Medical Gods I met upon Earth: Part VIII

Schematic diagram of normal sinus rhythm for a...

Schematic diagram of normal sinus rhythm for a human heart as seen on ECG (with English labels). (Photo credit: Wikipedia)

The Messiah of Medicine
© Dr. Rajas Deshpande

“Sir, many times last night, I felt it was so easy to slip in some wrong drug to that rapist: if that criminal is allowed to go back in the society, he will just continue to rape more women”.
Said the devastated intern with tears in her eyes.

We had had a tough ICU night, me and this intern, attending some critical cases along with a famous businessman who had been arrested (again) for an alleged rape and was admitted in the ICU for chest pain. He did have fluctuating high blood pressure and mild ECG changes. The intern was too affected, just like rest of the town, by his alleged crime. Our professor came early morning to see him and other emergencies. While having tea after the rounds, this tearful intern said these exasperated words to our beloved professor.

Dr. Pradeep Yashwant Mulay sir answered: “You are a Doctor, not a judge. Be it a Priest or a Murderer, your decisions must only be for their good”. You have to train yourself to keep all your judgmental attitudes and prejudices out of medical care. Even if your enemy comes to you as your patient, your only duty as a doctor is to save him and do the best for his health”.
Dr. P. Y. Mulay sir taught us apparently simple things that were the most difficult to follow in real life medical practice: but he also showed us how to, by practicing them himself. He honed the very basic “medical thinking” among us students.

There is a “Take Off” point in everyone’s life when they finally meet the person who they want to be like. Everything changes there. The desire to be a good doctor can only be created by someone who dons the charisma and persona that only comes with being a genuinely good doctor. It cannot be faked. I was on the verge of quitting MBBS course once, wanting to pursue the spiritual. It was in the beginning of third year. Having just read the Holy texts from many religions, I had lost interest in the ways of the crowds.

Then for one post lunch lecture session Dr. P.Y. Mulay walked in.

There was an actual aura of brilliance around his face! Simple, calm soothing but handsome personality, a smile as reassuring as a mother’s hand upon one’s head, deep, heavy and strong voice of a philosopher and an answering style that was inimitable: a short pause after listening to the question, that sphinx-like smile and then the perfect answer that could be, to any medical or non-medical question. His eyes always contradicted the calm on his face: “Challenge me if you can!” they irradiated.

His first lecture was about Vitamin B12. For the first time in medical years, I understood every word of a lecture without making an effort (I remember most of it even today!). Wanting to know more, I asked him few questions after the class, walking with him down the staircase. He did not show any prejudice towards me for being ‘different’ in being too active in many extracurricular activities (No, I will not explain this, but all legal stuff you know!). He was the first teacher, who talked to me like I was any other student.

I started being regular for his lectures. He once mentioned a quote from the famous novel “Final Diagnosis” by Arthur Hailey, and asked the class to read it in free time. That book was not for exams, so naturally I got it on the same day and read it in a week. I had many questions again, and he took me to a nearby tea shop to answer them all. I felt alive and was mentally back again in MBBS. He continued to guide me.

“You have to be like the architects of the Taj Mahal: The emperor paid for it, the labourers made it, but the conception of that idea is the most important thing about it. They imagined something so beautiful and grand that didn’t yet exist. That live imagination alone can supersede the beauty of that dead structure”. He answered once when I asked him how should one plan life and career, especially with wanting to do so many things at once at all times. I learnt from him: What is done, achieved is dead. The next idea in your mind is life.

“I want to do my MD medicine under him. That is my aim”. I told my scanty friends and started studying. Lower number of PG seats marred this dream for a year, and after a lot of prayers and restless nights working as a lecturer in pharmacology (often deputed in surgery) at Nanded civil hospital, I got one of the most wonderful news a doctor could get in his life: M. D. Medicine at GMC Aurangabad, where PY sir worked!

His always-happy face had become “very happy” because of the birth of his son Tejas by then. Wherever I was posted, I made it a point to attend his rounds whenever I could, bugging him with unending doubts of a vast subject that has no syllabus! He was loved by all students, and there used to be a competition for being his favourite. He must have sensed the dire need for my resurrection, so he gave me more attention then. He had a painful spine due to ankylosing spondylitis, and didn’t ride a two wheeler himself. I sensed the opportunity and selfishly grabbed it. He agreed to my request to drop him home after the rounds, and those twenty minute rides with him on my Bajaj Super were my heaven as a student, the discussions we had then have formed the basic doctor within me. Honestly, being seen around with him raised my sanity quotient among my colleagues too!
How I miss those ‘Arabian Evenings’, where my idol told me of life, riding on a two wheeler with me!

“Instincts are very dangerous for a doctor. Every single function as a doctor must be based upon logic and reason, and however intelligent one may be, one must never let instincts take over scientific decision making. At least not as a student”.

“There is seldom any ‘classical’ case of any disease: look carefully and you will find an exception to its textbook description. No two Mitral Stenosis cases are same. You must continuously review your findings and interpretation, and make decisions individualized for every patient”.

“A doctor must at least know what he doesn’t know, and never presume. Take a second opinion, open your books, and find out your answers. If there is still no answer, be honest about it to yourself and to the patient. A doctor who thinks he knows all is a dead doctor, for medicine changes every day. There’s always something more to learn about even the smallest topics in medical science”.

“The difference in Medical Confidence and Overconfidence is actually life and death”.

His peace was impeccable. He never lost his calm. “You declare your mental abilities when you lose your calm. There are no problems pitted against you, there are only situations. Your emotional reaction to them, your dislike, panic and the fear about bad outcome transform situations into problems. Stay calm, detach yourself from the fear of a bad outcome, and you will see better results”.

It is very common to see angry, shouting, arrogant, mannerless and abusive doctors (especially successful) who take pride in showing down their own juniors, staff, and students in front of many patients / relatives, sometimes for mistakes but often to impress patients. No angry person in a hospital does any good to anyone including him/herself. Angry doctors upset the students, staff and patients alike. Anger is justified only when other options of mannerful communication are exhausted. PY sir called us to the office and scolded us if we were wrong, but the scolding happened with a smile. Or he would accompany us to the tea shops near the hospital and explain why we must change. His love was a greater force against our committing mistakes than anyone else’s fears.

He encouraged the odd and different within me, challenging me often. He gave me difficult to find topics to talk about, in that era without internet. Once he just wrote “MRDM” in front of my name in the seminar list. Asked what, there came that curiously naughty ‘gotcha” expression on his face, he answered: “Find out”. Malnutrition Related Diabetes Mellitus (MRDM) was just recently described in India, and that seminar prepared me and my fellow PGs to deal with this difficult disease.

He taught me to infuse Paclitaxel (anticancer drug) to a patient, at a time that this drug was not even available in India, and was imported for someone. He stood by the side of ICU patients with us to teach us the rhythm changes in cardiac patients. I remember his beautiful talks about reperfusion arrhythmias in patients of heart attack (after the clot dissolves, the resumption of blood supply to the injured area may generate abnormal rhythms in heart, some of which may again be fatal if not treated). His recitals on Parkinson’s disease, epilepsy, hepatitis, tuberculosis etc. while we walked on holiday mornings in warm sunlight between wards are unforgettable.

One of the most painful things in life is when two people you love fight each other: be it parents or teachers, it scars your heart. PY sir saw to it that the students are never affected by disputes between two teachers. I also respect him most for one rare trait among senior doctors: he never left the side of a patient in distress or emergency. He didn’t leave it to his students / PGs to deal with them. He waited till the situation resolved. His lancet sharp presence of mind never left him. His mind was like a control center for every situation he came across, and he was always prepared in the face of surprise.

Those days the “Super specialty practice” had not reached Aurangabad, and we only had two. Dr. S. G. Kulkarni, “The Kidney Genius” virtually ran everyday from ward to ward attending patients, performing kidney biopsies and monitoring Haemo and Peritoneal Dialysis patients, simultaneously teaching multitudes of students how to dialyse a patient. If Dr. S.G. Kulkarni had chosen to be in private practice then, he would have defeated richest of the rich doctors hands down, but he chose to spend most of his career doing it all free for a negligible salary, teaching hundreds of budding physicians how to deal with and protect kidneys. I am deeply indebted to him and am also in awe of this man with a mission for the kidneys of the poor which otherwise are only cared for if they are to be transplanted!

Dr. D. V. Muley had developed himself into a cardiologist, and taught us even temporary pacing of the heart in that “makeshift” ICU. He drove me madder then, by making me prepare and study the peripheral smears and also the ECGs of each and every patient admitted in the ward. It is difficult to imagine the amount of light your past gathers, and its relevance in future!

Except Dr. SGK, and Dr. DVM, there were no super specialists, but Dr. P. Y. Mulay covered for almost all of them. Although Diabetes and Liver diseases were his special interests, he knew so much about almost everything we asked, including our weird questions. He asked me to research about the insulin coma therapy and glucagon. He often discussed with us chapters from the Sheila Sherlock’s Liver textbook. He was a wizard about infectious diseases, and when I was posted with him in the infectious ward, got us a microscope to teach the hanging drop preparation for cholera bacterium along with routine bedside pathology. I remember the pride when our first neonatal tetanus baby patient was discharged, thanks to his perfect guidance!

Dr. Mangala Borkar, one of our professors, besides being an excellent physician, was also an artist par excellence. She had made many beautiful drawings of different neural pathways and brain and spine anatomy in her ward, far before Netter’s atlases were commonplace. She conducted weekly “CPC” (Clinico-Pathological Correlation) sessions, the most dreadful activity in our curriculum where a medical puzzle was given, and the PG had to find out and justify the answer. Students were introduced to the depth of medical waters here. PY sir most usually found the answers fastest, and his academic wrestling sessions with the other professors left us spellbound, for that level of scientific proficiency was unbelievable in those pre-internet days!

Doctors and their families spend their entire life in the shadow of deadly infections. I remember how my father broke down when I proudly told him I had volunteered to work in the Plague ward during one epidemic. (Baba of course allowed me, but was very sad for many days after that). PY sir had always taught us: “It is your duty to take care of yourself while treating patients. Wear mask, gloves and take every precaution you can to avoid direct contact with body fluids, irrespective of the diagnosis. Patients are not aware if they have infectious conditions, and may not tell you in some cases. Wash hands after examining every patient. Gargle with saline if someone coughs or sneezes upon your face”. These simple precautions must have saved so many of his students! There are so many doctors who suffered and some who died due to their occupation of human medical service, and I so much wish they all had teachers like him!

He was the honorary doctor to an entire medical college. Almost every doctor or student with a health problem reached out first to their beloved PY sir, and almost everyone returned with a smile. For he was the most reassuring doctor we ever met. “We doctors forget common conditions when we are sick. We think of the worst, and scare ourselves sicker” he told me when one of my unbearable headaches turned out to be a simple sinusitis. I have called him umpteen times since then, including few months ago when my child had Dengue. “Rajas, your child will be ok in a week, but I am worried about you. Don’t let stress affect you. Eat and sleep well, relax and take rest”. It was after 14 years of my father’s death, that anyone said these words to me again!

This son of a teacher from a humble family has gifted hundreds of “The-best” quality physicians to India over so many decades! I am blessed to know this “Messiah” of Medicine, the mother branch of specialties!

During my last year in MD, PY sir bought a four wheeler, modified it with hand controls and seat positioning. As we once returned from a late night meeting, on the empty roads, I rode my scooter besides his van and shouted: “Sir is that van comfortable? You must be having to drive slow with those hand controls. Does the seat hurt your back ?”.

He laughed: “Let’s see who reaches Nirala Bazaar first” and he started speeding. Not believing what just happened, I raced him that 5 km chase, only to find him waiting there with a huge smile upon his face.

“All the controls are in the brain, Rajas!” He said.
I realise the meaning of these words everyday till date.

PY sir, please continue to bless our world with your brilliance for a thousand years more! (ok, logically speaking, at least till you are 120 years old!). I respect, adore, envy and love you!

PS: And yes, Sir, I would like another race please, for now I have a four wheeler too!

© Dr. Rajas Deshpande

Dr. Rajas Deshpande's photo.
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