First job, MS, Calicut, Vatakara and Kannur

(This post has some overlap with the My autobiography post, and has some added details.)

Internship

Before taking up a job as a doctor, we had to finish one year compulsory rotating Internship. We get our degrees only after that. Then, to get Registration, one year senior house-surgeoncy with six months in Surgery and surgical specialities, which included Anaesthesia and ENT, and six months in Medical and medical specialities, which included Paediatrics and Dermatology. By this time Chechi and family came to Trivandrum on transfer. So I started staying with them, for home-cooked food.

I began by staying in the House Surgeons' quarters near the pay wards, above the then Casualty block. No food was served there, so we would get parcels from hotels - one Viswanathan brought food for Krishna Shenoy and me, only in the evenings. Lunch was in the canteen. I used to frequent Chechi's house, mainly for food to start with, and later for stay also. Chechi was staying near the Ayurveda hospital. I made bus trips - no other transportation. I tried to be stingy to pay the minimum bus fare, using various techniques like alighting one stop earlier, and then walking the rest of the way.

I just attended the theory classes and not much theater work - passing the exam was the main aim; training could be done any time after passing. Theory classes were group case discussions, topic reading and discussions, case presentations, for which I prepared by going to the library and by private reading in the room. The main text books were Hamilton Bailey's and Ian Aird's textbooks of Surgery - the latter extremely boring, but exhaustive. I relied mainly on Bailey, with the addition of Farquharson's Operative surgery. I collected as much surgical information as possible from all sources.

First job and MS

Going back to my first job as assistant surgeon - the Desamangalam dispensary was a small one. It catered mainly to OP (outpatients) with just 8 beds. Snakebite cases used to come often from an estate nearby. We treated snake-bites - mostly Viper bites - with the available anti-venon serum. The estate manager Joseph said he would buy and give us anti-snake-venom from Poona. I treated a few people for snake bites and also other illnesses there. I conducted occasional surgery too - I developed a craze for surgery from there. OP used to be more than 200-300, morning and evening. Drugs were in short supply, so we had to purchase locally. Difficult cases were sent to Wadakkanchery taluk HQ hospital. We were forced to examine patients at home too, and some used to call me home just for seeing a patient or sometimes delivery - mostly normal. The home visits would sometimes take hours, walking all the way through paddy fields where snakes were aplenty. 

I got fed up of these tedious home visits, which forced me to go for a PG course. My preferred option was Surgery. I got admission for MS General Surgery, with the course to start in February 1963. We were four batch-mates from service and four already doing house-surgeoncy in surgery These latter had one year of training already, and we four who joined from service were at a disadvantage. In spite of all this, we carried on as mentioned before with the classes. Though Professsor was mostly impartial, the residents were favoured - especially Dr Roy Chally, whom he used to call often for various things. Dr CP Nandakumar was favoured by Dr Sivarajan. The advantaged ones were CP Nandakumar, Roy Chally, PJ James,and John. The others were CP Matthew, NR Lilly, Kumaradas and I. Finally three from the favoured group passed, and one from the other group. I was the one who passed from among the latter group. The amount of relief I felt after passing was to be experienced to be believed!

Posted at Calicut

My two years of MS course was considered as on deputation by the Government, and so I had no break of service. After completing MS, posting order came to join in Kottapparamb (then general) Hospital (now W& C hospital). My boss was Dr N Mohandas - an extremely decent gentleman. He allowed me to work with him and I had a free hand. Actually I learned doing surgery from there, assisting Mohandas and doing surgeries myself . We sometimes had a ward full of PO (post-operative) cases. The number of cases and the types of surgery we did there would surprise anybody. I developed confidence there, to tackle any type of case - surgery, gynaec, or ortho. I don't think I would have developed this confidence anywhere else. 

I continued like this for three years but for the last one year, I was with the Superintendent of the hospital, Dr Thirumulpaad, assisting him. He was not very professionally competent and he knew it; he asked me to look after the unit and that was a blessing in disguise for me - I could do more surgery alone, which increased the level of my confidence.

Vatakara and cases

This was the time Badagara (now Vatakara) was asking for a surgeon through the Government and through public petitions. So my posting there was immediate. A few doctors (especially Dr MK Prabhakaran) were enjoying their stay there, and did a KATHA KALAKSHEPAM welcoming me to Badagara. This Dr Prabhakaran and Dr V Jayaraj from Mahe were very close to our family from then onwards. Until I bought a new car - Herald Standard - I would use Dr Jayaraj's car occasionally. Work for me in Badagara was really hectic. All types of surgery - I had to go for all emergencies and also teach the lady doctors how to do LS (lower segment) Caesarean apart from doing them myself occasionally. I was also doing all sorts of gynaec surgery like Colporrhaphies and Hysterectomies because there was no one else to do it - actually gynaec was forced on me. I've tackled many ruptured uteri (thanks to many untrained midwives around) - there was one I did under local anaesthesia because the patient was already in shock, on Dextran. We did any procedure, as the patient had so much faith and confidence. Even a death on the table would not be blamed on us - they would blame themselves as their VIDHI (fate). That was the golden period for us surgeons - without consumerism - we had the best doctor-patient relationship.

Apart from routine work and surgery, I had to take general duty too - 24 hours - and an occasional post-mortem. Once, when I was on duty, I was called for a post-mortem on the beach. The police escorted me and there was a large procession to the beach. After all that, it turned out to be a foul-smelling decomposed body, and identification was impossible. I gave an opinion: body too decomposed to identify, cause of death not known. The drama ended there, and I returned for continuing my duty. Another medico-legal case was the death of a notorious rowdy, on the 8th day after a stab on the abdomen. The funny thing was that there was no one to support this rowdy as he was so notorious. It ended up being a routine post-mortem. Its court case ran for months and years with no result.

Some interesting cases: one was a twins inside a fallopian tube - Ectopic pregnancy - and another was a sebaceous horn on the chest-wall - quite long and tortuous. The second case was flashed in newspapers, making me and the hospital (Badagara hospital) quite famous. People talk about it even now. I kept the specimen for some years, but have lost it now. A third interesting case was a large bladder stone, almost filling the bladder. It was causing trigonal irritation the patient had piles-like symptoms. Another was a slow rupture of uterus due to a previous Caesarean with an 8-month-old foetus lying free in the peritoneal cavity, with the cord still attached to the placenta inside the contracted uterus. There were many more such interesting episodes and incidents.

Kannur

Rema was then working in Orkatteri PHC - she liked that posting. In order to get posting together, and to have an ophthalmologist, she was posted to my hospital. Actually she was learning driving while at that PHC. There was no Ophthalmic unit at Badagara, and she was asked by the chief, Dr Chacko, to take general duty. She objected, but to no effect, and was forced to take duty under protest. That caused some small friction. It was at this time Kannur District hospital needed an Ophthalmologist. She was posted there (as the minister Mr Balakrishnan was from Kannur). She was very popular there but was a strict disciplinarian. She did lots of cataract surgeries there and the crowd in her OP (out-patient consultation) was increasing. She didn't see patients at home, but I did. I was in the 3rd surgical unit there, and had lots of patients from Badagara. Rema became pregnant with Anju at that time. Once the pregnancy was confirmed, she went on leave, never to come back. I've written about Anju's delivery etc elsewere.

We had a small wish - to go to the UK and get the FRCS qualification. I had finished 8 years after my MS and would have to start studying again, which I knew was not easy. We decided to do it, and so I got the UK General Medical council Permanent Registration and then started all preparations for going to the UK. I sold my car and shifted the household to Thrissur (details are mentioned elsewhere). The flight was on May 1st. Rema and Anju were at Ahmedabad with Rema's parents.