Medical Gods I met upon Earth:

Medical Gods I met upon Earth: Part III
(c) Dr. Rajas Deshpande

“My decision is final. You can kill me now”

Said my professor to the mob in his room, about twenty hardcore muscular giants in the trademark outfit of a dreaded political party.

He was just about five feet, thin built, and sat placidly upon the chair in his chamber. I stood behind the mob, terrified, vaguely wondering what would be the best self-defense and / or escape in that small old homely room called Department of Medicine. There also was immense anger and respect at that professor: why is he risking his life?

A political leader was arrested, this time for murder, but allegedly had many past rapes, murders etc. to his criminal record. It is an established politico-legal tradition to develop chest pain and go to hospital if you have enough power. Jail is only for the financially or politically poor. So this leader came to GMC Aurangabad (Ghati) Hospital with chest pain, on the day of arrest by police.

I was on call, I informed Sir. He told me to completely examine the patient, do an ECG, run some blood tests and get back to him on phone. Everything normal, he ordered overnight observation of the patient and repeat ECG next morning. That too was normal. Sir came for rounds. He went straight to the patient and after examination, told the ‘leader’ he was being discharged as all was well with his health.

Then came a request wrapped in order-cum-threat: “Don-teen divas ithech theva saheb.. mala bara watat nahiye (keep me admitted for 2-3 days more, I don’t feel good)”.
“Discharge him Now! Then join the rounds.” Sir told me in front of the patient, and moved on.
Within few minutes, many Jeeps and trucks entered the hospital. There were slogans in the name of that leader, and amidst all this, we walked with Sir to his cabin.

One good thing about a mob of goons is that they are not very articulate. They don’t waste time in the service of literature. They are short and direct in their talk.
“We will kill you right here, right now, if our leader is discharged ” said the mob boss.

Medicine Professor Dr. Vitthal Gopalrao Kale answered the mob:

“My decision is final. You can kill me now.”

Some 2-3 goons actually got up, unable to think beyond obvious word meanings. Their leader asked them to hold on. Swallowing twice, then with folded hands and mellowed voice the mob boss said “Vichar kara Sir (Think again)”.
Sir didn’t answer.
The mob left after few minutes of gaze-holding war.
When the police jeeps took the criminal out that day with heavy bandobast, we resident doctors felt a sense of security we had never felt before: we had a tiger for our professor!
Sir had mastered such situations long before any of those goons was born. He had faced morchas, verbal and physical attacks, allegations and enquiries fearlessly.

For he was the Don of honesty and discipline. He stood by his words, his commitments and principles, defending them with his life.

Joining the MD Medicine course at GMC Aurangabad was associated with various anxieties and fears: genius-class teachers like Dr. VG Kale, Dr. PY Muley, Dr. SG Kulkarni, Dr. DV Muley, Dr. Mrs. Mangala Borkar, Dr. SH Talib, Dr Anilkumar Gaikwad were all known to teach best and expect best of hardwork too, but the fear of facing Dr. V.G. Kale exceeded all other fears and anxieties.

————————–

No guns, no whistles, no Sirens, no police in sight, but every morning at 0845 hours sharp, a curfew prevailed between the Department office and Ward 8/9 Dr. VGK unit. Patients were in their bed, no extra relatives around, nursing staff in attention, wards cleaner than any other govt. premise I have ever seen, and poor resident doctors like myself with a big lump of fear in throat hiding behind the senior residents, who mostly had the resolve and disposition of one walking towards the end of life.

He taught us the art of Good Medical Practice.

For medicine is not only diagnosis. It is not only compassion or sweet talk. It is not only knowledge. In addition to all these, medicine is about extreme discipline, extreme concentration, a sturdy confidence that banks only upon truth and honesty.

And that is where most of the world always locked horns with Dr. VG Kale. He did not tolerate hanky-panky in medicine.

Ask the professor whom he threw out of the ward for not wearing an apron, ask the nursing in charge who faced his ire, ask the ward boys who were transferred out, and ask hundreds of medicine residents like myself who actually stammered and trembled presenting cases to him: say anything else they may about him, he was true, honest and strict to the core.

“Someone’s life is dependent upon what you do and how you do it” he carved upon our hearts.

As rounds started, a parade of clinical accuracy and truth ensued. No one could bluff him, he probably had a bluff sensor.
————————-

“What is his urine sugar level today?” about a chronic diabetic.
“Sir 2 plus” Satish, the resident doc bluffed confidently.
“Did the doctor check your urine today?” he asked the patient.
“I didn’t pass urine yet” said the patient.
“Then this doctor must have entered your bladder while you were asleep”, he said, looking at the resident.
“Sorry Sir, it was about another patient” Satish. (medical escapes are standard in learning phase).

“Doctor, learn to own up your mistake. If you commit a mistake and own it up, I will scold you but will still believe you. If you lie even once about a patient, I’ll lose faith in you forever”.
He said.
———————

My first case presentation to him. No sleep out of fear. 65 year old with gradually increasing weakness on left half of body. I have done what I know of the clinical examination, skipping what I thought was irrelevant. 30 minutes before I was to present, as I came out of the washroom for the third time that morning, Dr. Majid, my courteous senior came to me in a hurry and whispered in my ear “Did you examine patient’s scrotum?” I said no, what had it to do with paralysis on one half of body?

“Go check fast.. and don’t tell Sir I told you”..

Patient had a mass in the scrotum, a testicular malignancy.
I took the patient for presentation.

“When did you find out about his testes?” Sir asked me towards the end.
“Sir today morning. Sorry Sir, I had missed it yesterday”
He laughed. He looked at his colleagues proudly: “They will only learn if they are afraid of you” he said.
———————-

An old man was sleeping with a cover upon his head during rounds, in spite of being told that Sir will see him in a few minutes. An irritated resident doctor who had been up all night and eager to finish rounds pulled the patient’s cover sheet down when we reached him.
“Tumchya baapala pan asech uthavita kaay? (Do you wake up your father like this)?” snapped Sir. We never woke up a patient again for rounds, and if we had to, only too carefully, apologizing for the same. One sentence forever led to a change in the behavior of 10 doctors / staff on round that day.
———————–
I received a firing many times too, but the one I remember is for not supervising an intern while she was inserting needle in a patient’s vein. I was nearby with another patient, and the intern poked the patient many times in an attempt to get the vein. “Will you poke your mother so many times?” He asked us. He told us how essential it is for the doctor to feel the pain and never take the patients for granted, poor or rich, expressive or silent, good or bad behaved.
———————-

His elder brother whom he respected like a father (I heard Sir’s voice emotional only in front of his elder brother) was admitted in our ward, Sir came and asked me to collect his blood for some test. With Sir standing near me, when I held the syringe, my hands trembled for the first and last time in life. He took the syringe, collected blood in the first prick, and said “your compassions and respect or fear should never interfere with quality of medical care”.
————————-

In today’s net-based-knowledge-age where students can recite rarest of the rare syndromes but cannot examine a patient correctly, the relevance of this “respectful fear” stands out: however western we may become, we must face the truth: that fear (of humiliation, of verbal thrashing, of insults and sarcasm, and nothing else) alone drives most Indian students to learn to do things accurately. Unsupervised freedom in learning life-sciences quickly converts into a talkative arrogance that may turn dangerous and cost lives in medicine. This nightmare is unfolding right now, and not only in India.

A police constable was sleeping, sitting upon a chair, with his rifle held between his legs, supposed to guard an admitted prisoner. Sir woke him up with a sturdy pat upon his back. He thrashed the constable verbally. He started arguing arrogantly with Sir and said “Zara Godi Gulabi ne saanga na (Why don’t you say it with sweet words?)”…. Sir paused with his classic fierce gaze and commented “Tu maajhi baayko nahi ahes godine saangayla… police constable ahes, hi duty sodun zopne gunha aahe (you are not my wife to tell you in sweet words: you are a police constable, you must know it is a crime to be sleeping upon this duty)”.
We felt Sir was being irrationally angry. But in a few weeks, another prisoner ran away from a nearby ward, shooting at the constable guarding him. We learnt later that criminals have a different way of thinking, and hospitals are a good potential escape opportunity for them.

When someone is strict and honest and NOT corrupt, defamation by those hurt is the inevitable price they pay. People know where it hurts most to a straight soul. Right from partiality, casteism, dictatorship etc., many false allegations by the displeased are rampant. And small mistakes, if any, are blown out of proportion.

He does not need me to defend anything. But I must tell here that in the three years I worked under him, he was completely impartial to the patients. No resident doctor / senior doctor or other staff was spared mistakes or negligence in patient care, irrespective of our social / religious status. His mind was wired to teach us not only the art of Medicine, but the highest sense of duty.

His one-liners were terrific. He had an inherent hate of interference in clinician’s work by administrators (now managements). He didn’t hide it.

Once a forensic professor came to the wards in administrative capacity and asked us about some patients’ medicines. After he left, Sir’s face contorted in a suppressed smile. “Unko bolo we deal with live bodies, he doesn’t have to worry about outcomes unlike us”.

Once a high court officer called him to see a Judge in a guest house for a minor complaint. Sir asked him “Do you send Ministers / Judges to hospitals for holding courts / meetings if the doctors have a problem?”.

“I know people may not like the way I speak, but I have never taken a favour from anyone, I don’t owe it to anyone to hide the truth. And even if someone is dear to me, I wouldn’t lie for them”.

Once his contemporary cum rival treated an injured lion in the local zoo, newspapers carried the news with names. Sir smiled “Ab veterinary doctor Aadmi ko treat karenge”.

Anger is misinterpreted just like love and politeness in this world. Sir was short tempered, but never unjust. He always apologized if he thought he hurt someone. I know of many colleagues, teachers who depended upon Dr. Kale to speak the truth, which they couldn’t. He helped many in crises, but very few stood by him in his difficult times.

Medical knowledge and skill, however advanced, have to stand upon a base made up of fearless honesty, truth, discipline of body and mind both, and concentration. A doctor without these qualities becomes a medical businessman, not a respectable doctor.

My fondest memory of Dr. Kale is on one “teacher’s day” when we resident doctors felicitated our teachers in Department of Medicine. His answer to the decoration was “If a policeman catches a thief, it is his duty, he must not expect praise for it. It is my duty to be a good teacher, the best I know, and to make the best doctors possible out of you all. I don’t need / deserve any felicitation for doing my duty. God bless you!”

Thank you, Dr. V. G. Kale Sir for teaching this to thousands of students over 35 years, driving but a scooter (yes, we were afraid of that green Bajaj scooter too), and living in a simplicity that will always be an example for us.

I am proud to have trained under a braveheart saint like you.

© Dr. Rajas Deshpande

PS –
Sir is now enjoying his retired life, and continues to bless and guide students like us. For those of his students who wanted to reach out to him, here’s his e-mail ID : drvithalkale@yahoo.co.in

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