Medical Gods I met upon Earth: Part I

English: This 2006 image depicted an adolescen...

English: This 2006 image depicted an adolescent female in the process of receiving an intramuscular immunization in her left shoulder muscle, from a qualified nurse. The girl was assisting in the procedure by holding up her sleeve, while watching as the injection was administered. The nurse was using her free hand to stabilize the injection site. http://phil.cdc.gov/phil/details.asp ID 9400 (Photo credit: Wikipedia)

(C) Dr. Rajas Deshpande

KEM Mumbai Ward No 10.

2.30 PM somewhere in 1999.

Prof. Dr. Sorab Bhabha, Neurologist, entered the clinic room.

Dr. RNR, my seniormost chief resident appearing for DM Neurology exams, was to present the case to him. Three other batches of DM students, almost 20 others including medicine residents, lecturers, interns were in that small room, strategically located to see all but hide faces to duck direct questioning. Patient sat on the couch. ADEM (Acute Disseminated EncephaloMyelitis).

Dr. Bhabha took his chair in the center. Suave. Face that oozed brilliance and kindness, only balanced by the mockery in eyes. A smile that was a punchline before anyone even started. Very fair, Thin built. Cream and brown, dark tie. English in appearance. Camel skin knapsack, reddish brown shoes. Stubble and carelessly tossed back hair. All in all, the picture perfect genius.

Of course Dr. RNR, however studied he was, was trembling. There is nothing more enjoyable for medical PG students than case presentation by a senior who they know is going to be skinned and scarred alive. It’s a dessert. RNR started.

What followed was 2 hours of a dream. We forgot where we were, we got lost into his descriptive interpretation, analysis and differential. He actually created the vision of the entire visual pathway there in the center of the room, only with his words. When he concluded the differential, we knew we are with one of the topmost Neurological minds in the world. There couldn’t have been other possibilities. He had “caged” the case. Boldly people asked him questions, and smiling, he answered. Point and shoot answers.

Of course he didn’t entirely disappoint us on the skinning front. (“Hammer ka awwaaz toh bahut aa raha hai Professor, reflex nahi aa raha” meaning “your hammer makes a lot of noise, but one can’t yet see the reflex” etc..) The only difference was that the one being skinned also had to laugh at the crisp stinging tacit sarcasm for its accuracy, and the beauty of his language that could not be matched.

Upon finishing the clinic, he started to walk his fast cadence towards parking. I ran and asked him that there is a complicated case we could not understand, and my other teachers had suggested I discuss the case with him too (Old man, confused and convulsing 3 days without fever / stroke / trauma / infection / metabolic abnormality or prior history). He asked me to summarize the history and exam in minimum words. As I did he said “Google Serotonin Syndrome”. I did. The patient went home in few days completely improved. The connection of this syndrome and the drugs that patient took was published only a month earlier.

Whatever we asked, he made it a point to explain in a way that one would learn from the very basic. He was very compassionate to everyone, but intolerant of any hypocrisy, show or lying. He didn’t spend time arguing where it was a waste of time. “I have worked upon five continents, Rajas, and the best clinical experience one can acquire is in India.. Don’t waste any time in arguing with anyone, however small or big. Mention your point twice, smile and leave”.
God how much that has always helped me!

Once a kid with stimulus sensitive epilepsy was being presented. Upon patting the shoulder of this 5 year old girl, she would go in a flurry of what appeared to be myoclonic movement, only a tad bit prolonged (maybe a second longer). We all were eliciting it to present it to him, and trying our own analyses of what was happening.

In he came. Case started. As the presenter raised his hand to demonstrate, Dr. Bhabha said “No”.. We all were so eager to show him what happens. Mobile phone videos were not yet available. But he declined. “None of us has the right to precipitate a seizure, even if for learning. It is discomfort for the patient” he said.
I have rarely seen that affection for a patient again.

Eventually my turn came to present a case. Anxiety peaked, and ego started quivering like a jelly. The happy gathering was all curious to see the new resident (yours truly) being painted black n blue. I started the history after basic data: “Sir the patient had some gluteal intramuscular injection, and within a few minutes had blebs and rashes only on that leg, then became paralysed in that leg then in other after a few hours” ..

“Dear Professor (that was his pet sarcastic name for of any new resident doctor), just because someone sitting by a moonlit pond had a seizure you don’t call it “Lunarogenic Epilepsy”..!
I willingly joined everyone in the laughter that followed. I had my ego too, and it revolted. After the case was over, I went to the patient who was still admitted in the same ward, and asked him about the correctness of history. Once he confirmed, I ran back and trembling, asked Dr. Bhabha “Sir, I apologise , but I confirmed with the patient, and he assures that it was so.. would you like to confirm?” He smiled “If you are sure you are correct, never apologise. Truth will show itself. Now find out what that injection could have been”.

My fear of him disappeared, and respect multiplied. I stalked him and followed everything he said.

(Will continue as part II)

© Dr. Rajas Deshpande

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