The City of Hearts
Stories of the hospitals that Indian doctors built — and of the people who refused to let the country remain a waiting room for someone else’s medicine.
This is written in the voice of a book about Indian doctors: long, human, with reconstructed rooms and conversations drawn from public interviews, memoirs and the record of how these places actually rose from dust, duty and stubbornness.
Chapter One — Medanta: The House That Would Not Be Borrowed
The first thing patients notice, even now, is the light.
It falls across the lawns of Gurugram in long, unhurried slabs. Forty-three acres that were once the edge of the city, a place where trucks coughed and the monsoon turned the plots to soup. In November 2009 the glass towers of Medanta — The Medicity stood finished enough to receive the living. One thousand two hundred and fifty beds were promised. Forty operating theatres. Three hundred ICU beds. An intraoperative MRI so a neurosurgeon could open a skull, look again, and know whether the last millimetre of tumour was still hiding.
Dr Naresh Trehan walked the corridors before the public did, the way a man walks a house he has mortgaged his name to. He was in his early sixties then, the moustache still dark at the edges, the walk of a cardiac surgeon who has spent decades standing on the left side of a table while a heart, empty and still, waited for him to decide.
A junior administrator hurried beside him.
“Sir, the dual-source CT is calibrated. Siemens team is still in the basement.”
Trehan did not slow.
“Tell them I want it working before the first chest is opened. I did not come home to wait for a machine.”
“And the Ayurveda wing?”
He stopped then. The question had been following him for years.
“We will not copy America and then complain that America is expensive,” he said. “Four billion people live the way we live. If our medicine is only a photocopy of theirs, we have already lost. Put the herbs next to the theatre. Let the two talk.”
That sentence — half sermon, half engineering brief — is the soul of Medanta. It did not begin on those forty-three acres. It began in a three-room flat opposite Plaza Cinema, Connaught Place, after a country was cut in two.
The rooms that were clinics
His father was an ENT surgeon. His mother delivered babies. Before Partition they had practised in Lyallpur. After it, the family arrived in Delhi with the particular poverty of people who had been professional and were suddenly only displaced. Fourteen relatives in one room, then a three-room allotment: two rooms given over to patients, one room for the living.
A boy sat on a trunk and watched strangers come in with their faces wet and leave with their faces dry.
“Why do they smile when they go?” he asked his mother once, after a woman whose labour had lasted the night finally slept.
“Because we did not send them away,” she said, washing her hands in a steel basin. “That is the whole profession. Do not send them away.”
His parents did not push him toward medicine. They knew what it stole from a family. The boy pushed himself. He was born left-handed. A Hindi tutor, believing the left hand unlucky, broke the knuckles until the child wrote with the right. Years later colleagues would watch him suture with either hand and not know which story they were watching — the broken one or the stubborn one.
In 1963 he took a train to Lucknow, to King George’s Medical College. Delhi felt too close to the girl he already loved. Madhu. His parents hoped distance would cool it. Distance did the opposite. Every other weekend he rode back, a medical student with notes in one pocket and a ticket in the other.
“They think Lucknow will save us from each other,” he told her once, standing under a neem near the college gate.
“Then they do not know us,” she said.
He married her. The partnership would outlast two hospitals, a public quarrel, and a city that learned to call him by one name.
The Mexican bandit of New York
November 1969. He landed in America with long hair and a drooping moustache. Later he would laugh and say he looked like a Mexican bandit. Seniors at Thomas Jefferson in Philadelphia looked at the bandh gala and the hair and told him, almost kindly, that Dr Frank Spencer at New York University did not speak to foreigners and that the waiting list for that residency was five years long.
He got in anyway.
Spencer was the kind of teacher who could silence a theatre with a glance. Trehan learned the grammar of the chest: how to still a heart, how to trust a pump, how not to hurry the stitch that holds a life. He stayed nearly two decades. Assistant professor. A practice that could have kept him in Manhattan until the end.
Every year, he later said, some three hundred Indians found their way to New York for hearts that India could not yet mend.
“For every one who could buy the ticket,” he told a colleague one winter, hanging his coat in a locker that smelled of disinfectant and snow, “there are hundreds who die in a queue at home. I am repairing the rich man’s cousin. I am not repairing the country.”
“So go back and starve?” the colleague said.
“So go back and build.”
Most of his generation stayed. He booked a passage.
“Where on earth will you get 150 patients?”
- Delhi still treated a free-standing heart institute as a kind of madness. There was not, Trehan liked to say, a single such institute anywhere in the world when he began. A chance meeting with H.P. Nanda of the Escorts group — tractors, farm machines, a man who understood factories — gave him land on Okhla Road and the nerve to pour concrete.
Local doctors took him aside.
“Naresh, outsource twenty beds. We will fill them. You cannot do this alone. Where will you find a hundred and fifty heart patients in this city?”
He looked at them the way he had looked at the tutor who broke his hand.
“Bring the best medicine,” he said. “Be sincere. Be affordable. Be a place people can trust. They will break the door.”
They broke the door.
Escorts Heart Institute became the place North India pointed to when a chest pain became a sentence. For nineteen years he ran it as if it were a public trust wearing a private name. Then the ground shifted. Fortis bought Escorts. An SMS on a Wednesday evening in 2005 — Breaking News: Fortis buys Escorts — arrived like a second partition.
He would call it the greatest betrayal of his life.
In May 2007, on the rooftop of the Taj, a conversation ended a chapter. Mutual parting, they said. He left the hospital he had built. Fifty doctors walked with him. For a time he operated at Apollo, a guest in another man’s house, because patients do not pause for corporate wars.
Madhu found him one night at the dining table with a map of Gurgaon and a pencil.
“You are going to do it again,” she said. Not a question.
“I am going to do it properly,” he said. “Not a heart shop. A city. Mayo. Cleveland. Hopkins. But ours. Knowledge made here, for our people, at our price.”
“And if they lock you out of this one too?”
He smiled without humour.
“Then I will build a third. I am not a tenant in my own profession.”
Forty-three acres and a Canadian pencil
- He and entrepreneur Sunil Sachdeva acquired the land on the outskirts of Gurugram. Avenue Capital put in ₹224 crore in 2006. Punj Lloyd came in. Yes Bank and a clutch of public-sector lenders carried debt. The bill would run close to ₹1,200 crore. Trehan put his own money on the table this time. No one would be able to SMS him out of his own building.
Architects — Canadian and Indian — were told to design not a hotel with wards but a machine for safety. Corridors that did not lose a crashing patient. Theatres that could swallow an MRI. A neurosciences “brain suite.” A place where a surgeon could operate and then look again, in the same room, without rolling a half-dead body down a lift.
“India does not need another pretty lobby,” Trehan told them. “India needs an institution that can generate new knowledge. Western knowledge is for Western bodies and Western wallets. We have to invent the cheaper miracle.”
They argued about bricks and marble the way other men argue about cricket. He turned up for two or three days at a time and pointed at samples.
“This one. Patients will touch it for twenty years. Do not give them a surface that looks tired in five.”
Sceptics circled. A 1,250-bed multi-specialty on the edge of a city that was still learning to spell “Gurgaon”? Full-time specialists, not visiting consultants who vanished at 2 p.m.? Integration of Ayurveda with a dual-source Flash CT?
He had heard the same music in 1988.
“If I do a hundred operations, the cost is high,” he said. “If I do two hundred, it halves. You cannot put three hundred crore of machines into two hundred beds and then pretend you are cheap. Scale is not greed. Scale is how the poor get a chance.”
November 2009. The doors opened. The first years were thin in beds, thick in faith. Four hundred, then six hundred, then the climb toward the full complement. Revenue followed the patients. Carlyle bought a stake. Temasek arrived later. The listed company that grew from that bet would one day be counted among India’s serious healthcare names. Rankings would put the Gurugram flagship at the top of private hospitals in the country, and for years among Newsweek’s global lists. That is the newspaper version.
The human version is a man in a white coat who still thought like a Partition child: do not send them away.
The last stop
On ordinary evenings he still walked the ICU.
A farmer’s son from western Uttar Pradesh, chest wired, eyes wet, whispered, “Doctor sahib, in my town they said only America can do this.”
Trehan sat on the edge of the visitor’s stool, something he had watched his mother do in Connaught Place.
“America can do this,” he said. “So can we. That was the entire point of the building you are lying in.”
The boy’s father, standing with a steel tiffin and a folded gamchha, did not speak. He only nodded, once, the way men nod when a debt has been named and then cancelled.
Medanta spread — Indore, Ranchi, Lucknow’s great Avadh hospital, Patna, Noida. The founder grew older and did not retire from the table. Colleagues joke that he will suture his own retirement. He talks of cost the way other surgeons talk of grafts: as a moral variable. A bypass that costs forty thousand dollars in the United States and under four thousand at Medanta is not a discount. It is a different civilisation’s arithmetic.
“We are the last stop,” he has said. “People come when every other door has closed. If we cannot keep the price inside a family’s reach, we have only built a prettier last stop.”
That is the story of Medanta: not a miracle dropped from the sky, but a man who left a New York practice, built a heart institute, lost it, and then raised a city of specialties on forty-three acres because he refused to be a guest in Indian medicine.
The other great hospitals of this country were built by people who, in their own decades, made the same refusal.
Chapter Two — Apollo: The Night a Young Father Died in Madras
Years before Gurugram’s glass, there was a nursing home in Chennai and a man of thirty-eight who needed a bypass that did not exist in India.
Dr Prathap C. Reddy had come home from America because his father wrote him a birthday letter that pulled harder than any fellowship. He had a practice. He had daughters. In late 1979 he told a family that Texas could save their husband and father. The ticket and the surgery were fifty thousand dollars. They could not raise it. The man died.
Reddy sat with the file after the death certificate was signed.
“Why should they go abroad,” he said to the empty room, “when Indians are already at the top of every other field? Why can we not do it here?”
Friends called him crazy. Build a nursing home, they said. Expand what you have. A corporate hospital? In the Licence Raj? Medical equipment taxed like perfume? Banks that did not lend to hospitals?
He flew to Delhi on Fridays until the bureaucracy knew his face. He reached Indira Gandhi.
The reconstructed room is simple: a prime minister who was hunting for Indians who came back instead of leaving, and a cardiologist who did not soften the sentence.
“In this country,” he told her, “only two kinds of people get good care. The powerful man flies free; the embassy pays. The rich man does not ask the price. Everyone else waits, or dies.”
Duty on machines came down. A share of the poor would be treated free. M.G. Ramachandran in Madras had once sent a handwritten note to stop construction, mistaking the project for a hotel. After a letter from the Cabinet Secretary, MGR’s men went looking for Reddy across the city.
“If there is something between us,” the chief minister said when they finally met, “you should not go to the prime minister. We should sort it out.”
They sorted it out.
On 18 September 1983, Apollo Hospitals opened on Greams Road with 150 beds. Reddy had wanted Mrs Gandhi to inaugurate it. She declined, saying the country already gave her enough credit, and sent President Giani Zail Singh instead. A daughter, Suneeta, had suggested the name — not the moon shot, she said, but Apollo the healer.
A surgery that cost fifty thousand dollars in Houston could be done for a fraction on Greams Road. The first corporate hospital in India did not only treat hearts. It taught the state that a hospital could be an industry without ceasing to be a mercy.
From that 150-bed seed grew a network that would touch tens of millions, open pharmacies and telemedicine rooms, and send a signal to every young doctor who still thought excellence lived only west of Greenwich.
Reddy, much later, would say the country must learn to say Heal in India the way it had learned to say Make in India. The sentence began in a nursing home with a dead thirty-eight-year-old and a doctor who would not write another referral to Texas.
Chapter Three — Narayana: Mother Teresa and the Factory of Hearts
In Kolkata, in the early years after Dr Devi Shetty came home from Guy’s Hospital in London, a telephone rang in an operating theatre.
Mobile phones had not yet colonised India. The anaesthetist took the landline.
“They want a home visit.”
“I am a heart surgeon,” Shetty said, without looking up. “I do not make home visits.”
The caller persisted. If you come, it may change your life.
He went.
The patient was Mother Teresa. The White House called the hospital. The world offered to airlift her. She stayed with the young surgeon who had been asked to leave his theatre. He would be her physician for the last years of her life. Two photographs of her would hang in his office for decades, one with the line he loved: Hands that serve are more sacred than lips that pray.
She looked at him once, after a long silence, and said something he never stopped repeating.
“Now I know why you are here. To relieve the agony of children with heart disease. God sent you to this world to fix it.”
He had already decided, in the fifth standard, when a teacher spoke of Christiaan Barnard’s transplant, that he would be a heart surgeon. In 1992 he performed India’s first neonatal heart operation on a baby measured in days. Volume became his theology. If a solution is not affordable, he said, it is not a solution.
His father-in-law, a builder, put up the capital on one condition: the hospital would stand in Bengaluru. On the city’s edge, on a campus that grew into Narayana Health City, Shetty built what journalists later called a factory of hearts — not because the work was careless, but because the assembly of skill, standardisation and scale could drop the price of a bypass toward what a working family might survive.
Thirty surgeries in a day, in the years of peak rhythm. A bill that made American administrators blink. Cheap scrubs. Cross-ventilation where vanity wanted central air. The poor and the working class as the business model, not the afterthought.
“We jump out of bed,” he told interviewers, “and tap-dance to work.”
The tap-dance was for a child whose parents had sold a field, and for the belief that charity in healthcare is not a donation box. It is a price list that does not humiliate.
Chapter Four — Vellore: Three Knocks Before Dawn
Long before corporate hospitals, before even independent India’s first great public institute, there was a verandah in Vellore and a young American woman who had sworn she would never become “one of those missionary Scudders.”
Ida Sophia Scudder had come only to sit with her ailing mother. One night in the 1890s the knocks came.
First a Brahmin. His child-wife was dying in labour. Would Ida come? She was not a doctor. She offered her father. The man refused. A woman could not be seen by a man outside the family. He would rather she die.
Ida returned to her desk, shaken.
Second knock. A Muslim. The same plea. The same refusal of her father.
Third knock. A high-caste Hindu. The same darkness at the door.
She did not sleep.
“Within the touch of my hand,” she wrote, “were three girls dying because there was no woman to help them.”
In the morning the tom-tom beat in the village. A servant went out and came back. All three were dead.
She packed for America, entered Cornell’s first medical class that took women, and returned in 1900 with a stethoscope and a stubbornness that would outlive her. A donor gave ten thousand dollars in memory of a wife. A one-bed dispensary. Then the forty-bed Mary Taber Schell Memorial Hospital for women. Roadside clinics under trees. A nursing school. A medical college that began with a handful of girls whom she taught herself.
Mahatma Gandhi visited in 1927. The little campus became Christian Medical College, Vellore — a place that would perform India’s first successful open-heart surgery in 1961, the first kidney transplant in 1971, work that other hospitals still send when the case is strange and the family is poor.
Ida had not wanted India. India knocked three times. She opened the door and never fully closed it.
Chapter Five — AIIMS: A Princess, a Prime Minister, and a Temple of Science
In the first years of the Republic, Jawaharlal Nehru wanted a medical Johns Hopkins for India — a place that would train teachers who would then staff every other college. The Bhore Committee had said so in 1946. Calcutta was suggested. Bidhan Chandra Roy, physician and chief minister, said no. Delhi received the dream.
The person who carried the files, the foreign grants and the stubbornness was Rajkumari Amrit Kaur: princess of Kapurthala, Oxford student, Gandhi’s disciple, India’s first health minister.
On 18 February 1956 she stood in the Lok Sabha without a prepared speech.
“It has been one of my cherished dreams,” she said, “that for postgraduate study and for the maintenance of high standards of medical education in our country, we should have an institute of this nature which would enable our young men and women to have their postgraduate education in their own country.”
New Zealand laid a foundation stone. Rockefeller and other foundations sent money. Faculty were coaxed home from abroad. For a time the infant institute lived in barracks beside Safdarjung. Nehru spoke of it as a temple of science. Students still speak of it as the dream college — crowded, fierce, public, and unwilling to pretend that excellence is a private luxury.
AIIMS did not have a founder-surgeon in the Medanta sense. It had a nation trying to prove that independence included the right to learn medicine without a foreign stamp. Every later private giant — Apollo, Escorts, Medanta, Narayana — would hire men and women who first learned their fearlessness in public wards like these.
Coda — What the buildings remember
Stand at dusk on the Medanta lawns and you can, if you are sentimental, hear the older buildings answer.
Connaught Place says: two rooms for patients, one for the family.
Okhla Road says: they told you there would be no patients.
Greams Road says: a young father died because the plane ticket was the treatment.
A Kolkata parlour says: make a home visit; it may change your life.
A Vellore verandah says: three knocks.
A Lok Sabha bench says: let them study in their own country.
Indian doctors did not only staff hospitals. In the second half of the twentieth century and the first decades of the twenty-first, a certain kind of doctor became a builder — of theatres, of price lists, of schools, of arguments with the state. Some built for faith, some for the Republic, some for scale, some for the particular pride of not sending a countryman to New York with a boarding pass and a prayer.
Trehan, walking those Gurugram corridors in the early days, used to tell his people that the work was a continuing journey. Better and better, he said, and cheaper without becoming cruel.
A nurse once asked him, not unkindly, whether he ever missed the quiet of a New York practice.
He thought of the trunk in the Connaught Place room, and of the left hand that had been forced to become two hands.
“I miss nothing that did not include this country,” he said. “If the building is good enough, the country will come to it. That is the only test.”
The country came.
It is still coming — with tiffins and referral slips and the old, unkillable hope that someone, behind those lights, will not send them away.
deemagclinic
deemag and chest clinic 