs.
On my way home to lunch, it was obvious to me, that the other residents had missed the point of the whole exercise. It was not a matter of who was right or wrong but one of putting things behind with one of the three most important words in English language “Sorry” ( “Thank you” and “Please” being the other two). I was not angry with those residents - not in the least; I felt sorry for them.
For, some day when they are older and lived through the travails of life, seen ups and downs over which they have no apparent controil, have their own 25 year old kids, they will realize how important it is to learn to get along with others, not to let minor issues hurt yourself or that the Newton’s third law is about “mechanics” not human relationships
When dogs bark; you do not bark right back – just walk along and away from them.
It is never too late to learn.
June 2007
There are cat fights and dog fights.
The only difference is that animal fights do not involve ego. And hence they can settle without much backlash.
Not so easy with humans; not- especially if you a 25 something resident in KEM!!
Resident warfare is nothing new – not to us in Radiology anyway, where we have had to interact with virtually every other department in the hospital.
In my times as resident, it was not warfare – just fights – simply because all residents were GSites, we were mostly from the same batch – most were friends. Even after a heated argument, most times, we were friends again. Not so today. There are major cultural and “ethnic” differences amongst residents, language barriers exist and misunderstanding of what is said, heard and meant is rampant.
So, we no longer have fights – just plain simple warfare.
There are many variations and uncertainties about these resident warfare – the only certain thing is that it will occur with alarming regularity.
It all started with a couple of phone calls (not one, but two) at my home on a lazy Sunday afternoon from a couple of residents from one of the superspeciality units complaining about the “rude and threatening” behaviour from a radiology resident. I listened politely to the outpouring on the phone and as is usual, I said, “We will sort it out tomorrow”.
Tomorrow came.
I have learned from experience, not to open my mouth without listening to both sides… and as happens always, the versions from the radiology side and the “other” side were quite and significantly different – I got a distinct impression that some blatant lies were being let loose. All this is old hat for me, so I did not bother to counter or argue since I have always held that in matters such as these “The truth is always somewhere in between.”
And the exact truth is impossible to ascertain and in my opinion, no energy and time needs to be wasted on this.
As is my won’t, I gave philosophical lecture to the residents from the other department (my own resident must have had enough of this just being a radiology resident)… I thought things would smoothen out. A couple of hours later, the five of us sat to round to put one more “L'affaire des residents” behind us.
The concerned department Chief, each, the two concerned residents from that department, the radiology resident and I sat across.
“I do not want to go into details” , I started off to my resident – “What you said seems to have hurt them”. So I suggest you just say “Sorry” to them, if what you said has hurt them.
The poor radiology resident had no option against my request, which must obviously have been seen as a command.
“I am sorry, if I had hurt you” promptly blurted the radiology resident.. I felt great. The resident had lived up to my expectation and “ideals”
“Now why don’t you say sorry” said the other department chief to his residents.
A few tense, silent moments passed and out came the shocker.
“We do not think we have done anything that we should say sorry for” was the startling response from them
I was aghast, taken aback as this what I had least expected.. From there demeanor, it was clear that there was defiance and no remorse. I saw no pint in pushing the matter further.
I politely thanked my contemporary and along with my resident left the room.
On the way down, I could hear sobs from my resident. That too didn’t shock me – it always ends in sobs and tears.
“I do not want you to feel bad about having to say an unilateral sorry; I said to my resident who was walking along, “In fact, I am proud that my resident has the courage and sensitivity to behave in a civilized manner. That they did not want to say sorry is their problem, It in no way reflects on you.”
With that I left the resident to personal thought and sobs.
On my way home to lunch, it was obvious to me, that the other residents had missed the point of the whole exercise. It was not a matter of who was right or wrong but one of putting things behind with one of the three most important words in English language “Sorry” ( “Thank you” and “Please” being the other two). I was not angry with those residents - not in the least; I felt sorry for them.
For, some day when they are older and lived through the travails of life, seen ups and downs over which they have no apparent controil, have their own 25 year old kids, they will realize how important it is to learn to get along with others, not to let minor issues hurt yourself or that the Newton’s third law is about “mechanics” not human relationships
When dogs bark; you do not bark right back – just walk along and away from them.
It is never too late to learn.
June 2007
Killing Fields
Ever so often, when I am lecturing to or taking clinics for residents, I say “You are all like my 14 year old son, - very intelligent people with no brains – fortunately for you,it is not your fault”.
In the last 25 years, I have yet to see a resident with native intelligence and common sense – a sweeping, hurtful statement, you say; so be it. During this same time, I have seen very bright young minds, sharp, incisive and quick on the take.
No. There is no contradiction – common sense and intelligence or being “brainy” are very different things. Common sense comes out of a lot of internal circuitry – developed because there was an unadulterated PCB on which it could develop. “Brainy – comes out of today’s education system – 2002/200 marks; 27 (!) levelling for the first position at 202/200. Kids - who know the structure of the neuron at 12 – without knowing what it is all about.
That is what our residents come out of. A totally polluted soil in school and college with a lot of garbage for manure; 12 hour “school days”; tuitions from the age of 12 and parents who all want their children to top the merit list. The residents have worn blinkers all their life. They see nothing but an MCQ for a frontage and a merit list at the end of it – a merit list on which their future depends at every stage of life - at age 15, 18, 24,28 …….100!
It is no wonder then, that what they travel through is not green turf of life but the blood-red killing fields of competition.
Tolerance, empathy, respect and admiration for their compatriots and colleagues are the last things that they have learnt – because if they did have these qualities, they would long since have perished in their competitive life. It is a dog eat dog world. These are the killing fields of Pnom Phen.
Today in our department I am seeing an extreme manifestation of this phenomenon; when no one is happy that their colleagues have done well – nay very well – in their exams. They are busy finding fault with whoever has done well. Tolerance is not a word in their dictionary.
Let’s face it – Life is never perfect – no exam is perfect, “no examiners” are perfect – partiality in life occurs in one form or the other at every stage of life – even parents have favourties amongst their kids. Look back from your school days – your favourite teachers; you were favourite students of one teacher or the other – look back and you will see that each one of us, has at different times, benefited or lost because of it.. But, it is important to be graceful in accepting an exam result just as it is important to be equanimous in accepting what life spreads out for us at different times.
When I see residents, crib and crab, back-bite and hurt at this “mature”: age , I am left if a deep sense of despair and sadness – a feeling that I have failed somewhere. Are we never aware of the hurt that our actions can do to others especially when we do it under the freedom of anonymity? Can we not be happy in somebody else’s happiness; can we not think of the “we” rather than of the “I”?
I still don’t blame my residents for what they are or what they do. We as teachers and parents are responsible for this mess – a mess that starts in school and one that ends at DM. But, we will be failing in our duty, if we do not point this out them; if we do not tell them that that there is another way, where character and not marks or medals matters. Because if we don’t teach them these values now, they will learn these late in their lives - but then, it would have been too late - for them and so too - for so many others.
Remember, my little fellows – it is possible to be happy in somebody else’s happiness!!
March 2006
In the last 25 years, I have yet to see a resident with native intelligence and common sense – a sweeping, hurtful statement, you say; so be it. During this same time, I have seen very bright young minds, sharp, incisive and quick on the take.
No. There is no contradiction – common sense and intelligence or being “brainy” are very different things. Common sense comes out of a lot of internal circuitry – developed because there was an unadulterated PCB on which it could develop. “Brainy – comes out of today’s education system – 2002/200 marks; 27 (!) levelling for the first position at 202/200. Kids - who know the structure of the neuron at 12 – without knowing what it is all about.
That is what our residents come out of. A totally polluted soil in school and college with a lot of garbage for manure; 12 hour “school days”; tuitions from the age of 12 and parents who all want their children to top the merit list. The residents have worn blinkers all their life. They see nothing but an MCQ for a frontage and a merit list at the end of it – a merit list on which their future depends at every stage of life - at age 15, 18, 24,28 …….100!
It is no wonder then, that what they travel through is not green turf of life but the blood-red killing fields of competition.
Tolerance, empathy, respect and admiration for their compatriots and colleagues are the last things that they have learnt – because if they did have these qualities, they would long since have perished in their competitive life. It is a dog eat dog world. These are the killing fields of Pnom Phen.
Today in our department I am seeing an extreme manifestation of this phenomenon; when no one is happy that their colleagues have done well – nay very well – in their exams. They are busy finding fault with whoever has done well. Tolerance is not a word in their dictionary.
Let’s face it – Life is never perfect – no exam is perfect, “no examiners” are perfect – partiality in life occurs in one form or the other at every stage of life – even parents have favourties amongst their kids. Look back from your school days – your favourite teachers; you were favourite students of one teacher or the other – look back and you will see that each one of us, has at different times, benefited or lost because of it.. But, it is important to be graceful in accepting an exam result just as it is important to be equanimous in accepting what life spreads out for us at different times.
When I see residents, crib and crab, back-bite and hurt at this “mature”: age , I am left if a deep sense of despair and sadness – a feeling that I have failed somewhere. Are we never aware of the hurt that our actions can do to others especially when we do it under the freedom of anonymity? Can we not be happy in somebody else’s happiness; can we not think of the “we” rather than of the “I”?
I still don’t blame my residents for what they are or what they do. We as teachers and parents are responsible for this mess – a mess that starts in school and one that ends at DM. But, we will be failing in our duty, if we do not point this out them; if we do not tell them that that there is another way, where character and not marks or medals matters. Because if we don’t teach them these values now, they will learn these late in their lives - but then, it would have been too late - for them and so too - for so many others.
Remember, my little fellows – it is possible to be happy in somebody else’s happiness!!
March 2006
Sunday!
“Sunday/” - that was the startled exclamation from the resident.
“You really mean you want me to do these routine procedures on a Sunday” is what seemed to go through the resident’s mind.
Maybe 10 years back I would have said “Why not? What’s wrong with a Sunday”; but, time had taught never to take residents for granted; so I gladly agreed to a rescheduled appointment on a weekday!.
As I ponder the last 25 years, I think of all the crazy things that we used to do in the department on Sundays. There was always the routine stuff – indexing patient records, following up patients, a visit to the PM room, petrous tomograms and so forth.
There were the other routine stuff; arranging and stock-taking of catheters in 53 – planning and pondering what to order. There were times were whole Sundays were spent in indexing and arranging teaching files only to have to redo it several Sundays later.
There was a period of time, when for several straight weeks, we would do barium follow throughs on Sundays – 20 at one go – because there was such a massive backlog!!
Of course, all these were initiated with a “double omlette” at the corner Irani hotel (where the Aditi restaurant now stands) and interspersed with interminable cups of tea from a variety of places.
So when lecturers tell me “What’s the point - we have nothing to do while on call” – I have only told, them, that doing more of the same is not academic radiology is all about. If you continue to do “more of the same”, you are not doing your job as a radiologist in a teaching hospital - because at sometime someone else is supposed to take over and you are expected to move ahead in academic life. We cannot and should not live life for ourselves when we are in academic radiology. If the truthful answer to “What will I leave behind if I leave tomorrow/” is zilch - if the things that you are doing today cannot continue if you are not there tomorrow, you have wasted your time here.
Back to Sundays. It is a day to catch up – on patient care, research and reading. When you are a resident or a junior faculty – there are no Sundays – only one more weekday –last or first – is as you like it. And why is that so? - simply because at that young age you are so full of energy that there is no time to stand and stare. How much “more” you can do entirely depends on how interested you are in doing things. If you want to be a path breaker – a path maker – Sundays are the day for you.
After all, letting go of the “holiday” 150 Sundays in a life time cannot be a big deal. What you gain by making the best use of them will stay with you for ever - even as you leave it behind for others to savour and reminisce.
Maybe, the next time I ask for an appointment for a routine patient on a Sunday, there won’t be a startled response – only a cool calculated statement – Why don’t you so it yourself – may be you can even add it your story of Sunday exploits!!
January 2007
“You really mean you want me to do these routine procedures on a Sunday” is what seemed to go through the resident’s mind.
Maybe 10 years back I would have said “Why not? What’s wrong with a Sunday”; but, time had taught never to take residents for granted; so I gladly agreed to a rescheduled appointment on a weekday!.
As I ponder the last 25 years, I think of all the crazy things that we used to do in the department on Sundays. There was always the routine stuff – indexing patient records, following up patients, a visit to the PM room, petrous tomograms and so forth.
There were the other routine stuff; arranging and stock-taking of catheters in 53 – planning and pondering what to order. There were times were whole Sundays were spent in indexing and arranging teaching files only to have to redo it several Sundays later.
There was a period of time, when for several straight weeks, we would do barium follow throughs on Sundays – 20 at one go – because there was such a massive backlog!!
Of course, all these were initiated with a “double omlette” at the corner Irani hotel (where the Aditi restaurant now stands) and interspersed with interminable cups of tea from a variety of places.
So when lecturers tell me “What’s the point - we have nothing to do while on call” – I have only told, them, that doing more of the same is not academic radiology is all about. If you continue to do “more of the same”, you are not doing your job as a radiologist in a teaching hospital - because at sometime someone else is supposed to take over and you are expected to move ahead in academic life. We cannot and should not live life for ourselves when we are in academic radiology. If the truthful answer to “What will I leave behind if I leave tomorrow/” is zilch - if the things that you are doing today cannot continue if you are not there tomorrow, you have wasted your time here.
Back to Sundays. It is a day to catch up – on patient care, research and reading. When you are a resident or a junior faculty – there are no Sundays – only one more weekday –last or first – is as you like it. And why is that so? - simply because at that young age you are so full of energy that there is no time to stand and stare. How much “more” you can do entirely depends on how interested you are in doing things. If you want to be a path breaker – a path maker – Sundays are the day for you.
After all, letting go of the “holiday” 150 Sundays in a life time cannot be a big deal. What you gain by making the best use of them will stay with you for ever - even as you leave it behind for others to savour and reminisce.
Maybe, the next time I ask for an appointment for a routine patient on a Sunday, there won’t be a startled response – only a cool calculated statement – Why don’t you so it yourself – may be you can even add it your story of Sunday exploits!!
January 2007
Keeping time
I was sitting at the PC when the resident very politely asked me "May I leave now Sir?" Instinctively, I looked up at the wall clock - it was 4.20 PM - time, in fact, well beyond time (4 PM) - for radiology residents to scoot from the No. 10 reporting room.It is interesting how the No. 10 reporting is always covered by residents from 8AM-4PM. You will rarely not find at least one resident there; even if it means someone else from somewhere else to cover for lunch times and "break-times". Some would like to think that this is simply because, the residents are scared of me as I spend most of my time in this computer den; but, I would rather think that they are being considerate to their Chief - poor old man; why let patients come in the way of his work.Come in the way of my work? Yes. … why these residents won't even let me report plain films in No. 10. "Sir, please do not bother"; we will take care of the reporting, Sir" is their usual refrain.. I am sure I must be making too many mistakes or missing too many findings on plain films ...which is what they are probably worried about…To say they scoot on time - is being unfair to my residents. By far and a long way, most work beyond their duty hours and often beyond the call of their duty. Like most residents elsewhere, they too end up doing odds and ends from mehters' chores to the bosses PowerPoint presentations. So, far from being a Hitler as I was back in the eighties and nineties, I am now more considerate and accommodating to the odd - take it easy attitude of residents.Faculty is another ball game all together. Most have goals and ambitions for themselves and the department and are mature and understand that they are supposed to be more responsible and set examples - not that it happens all the time. So ever so often, I look them up, - telling them it is important to maintain time ; patients are waiting, other consultants may be looking for them and that not being available is inconveniencing everybody around.. After all, if there is one place that people call all day long - that is radiology and we better be there when we are wanted or else we will not be wanted and you will have only yourself to blame. Besides everything else, you are cheating, if you don't keep time.Such lecturing works for a while and then again it is back to square one. I realize, we can not and should not police faculty or for that matter residents; they are too old and intelligent not to know their responsibilities .. and…. I keep hoping - surely some day they will keep time… won't they?
June 2006
June 2006
Savour Criticism
About 10 years ago, when I standing in a queue to pay fees at my son's school, some one came up from behind and in a rather stern voice said "Excuse me; will you fall in line please"? Startled, I looked around, mumbled an apology and said to myself "She must be one of those strict school teachers. Whoever, she was, a strange "how can anyone order me around?" thought came over me. You see, when you have been an HOD for some time, you are not used to people finding faults with what you do and correcting it - at least not to your face - irrespective of how wrong you may have been!With time, one gets used to this idea and if you are not watchful, complacency creeps in - "I can do nothing wrong". People are scared to tell you your faults, your department's faults - though a lot of back-row chatter may be going on behind you. With no feedback about your minuses, the rot sets in.On their very first day in the department, I make it a point to tell all new residents that they are free to point out my mistakes and should not think twice about it. The unfortunate end to this little advice is not seldom does any resident actually points out a mistake or error in judgment. Occasionally, when one of the bolder residents does point out something, I relaise how wrong I had been all along.Colleagues in the department are no better; most are still scared about the HOD or perhaps couldn't care less about that old blighter! Friends from other departments generally say the good things; hesitate a lot before pointing out bloomers and generally keep a "cool" relationship. Occasionally, we have a Dilip Karnad, with whom I have endless conversations, who to this day, has almost never had anything good to say about our department and has been my unending source for the masala of criticisms and I treasure and respect him for that. For, had it not been for his voluminous criticisms, we would have been much worse off in so many activities of the department. Unfortunately, his is not a common species.So, the other day, in one of the HOD meetings, provoked on some subject, VJL, as is his won't had choice criticisms in full public view about our CT and perhaps the MRI sections. Though some others, immediately voiced their disagreement with VJL's opinion, I was indeed momentarily shocked - for thus far, he had never mentioned any of this to me and I had counted him as one of my close friends in the campus! After the initial startled response, my defenses were back in place and I said to myself "I should look him up tomorrow and ask what the problem is.Tomorrow came and we bumped into each other - where else - but outside the canteen! Before I could say anything, he apologized profusely for "yesterday's outburst"; "it was not warranted" he continued. As others were present; I just let it go off without any further exchange. But, I know, there must be a problem and I will get it out of him.Listening to criticism - in fact seeking it, is an absolute necessity especially for those who make decisions and are in power. It does not matter where it come from; it does matter if much of it is garbage; it does not matter it is from the junior most resident. That is why GSMC Sounding Board; that is why - the Radiology Sounding Board where anonymous postings are allowed - a place where from we get important feedback.
I wonder how the Deans feel; sitting alone; rarely hearing in-house criticism - though a lot it goes on beyond earshot. I for one, have had interesting responses to my unpleasant feedback to the Deans - but these anecdotes will have to wait for another "Chairman's Corner" !
September 2004
I wonder how the Deans feel; sitting alone; rarely hearing in-house criticism - though a lot it goes on beyond earshot. I for one, have had interesting responses to my unpleasant feedback to the Deans - but these anecdotes will have to wait for another "Chairman's Corner" !
September 2004
They come and go
I take every opportunity to visit my son's school.. simply because I love to see those young, eager kids so full of life run in out of school. I see those tiny tots just entering school and those grown ups sprouting newly grown hair on their chins and I marvel at those teachers who transformed them from those 'crying kids' of Jr. KG to self confident teens of Standard X
I always wondered how those Junior KG teachers felt when they see the same 'old" kids at their 10th standard passing out function. Do they all a sense of pride and achievement or is it a feeling of “just one more batch” passing out?
Come February and we have a similar yet somewhat different happening in our department (many others too - I am sure)
An old group of residents (whose names and faces I manage to memorise in the last 6 months of their stay with us!) will leave and a new gang will come in. They come in all shapes, hues, colors and accents. Through days, weeks, months and years of their work with us, I come to know them better. Though I am often told that they are not as nice and decent as they behave in front of me, I always felt that we are very lucky to have good, often very good residents working with us. It is rare for me to have to reprimand one - to be sure some are more committed than others. Some will just walk through their three years with us whereas others will do anything for the department and show great enthusiasm and spirit. It is such several generations of young enthusiastic minds that have helped us to be a decent department. They not only help themselves but also help the progress of the department.
And when it is time to leave, some will leave without as much as saying a 'goodbye’ ; others get very emotional and breakdown - over the years I think I've seen them all and each time it is moving experience.. For after all, that is what we are here for - to help these young doctors to be good specialists. Though frankly, I believe we do not teach them all we should; but I am sure we teach them what not to do and what not to be.
And years hence, when they write or call, I have trouble remembering their names and faces - but some memories always remain.
And tomorrow a new batch will come.. and I will talk to them my now familiar “Welcome talk” …. and so a new batch is born even as I wonder how they will turn out be!
They come and go; but ever so often, they leave something behind for all of us to savour.
February 2004
I always wondered how those Junior KG teachers felt when they see the same 'old" kids at their 10th standard passing out function. Do they all a sense of pride and achievement or is it a feeling of “just one more batch” passing out?
Come February and we have a similar yet somewhat different happening in our department (many others too - I am sure)
An old group of residents (whose names and faces I manage to memorise in the last 6 months of their stay with us!) will leave and a new gang will come in. They come in all shapes, hues, colors and accents. Through days, weeks, months and years of their work with us, I come to know them better. Though I am often told that they are not as nice and decent as they behave in front of me, I always felt that we are very lucky to have good, often very good residents working with us. It is rare for me to have to reprimand one - to be sure some are more committed than others. Some will just walk through their three years with us whereas others will do anything for the department and show great enthusiasm and spirit. It is such several generations of young enthusiastic minds that have helped us to be a decent department. They not only help themselves but also help the progress of the department.
And when it is time to leave, some will leave without as much as saying a 'goodbye’ ; others get very emotional and breakdown - over the years I think I've seen them all and each time it is moving experience.. For after all, that is what we are here for - to help these young doctors to be good specialists. Though frankly, I believe we do not teach them all we should; but I am sure we teach them what not to do and what not to be.
And years hence, when they write or call, I have trouble remembering their names and faces - but some memories always remain.
And tomorrow a new batch will come.. and I will talk to them my now familiar “Welcome talk” …. and so a new batch is born even as I wonder how they will turn out be!
They come and go; but ever so often, they leave something behind for all of us to savour.
February 2004
Inspire !
At times, I have this habit of indulging in self evaluation. Off and on, when I get back home from work and when I am all to myself, I do a sort of audit on what I had done for the day at work. For a long time now, doing things "one more time" has stopped mattering to me. In those moments I have always asked myself - did I do something new today? A recent TV ad which has this wonderful punch line "When was the last time you did something for the first time" aptly says it all for me. For, I have no doubt that being in a teaching institution "doing something new" has to be our call. The luxury we enjoy here of being able teach and practice medicine essentially beyond the confines of finances and the unique opportunity of being surrounded by intellectual companionship puts us in an enviable position of being able to practice medicine - as a science and teaching - as an art! Haven't we all heard it said a zillion times that "Medicine is a noble profession" and also that "Teaching is a noble profession"? But I have not lately heard any one say what it means to be both - a medical teacher. My own answer is that we are the most lucky of all - the chosen ones! With this proud privilege, comes a loadful of responsibility - of living up to it. Each day we exert our gray cells even as we listen to and examine patients, peer over microscopes, squint our eyes in the glare of the view boxes or as we delicately perform a surgical operation. Less often - perhaps, we sit huddled with students and residents as we teach them what we have learnt over a life time. If you look at these activities, these are what we do day after day, the same thing over and over again. Monotony is the greatest killer of all.If you look at the history of science - whether it be in medicine or mathematics, many things - new and profound - have happened to or have been created by motivated people. Dedication is one thing - motivation and inspiration - quite another. Surely, as doctors we can motivate patients to do the right things to get well and remain healthy. But that's just a one on one. To do that, you do not have to be professor in a medical school. On the other hand, being one, puts you in a unique position of being able to motivate and inspire your colleagues and residents. The higher you are in the hierarchy, the greater the opportunity. As you rise higher, it is this quality of yours that will make a difference. Ignite a young mind and in time see what a spectacular "light show" it produces - a light show that could affect hundreds of thousands of lives in ways which you could not have imagined in a thousand lifetimes. Build a great team and inspire them to great heights and achievements and they will surpass your wildest dreams.As teachers, more than anybody else, we have this unique opportunity to be sparks to light up the fireworks that is all around us. This is an opportunity, we cannot let go by in the tedium of daily work.A small spark from the flame that you carry is all that you need to share - I am sure you will. Now sit back and enjoy the fireworks!
May 2004
May 2004
The Cobbler
It was pouring "dogs and cats" - not "cats and dogs" as Snoopy of "Peanuts" fame would like us say on this Sunday afternoon even as I walked on the road leading off from my school towards the bus stop, a road I had traveled 4 times a days all during my school days. At that very moment, my sandals decided to give way."Oh! No!" I muttered as walked - hoping against hope - towards the corner where our 'family cobbler' used to have a tent almost 35 years ago. Stumbling along, I was relieved to see the familiar tent at the corner and amazed that it still stood. The dark, brown-black tarpaulin of yesteryears had given way to a slick bright blue plastic sheet but the old man I vaguely recollected was not under the tent. Instead the tent's tenant was a bright, young, clean shaven man - 25 odd years old. As he started attending to my sandals, a flashy car drew up along side and a young lady in high heels stepped out. Her sandals had obviously given way and she was struggling to walk up to the cobbler. The lady arrogantly slipped off the sandal towards the cobbler and said:"How much"?The young cobbler inspected the footwear carefully, made a diagnosis and announced the fee with four fingers of the hand,"Four rupees!" exclaimed the woman, as she picked up the sandal in a huff and walked off toward the car. Unfazed by the near scream of the lady, the cobbler carried on mending my sandal. As it was taking a while with the suturing job; I engaged him in some conversation."There used to be an old cobbler in this spot many years back, I said "What happened to him?""Oh, my father?" he asked "he passed away about 10 years back""So you have taken over" I offered politely."Had to" he said; "I was not even 15 when my father passed away. I had to do this for a living"."Why do not go and get educated in a night school or something" I suggested condescendingly.He gave me a wry grin. "I have passed B Com in first class sir he said and I work as a multimedia operator man in a local firm".My shame knew no bounds. I had to say something to cover-up."Then why this?" I asked, awkwardly pointing to his cobbler's wares."This gave me life; how can I give it up? I work on this on this on Sundays; no body can take away this job from me. I do this in my father's memory" he continued - never looking up at me.I could have cried.By this time, the job was done. "Two rupees" he said, before I could ask.I gave him a five rupee coin and walked off before he could return the change. I didn't dare to look back for I was afraid he would be giving me that knowing smile.All through the bus-trip home, the cobbler engaged my thoughts. He is the true man, I said to myself - a man with a spirit and grit aiming for the sky with feet firmly on the ground.I know of many such people, people who have struggled and changed lives for future generations - a change so profound - one would scarce believe that they were from the same lineage.We should be grateful to such heroes, my grandfather included - If only girl with the torn sandals cares to look back into her past, she will surely find once such hero in her own family. I wonder if this is the behaviour that hero wanted of his future generation. Some one needs to educate that girl and perhaps many others that there is something called….. Dignity of labour.
July 2003
July 2003
What do you make...?
It never ever occurred to me that I should do private practice – not as an intern - when I was deciding on a specialty to choose as a career – not today when it appears that private practice will be ‘legalized’ for us.
Why? Many have asked me off and on. Those who are close to me and know me well have sort of written me off – “He is slightly off…” they would say and some of you, I am sure, will readily agree- perhaps increasing the “slightly” scale!
Over the years, I have easily adjusted to a lifestyle that suits my pocket. I have few wants though one of them is an expensive hobby; but, mostly I make my ends meet with my handsome BMC pay – cuts and all - and my wife supports me when the well runs dry.
“Why?” many have asked – “Why am I still in KEM? - in the BMC” of all places! The obvious answer would of course be that no one else wants me. And the BMC expects very little of me – I work 9-4 (many will disagree) ; I have unending leave to my credit .. I stay across the road from the hospital and don’t have to find my way through the traffic snarls of Bombay. The plusses are unending. Besides, I am a very selfish guy; I like what I do here and so I am here – QED.
The other day, I was at this social meet attended by the rich and wealthy and someone (not a Doc) asked rather impolitely “ What do you make Ravi?. When I truthfully told him the figure of my rather ”enviable” take-home pay – he sort of snorted and looked at me as if I were out of my mind. A former teacher of mine – a die-hard full-timer - who had joined in on conversation by then chipped in…. “You want know what these guys in the teaching hospitals make? he asked of that five finger diamond-ringed acquaintance.
“Yes” said the gold mine; “Ravi just told me”
‘Then now let me tell you what they make’ carried on my teacher.
“ Guys like Ravi” he said “work as doctors in hospitals that cater to the very poor. They bring the wealth of their knowledge and experience to help treat these poor patients. They work against all odds and make these hospitals what they are today”. “Speaking for KEM” he continued. “If you have an emergency, there is no better place than a teaching hospital to seek treatment – even today. The resident doctors who will attend to you there are the best young brains in the country and these guys teach them. They mould and nurture them and make them into good doctors who, years later, will treat you in the five star hospitals all over the country”.
He was getting a little animated .. and continued…
“You want to know what these guys make?…let me tell you … They make a difference – difference as teachers – difference as doctors. Very few are blessed to be able to do this in the two noblest of all professions”
By that time, my heart welled with pride.
“Yes. That’s it “ I said to myself “It is true for so many of us”
So the next time anyone asks me “What do I make at KEM? - I am.throwing modesty to the winds, going to say:
“I make a little money and a lot of difference”
Don’t you too?
December 2003
Why? Many have asked me off and on. Those who are close to me and know me well have sort of written me off – “He is slightly off…” they would say and some of you, I am sure, will readily agree- perhaps increasing the “slightly” scale!
Over the years, I have easily adjusted to a lifestyle that suits my pocket. I have few wants though one of them is an expensive hobby; but, mostly I make my ends meet with my handsome BMC pay – cuts and all - and my wife supports me when the well runs dry.
“Why?” many have asked – “Why am I still in KEM? - in the BMC” of all places! The obvious answer would of course be that no one else wants me. And the BMC expects very little of me – I work 9-4 (many will disagree) ; I have unending leave to my credit .. I stay across the road from the hospital and don’t have to find my way through the traffic snarls of Bombay. The plusses are unending. Besides, I am a very selfish guy; I like what I do here and so I am here – QED.
The other day, I was at this social meet attended by the rich and wealthy and someone (not a Doc) asked rather impolitely “ What do you make Ravi?. When I truthfully told him the figure of my rather ”enviable” take-home pay – he sort of snorted and looked at me as if I were out of my mind. A former teacher of mine – a die-hard full-timer - who had joined in on conversation by then chipped in…. “You want know what these guys in the teaching hospitals make? he asked of that five finger diamond-ringed acquaintance.
“Yes” said the gold mine; “Ravi just told me”
‘Then now let me tell you what they make’ carried on my teacher.
“ Guys like Ravi” he said “work as doctors in hospitals that cater to the very poor. They bring the wealth of their knowledge and experience to help treat these poor patients. They work against all odds and make these hospitals what they are today”. “Speaking for KEM” he continued. “If you have an emergency, there is no better place than a teaching hospital to seek treatment – even today. The resident doctors who will attend to you there are the best young brains in the country and these guys teach them. They mould and nurture them and make them into good doctors who, years later, will treat you in the five star hospitals all over the country”.
He was getting a little animated .. and continued…
“You want to know what these guys make?…let me tell you … They make a difference – difference as teachers – difference as doctors. Very few are blessed to be able to do this in the two noblest of all professions”
By that time, my heart welled with pride.
“Yes. That’s it “ I said to myself “It is true for so many of us”
So the next time anyone asks me “What do I make at KEM? - I am.throwing modesty to the winds, going to say:
“I make a little money and a lot of difference”
Don’t you too?
December 2003
Listen
Many of us - especially heads - live in our ivory towers. Take the Chief of Radiology for example - never stops boasting of the "State of the Art" equipment ; a fully networked department- reasonably staffed with faculty and residents - purported to be one of the best teaching departments; high volume of patient load, great interventional work, good library and paper publishing record. Looks impressive; many outside KEM believe and think so. But Alas!, here at home in KEM as I listen carefully to my close friends- I realize the harsh reality - poor quality x rays; bad patient scheduling; wrong procedure reports; a mad-house called "USG"; lack of rapport of faculty with colleagues from other departments; Ravi is impossible to find… the list is endless. But could there be such a stark difference between one's vision and the others' perception? Radiology is supposed to be a "service" department - servicing the needs of others; in a broad sense all departments are servicing the needs of others. Neurosurgery services the needs of a pituitary tumor patient from endocrine; cardiac surgery of a mitral valve from general medicine, the AKD of ARF from all over the hospital .. and so on. The point is, in a hospital such as ours, interdepartmental interaction is inevitable. Therefore, it is important to know what our referring physicians think of our services. Fortunately or unfortunately, the patient is blissfully unaware of the often subtle, but always internecine politics between departments. We can judge ourselves only by listening to others - many of whom are our well wishers - if only we care to listen. Let's ask our close friends what they think of the services we provide them and their patients and then the true friend will tell you the problems and deficiencies. Listen to them carefully; mull over them, discuss them with your colleagues in the department and you have a chance to correct the problems. Gloss over them, treat them with disdain in an "I am the best" attitude and you will sooner rather than later become irrelevant in this place called KEM. The only patients you will treat are those referred to you from elsewhere. When this happens - the time has come for you to stop and listen - to the undercurrent of softly muttered criticism. If you do not keep your ears open and listen, you will enter the realm of "Who cares what they say" ego trip - a trip from which there is no return. It is just not enough for the patients you treat to be the "validation" for what you do. On the other hand, what you do and what you say, what you believe in and you have "achieved" has to be validated by your peers here in the campus because there are the ones who are most likely to know the true state of affairs, because they are the ones that interact with you and your patients on a day to day basis - either on consultation or referral. As a radiologist, I learned early in my training, the importance of "follow-up". As a radiologist, too, I have the privilege of coming in contact with several colleagues across multiple departments in the hospital. I have often heard one department claiming to be doing "first class work" when the rest of the hospital is highly dissatisfied with the services they offer or the quality of patient care they provide. In the absence of any formal audit process in our institution, the only way you can improve yourself- if you care to - is to listen. Listen to the harsh criticisms, listen to frayed tempers, listen to camouflaged sarcasm,; mull over and improve where necessary. After all, the next best thing to improve from other people's mistake is to improve from our own mistakes. Listen - because, they are not always singing your song!
March 2003
March 2003
Roots"
On a lazy Saturday afternoon, sipping tea on the katta with VJL, I discussed animatedly how green and beautiful some parts of our campus were. Surely, this must be one of the high points of living on the campus - especially on the third floor of the AD bungalow – for I see beautifully blooming yellow gulmohors at this time of the year as I sleepily open the living room door to welcome the milkman!
Even as this scene repeated today, a loud barking noise from the footpath down below drew my gaze. A friendly neighborhood dog was doing its morning tree watering rounds. The roots of this stately, three storey tall, yellow Gulmuhor tree were being watered by urea rich fluid. The dog should have known better or should it?
What a predicament for the roots of the grand old tree sprouting such beautiful flowers- I smiled to myself - even as, at that very moment this essay started taking shape in my mind - Roots – I thought to myself– they symbolize what we are today, where we come from.
How does one remember and respect one’s roots?
Our roots go back to our parents .My parents –simple middle class folks- struggled hard to educate and bring me up. I go to see them just ones in a while though they live just a few kilometers away. My mother often chides me for this – perhaps I should visit them more often – I promise myself – I will…several months pass…
My school life was an enjoyable one – one phase of my life I would give anything to live again. My teachers taught sincerely – I greatly respect some of them and fondly remember others. But, even today, I have done precious little for my school though I can give back in many ways….
Two years at Ruia were a washout – nothing exiting there – take it or leave it!
And then came 1971 – the year I entered GS and as of today , am still closeted in its myriad interiors. Perhaps this is where my true roots lie – not surprising when you consider that I have spent more than half my lifetime here. I owe a lot to my teachers - some taught their subjects; others a way of life and yet others became role models. I will for ever be indebted to them.
Here at home in Radiology, the soil was fertile and I had a few great mentors. People who showed me the way and stepped aside in dignified silence – ever so gently nudging me on. I have not forgotten them – I never will, They were the pioneers – those, like me, that followed just broadened the horizon they had opened.
I feel sad when I see people forgetting their roots; forget where they come from and what they were before they became what they are today. People who will glorify themselves at the cost of the coming generation – for, to them there is no past - only the glorious present in first person singular. It does not strike them that today it is their duty to enable such a glorious future for those that are in the " present".
I suppose it will all square up in the end – those that forget their roots will be forgotten the day they cease to be –they would have left nothing behind – not for themselves – not for others.
April 2003
Even as this scene repeated today, a loud barking noise from the footpath down below drew my gaze. A friendly neighborhood dog was doing its morning tree watering rounds. The roots of this stately, three storey tall, yellow Gulmuhor tree were being watered by urea rich fluid. The dog should have known better or should it?
What a predicament for the roots of the grand old tree sprouting such beautiful flowers- I smiled to myself - even as, at that very moment this essay started taking shape in my mind - Roots – I thought to myself– they symbolize what we are today, where we come from.
How does one remember and respect one’s roots?
Our roots go back to our parents .My parents –simple middle class folks- struggled hard to educate and bring me up. I go to see them just ones in a while though they live just a few kilometers away. My mother often chides me for this – perhaps I should visit them more often – I promise myself – I will…several months pass…
My school life was an enjoyable one – one phase of my life I would give anything to live again. My teachers taught sincerely – I greatly respect some of them and fondly remember others. But, even today, I have done precious little for my school though I can give back in many ways….
Two years at Ruia were a washout – nothing exiting there – take it or leave it!
And then came 1971 – the year I entered GS and as of today , am still closeted in its myriad interiors. Perhaps this is where my true roots lie – not surprising when you consider that I have spent more than half my lifetime here. I owe a lot to my teachers - some taught their subjects; others a way of life and yet others became role models. I will for ever be indebted to them.
Here at home in Radiology, the soil was fertile and I had a few great mentors. People who showed me the way and stepped aside in dignified silence – ever so gently nudging me on. I have not forgotten them – I never will, They were the pioneers – those, like me, that followed just broadened the horizon they had opened.
I feel sad when I see people forgetting their roots; forget where they come from and what they were before they became what they are today. People who will glorify themselves at the cost of the coming generation – for, to them there is no past - only the glorious present in first person singular. It does not strike them that today it is their duty to enable such a glorious future for those that are in the " present".
I suppose it will all square up in the end – those that forget their roots will be forgotten the day they cease to be –they would have left nothing behind – not for themselves – not for others.
April 2003
"Both are Better"
He would have been hardly three years old - but, I used to (and still do) call him "Professor" - so to maintain anonymity - let's call him just that - "Professor"One day, my son who was also three then and one other friend of his - also three - spent an intense half an hour making complicated contraptions out of "Leggo". Expectedly, at the end of the exercise, a fight broke out between them as to whose contraption was better.All this while, "Professor" was sitting by my side admiring a "model train" catalog.Pretending not to notice, I was watching the spectacle. The two kids then approached "Professor" and asked of him the obvious question."Hey! Who's Leggo is better? "Professor" took a while to answer. I pretended not to listen simply because I didn't want to get involved in this sticky situation of three-year-olds.But "Professor" was unperturbed. After a brief look at the pieces he pronounced his judgment"Both are better"I almost fell off the chair I was sitting in. Was I a witness to the first wise words of mediation spoken by a future Secretary-General of the United Nations?Being diplomatic does not come to us naturally. We tend to find fault in others and find joy in pointing this out to them. "Wus ho kya aatha hai?" is the KEM trade-mark. That is normal; that is what most kids do - no adult "etiquette" or finesse for them - they call a spade, a spade.But when you are a doctor dealing with numerous colleagues and patients, being truthful about everything - literally - is not always the best way around. Being a radiologist you learn this early in life. "Be nice to the referring physician" we are taught. Else "You will starve for want of patients". So early in life we learn the art of correcting, gently and unobtrusively, barium films hung upside down on the view-box by senior surgical consultants or a neurologist who has the lateral film of the cervical spine upside down and is expounding the findings in a cranio-vertebral anomaly!Early in life too, we are taught the art of "how to hedge". There are no better fence-sitters than radiologists. The better their command over the English language, the better fence-sitters they turn out to be. Here is a typical example of a "Conclusion" in the report on a chest film""The remote possibility of the probability of this lesion being a malignancy cannot confidently be ruled out on this film. However in view of …… a CT scan may be done if so indicated clinically. This report says a lot without saying anything. In the court, I have protected my backside! Or consider this " I am not sure, I do not disagree with you" Only "weather reports" can beat such "diplomacy".All considered, I feel being diplomatic, is good training. When some one says "I think this is a benign ulcer", instead of retorting "No I think it is malignant" - it does not take much effort to say " It could be.. it is of course possible, but I think it is almost certainly malignant'. You friend will get the idea and ask for a biopsy. He will not send a sleepless night over how he had made a fool of himself. One needs to be particularly careful especially when discussing "mistakes" committed by fellow physicians in front of patients. When it is a honest error, or mistake and not a case of negligence, there is no need to rub it in; gently explain to the patients how such things can and do occur - after all no one is God.. Remember, one day the shoes may be on the other foot,So, dear resident, learn early in your resident life the truth expounded by a three-year old. In life, it is often a case of "Both are better"!
January 2003
"In my heart of heart...."
Fifteen or twenty years ago - things at our hospital were not as bad. We had more people around, material was more easily available; the hospital was run by the administration and not by the unions and politicians as it probably is now. Even then, many of us strongly felt that there was a need to change the system of medical staffing so as to retain people. At that time, some of us spear-headed a movement -one of the many thus far- to allow full timers private practice. All supported it - we swore by it. However, one man - one of the most respected in the campus - Sunil Pandya - the Chief of Neurosurgery - strongly opposed it. We adored "SKP"; he liked us a lot; he knew we were the future of KEM; he supported us in all our endeavors. But this time around it was a firm "NO". "I am sorry" he said. "No matter how hard you try to convince me; I will not be convinced. The "practice allowed" system has been tried in other states and it has the dubious distinction of being a consistent failure. In all states, the standard of medical practice, ethics and education has gone down. There is no way I can support you."The four of us (Bharat Dalvi, Mukund Thatte, Dilip Karnad and I ) walked dejectedly out of his office muttering some uncharitable comments about the "Old man".Time went by - Bharat and Mukund chose to go into private practice - and two of the brightest young minds were lost to our institutions; Dilip and I stayed back for our own personal reasons. A couple of years ago, there was a move again to reactivate the "demand" for allowing practice to full timers. This time around things were much worse - the staffing situation had become alarming; some superspecialities were on the verge of derecognition and most of all, the finances of the BMC were in doldrums. Most importantly, the MCI dropped its demand that medical teachers could not do private practice. With some concerted effort and support of Deans; our cherished dream seems to be coming true. Full timers, it seems now, will, in the near future, be allowed private practice (with the proverbial "many a slip between the cup and the lip" permitting!).So why am I not jumping with joy? Why am I pensive and worried; why am I having second thoughts? The answer is age and experience. Now 15 years since what Sunil Pandya told us; the reality of his words still haunts me. I know and understand ground reality better. I know and understand that human beings in Mumbai's teaching hospitals cannot be very different from those in Tamil Nadu, Andhra Pradesh, Karnataka, Gujarat, Rajasthan or so many other states which are regretting the decision to allow private practice to full timers.I can well imagine what will happen. Full timers will spend less and less time within the campus; teaching and research will be the first casualties; malpractices many creep in; hospital facilities may be misused…. the list is unending.Am I a pessimist; is there not a positive side? I think not. In my heart of heart, I know that medical education and training will go to the dogs.In spite of all this; when asked for a vote; I put my hand up in favour of trying this new system. My reasoning was simple. Things are very bad now; they will surely get unmanageable if nothing is done. With the new system, there is a small hope - very small - but surely some hope. I only hope that we devise a simple way of getting back to the "no practice allowed" system -if things go awry in a few years. I really hope so.Today, more than any other time in my life, I truly understand …What they mean, when they say "Caught between the devil and the deep sea".Life does test us; does it not?
December 2002
December 2002
"I don't know"
It was one of those hot but cloudy October afternoons. As I stood sipping a hot cup of coffee outside the canteen , I saw two seniors professors -both known for their hot-headedness - animatedly arguing outside the library. I thought a punch would soon follow - but then some one joined me and I lost touch of the "Two Professors Action" Days later, sitting in the cool of the MLT waiting for the Dean to arrive for one of those, now familiar, HODs meeting - I found both those professors - lets call then Professor O and Professor F -(that's 128 bit encryption) - sitting a few seats away. Curious as to what they were fighting about, I asked -"Hey! What was it that the two of you were fighting about the other day outside the library"?"YOU". Pat came the reply from "Professor O"Generally known for my peace making rather than peace breaking nature, I was aghast."Now, what have I done?" As Professsor O rambled on, the realization slowly dawned on me that the fight was not about what I had done; but, rather about what I had not done. The argument , it turned out, was about how the head of the department of radiology could say that he knew next to nothing of ultrasound and get way with it and ask one of his junior colleagues to do the ultrasound examination of a very close relative of Professor F. At this time, Professor F joined in His face was smiling - but , inside him , he was dead serious as he said:"YOU can get away with it because you are RR. If any of us say such a thing we would get a "memo". I did not know whether feel good or bad about it; but I did feel sorry for ProfessorF - I had let him and his relative down - or had I really?Saying "I do not know" comes very easily to me - there are so many things in radiology that I do not know. Should I be ashamed of it; should I slyly hide it? Should I gloss over it; should I say "Well, you know how it is …."Early in life, as a radiology resident, I had come under the influence many great teachers. Some like Dr.Sunil Pandya, the former head of Neurosurgery had profound influence on my attitudes. I learnt from him many things in Neuroradiology and many important facets of life. He never consciously taught any of these - but like a true teacher - lead by example.. Watching and growing with him, I learnt that there is no shame in saying "I don't know". - because that is basic intellectual honesty. Soon I realized, that in large teaching institutions such as ours, there in no place for a "I". The department is the "I" and all of us, from the senior-most professor to the junior most resident, are just parts of it. Over the years, as I lived through life, I realized the profound truth behind this philosophy.We are here as teachers as well as students - we learn as we teach and teach because we want to learn. We are here too as doctors to whom the patients look up and often implicitly trust. It is our prime responsibility to keep that trust.To be able to do this we should draw on the all resources in the department. Our primary responsibility is towards high quality patient care and teaching by the department as a whole. It does not take a great deal of arguing to convince any one that given the vastness of our specialities today, it is not possible for any one of us to be competent (not just 'also ran') in all subspecialties of our discipline - whatever that be. The department is a combined effort - not a personal kingdom of the head. We have the obvious choice of being mediocre in everything and perish in mediocrity or have the better option of allowing our colleagues to excel in different subspecialties and set up a department which as a whole, will provide a level of patient care and teaching befitting a teaching hospital. Most departments have made the choice and officially or unofficially there are specialists and subspecialists in most of them. And whenever, I am asked a opinion on something that I feel a colleague of mine can answer better - however "junior" he or she may be - I feel it is my duty in the best interest of the patient - to refer the case to him. When I do this , I feel no guilt or shame-just the warm good feeling that the patient will get the best advice our department can provide.This way, I have seen people grow and excel; this way we will provide high quality care across all facets of our chosen speciality, this way we have the luxury of nurturing excellence; this way our residents can learn from masters and hopefully will be motivated to excel. And this way, if I retire tomorrow, nobody will miss me. Is that not what running a department is all about?
October 2002
October 2002
Us Vs they..
In a large institution such as ours, problems always abound; unfortunately, sometimes, only problems abound.
Some problems are chronic and people have stopped noticing or bothering about them. Others are subacute; they come up off and on – some fire fighting is done and things are back to “normal”. Some times, though, acute problems flare up, tempers fly and a little or a lot of damage is caused or made to be caused.
When things do not go on smoothly – some one has to oil the system and get it back on the rails. The real problem is who is to fix these problems when they arise and who is to fix all those other chronic problems?– and thereby hangs a tale.
As many in the campus say, irrespective of who the Dean is, RR is good at getting into his/her good books! Be that as it may, I really have faced the wrath of many deans for saying the wrong things at the wrong time and as is my wont - shooting of my mouth excessively. Exasperated, one of Deans told me:
“The Dean is only the first amongst equals – each one of you “Heads” has as much responsibility to see that this place runs smoothly” (this sentence is of course with the expletives deleted!)
So, that is what the Dean expects of the HODs ; perhaps that is what the HODs will tell their colleagues and so on down the line down to the first year resident…
Is this the way it is supposed to be; is this fair? Are all of us equal? Or are some of us more or less equal than others? Are we expected to do things which we need normally not – if only to see that this place runs smoothly?
Simple answers to these questions is not something I do not know or have; but, I do know that many do not think that way – each and every one, they say, is supposed to look after his brief – do not expect doctors to look after all the work in the campus.
Are we – is each one of us - responsible for all problem-solving in this campus? Are we, as doctors, as someone said – look after everything – even if it be the cleanliness of the toilets – in fact, even the legendary Dr. Jivraj Mehta is supposed to have done this.
I suppose it all depends on why each one of us here in spite of very green pastures all around us. When some one asks me this question – I have a stock answer – I say “Most stay back in KEM because they are incompetent or lazy – I am a rare exception – I am both!”
Jokes aside – it is indeed difficult to generalize. For me, and I am sure, for many others, KEM has been home. We proudly entered this place as impressionable teenagers and now have spent a greater part of our lives in its campus. We own this place and the place owns us. It is a strange, compulsive relationship.
Thus, most times (except when I am desperately angry at some event and blame the Dean for all our ills), I feel responsible for the things that happens in “my home”. That is why, as many have said before – I tend to poke my nose in every thing that happens in the campus. I strongly feel that the one head alone cannot run this place. We have to pitch in our bit as and when our time, mental energy and physical strength permit. We may not agree with all the decisions of the Dean at all times – but we have to respect it, even as we point out the flaws theirein. Do we expect anything less from our own colleagues and juniors?
So, to me, the “Us” includes all those who feel one with the institution; those who feel proud that we are one of a kind – with a great history and tradition and we should unitedly face all adversities – because if we do not do that now and let things slip up, as they rapidly seem to be, the past would have been shortchanged and future will never pardon us.
And those who fail to realize this; those that see our institutions as mere organizations; as bottomless financial pits; those that fail to realize that we are one of the "IITs of Medicine" in India; that we provide the best brains in medicine which then fan all over the country and treat the VIPs in five star hospitals and therefore need to be specially nurtured are the “They”. We have no quarrel with them – it is for us to educate them to see in us what we really are –a unique institution and people - without parallel in the whole of the BMC and few in the rest of the country’s medical landscape and convince them that these institutions need to maintain their tradition of being the most sought after.
After all, we deserve the best; anything else - would be less!
October 2002
"Out on the road.. "
Generally, I am happy with where I am and what I do – and as my wife never tires of saying … I am a creature who relishes monotony. Not quite. Every once in a while, when an invitation to travel out of Bombay and lecture comes my way and becomes impossible to resist – for political or other reasons, I pack my bag and off I go.
In the eighties and early 90s, this would have been three to four times a year. Now that people have realized my true worth, I seldom get invited to lecture. And if per chance, I am, my topics are as the host would like to call “for a mature speaker”. Parenthetically what is not stated is that they now have better speakers to give “talks” – thank God for that – and that I am too powerful (politically?) to be written off and so I am asked to lecture on such as “The history of Neuroradiology in India”. I take this in my stride, tell myself – well, this is not too bad; all the while dreading the day when I would be asked to talk not about the history , but “ The future of Neuroradiology in India”. That would make feel real ancient.
So less frequently than before, I am out on the road. These trips are usually fully paid for. I am invariably treated well, often very well, by the generous hosts. I feel good – as I carry the institution’s and departments “flag” around.
I usually have a series of lectures to give (naturally, the hosts want their ‘paisa vasool’). These are what I call “teaching lectures” Unfortunately, for the audience, when I am in form and well cared for, I do not easily tire of hearing my own voice. So the monologue goes on for several hours… till..
The lectures are over and it is break time as the school kids call it. I dread these hours. When you are at the microphone, you are the master – you can get away with murder. Break time is something else. You get asked the questions. This is the point of this rambling essay. It does not matter where you are – whether it be in metropolitan New Delhi or rural Madhya Pradesh – these questions often floor you – because they are asked by bright young minds. Then there are those people, who have made a rare diagnosis; those that have performed an unusual intervention under trying situations or those that want to visit with us for further training. These students often know and say things that I have not even heard of .. things that make you respect human genius where ever it is.
Being used to Bombay and GS; we live in Ivory Towers. We are the best – none shall touch us. This arrogance of mine was first shattered some 15 years ago when we had the first non-GS residents in our department from our arch rival – GMC. These young ladies were phenomenal -both in sincerity and capability. The GS bastion was being invaded.
Then a steady stream of ‘outsiders’ started invading us. First from other colleges in Bombay and now from all over India. Invariably, they are well read, highly motivated young residents and they will do any department proud. If you train them well, they will go back to where they came from and spread your message – there can be nothing more gratifying than this.
So the next time, you feel you are “the Best” ; GS is the “greatest”, go - pack your bag and hit the road for a lecture series.
More often than not, you will see talent all round you and will return home - a more humble man.
September 2002
“Sir, can I talk with you for a minute ....?"
Mornings, for me, are an assembly line.
Nothing seems to change .. well, most of the time. With the most important event of the morning - packing my son off to school behind me, I turn my attention to the more mundane things in life and generally look forward to the day at work. And even as I climb down the three stairs of the AD Bungalow and take a long walk lasting all of three minutes to reach the department, I spend a few brief seconds trying to organize the six things that I would have to do - first thing - on reaching the department (I have long since forgotten how to remember any list longer than six - that was always the limit of my DD – now, even that is becoming difficult!)
The number one thing is - check my mail – without this, my engine refuses to start. Even as I do this, once in a while, often, on a Monday, - I hear a hesitant voice behind me –
“Sir, can I speak to you for a minute?”
That does it - I tell myself - even as I turn my head grudgingly at the poor resident - because, from years of being a head of a department (I have long since stopped counting how many), I know what these words mean. They mean TROUBLE. That resident of mine has had a tough time the last night - got into an argument with a surgical resident about an ‘unindicated’ sonogram. His voice is anguished, when he says that the surgical resident used expletives in the course of their ‘fight’. Expletives? Against my resident.. My passion is aroused. A war cry goes out. The surgical resident is summoned and summarily fired. The radiology general has resurrected his loyal man in war!! I feel good; my resident feels good.
This event repeats itself with the same results. Each time, my morning is made; I am hero amongst my residents!
Then, some five years ago there was a twist to the tale. Even as I was about to blast off an OBGYN resident, she hesitatingly said:
“Sir, can I say something?”
Lost for words at this unexpected response, I plodded her to go on. What followed was a narration of events exactly the opposite what my resident had told me. According to her, my resident was at fault. My resident had been rude. Drops of saline cascaded down her cheek I had learnt my lesson in life –not once , but several times thereafter, that the versions from two people are always different- often very different – wherefrom follows what I like to call the -
“Ravi’s Law” (I would like to think that this is my original, though very few agree!) which states:
“The Truth is always somewhere in between” - with more experience, I now have a rider on this -
“Never make up your mind without hearing both the sides” - because in matters such as these, no one is really lying – they are often telling what they think is the truth!
Having learnt my lesson from a resident 20 odd years my junior, I often pondered over the whole issue of my resident Vs the other resident and in an amazing flash of rare inspiration, I realised how foolish I have been all these years.
After all, who are all these residents?
They are bright, young and enthusiastic people in their mid twenties who lead difficult lives during the three years of their residency. They are with us in our departments for longer periods than they are at home – some far away from home. They look up to us; they treat us with respect; they help us make our dreams into reality - they are always there when we need them the most.
In turn, we owe them a lot – not just education in medicine, but a lot that they need to know about life and getting along in life. We are their guardians – molding them in their impressionable and formative twenties - teaching them not just to be competent physicians but good human beings as well – teaching them how not to make the mistakes that we have made. Teaching them that the three most important words in the English language are:
“Please”, “Thank you” and “Sorry”
If we can do this, we have achieved a lot.
July 2002
As you walk along
The one thing that sets us apart from all other “repairers” is that we deal with human beings.
And these very human beings are the ones that surround us as we walk along the long and stately, but crowded, corridors of our hospital. They are so many of them that we bitterly complain about being besieged by them. But then, give this a thought in one of your leisurely moments. They are there, because they are sick or they are the near and dear ones of those who are sick. I never tire of saying this… they are here not because they want to .., but because they have to.
And then many of us (I, included) walk along these corridors as if we were afraid to look left or right (some even seem to be averse to look up or straight; all the while seeming to admire the tile work on the floor!) and, when we stand on the corridor to exchange words with colleagues, we are careful to avoid those danger spots, where patients are most likely to ask for directions (the place outside radiology is a classic example).
And inside general radiology, on a crowded morning, I see swarms of patients, but no compassion. I see a beleaguered mother trying to console a sick child, standing at the end of what seems to be a never ending queue for a 30 second chest x ray – but none of the radiology staff has thought it fit to push her up forward in the queue. So the mother waits… and the child wails …. and the chaos goes on…nobody seems to care .. or, at least, so it seems.
The reason is not far to seek….
If you see any one in a white coat animatedly giving directions or explaining things to a patient in the corridor, I bet you 100 to 1, it is a first term medical student or student nurse. By the time you are through with your clinical terms .. you have hardened worse than a raw potato frozen in a deep freeze - to a point that nothing seems to move you. Some even say … it better be that way – else you cannot function as a doctor.
Not really……
If one realizes that a greeting softly spoken, a polite “please sit down” or accommodating a patient who turns up late for an appointment or - as you are getting into a lift - “you first”… can make a world of difference to a patient who has been in a cross country race across the four buildings of the hospital or patiently giving directions to a lonely, anxious mother, with a head-injured baby in her arms trying to solve a jig-saw puzzle of reaching Ward 3 from the casualty.
“Who has the time?” says my wife, as she reads over my shoulder, these words appearing haltingly on the monitor screen. In reality, however, it does not take much off our time to spend a helpful few minutes with patients who need us or seem to be lost in the maze of our corridors. I do not know what it does to you .. but a small ‘thank you’ from one such patient makes the day for me.
More than all this, your students and residents who see you doing this are unlikely to turn away a patient asking for directions .. or turn a blind ear to wailing child …a new generation has been taught the first lessons in courtesy we so sorely seem to lack.
July 2002
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