The Countdown...

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


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


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


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


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


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


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


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


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


Fondly,


Ravi.


November 30, 2010

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Sisters !!

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

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

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

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

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

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

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

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

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

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

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

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

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

November 2010

Missed opportunities of the 'other' kind

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

When death strikes over a cup of coffee..

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

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

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

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

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

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

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

QED., right??

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

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

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

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

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

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

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

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

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

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

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

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

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

How I hope - we will wake up – soon!

February 2010.