MD An Odyssey (1)

MD(Medicine)—AN ODYSSEY

1956

During my undergraduate days PATHOLOGY attracted me most. (Much later I could empathize with the pathologist in Arthur Hailey’s “Final Diagnosis”) . MEDICINE won me over when I scored the highest marks in the university in final MBBS exam.(Have I told you this ,Suba?)(This was the first of a few ‘firsts’—first in medicine in junior medical officers course in AFMC & later first in MD(medicine) Panjab university & ofcourse first in DM(gastroenterology) by virtue of being the ‘lone’ candidate!) But during the house surgency period we concentrated on learning the ‘practice’ of medicine. Since I had failed in Anatomy (there is a story here but not now) chances were not bright in gaining admission to PG in major subjects as those who got MBBS without failing in any subject during the 5 yr course would be preferred. That I was born to Brahmin parents was a ‘minus’ point! Appa desired that I join him in SVPR since Anna had already joined Indian Navy. (Destiny had different idea). More out of desire to visit Delhi than with intention of joining AMC two of us responded to a call for interview for DPRC (direct permanent regular commission in Army Medical Corps. L Block in AHQ where interview was conducted was a dilapidated very old building. But interview was fun simply because I had no intensions then of joining AMC even if offered. I finished house surgeoncy . After returning from Delhi I continued with house suegeoncy n Stanley and even extended it by three months to work in labor ward (How I hated it!!) to be better equipped to life of a ‘general practitioner’. Anna had bought FORD POPULR ,brand new car costing Rs.SIX THOUSAND only!! He did not have driving license. I had. So I drove anna, manni, & suppamani from SVPR to Malabar hills, Bombay.

1957

During my holiday there I joined DVD (dermatology & venereology) in Grant Medical college under Dr.Maniar prompted by a desire to delay returning to life of private practionner. Life waswas far less complicated those days—Dr.Maniar asked me to write an application in plain paper (no forms  etc). He forwarded the same with his recommendation / approval  to Bombay University  and I was admitted to DVD (dermatology & venereology) in Grant Medical College under Dr.Maniar.I used to drop anna in Nair Hospital where he was in charge of NCC and drive the Ford Popular to Grant Medical. Evenings I loved the drive through ‘Marine Drive ‘from Malabar hills to Colaba causeway to play tennis. Life was good BUT to be content with DVD while my ambition was MD(medicine) and to have to return to SVPR as GP were bugging me deep within.

1958

 After close to two years  from my interview in Delhi I received letter from AHQ that I had been selected to join DPRC in AMC. Till then I had forgotten all about Delhi interview! Anna said YES. Appa, as always, okayed  what his children wanted. MAHASANNIDANAM  (Sringeri) after his stay in our house in SVPR was camping at Sattur. Appa took me to him “kannanukku pattalathil sera order vandhirukku. Ennudamum irukkalam. Ungaladhu aasirvadam venum” prayed appa to the pontiff. “paiyan viruppappadi aahattum. Ennudaya aasirvadaam “I joined AMC with blessings of His Holiness. No regrets at all.

03Feb 1958

I repoted to AMC center Lucknow. 02Feb 1958 Papa married Kasi. I could not attend.(Later I was to miss her daughter Jayanthi’s wedding because I was in Tokyo learning ERCP & colonoscopy).Baptism into AMC consisted of 3 months in AMC centre in Lucknow & 3 months in AFMC Pune ending with an exam in AFMC in all subjects. I stood first in Medicine. Maj Gen Karani commandant AFMC offered me selection to train in Hygiene (dignified by the term ‘Preventive Medicine!) straight away with a carrot that he would get me posted to AFMC instead of being posted to ‘field area’ (J&K, Nagaland etc). Anna insisted that I should accept the ‘golden offer’ thereby assuring the backing of the General as well as avoiding suffering hardship in J&K. I declined. Medicine & nothing else was my choice. Completed three years in J&K , married  Jaya in this period, posted to MH Aurangabad ,where J & I set up our FIRST home. Here I met Prof. R D LELE, HOD medicine in Aurangabad medical college. Tennis court in the club was where I met him. He permitted me to attend his ‘bedside’, lectures whenever I found time. I bicycled (first transport I owned!) daily , sometimes in the afternoon as well. He was a good teacher . (He retired from KEM Bombay and wrote for the first time a text book of medicine in ‘marathi’ & was responsible for propagating “nuclear medicine”—(Google to know more about him).  AHQ order indicating that I had been selected to “advanced medicine course” ( PG Course in MD in civilian  lingo) was received. ( Basis of this selection, I was to learn later, was my performance in JMO (junior medical officers) course  and ACR -annual confidential reports- . Everything was JUST thos e days! I had no papa in services.

1960

Reported to AFMC. Strange coincidence—anna was in the last leg of his training in surgery there & I in the first leg .( When I joined Stanley Medical College anna was in final year !!) After 3 months assessment is made and three who topped were retained in Pune & rest sent to Delhi or Lucknow. RK Suri, Gandhi & I were retained in Pune. Surgeon commander Kuppuswamy (retired as Vice Admiral) was in the faculty. A lot can be written on my tenure in Pune as PG student but I must record learning from my teacher Maj.O.P.Malhotra,clinician par excellance. I will site one instance. I was called to the house of an AMC brigadier to examine his teen age daughter who was in “coma”. ? drug ? suicide. On my request Maj Malhotra came. Diagnosis “hysteria!!”I learnt then that Hysteria was a positive diagnosis & not one by excluding all other possibilities (reductio ad absurdum) .

1962

Indo China war broke out. I had just FOUR months to complete term days for MD in Pune University. All leaves ,All courses were cancelled forthwith. That included our MD course in Pune University. I was posted to MH Ferozepore as ‘graded specialist in mrdicine’- a term which indicated that I have not yet acquired MD from a university but was deemed good enough to be a physician.

Indo Pak war over. Peace & Jaya + chellachu returned to Ferozepore.  I approached Pune University asking how I may complete MD. The reply was a shock. ‘Your MD course is terminated because you “left” without completing two years”.I didn’t leave on my own,I was ORDERED  AFMC pleaded helplessness. No papa in AHQ either. Well Ferozepore was a quaint little town but with a sizable troop deployment. Good club with lawn tennis courts ( first time I played on lawn courts!). Good work load in hospital, Life was indeed comfortable BUT how on earth am I to get MD behind my name?!. Fortune smiled.  Maj.Virk was admitted with ‘pericardial effusion’ & life threatening ‘cardiac tampanod”. If paracentesis of effusion (withdrawal of fluid accumulating in the sac covering the heart) was not done IMMEDIATELY death was imminent. Issue then was not how many I had done earlier but the patient was a VVIP –son of Deputy commissioner of Ferozepore District--  Well,  I did it with ONLY Maj Chahal (surgeon) supporting me. I took out a few litres and Maj.Virk lived. The elder Virk brought Prof PN Chuttani, Director PGI Chandigarh to MH Ferozepore to advise. I ‘presented’ the case & later took him on a ‘ward round’ highlighting problems in selected cases. Prof.P N Chuttani was short but had a ‘bachan ‘like voice ,spoke with authority and in impeccable English lazed with typically Punjabi humor! I was impressed. “Where did you pass MD?” opened the flood gates & I poured out in agonizing details on the way my course was aborted by pune university (not failing to mention in passing how ungrateful & insensitive Pune varsity was to the plight of serving soldiers!) And shot out “how may I join PGI?”. “come along” said the prof “WE (don’t miss the royal we!) will take you in”. “I can talk to Inder” said he. My CO promptly intervened assuring that AMC will help Krishnan to join PGI and at that stage it might not be appropriate to talk to Gen Indersingh. (Gen Indersingh was the senior most physician in AMC and virtually decided the fate of every physician in service! And my CO knew a word from even the director PGI may indeed be inimical to my interest.) MD bug lying dormant till then came alive. There was no way that I could pursue MD in PGI while continuing to be in active service. I could not be posted back to Pune because no of seats allotted to AFMC was limited. Madras university did the best –they never replied! Well then how did I land in PGI? Wait for the next instalment!

MD An Odyssey (2)

MD An Odyssey 3

Back in ferozeore and ‘routine ‘activities with playing good tennis everyday and enjoy playing with toddler Suba at home. Prospects of admission to a MD course were receding but hope of getting into PGI Chandigarh kept simmering. There was no valid reason for this utopian dream---but  another lucky break presented itself.

DDMS Northern Command, MajGen Rao (nick named “Jinnah rao” because of his close physical resemblance to the Waziri Azam) arrived in MH Ferozepore on an ‘inspection’ visit. He was thin & tall with a pipe in his hand –I had a terrible urge to advise him against smoking because his chest was typically”pink puffer” type of emphysema.--- Usual round of wards and a clinical meeting were organized. I was lucky to muster five ‘interesting ‘ cases including one “Fallot’s Tetrology”, Posterior inferior cerebellar artery syndrome, and a patient with “cavernous” type of bronchial breathsound. The good general even condescended to take my steth ,auscultated & gave me a smile of approval. I remain grateful till today to my CO(commanding officer), LtCol.AK Choudhry, who arranged for me to meet the General in CO’s room.My surgical colleague Maj.Chahal also persuaded the CO.  I repeated my ‘sob story’ once again and remembered to point out the offer to join PGI Chandigarh for MD by the Director himself. The only way I could EVER achieve my ambition of MD is if I can be granted “study leave” Thankful to my CO again when he added “Please Sir (Punjabis always add please!)This boy deserves to be helped”.  Gen.Rao “Avtar (first name of my CO) write a note to me. I will see what can be done”. Like in the movies I imagined I was already in PGI running up & down the ramps of the mammoth buildings! !! CO said “ Krishnan, these senior officers promise a lot. But I am not sure they act on it” All I could do was to go back to ‘Black night’ the only affordable scotch by an army officer.

Couple of weeks later CO sent for me & showed the letter Gen.Rao had written to DMS  Army (Director of Medical Services). A brief summary of my sob story was attached and the covering letter said “I strongly recommend that Capt.Krishnan be granted study leave at the earliest”. A month or so later ORDER from DGAFMS was received—Capt.Krishnan is granted study leave for two years--.Hurray !! but there were still hurdles to cross—my pay drops to half of basic pay and NO allowances, No service accommodation & had to rent one at MY expense & a few more niggles--. Jaya stood by me. I was welcomed to PGI. Mr.Virk (whose son I treated for pericardial effusion) helped me rent a house in 15  sector with only Madhya margh separating my house from PGI in 12 sector. My tenure in PGI is till today “THE GOLDEN PERIOD” in my life.

1966

Icing of the cake: Prof.Chhuttani took all his students to the  canteen & gave us tea after the weekly grand round.. Other faculty members also joined. Discussions were usually on matters not medical! Jokes were common. During one such ‘tea ceremony’ Prof.Chhuttani suddenly asked me “when are you completing?” “nine months more” I said. He turns to the faculty present there “Why not let Krishnan appear this December (3months away!)?” “Yes Sir” was the chorus of reply. Prof.Ashok Seghal was entrusted with the task formalizing the proposal to the standing committee and obtaining sanction. Believe me ,NOBODY bothered to inquire whether I was prepared for this jump?! Every one of us had gone through nightmares when your roommate corrects you to say that exam is only 48 hrs away & not 72 hrs one believed! And here these guys are chopping off FULL SIX MONTHS ! When I reached home the distraught expression on my face alarmed Jaya. When I told her she not only cheered up but even suggested that I deserved that ‘alcohol ‘ to celebrate the commendable confidence that I had generated with my teachers. Well,Jaya & my teachers were proved right. I passed standing First in Panjab university!

The exam was an ‘ordeal’—I must mention how it ended. In PGI candidate reported at 7am and stayed till all (clinical, oral etc) were all completed—7 or 8 pm! At about 7pm I was ushered into the room with ALL examiners sitting together for the final blow. Only Prof.Chhuttani was the internal examiners while other three were from Delhi, Jaipur & Bombay. As soon as I entered “Wait outside, we will call you “ said one of them. I walked dazed firm in my conviction that I had failed. Dr.Khatri ,Asst Prof in cardiology, consoled me saying “major saab, agar aap pass nahi hote qui nahi pass hoga”   Calling bell sounded. I walked in with trepidations. Sour expression on Prof.Chhuttani’s face made me miss a few beats. One of them asked me to read the xrays displayed. I had just reached the second one when I heard my mentor saying “That is enough. Krishnan. You can go”. On walking out of the room I collapsed in a chair with Khatri encouraging me with a cup of tea and reassuring that I could not have failed, adding that how can that happen to one who had scored One A+and four As in clinical.He was one of the invigilators. I could not go home to inform Jaya & so was resting in the duty room. An hour or so later Khatri walks in “Major, you stand first in Panjab Varsity” Prof.Chhuttani wanted to go through all the marks with a view to awarding me a GOLD MEDAL which is offered once a few years to a candidate by PGI for an EXCEPTIONAL performance. I had scraped through in pathology paper and I could not be conferred this honour. That was the reason why Prof.Chuutani was visibly upset!!  (I started this narration saying that pathology was my first love. Ironically it was pathology that spoiled my chance of Gold medal from PGI.)

An odyssey had ended but perhaps not?

Tail piece : I must record my indebtedness to many who helped me in achieving what looked well nigh impossible. Many were not known to me earlier like ADMS TNKK AREA, Gen.Rao, Prof.Chhuttani, my CO col.a k choudhry.  And of course Gaj who helped me complete MD thesis in the shortest possible time. These persons had instilled in me an abiding trust in ‘goodness’ of fellow humans and shown me the path to follow in my life

MD An Odyssey (3)

MD An Odyssey 3

Back in ferozeore and ‘routine ‘activities with playing good tennis everyday and enjoy playing with toddler Suba at home. Prospects of admission to a MD course were receding but hope of getting into PGI Chandigarh kept simmering. There was no valid reason for this utopian dream---but  another lucky break presented itself.

DDMS Northern Command, MajGen Rao (nick named “Jinnah rao” because of his close physical resemblance to the Waziri Azam) arrived in MH Ferozepore on an ‘inspection’ visit. He was thin & tall with a pipe in his hand –I had a terrible urge to advise him against smoking because his chest was typically”pink puffer” type of emphysema.--- Usual round of wards and a clinical meeting were organized. I was lucky to muster five ‘interesting ‘ cases including one “Fallot’s Tetrology”, Posterior inferior cerebellar artery syndrome, and a patient with “cavernous” type of bronchial breathsound. The good general even condescended to take my steth ,auscultated & gave me a smile of approval. I remain grateful till today to my CO(commanding officer), LtCol.AK Choudhry, who arranged for me to meet the General in CO’s room.My surgical colleague Maj.Chahal also persuaded the CO.  I repeated my ‘sob story’ once again and remembered to point out the offer to join PGI Chandigarh for MD by the Director himself. The only way I could EVER achieve my ambition of MD is if I can be granted “study leave” Thankful to my CO again when he added “Please Sir (Punjabis always add please!)This boy deserves to be helped”.  Gen.Rao “Avtar (first name of my CO) write a note to me. I will see what can be done”. Like in the movies I imagined I was already in PGI running up & down the ramps of the mammoth buildings! !! CO said “ Krishnan, these senior officers promise a lot. But I am not sure they act on it” All I could do was to go back to ‘Black night’ the only affordable scotch by an army officer.

Couple of weeks later CO sent for me & showed the letter Gen.Rao had written to DMS  Army (Director of Medical Services). A brief summary of my sob story was attached and the covering letter said “I strongly recommend that Capt.Krishnan be granted study leave at the earliest”. A month or so later ORDER from DGAFMS was received—Capt.Krishnan is granted study leave for two years--.Hurray !! but there were still hurdles to cross—my pay drops to half of basic pay and NO allowances, No service accommodation & had to rent one at MY expense & a few more niggles--. Jaya stood by me. I was welcomed to PGI. Mr.Virk (whose son I treated for pericardial effusion) helped me rent a house in 15  sector with only Madhya margh separating my house from PGI in 12 sector. My tenure in PGI is till today “THE GOLDEN PERIOD” in my life.

1966

Icing of the cake: Prof.Chhuttani took all his students to the  canteen & gave us tea after the weekly grand round.. Other faculty members also joined. Discussions were usually on matters not medical! Jokes were common. During one such ‘tea ceremony’ Prof.Chhuttani suddenly asked me “when are you completing?” “nine months more” I said. He turns to the faculty present there “Why not let Krishnan appear this December (3months away!)?” “Yes Sir” was the chorus of reply. Prof.Ashok Seghal was entrusted with the task formalizing the proposal to the standing committee and obtaining sanction. Believe me ,NOBODY bothered to inquire whether I was prepared for this jump?! Every one of us had gone through nightmares when your roommate corrects you to say that exam is only 48 hrs away & not 72 hrs one believed! And here these guys are chopping off FULL SIX MONTHS ! When I reached home the distraught expression on my face alarmed Jaya. When I told her she not only cheered up but even suggested that I deserved that ‘alcohol ‘ to celebrate the commendable confidence that I had generated with my teachers. Well,Jaya & my teachers were proved right. I passed standing First in Panjab university!

The exam was an ‘ordeal’—I must mention how it ended. In PGI candidate reported at 7am and stayed till all (clinical, oral etc) were all completed—7 or 8 pm! At about 7pm I was ushered into the room with ALL examiners sitting together for the final blow. Only Prof.Chhuttani was the internal examiners while other three were from Delhi, Jaipur & Bombay. As soon as I entered “Wait outside, we will call you “ said one of them. I walked dazed firm in my conviction that I had failed. Dr.Khatri ,Asst Prof in cardiology, consoled me saying “major saab, agar aap pass nahi hote qui nahi pass hoga”   Calling bell sounded. I walked in with trepidations. Sour expression on Prof.Chhuttani’s face made me miss a few beats. One of them asked me to read the xrays displayed. I had just reached the second one when I heard my mentor saying “That is enough. Krishnan. You can go”. On walking out of the room I collapsed in a chair with Khatri encouraging me with a cup of tea and reassuring that I could not have failed, adding that how can that happen to one who had scored One A+and four As in clinical.He was one of the invigilators. I could not go home to inform Jaya & so was resting in the duty room. An hour or so later Khatri walks in “Major, you stand first in Panjab Varsity” Prof.Chhuttani wanted to go through all the marks with a view to awarding me a GOLD MEDAL which is offered once a few years to a candidate by PGI for an EXCEPTIONAL performance. I had scraped through in pathology paper and I could not be conferred this honour. That was the reason why Prof.Chuutani was visibly upset!!  (I started this narration saying that pathology was my first love. Ironically it was pathology that spoiled my chance of Gold medal from PGI.)

An odyssey had ended but perhaps not?

Tail piece : I must record my indebtedness to many who helped me in achieving what looked well nigh impossible. Many were not known to me earlier like ADMS TNKK AREA, Gen.Rao, Prof.Chhuttani, my CO col.a k choudhry.  And of course Gaj who helped me complete MD thesis in the shortest possible time. These persons had instilled in me an abiding trust in ‘goodness’ of fellow humans and shown me the path to follow in my life

Ferozepore (1)

Ferozepore 1
1965- -I was physician in MH Ferozepore -Indo Pak war breaks out-7 Infantry Division moves out IMMEDIATELY to Khemkaran sector-Overnight the town is empty , deserted. Families of officers had to fend for themselves all the while praying for safe return of their husbands except of course the AMC officers! Suddenly four wives ,all South Indians, landed in Capt. Krishnan's house because their husbands told them so for the simple reason that'medical specialist' will not be moved out! Next morning ALL the four + Jaya and  Suba, 1 1/2 yrs were "packed"in Mrs.Pillai's Amby and the driver was instructed to proceed to Delhi. ( Later I learnt that all roads to Delhi was  one way "FROM" Delhi to facilitate army movement, but somehow clever resourceful mallu driver reached Delhi .How simple it sounds now!! It took ALL OF SEVEN DAYS before Ltcol Murthy could contact his elder brother Venkatraman then GM Air India staying in 3 Circular Road New Delhi. Suba & Jaya were staying with them. Till then it looked as though those seven days were longer than one யுகம் ! To confound our misery were rumours like “petrol pumps ordered NOT to supply petrol to civilian vehicles” Black out in Delhi and vehicles were forbidden to use even parking lights ’Mallu driver is driving in Delhi for the FIRST time”  “Did my chellachu   get something to eat or drink?” My thanks to Mrs.Pillai (where ever she is now).Unforgettable one week !!
Mr.Vekatram’s pet was BIG Ulsatian ,almost as tall as Suba was then .They two took an instant liking for each other & Suba used to play with him & even ride on him fearlessly!! Two weeks later Jaya & Suba moved to a cousin of Vedam Patti in govt accommodation located on a road from Connaught Place & Karolbagh.That is where I met them much later.

Truck loads of casualties poured in to MH Ferozepore -150 bedded hospital, with one physician, one surgeon (MONI,SSRC officer),one gyenaecologist, one ophthalmologist ,one pathologist and one CO(commanding officer) .The last mentioned could not help because he was a thorough bred administrator . There was NO prior warning from AHQ (army head quarters) either in informing us to expect loads of casualties or in providing materials  or manpower. That is PLANNING & INTELIGENCE Info !!.   
Surgeon ,Gyenec & opthalmologist (latter two because they can cut & sew!) were inside the one OT(operation Theatre) with a minor OT as annexe. For FULL THREE days & nights they came out only to ‘answer call of nature’( I have  heard this dignified expression only from Tamilians?) ,reclined on a chair when sleep was impossible to resist, bit into whatever was supplied. So did the OT nurses and ORAs (Theatre assistants). When I recall this my heart brims with pride even now.
My duty was to prioritise the casualties –sounds simple but I thank the Lord I did not have to do it again in my life.. After a hurried assessment I had to decide whether casualty “A” has better chance of survival with surgery than casualty “B”.and send the one with better chances into OT and offer “expectant” treatment  (medical profession is successful in inventing such phrases to delude the relatives into believing that “doctor is doing his best!”.) to those I had condemned. No colleague to confer, no lab to help. , I don’t know if I prayed for the decision to be right. I don’t think I had the time. But I recalled my appa ,General Medical Practitioner, predicting death with uncanny precision and advising relatives not to waste money any more on treatment but save it for final rites.But again they were sick persons & here in fronf of me were thakada jawans (healthy soldiers) in their prime of youth but maimed by war.
Pathologist did the blood grouping & cross matching. We NEEDED blood not litres but gallons! Only AMC personnel posted to MH were around and each one of them was fully engaged. Somehow news reached the civil population and in a moment droves of donors walked in. Ask Indian to face a national crisis and no one can better his response!! What is more Dal Roti was also brought by them in plenty.
Time for ‘ward rounds’ was available in the nights when trucks & ambulances stopped. No lights allowed. My nurse & I waded thru darkness guided by my pen torch. ( Later I was to meet this nurse as the wife of an airforce officer in Delhi) ”Is that you Krishnan? This voice cant be any one else’s” I rcognised the voice too. Joshi,  Sapper (Engineer)  officer.
 During my tenure inJ&K I was drafted to escort a recce team from Srinagar to Leh. Awaiting to get adequate number of mules to carry us & the rations we were asked to stay in Srinagar transit camp.Joshi was the sapper officer in the team. Strikingly handsome and bubbling with energy Joshi & I enjoyed each other’s company. It was a paid holiday in Srinagar .We were out every day exploring Dal lake in  boats or hiking or just walk & walk thru streets .He also was an avid sportsman, Hockey was his forte. Leh recce was called off after four weeks because specified number of mules was not available!!
“is that you Joshi?” I yell ,all the time troubled  not knowing why he was in the hospital . I rushed up to him & asked. Joshi asked me to flash the torch on his legs. Oh God! No legs!! He had stepped on a mine & both lesgs ,one below knee & the other upto ankle were blown.I cried aloud. Doctors are human too. Sister Gill ( I remember her name now) consoled me. She said “ Sir, at least your friend is alive”. She had lost her father in 1947 war in Kashmir when she was barely a few months old.

To be continued…..