Medical Gods I met upon Earth

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

“He’s a King.. and also a Superman” Deb said.

One of the most respected figures in the world of clinical and research Neurology, director of a specialty unit and professor in one of the best reputed western universities, and the highest among genius Masters I met in my life yet, Dr. John Bach was also the favorite swoon of many women and some men at the University Hospital.

I was dining in this only Indian restaurant in that Canadian city, with Ravi and Krish from India, Deb from Australia, Mary from Canada and Mindy from Argentina. We worked in different units, but heard almost daily about Dr. John Bach from Deb, who was his fellow of two years, and she was oh-so-much in awe of his personality.

This Neurology set-up was one of the last place one could refer patients to, the top of the referral pyramid in Neurology. Giants, Stalwarts and Titans were commonplace in this department. These names were familiar because we had read textbooks written by them, diseases, syndromes and procedures were named after them, and some had become immortal by their contribution to medicine: Nobel winners/ their coworkers, discoverer of Insulin, pioneer of repositioning maneuver in vertigo, creator of aneurysm clips, world best in stroke to name a few.

This was different from the Indian experience in many ways: although these people were among the topmost in the world, they still wished you even when you were a student. You could talk frankly, have coffee and share lunch, call them by their first name and they would not mind standing behind you in the coffee queue. Nobody misused students to get personal work done. No high-handedness as a teacher. In short, students were treated very well, almost equal. The dwarfer you intellectually are, the more you tend to demand respect and show people down. The only superiority most of these giants donned was their work, and that alone was sufficient to intimidate the students.

Unfortunately my boss (Dr. JJ) had employed two of us “Indians” in one fellowship grant; it earned him twice the revenue through the patients we saw for him. So we received half the salary of what all other fellows did. Being Indian doctors we were used to poverty, but given the high rents, we were left too short to spend in hotels. Once while we were dining in this Indian restaurant, Dr. Bach walked in. An ecstatic Deb introduced us to him.

About six feet three inches, German looks, thin but strongly built, scanty hair, restless hands and feet, with a handsome face that reminded me of Ayn Rand’s words: the face without pain or fear or guilt!

He finished his dinner before us and left. The waiter brought some desserts. He told us: “Dr. Bach has paid all your bills, he added these desserts to your order.” Deb laughed aloud: “I told you” she said!

“Thank you Sir” I said as Dr. John Bach entered the OPD next morning.
“Pleasure!”, he said, as if nothing had happened to his Hundred plus dollars.
He asked: “How fast do you do a Neurophysical examination of a patient in OPD?”
“Twelve minutes” I replied proudly, we are used to timing.
(Routine screening Neurological examination in Outpatient set-up is minimum 80 steps, and may extend beyond 120 different things a Neurologist must check. Skipping is dangerous).
“That’s too much time. I take 3 minutes.” He handsomely smiled.

Now this lure was irresistible.

“Sir I would like to see once.”
“Call me John, not Sir. Join me in OPD when free.”

My boss Dr. JJ once humiliated myself and my colleague to impress some female student and we had an argument as one of the insults included his “favour” to Indian students by employing them. This argument repeated, and to get back, he cancelled the permission he had given me to bring my wife and kids from India to stay with me. I quit him.

Serendipity then did a Heimlich’s upon my future.

Dr. Bach asked if I wanted to join him, as Deb was leaving. If I passed the interview, I could join, with almost thrice the stipend. The day I joined Dr. Bach, my world changed forever.

He did teach me his own technique of performing an OPD Neurological exam in three minutes, without missing the details. He was a medical genius, for the lack of any superlative adjective. Right from origin of medical words to the newest pharmacological advances, he had it all on the tip of his tongue.

His concentrated gaze, that genius torch of brain and eyes, was like a laser beam picking up every abnormality, registering, categorizing, analyzing and assimilating every small and big detail, discarding the unnecessary and reaching a conclusion just as he finished the examination. He was twice the character Sherlock Holmes to me. If he had a doubt, he asked us students, mostly we couldn’t answer, then we ran to the comp and found the best to be offered to the patient. There was no pretending, high-handedness or an “I know all and better than you” attitude unlike most teachers. And no “unnecessary show” of knowledge by diverted discussions.

He taught me that unless you answer each question the patient wants to ask, the consult is not over, and he also taught me how to “steer” people who keep on asking the same questions / initiate irrelevant discussion/ speak vague. He was as tactful as a mother would be to her child, in case a bad news was to be shared with the patient.
———————

“I have been isolated and boycott, RjaaS (that’s what he called me), by most of the international community for speaking the truth. People do not like it. More than half the research is either misdirected, twisted or almost useless… Huge funds cross hands to manipulate data, you can then get almost ANY reference on pubmed to prove yourself correct… at least one can generate enough confusion for his contention to be accepted.”

Blind replication of western research, Statistical collections, Manipulating data, Conducting trials rejected by developed world as unethical or dangerous, Tweaking studies to publish them as one’s own.. India is also one of the largest playground for such practices.

He taught me the intricacies of analysis.

Nightmare is too insufficient a word to describe what is going on in medical research today. Studies are planned with a specific point to prove, and data is manipulated accordingly, right from the patient selection to the interpretation of outcomes. There are committees paid highly to “sort out” or mask the unwanted inferences. (“The standard double-blind placebo controlled multicenter international” seal of authenticity has many holes, although there is no bypass to it.. It’s like democracy: in the absence of a better system, the majority supervenes, and if the majority is corrupt, there is no option but to submit).

He showed me two documents: An original FDA drug report about a new molecule, and its actually published (manipulated) version. The difference was comparable only to that between a child’s mind and a murderer’s. Most practicing doctors, students, and patients are blinded to what happens behind the scenes of a drug research and launch. Costlier the drug, more the chances of professional infidelity. Vehement prescription of any new drug launched is a great threat to today’s medicine.

Dr. R.B. Bhagwat, one of the most senior and respected physicians in Aurangabad India was once examining my grandma. I was a PG medical student at Aurangabad GMC then. I had asked him his opinion about Alprazolam, a newly launched drug then. “There is a honeymoon period for every drug,” he had said, “your final opinion must survive that period”… That “magic” drug then is now the addiction of millions all over the world.

10 years later, Dr. Bach thus showed me the proof of this.

“Never presume” said Dr. John Bach, “Never take anything for granted. Question everything, right from the sanity, intention and wisdom of one saying it, however big the other person be, whatever his post and credentials. Challenge everything” he said often! Whenever someone said “In my experience” during an academic discussion, Dr. Bach laughed aloud and said “you just murdered the science in this argument!”

He loved it if I could catch his mistakes. He rewarded me if I proved him wrong. He is the only doctor I met who, in spite of being 20 years my senior and a global big-shot, took me to other consultant friends in OPD and told them proudly that his student proved him wrong.. There was no question of ever presuming I knew better…. for he was the Master, but unlike many other Masters I had met, he was open to others being correct and him being wrong too. We can all learn to accept that some rare times students / juniors are correct, we may be wrong, and egos should not interfere with a doctor’s analysis or diagnosis.

For in the field of Medicine, nothing is above the good of a patient, and the doctor alone has the capacity to guard that good.
Lying to a patient is equal to double blasphemy: you kill their trust and your own integrity. One can understand exceptions like reassuring a dying patient, lying to avoid violence and lying in a hope to calm down some patients who may harm themselves, beyond that the margins blur.

We in India have also the concern of rampant “illiterate, gunda culture” which is averse to truth, and expects Bollywoodian doctors and events.

I had to go somewhere once, and had not my own car yet. Without my saying a word, he gave me the keys to his Lexus, no questions asked. I had no dental insurance, and needed a tooth out. He sent me to his dentist and paid my bills (Dental services are very costly there). He always respectfully introduced me to his patients, and praised me too (undeserved, I agree). He protected me from racist patients. He saw to it that I was well provided for.

He played violin at concerts. He was an excellent connoisseur of wines. His reading was voracious, and sense of humour out of the world. His English was impeccable, We played a game of using a minimum number of words to express something. He challenged me if I could shorten any of his sentences, without altering their meaning. Only few like him would know how precious time is. This habit of ‘not beating around the bush’, and avoiding every single unnecessary word has added years to my life.
—————

I asked him, ‘How does a practicing physician or student distinguish between true and pseudo-knowledge/ research in medicine? If so many research trials are manipulated, what to believe?’ He introduced me to the Cochrane database, which analyses claimed research outcomes, and lists the good, the bad, and also the unknown about every drug, and also taught me how to discover the hidden information within a trial. He trained me also to check the details of patients enrolled in a study. It was common observation that claims of a drug being very good in a study usually were associated with enrollment of milder cases with lesser chances of progression and better chances of recovery. Whether this was the normal course of that disease in those patients, or the thousand-dollar drug really helped them, was difficult to dissect.

“RjaaS, one must cut off all the glamour, lights, orchestra, aura and the desire of social acceptance to see the naked truth about anything. The real nature of a person or something they contend can only be seen then”, he said when he gifted me the Eskimo hunting glasses (seen above), made of seal bone, which cut off the light reflected from the snow on all sides, so one can see only the target through the small slits. And yes, he never wrapped a gift.

We could criticize each other and make fun of the differences we had. He was German by origin, and did have a bias like all of us do, based upon some of his experiences. He desperately tried to change himself here.

‘Do you have these rides in India, RjaaS?’, he asked when I returned from the Toronto National Fair.
‘No, Dr. Bach, we have different rides.’
(I was too embarrassed to admit that my country was ten years behind those helicopter rides.)
‘Then what do you have, tiger or elephant rides?’, he sarcastically beamed.
‘Yes, sir, and many Canadians come to India to enjoy them.’
We both laughed.

‘I once had a psychotic fellow’, he told me, and then laughed loudly, and said ‘That fellow can also use the same sentence about me.’

He readily understood that people may dislike / isolate him for being superior, far better, and also gay. He was not sure if we Indians would accept his orientation, so initially was reserved about it, but then he did invite us all to a party in his palatial bungalow, one of the most beautifully adorned homes I have seen, with busts of Napoleon, Aristotle, Plato, Darwin, etc., in every nook and corner. He had the best modular kitchen I have seen, with the central platform also having a glass control panel of his Bose audio system. Fond of cooking, and an expert too, he had a collection of spices from all over the world across the cupboards spanning one entire wall. Everything was state-of-the-art clean.

Like the range of sound for human hearing is limited only to certain decibels, some intellectual processes, some feelings, some emotions are out of range for most, and in general people are scared of what they don’t understand. To expect an individual with average IQ to completely grasp the thought processes and behavior of a genius is unjust and irrational. We readily end up labeling higher placed intellect madness.
Although Dr. Bach usually neglected those who did not understand him, most of the world around him was ‘two sandwiches short of a picnic’ for him. He did not waste time for the ill-behaved, irrational and hypocrites.

He was always excited like a child to learn something new in neurology, and he refused to be at peace with a question mark lurking in his mind. For umpteen times a day I ran with him 7 floors up and down to discuss with radiologist or pathologist about a case in OPD, and the patients seen by him never carried home a question mark about their medical facts.

He wore a limited edition (? only 60 made) Swatch with brain as a dial and vasculature as the hands. He told me that it is no more sold. I naturally obtained one via ebay in a few days (seen above). I love this watch much more because it reminds me of him everyday. He also got me addicted to own the best of digital technology, and to put it to use for personal and patient care.

Dr. Bach gave me the two most precious academic opportunities of my life, those of writing chapters as first author in two of the most prestigious neurology textbooks. This crown of my CV is thanks to him. When I told him this was one of my dreams, he said “Well, dream the next one now, there’s no time to waste.”

A day before I left Canada, Dr. Bach invited me and my family for a dinner, and himself cooked almost 12 dishes, half of them Indian. He did get emotional when he commented ” RjaaS, you will have to grow up one day to the painful fact that medical achievements always fall short of expectations. I have spent 26 years seeing neurology patients, had a terrific career and saved many, but my quest of finding a solution to this one disease (his specialty) always eluded me.”

I knew part of this by experience: When you don’t achieve what you set out to achieve, whatever else you achieve seems meaningless, and there is no solace to the intellect in mindless repetition of the routine.

Medical market is driven by money, also necessary for its own sustenance, research and growth. When majority makes decisions, and majority likes money, one can readily understand the obligations upon many decisions. We live a world where if you don’t fall in line with the majority, you mostly sacrifice your social career. When researchers directly or indirectly invest in pharma shares, we don’t need a trial to predict the outcome! I was surprised to the core when at an international conference at Vienna, he told me in advance about some speakers who would speak / camp for a particular medicine.

The tears in Dr. Bach’s eyes that day represented the agony of hundreds of medical practitioners and researchers all over the world who want to live honest and glorious life of achievements, but whose dreams are sabotaged by their own medical community, governments and a society near-totally blinded to the truth of what goes on in medical practice research.

Today there are achievers, but there could have been ten in place of one. There is good research, but only a tiny percentage , and the divine class of medical geniuses who set out to change the world, by finding cures and solutions is dying every passing day, to be replaced by profit based practices and research.

Dr. Bach changed me completely, purified my soul, and taught the most important thing of all: to proudly accept who I am, to pursue what my intellectual self demands of me, with passion, love, dedication and the intensity of one who understands how short and unpredictable life is!

He thus added the remaining two sandwiches to the wonderful picnic of my life.

(C) Dr. Rajas Deshpande

PS:
Name changed for obvious reason. Dr. John Bach is an imaginary name.
He lives his retired life happily, travelling around the world.

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