My Tryst With Destiny

MY TRYST WITH DESTINY

At about 5am on Wednesday the 25^th June (it was a muhurtham day as later in the day I should have gone to attend wedding of daughter of  a colleague) Jaya woke me up saying that her stoma bag possibly needs attention. I examined. She was right. This is “mucus fistula” left behind after the transverse colostomy was carried out 2 ½ yrs ago because sigmoid was adherent to urinary bladder consequent to radiation given in 1994. (GI Surgeon and urologist were not confident of repairing this without causing greater harm. My problem was that the ‘bag’ was on a skin fold and bag needed change every other day. I was very uncomfortable with this.)  A temporary patch work was done and I prepared a new bag by enlarging the aperture. Meanwhile milk had arrived and Jaya suggested that I attend to the bag after coffee. I gave her and returned to my Ikea reclining chair for sipping mine. Noticed retrosternal ‘discomfort’. I had taken only a couple of sips of coffee. No alcohol the previous night. The ‘discomfort’ soon became ‘pain’ confined strictly in the “retrosternal” region. No radiation. No vomiting. Like my friend Jagan (neurologist) in exactly similar situation did, I also gulped down an ounce or more Gelusil. No relief. Urgent desire to defecate and passed brisk stools & could wash without difficulty BUT the pain did NOT abate a wee bit. On the contrary severity was increasing rapidly & I then had no doubt that I am ‘cooking my coronaries’. I went to Jaya in bedroom saying the same thing “Jaya, I am cooking my coronaries”. Poor thing, she did not understand what I was saying! I located the list of numbers I had left with her to call in any emergency and asked to tell whoever comes on line to come over quickly because “Kannan has pain in the chest”. That unnerved her and in her panic could not hold the phone to dial. I returned to my chair in drawing hall & started dialing. 4th person who answered was Dr.Palanisamy. “Jump into your car & come & take to hospital. I have developed ‘typical cardiac pain’” I ordered. While waiting for him I called up Dr.Satyamurthy, cardiologist. He was in the toilet (where else at 6.15 am!) .I requested his wfe to ask him to reach Apollo immediately FOR ME. Now the wait for Palanisamy to arrive. Most harrowing time. Pain was constant now but severe still without any waxing& waning. Suddenly I remembered description of ‘cardiac pain’—“a premonition of impending dissolution”. Believe me ,that was what I felt reclining in the chair. I let out a scream “ will someone please give me Morphine?” Jaya was blabbering something and pacing up & down. Hearing my scream she came up inquiring what was it I wanted.  Palanisamy had not yet come. I looked out of the window to see if Venkat’s car (s/o Thyagu E!,downstair neighbor) was parked. He sleeps the night in E1 to take care of his ailing mother. No it was not there that day. I slipped into a pant & WAITED! Palanisamy arrived ( He told me later that he took only 12 minutes reaching Snehasadan. (No it was eternity!). He examined me quickly.Pulse was steady, Heart sounds normal.(I asked him for S3!—he ignored me) Lung bases were clear. JVP was normal. (how I love clinicians who still examine the patient first) With him I climbed down the steps ,at the same time asking Jaya to call & ask some one to come over & stay with her. Let myself into the car Santro AT. He reassured me as he was driving out of Snehasadan that “you are alright Sir. “ “ No sweating.Good” . I realized that a well known accompaniment of cardiac pain was missing in me. (Recalled what I used to teach –sweating is an epiphenomenon resulting from fright and adrenalin overdrive! (Brisk bowel movement instead of sweating!) Wont you sweat if you step on a snake?—Another 12 odd minutes we reached the doors of Emergency in Apollo. It was indeed providential design that Palanisamy was contacted by me (instead of Suppamani, Nirmala, Sankar) because efficient administrator that he is he had warned the emergency, asked couple of PGs to be present there, alerted the cardiologist on duty as well as the cardiac cath lab .7.30 am: Apollo emergency--Well wheel chair was not there!! Ankit (PG in GE) Shanti with her husband Babu, Sarojini were all there, requested me to wait for one but I walked the few yards to the couch and the “works” were set in motion. I was stripped, ECG connections were attached, shaving of both groins and both cubital fossa done almost simultaneously! , IV line set up. IALL in a jiffy. I gave my mobile to Ankit & asked him to call my daughter Suba, No response as he showed the phone I saw he had dialed my niece Shuba .Showed  Suba’s number on favorites. As soon as I heard Suba’s voice I choked and could not say a word and even cried a bit ,all for the first time that morning. I missed her badly at this juncture. Gave the phone back to Ankit. ECG had been taken by then & he briefly informed her about acute coronary episode. I had recouped by then & spoke to Suba. Admired how mature my daughter is. She calmed me ,assured that now that I had reached in time all WILL be well. Spoke to Jaya informing her of coronary angiogram .Somewhat relieved that Sankar had reached E3 to be with Jaya.

I said aloud why morphine was not yet given.Pramod replied that 3mg morphine was being given IV. I could peep into the ECG. Noted elevted ST in some leads & knew that it was an acute myocardial injury. Pramod (about Sarojini’s seniority) cardiologist on duty chided me for trying to read the ECG! “Informed consent(!) “ was signed by me and I was wheeled into cath lab. Saw Nirmal, Sarojini ,Shanti there wishing me all the best.Transferred to the table, Satyamurthy patted to say he had reached. My pain reduced 50% !( I recalled seeing the relief on my patients when they know I was in the procedure room!I am sure if Satyamurthy had not reached in time Pramod would have attended with equal expertise and success. But still---) Angio, Ballon dilatation and stenting done,back in cardiac ICU , ALL done within the next 50 minutes. As I was wheeled out to cardiac ICU I noticed Sailam & a few more had landed. Such news spreads fast! On the way to ICU I spoke to Suba this time smiling because the pai had just vanished. “So quickly appa” was her reaction. (I was to know later that entire procedure took all of 45 MINUTES!)Rest relax & sleep ordered my loving daughter. Informed Jaya that needful had been done and I feel fine. Was glad to know that Revathi was comjng in a taxi from Bangalore.

Cardiac ICU was under renovation .Therefore I was admitted to a make shift arrangemen of a veranda converted to a ward. It didn’t make any difference because there were curtains all around . As soon as balloon dilatation was done pain had VANISHED TOTALLY.  I felt exhausted and sleepy. But I was to realize soon that one place where even Kumbakarnan cannot sleep was ICU. Two companions were on ventilators & every now & then NOK entered and let out a loud wail .Ward staff ordered them to be quiet or simply (said in mallu accent) escorted them out of the ward. But damage had been done, My sleep disturbed. My neighbor was in extremis with COPD receiving O2 thru tight fitting pressurized mask. Moment his cerebral anoxia improved or hypercapnia decreased he started pulling off the mask loudly cursing everyone around .I asked Anita (doctor i/c of ICU---she was a resident under me two decades ago!) why tracheostomy was not done. NOK refused permission. She managed to somehow restore some peace & quiet .i could sleep. Not too long! Pulse/ Bp/ Temp had to be recorded .I was hooked on to a gadget which was monitoring all these parameters but ISM (Dr.Satyamurthy) would trust only the good old sphygmomanometer. Anita ensured that I should not be woken up unless the monitor showed changes that needed confirmation. Heavily bandaged right groin weighed a ton and I was warned (!) that I can move all parts of the body but not the right lower limb.  Try & do that! After a few hours legs did not pain but the back started hurting thanks to lying flat all the time. “Just one day, Sir” nurses said one after another. On the left cubital fossa was an IV line. (I was amused to learn later that the only IV medication I received was Pantocid,.I informed the cardiac registrar that peak blood  levels when pantocid is given IV is only 3 hrs while by oral route it is 10 to 12 hrs. ) Of course How can a patient be kept in ICU without a IV line?! Night was relatively peaceful—one of two on ventilator was “declared” - --(meaning dead in Apollo parlance). COPD was moved to far end of the ward, I was helped to turn on my left. What a relief! Could sleep.

Next morning ISM walked in with his retinue of assistants & PGs. After quick assessment ordered transfer to ward. Shanti had already identified and blocked a room. Biggest relief was to see sunlight & outside world. Why should ICUs be shut out from day light and view of outside world? Could use the toilet for voiding urine! And I slept soundly practically the whole day. They had even detailed a special nurse whose main  task was to fend off visitors. Permitted ‘cardiac diet’ (no dessert!). ISM decided that I can be discharged on Monday (admitted on Wednesday). In the evening cardiac PG dropped in to do routine check. I asked him how many coronary stenting he had assisted. Quite a few Sir.”well, tell me about drug eluting stent. What is the drug that elutes & so on” I was not testing him but genuinely desired to know. Poor fellow turned pale. He mumbled some words but just then visitors came in. He was saved by the bell! If he was my PG he would have received a mouthful.

Suppamani escorted me home.Nisha had brought the ‘stair chair’ down. I was back home.

Reflections: 

When on that morning retrosternal pain was severe and Palani had not yet arrived ,I did not pray. Why? I don’t know why it did not occur to me .

Why did I not ask for ambulance from the hospital. Apollo ambulances are fitted with all equipment including defibrillators and technical assistants trained to use them. 

Did I miss warning symptoms? I cannot recall any for a week prior to the day of pain.

Thanks:

 Dr.Palanisamy,  Dr.Pramod ,   Dr.Satyamurthy , Dr.Anita.

Feels nice to be alive!                                                                                                                                               

DM---Odyssey again

DM--- odyssey again

MD in the bag and six months of study leave still available my attention was now on Jaya who had conceived again (chummu). Left Jaya with her parents in Madras & returned to Delhi to collect posting orders after MD from Medical Directorate. Bumped into Col.P.V.Ramachandran (who later was to become Lieut Gen & DMS Army ) in Connaught Place. I had known him from Lucknow where he was officer in charge of officers training wing. “What brings you to Delhi?” he enquired. (equivalent of “what’s up?” of today!!) I told him and requested if he can help me in getting posted to “field Area” (like Leh) now that my wife may not join me for about six months .He said “difficult’, but I will leave you with ADMS-P (posting) in medical directorate and dropped me close to L block saying that it would not be proper for him to go in with me. I had come here earlier for interview for DPRC. I was a civilian then & was surprised / amused at the dilapidated building. Entering now the ‘sanctum sanctorum’ of AMC  I was a bit hesitant , perhaps even intimidated—that is what OG uniform does to you. You are a bit emasculated of self-confidence and self pride!! Well, ADMS-P told me “Son (only in armed forces one senior to you addresses you as ‘son’ or ‘young man’) Your request can be granted but we have to cancel posting order already issued” .”Where Sir?’ I could with difficulty hide my apprehension of posting to somewhere in Eastern sector but not a ‘non-family’ station. “Reader in Medicine cum medical specialist Command Hospital/ AFMC Pune”. He was smiling. May be expression on my face provoked it. “But, How?” I was blabbering. “Lt Col K L Chopra, Senior Adviser in Medicine Command Hospital (teaching hospital for AFMC)  and head of 2^nd of 4 units in dept of medicine AFMC  had come to ADMS-P asking for a young medical specialist. DMS Army had already shortlisted a few names and the list was shown to him. Col.Chopra perused the doziers of all & picked my name. “But Sir I had not met him at all” I said. ADMS-P smiled again but this time tinged with barely concealed arrogance said “Records we maintain of ‘my’ (!) Officers are fool proof”. In my mind I thanked all those who had written my ACRs (annual confidence reports)  May be results of MD exam sent by PGI also helped. I am not sure of the latter because PGI note was addressed to office of DGAFMS & not DMS. Didn’t matter. I will be back in AFMC now as faculty member!!

FIVE GLORIOUS REARS in Pune.  Will skip the details to keep track of DM (ge)!But still I must mention my good fortune in the invaluable professional guidance I was fortunate to receive under Col K L Chopra. Tennis, twice or more often with Gen. Bewoor ( who became COAS –chief of army staff—later), Brig.Mahadevan,Dean AFMC & easily the best among the four SurgComdr Ramana Rao. All good thins have also to end---Posted to MH Dehradun. A look at map of India will show how J & I criss crossed ---madras –lucknow—pune—kashmir—aurangabad—pune—ferozepore—chandigarh—pune—dehradun. And the journey had just begun!

Dehradun was a semi hill station with salubrious climate and scenic beauty ,Mussoori hills as a back drop, seasonal flowers and more importantly delicious lichis  (lone medical specialist received basket loads of them from each of the three  Gurkha Regimental Centers located in Dehradun). MH was well equipped and had all specialties covered. Of course there was a tennis court patronized by station HQ as well as faculty from  Doon School & Rashtrya Miltary Academy. Added attraction for me ( and a constant source of irritation for Jaya) was regular contract bridge sessions .Suba joined 4^th std in  Cambrian Hall & Chummu in  KG . AND Jaya joined B Ed course in Meerut University. There were quite a few physicians & surgeons among the civilians and I was regular in their monthly meetings. (Best ever ‘Rumalaya Roti” was an added attraction---first time I tasted it). I organized the meeting once in MH. My CO here Col.Balram Mukherjee was supportive. An year passed by. Friends & relaives visted & were greatly impressed with the place. I was even called in by civilian colleagues for second opinion. All looked ‘honky-dory’ But I was bitten by yet another bug –“super speciality”. Jaya was blunt & candid. “We are happy, very happy in this place, you have ALL you desire, good work ambience, academics, tennis , bridge, & still you want to leave all this to pursue yet another dream? More importantly, are you still young (40yrs) to go through the rigors of post doctoral course and a horrible exam.Dont forget the half pay during study leave “ . Nightmare of MD exam flashed before me.” I don’t feel comfortable with the prospect of remaining yet another ‘also ran’ general physician” I pleaded. “Medicine is advancing in such a fast pace that even “if i were to run I cannot keep abreast all fields. I am physically fit—can play six sets of tennis nonstop-, there will be problems for suba getting into a new school so soon & you having to set up yet another house. Of course move will take place ONLY after you complete B Ed”. “Thanks for that consideration” Jaya replied “ I see how badly you want this. I didn’t ask you how & when. That is your look out. Go ahead. I am with you”. She deserved that hug.

Chandigarh chalo –Total of Five trips between Dehradun & Chandigarh .All in rickety buses. But it was an education in a way understanding the uncomplaining Indian exchanging jokes even when packed like sardines.   My plan : six months study leave  leave + get posted to Command hospital Chandigarh which was housed within the perimeter of PGI to complete one & a half years as part time DM candidate. Preposterous, Utterly impossible, Get examined by a shrink and a few more such helpful comments from friends. Chaman—Maj C L Luthra—ophthalmologist , next door neighbor, husband of Adarsh who did MD with me in PGI—picturised what all I would be doing to get DM(ge). Maj.Krishnan addresses DMS army “ Sir,be pleased  (he was a Punjabi) to pass orders granting six months study leave I am still entitled to & please post me to Chandigarh.”. Pronto ,young man, it is done”. Next Krishnan addresses the Director PGI “Sir. I know the rules on how DM student has to be whole time and he/she must stay in the campus for two years. , You know I AM a good student. Make an exception. Please help me.””Done. Join us immediately” He was saying all this in my house drinking my whisky.  But THAT was the reality. The KO punch would have placed Md Ali’s famous left hooks in the category of feather touches. He did shake the hell out of me. Adarsh chided her husband for the manner of his speech but did not differ in substance. Jaya understood the enormity of the task but said “Krishnan has a way of getting things” .The only words of encouragement uttered that day. Thanks again Jaya.  Well Chaman had helped to put the ‘super speciality’ in the back burner. But not for long! I wonder what drives one to attempt what is by any reckoning impossible to achieve! One area that seems to interest Nalanda is ‘neuro science’. (She had read ‘phantom brain’ by Dr.Ramachandran cover to cover!) Hopefully she will discover one more neuro humoral agent that is responsible. I decided to go to Chandigarh & seek the advice of Prof.Sehgal and if possible PNC as well.

Chandigarh was a small town those days .Mess of Command Hospital (CH) had only one guest room and there were no good hotels either. Oberoi had one but beyond the reach of army officer. I had to search for friends/relatives/or their friends!-to stay.

I should have mentioned this earlier. Gastroenterology was my choice. Cardiology was attractive Prof.Walia, HOD Dept of cardiology had told me “any time you want to join, you are admitted” Following open heart surgery  or cardiac cath the registrar HAD to stay with the patient till he goes home on earth or heaven. Two days, often longer, was this period. Not acceptable to me!.Neurology was not well developed in PGI those days.Nephrology was under Dr.Chug ,very much younger! My mentor was a gastroenterologist and so was Prof Sehgal .Perhaps that decided the issue. Dr.Sehgal  “ Difficult, but let us try & swing it in” “தேன் வந்து பாயுது காதினிலே “(Thanks Bharathi). Took me to Prof. Chhuttani (PNC) . “ However much I want to help Krishnan, as director I cannot unilaterally decide in your favor.” Ashok (Dr.Sehgal), present his case to ‘advisory committee’. You should know Krishnan I cannot speak for bending rules!”. I was confused “did he say yes or no?!” First attempt—lost 6-0. Dr Sehgal was unwell & some one else presented to Advisory Committee. The plea was rejected.  I went again. This time Dr.Sehgal asked me to meet members of advisory committee individually privately. Most helpful were Dr. Wahi,Psychiatrist and Dr.Walia, cardiologist. They briefed Dr.Sehgal the strategy to be adopted. I was told that Dr.Wahi argued my case with passion & conviction. Prof.Aikat ,HOD pathology & dean suggested that since this candidate was recommended by all we would take him on two conditions-1)his course will be extended by SIX months & 2) this case  will not  be accepted as a precedence in future. Hurdle one crossed. Well then how would I get study leave and posting to Chandigarh?

Why did Dr.Wahi take up my case? During my tenure earlier in PGI, once a month a debate used to be organized restricted only to faculty & students. One such was on “medium of instruction should be mother tongue & not English” Dr.Balakrishnan,( perhaps the first plastic surgeon in India) brought in from Nagpur (his wife Prof Devi HOD obstetrics adopted me as her younger brother) spoke in favour of English. (Reminded of V.Krishna menon both in eloquence & unmistakable mallu accent) Dr.Wahi spoke in Hindi. He quoted liberally from Kabir to Kalidas & had swung the all India audience which PGI had then to ‘mother tongue’. PNC usually chaired these meetings. I asked for permission to speak which was readily granted. I asked for permission to speak in tamil now that Dr.Wahi had spoken in Hindi. That was granted. I started ” தலைவர் அவர்களே என் மதிப்புக்குரிய வாத்தியார்களே “ “hey Krishnan ,what are you saying’ PNC stopped me. “Sir I have made my point. Teaching in mother tongue will result in  no longer of having a cross section of India as your students and what is worse you will be vivisecting this great country with its unique pluralistic society’. I sat down. Vote was in favor of English. Dr.Wahi was the first to congratulate me. We established instant rapport & friendship.

I pray every morning. Always asked Lord to bless my wife & children and till today I had not asked for anything for myself. Perhaps the good Lord considered that the best way to bless my family was to bless me! Brig Goel ADMS (assistant director of medical services) landed in Dehradun. REASON: ACR of colonel above had to have a certificate of fitness from a ‘medical specialist’ The ‘proforma’ for this had a column –pulse rate lying, sitting & standing!! I declined to fill it saying if cardiovascular state was to be assessed “masters test” (precursor to tread mill ) had to be done. Brig Goel was asked to clarify. “Bachu ( punjabi & UP seniors addressed all juniors this way) thum qui panga lehrahaiho. Just fill & send” (how does one translate “panga”?) I said “sorry sir”. Next came Maj Gen Pillai DDMS central command on an inspection visit. Ward rounds& clinical meetings were as usual organized. But as guessed by my CO I was asked me to meet him in CO’s room. I explained. He was convinced and promised to take this up with Senior Consultant in Medicine. I cashed in .”Sir I want your help”. He listened. “I will see what can be done” a statement ALL senior officers (including my good friends Raghu & Sammy) must have made routinely. Couple of weeks later copy of DO(demi official) letter from Gen Pillai to DMS was received by my CO in MH Deharadun recommending my posting to chandigarh.  I was posted to Command Hospital Chandigarh. Lucky again.

Back to Chandigarh- ; CO here was Brig.H S Gill, the very definition of pragmatism and an extremely kind benevolent human. He let me do the ‘ashtavadanam’ with a warning ‘bada shikayat nahi ana chayie’ and helped to get six months study leave also.. 

House in Sector 8. Suba & Chummu were admitted to Carmel convent. Jaya was snatched by Sacred Heart Convent because good Maths Teachers were always in demand . Jaya drove the children in Fiat 1100 to their school & later to her school. My routine :6.30am drive lambretta to CH (command hospital) round of ICU & acute medical ward .8am attend academic talk/ cpc/ seminar . in Lecture theatre 1 PGI. 9to 10 am back to CH. 10to 12 bedside in PGI.12 to 3pm CH . 3to 4 pm PGI.  4to5pm write disposals in CH. 5 to 8 or 9 pm library in PGI. And I was on call for medical emergencies in CH during the night. Oh God I can’t believe I did it!! Will I do it again? YES. It indeed was worth the benefit and much more except that I could not spend time with Suba & Chummu. There were days when Chummu had not woken up when I left and was asleep when I returned!

I will write about the exam later. Suffice it to say now It indeed was ideal. Examiners were not informed either the diagnosis or the results of tests if any. If an examiner desires to know report of tests he was told that this info would be conveyed to the candidate as well. Two long cases, Four short cases One internal & three external examiners. PNC chose not to visit the exam hall. Dr.Mehta was the internal examiner.I was the lone candidate !

Lt Col.Dr.S.Krishnan MD(medicine)., DM (gastroenterology)  --sounds good !

Tail piece: First and last time DM candidate in any speciality was allowed by PGI to be part time student and nonresident. To my knowledge study leave was never again allowed to be split. Dream” Impossible” became possible. President Kalam must be happy.  

Prof.Sehgal died before I completed DM. I took a while recovering from the shock.

 

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