Deepali!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The torch has been passed!

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

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

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

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

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

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

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

“No! that’s no way do it….”

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

“Just do it, forget the dean….”

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

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

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

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

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

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

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

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

So, what are you waiting for?

Teacher! teach thyself !!

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

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

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

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

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

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

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

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

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

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

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

ANS, Nimma, Pritha – are you listening?

January 2009.