Deepali!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The torch has been passed!

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

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

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

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

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

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

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

“No! that’s no way do it….”

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

“Just do it, forget the dean….”

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

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

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

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

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

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

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

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

So, what are you waiting for?

Teacher! teach thyself !!

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

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

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

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

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

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

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

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

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

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

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

ANS, Nimma, Pritha – are you listening?

January 2009.

Let them fly -away!

Stability is a good thing. 

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

 

 

 

All Rise

I cannot believe GS traditions can change so fast….

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

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

But, these are different times…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Giving....

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Back to School

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

March 2008

We are giving too much away….

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

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

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

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

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

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

August 2007

Behind My Back…

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

November 2007

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

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

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

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

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

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

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

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

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

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