Enthusiasm within quickly defeated the December chill, many years back, at the moment of the commencement of my MBBS in the Government Medical College, Srinagar Kashmir. The Principal and Dean of the College, Prof. Girjha Dhar, warmly welcomed us with her usual blend of style and high quality professionalism. “Remember that all human beings have 206 bones, and that the circulating blood is bright red among all races, irrespective of religion, region or race,” she reminded us. “And this profession demands dedication and sincerity. You must all work hard, and then devote yourselves to the service of humanity, irrespective of cast, color or creed “, she went on. Her commendable sermon is still fresh in the meadows of my memory, although years have passed since I heard it.
Once her speech was over, we all stood up and solemnly repeated the Hippocratic Oath which was read out to us by the Qatar-based heart surgeon Dr. Javed Khan, then CASS2 union president of the College. The function concluded with a cup of Saffron Qahwa, then we left the College’s elegant Anatomy Hall to begin our new lives.
No sooner we were out of the hall than a few esteemed seniors surrounded us.
“Follow in a straight line!’’ one ordered us. “Take them to the Leprosy garden straightaway!” commanded yet another from behind.
“Leprosy garden” – what could that be? The name sounded scary, but we were soon all relieved to see that it was just the intervening garden between the college and the SMHS (associated hospital within college campus) hospital. Reluctantly obeying orders, but to the delight of all the seniors, we started the fresher’s march-past. At 4 pm we headed to “Bemina Boys hostel”. In the College, the ragging went on for only a few days, but in the hostel the process continued, and we would only get to our rooms late in the evening.
“At sunset you must go to the dining hall without delay, have your dinner and wait and see what happens next,” advised one of the hostel seniors. We all followed his advice; it proved to be apt. Just imagine the stress of the anatomy hall, bio lectures and physio lectures, and then, in the evenings, groups of sirs waiting for us in the hostel. In short, all new students were sandwiched between the two, between the devil and the deep blue sea. I would often look across the Bemina Hostel grounds through the window of my room on the ground floor of B block, and envy the passengers travelling in the passing bus which I would take from time to time. Not only this, but I would often count the days right from Monday until I could visit home on Saturday.
One day I decided to prepare for the Anatomy Stage (a class test) well away from the hostel and its distractions. I headed towards the SKIMS hospital, where my cousin was doing his residency. Unfortunately, he had already gone home. In desperation, I booked a room in the nearby hotel and started reading. At around 9pm I enjoyed a tranquil dinner in the dining hall of the hotel. The weather was chilly and some of the dining hall customers were to be found warming their hands around the coal stove. I joined in their chat for few minutes, and left again soon after to continue my reading.
The next day, the stage (my class test) went very well. No sooner had I stepped out of the hostel bus that evening, then I froze in my tracks, as the person to whom I had been talking very frankly to the previous night in the hotel was my senior. It seemed that seniors were everywhere; there was no way of escaping from them! I tried my best to prevent eye contact with him but his eagle eyes sought me out.
“Follow me,” he commanded and he took me to his room. My heart started racing, and now I was sweating in the chill of December.
“Where were you yesterday? Washing dishes in the hotel?”
“Sir, I had Anatomy stage and I was preparing for that.”
“Stage!!!” the other senior sarcastically exclaimed.
“It has not started as yet! Go on, you will see!” he further exclaimed.
“Don’t waste your father’s money. Next time something like this happens, don’t even think of staying in the hotel,” he said more gently. “You can come to us and prepare here instead,” he went on.
“OK sir, thank you very much,” I replied gratefully. The next day, while washing my face I noticed that I was looking a bit miserable. “Ibu! meri Jan: things are difficult here, and it feels as if it will be impossible to complete the MBBS” whispered my heart.” After that, however, things changed steadily and some seniors started becoming friends.
After a few months, the Government Medical College CASS union election campaign started. It was all state of the art, and our group of freshers was an important focus of attention of all the candidates. Suddenly, they were all requesting our votes. Seniors were coming to our rooms in droves. What a great feeling of importance! The election campaign was interesting, being full of innovative ideas, posters, etc. and eventually the CASS union was duly elected. Months passed and things changed steadily. All the seniors became friends and wonderful guides. One could almost say we grew up together in that great hostel. Years have passed since then, but there is still great respect for all of them.
Oh! I forgot to mention this: a new batch of freshers joined us a year later. Our batch had conveniently forgotten the stress and difficulty of being a fresher, and in turn, we inflicted the same behavior on our juniors. Only then did I realize that all this was an endlessly repeating cycle of initiation. Various functions were organized by the CASS union during the following year. I recall taking part in one of the plays “Mafroor” (The Fugitive) staged in the Tagore Hall in Srinagar.
The hall was packed with students and faculty. I and eight other students, all dressed in white costumes, were supposed to be having a discussion in a café. No sooner had our seating arrangements on the stage been set up by the organizers than the curtains opened, and we were bathed in the fierce light of the stage lights like rabbits in headlights. We started delivering our respective dialogues perfectly, while pretending to sip coffee from small earthen cups placed on the table in front of us.
Quite honestly most of us had rather mugged up the highly philosophical theme of the play as nothing had actually traversed beneath the bones of our skull. Suddenly a shower of tomatoes started coming towards the stage; tomatoes were crossing like jets in front of our eyes. One of these burst near the corner of my mouth. Predictably, it was very ripe, and the juice spilt all over my white costume, as if I had suddenly laughed while taking tomato juice. In the midst of this rain of tomatoes, Yunis Shah came running from the left corner of the stage, followed by the late Khushal Paul Singh soon after, who came running on after him. Yes – the “conscience” of the person was trying to catch the “self”. They played a sort of hide and seek on the stage for couple of minutes and finally the “conscience” (Khushal Paul) caught hold of the “self” (Yunis shah), and a confrontation between the two started. “Why do you suppress me so much? roared Khushal Paul (“conscience”).
“Why do you pretend to be what you are not?” he went on. “I have a family, and I am not the only one in this whole wide world” replied Yunis shah (“self”). The audience was immediately gripped by this exchange, and stopped throwing tomatoes. Everyone became engrossed in the heated exchange between “self” and “conscience”. Finally, “self” agreed not to kill “conscience” and the curtains started closing. We got up from our chairs and all walked off the stage in a single line while raising the slogans “storm in a cup of tea and tea in a storm” (chai mein toofan and toofan mein chai).
“Well done, guys!” the director of the play said as we walked into another room backstage. He was puffing deeply on the cigarette in his mouth. “This was really just the dress rehearsal.
Tomorrow is the actual day of the performance, as the VIP show is then. I hope you will do equally well”, he added. “And I certainly hope there will be no shower of tomatoes”, I said smilingly, while still wiping the stains of tomato juice off my face. We changed out of our costumes and joined the rest of the audience in the hall. The curtains swept open again, there was a roll of drums and the orchestra started playing. Anil Ganjoo came on from one corner, and Sandeep Kaur from the other, and when they met in the middle of the stage they started singing, “Janey Kahan mera jigar gaya ji ——— (Where did my heart go ……?), the famous Bollywood duet by Kishore Kumar and Lata Mangeshkar. While constantly stamping his right foot in time to the music, Mr. Anil was at times shaking his shoulders as well, entertaining everyone in the hall. Inderjit Singh was wonderfully moving his head while rolling the drum.
They were lucky – no tomatoes were thrown at them! Instead, the hall resounded with clapping, and the audience even sang with them. Both the singers started acknowledging the claps of the audience, by means of the movements of their heads
until they finally completed the duet. Various other interesting cultural items followed. The next day, all the items were repeated in the VIP show, including our play. All events proceeded smoothly, much to the delight of all.
Another CASS Union function used to be “The Sports Week” at Bhakshi Stadium. As I recall, the winner of the musical chair among the faculty would always be the stalwart, usually an ex-professor, the award used to be as a mark of respect and love for him or her. In short, the Sports Week was a practical demonstration of team spirit and professional respect.
After 18 months we had to sit the first professional exam. The preparation was an uphill task and examination itself was quite tiring. “Listen Ibrahim, I have a friend in Lolab. It will be a nice break to visit him there. What do you think?”, said Sheikh Nissar Ahmad, my friend and batch mate. It was the month of September when we boarded a bus in Sopore. It moved at a snail’s pace, but as it moved, fresh currents of air filled the bus to Lolab. The driver went on intermittently picking up stranded passengers on the way. After Sogam, however, the road was rough, and if any bus came from the opposite direction, the dust thus swept up would enter our bus, forcing us to lower the window shields. This we did quite unwillingly for the area is gorgeous, like a bride, and the wonderful panoramas unfolding along the way constantly engage the imagination of the traveler, making it very interesting journey. After almost four hours on the bus, we reached Warnav, a small village in valley Lolab3 , famous for Moulana Anwar shah Kashmiri, the famous Kashmiri Islamic scholar of international repute. The view of the lush green valley was quite mesmerizing. Once we arrived, we were warmly welcomed by my friend’s father, who was sitting in the compound of his home. The compound was very large, and interesting too. In the corner of the compound a cow was tied to a small wooden peg. I imagined that she had just been milked, and now her beautiful little calf, which was brown, mottled with few white spots, was drinking thirstily from its mother’s udder. It was making wonderful little to and for jerky movements during this process, and the cow had turned her face towards the calf, the better to lick her baby affectionately. What a beautiful display of “unconditional love” it was – and alas, rarely seen among human beings.
Their house, though old, had a unique charm. There were multiple loops of red chilies and other vegetables hanging on one wall to dry, in preparation for the harsh winters in the area when fresh vegetables could become scarce. A wrinkled old lady could be seen sitting on a mat woven from dry gross (called Patuj in Kashmiri), holding a long stick. She was safeguarding the paddy, which had been spread on the mat to dry, from marauding birds. My friend’s father led us upstairs up a partially lit wooden staircase. As we walked up it, up our steps produced a characteristic chrick, chrick sound. As our host opened the door of their guest room, the friend arrived and he, too, warmly welcomed us. He threw open the windows and wonderful fresh mountain air filled the room. After a refreshing drink of tea, the friends took us around to give us a bird’s eye view of this beautiful area. In the evening it was quite interesting to listen to the friend’s father. “My dear sons,” he would address us, “never consider other person inferior to you. Your position in life is part of God’s great plan. See it simply as a test of your character. Conceit or pride will take you nowhere in life; remember that an overinflated ego can destroy a person. Remember never to boast of things you own or of your achievements in life.” He had no formal degree, but he was a man who seemed to have learned about life’s great truths from nature. Alas we can say that in modern times literacy may have increased, but education in its real sense has decreased, with values all over the globe changing. It took me years to understand just how fragile and vulnerable human beings are, and that there is nothing one should be proud of!
Over many years of practicing medicine, I have observed how an individual’s pride can be dashed to the ground as a result of relatively small alterations in chemical reactions in a human body in a diseased state. For example, after a small bleed or the formation of a thin clot in the parietal lobe of the brain, a billionaire doesn’t recognize his own face, as his or her memory gets washed away forever and he becomes completely dependent on others for his every need. I could cite innumerable medical examples like this, all of which serve to remind us that a person should refrain from pride and conceit. Coming back to our stay in their home, I am reminded that after a delicious dinner had been served, we slept like logs under our warm blankets. The crowing of a cock woke us up at the break of dawn – cock-a-doodle -doo – I awoke with a yawn, and soon – chrick, chrick – I became aware of the same sound of the wooden staircase I had noticed when coming upstairs the evening before. It appeared that the family had got up for morning prayers, and had wanted to do so without disturbing us. What makes the cock crow, and who sets its biological clock and why? I wondered sleepily. I went on thinking about this until I turned over and fell fast asleep again. What a wonderful order exists in nature. I am sure that you will agree that the disorder, if any, seen in the world, is crafted by none other than human beings, the supreme creation of God Almighty.
Soon after breakfast we again set off on a brief tour of the sub-valley where they lived. By the afternoon we were all set for our return journey. Our friend – for now he was my friend too – and his father accompanied us to the bus stop. After a short wait of about half an hour, a bus arrived from the nearby village. They bid us a warm goodbye and a few hours later we were back home again.
A few days after we returned, the results of our exams were made known. I had passed! The next step for us was to start our clinical postings. The third year of MBBS study really gives the feeling of becoming a doctor; you wear a white coat and a stethoscope round your neck, while visiting various hospitals. The clinical rounds in the associated hospitals of our college used to be of the highest quality. Every morning, the patients’ attendants would be removed from the wards by the paramedical staff, and then the team of doctor and us students would start the clinical round, led by the Professor.
The attendants would remain waiting outside the gate and the gatekeeper would often be seen struggling to keep the door closed; at times he would be seen lashing out at misbehaving attendants.
In those days there was a lot of emphasis on clinical medicine. The professor would listen carefully to the case history recounted by a house officer or a postgraduate student, then he would lower his glasses and finally start examining the patient himself. This would invariably set the presenter’s heart racing. The professor would almost always find something unusual in the patient, which had been missed by the house officer or the postgraduate presenting the case. One day while we were busy on our on clinical rounds, we heard the cry of a woman patient who had recently been admitted to the ward.
“Have you admitted a patient with meningitis (the inflammation of covering of the brain)?” interrupted the professor, while he was listening to the case history and examining the patient in front of us.
“Yes sir, in fact we did admit one patient with meningitis yesterday evening,” replied the admitting registrar, looking up sharply with look of surprise on his face. “That is a meningitic cry!” replied the great professor.
Those great teachers would share their irreplaceable experience with us, and not just theory, as many of them were accustomed to making diagnoses without the many methods of investigational support we have nowadays. Their clinical decisions would be spot-on, and at times when the patient was poor, they would opt for a therapeutic trial. I remember the patients calling them “saints”. They used to be full of respect for these great doctors, and, in turn our teachers were full of empathy and sympathy for them. “He trains what lies between the ear pieces of your stethoscope; respect him as he is your teacher, whereas I simply demonstrate”, said one of our professors while we were examining a patient with a heart murmur (an abnormal sound heard on listening to the heart, usually through a stethoscope, produced by the blood passing through deformed heart valves) in the presence of one of these great professors. The discussion on the genesis of heart murmurs used to be very interesting. Each consultant would provide arguments in support of his / her diagnosis. The patients would patiently submit to the elaborate auscultation process. Days later, echocardiography would prove most of the diagnoses to be correct. They had a passion for teaching and sharing their knowledge.
One day one of the professors brought an old patient of his to his outpatient clinic in order to discuss the case with the students. “Just examine his heart, but don’t talk to him” he instructed us, pointing towards the patient on the examination couch, waiting for the students to examine his heart. One after the other we used our stethoscopes on him, but no one could locate his heart sounds. When it was my turn, the patient pointed with his finger towards right side of chest but still said nothing. I placed my stethoscope on his right side and found wonderful heart sounds in that location. Yes, he had dextrocardia4. “So: what is your diagnosis?” the professor asked the students. “Sir, dextrocardia” I replied, but despite my efforts, the smile on my face indicated that I could have received a clue from the patient. “Sir,” I explained, “I didn’t talk directly to the patient, but he pointed towards the right side of his chest”. Everyone in the group laughed. Well, I have never come across another such case in my career to date, and had that great Professor with his passion for medical education not brought that interesting patient along, it would have remained a theory in our minds.
I recall a middle-aged male person who would often be seen moving around on a wheel chair as his both limbs had been amputated following Buerger’s disease. It is also known as thrombo-angiitis obliteran, and is caused due to heavy smoking. The hospital had given him some small job so that he could survive. One day it happened that we were in the middle of the clinical round led by Professor and leaving the ward.
The legless patient was coming towards the ward on his wheel chair. “He is the living example of disastrous effects of smoking. I can only advise you to never smoke yourself and, during your career, advise all your patients to quit smoking.” the great professor advised. I often see this patient in my mind’s eye when I do just this!
Another interesting and often seen person was a middle aged well-built man who was a little mentally challenged. You could ask him the time at any time of the day or night, and he would flip his arm and look at his wrist (which never had a watch on it) and he would tell you the time, accurate within a minute or two. I witnessed this myself a number of time, I could never understand how he did it. Extra sensual power (ESP) and what science doesn’t or cannot explain in full can kindles many thoughts in a sensitive mind.
(to be continued…)
Excerpt from the Book Bumby Roads authored by Dr. Ibrahim Masoodi.He can be mailed at ibrahimmasoodi@yahoo.co.in