Metamorphosis of Medicine
I studied mechanical engineering and became a missile scientist as a fairly good accomplishment of a career, which got me an opportunity to develop India’s first titanium airbottles, used in missiles to power the control system. The airbottles were successfully tested at Aerospatiale factory in Bordeaux, France, in 1985, in my presence. I was floating on Cloud Nine as they say.
Then, two things happened. I had a severe bout of tachycardia and was admitted to Nizam’s Institute of Medical Sciences, Hyderabad, under emergency. My heart rate was 240 beats/ minute and ECG waves were not even getting plotted. I was given electric shocks that broke the spell. But then, I did not respond to any of the available arrythmia drugs and had several other episodes while in ICCU.
There, on February 8, 1987, Dr APJ Abdul Kalam, Director Defence Research & Development Laboratory (DRDL), where I was working, visited me and right at that moment, I was in tachycardia. He nervously asked Cardiologist Dr B Soma Raju, who was attending to me, if he could do anything. Dr Soma Raju asked him to procure Amiodarone HCL, a new anti-arrythmia drug recently introduced in Europe but yet to arrive in India. And Dr Kalam got the drug for me pulling it off in a way that only he knew how.
Amiodarone acted on me like a “Sanjeevani.” Arrythmia disappeared like a bad dream and I joined my work in two weeks’ time as if nothing had happened. Realizing the ephemeral nature of life at a rather young age, I grew up in that one month as if by a few years. I gave my best to the Akash missile airframe and developed it almost single-handedly, winning in the process, Dr Kalam’s heart. He started calling me “Buddy.”
When in 1992, he moved to Delhi to head DRDO, Dr Kalam transferred me out of the missile program and assigned me, what he called the “superior” task of developing civilian spinoffs of defence technology. He observed that most of the medical devices and consumables were imported and that only the rich could use them. Life-saving medicine must be affordable and for everyone, he believed.
We created a Cardiovascular Technology Institute with World Bank’s financial assistance routed through the Industrial Credit and Investment Corporation of India (ICICI), which later became ICICI Bank. I successfully developed India’s first coronary stent with Dr A Venugopal Reddy at the Defence Metallurgical Laboratory (DMRL), making the very special steel. This work fetched me the 1997 DRDO award.
In 1999, legendary Prof Kakarla Subbarao, Founder Director, Nizam’s Institute of Medical Sciences gave me Harrison’s Principles of Internal Medicine. It was such an intellectual feast. I have never read that quality of English writing – no jargon and the most complex ideas expressed in plain words and phrases of dew-like clarity.
Dr B Soma Raju gave me Aequanimitas of William Osler that tackles head-on a timeless question: What makes a good doctor? “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head,” writes Osler.
In 2001, as if ripened to receive him, I met Maestro cardiologist Dr P Krishnam Raju. The only son of former Executive Engineer with the Andhra Pradesh Government and a landlord, Dr Krishnam Raju never allowed his wealth and privileges to act as deterrents to hard work. He won eight gold medals, every year topping his class, that included the first ever cardiology gold medal from the All India Institute of Medical Sciences (AIIMS) in the year 1978. Dr Krishnam Raju had been Head of the Department of Cardiology in Osmania Medical College, Hyderabad, till superannuated.
In 2005, we went to Myanmar together during Dr Kalam’s Presidency to help introduce super-specialty medicine there. Many people in Yangon spoke to Dr Krishnam Raju in Telugu. We learnt that their ancestors had sailed to Burma (earlier name of Myanmar) as it was part of British India and Rangoon (earlier name of Yangon) was the “happening city” as Mumbai and Dubai are now.
When we were walking through the campus of Rangoon Medical College, Dr Krishnam Raju noticed that it was an exact replica of the Andhra Medical College at Vishakhapatnam (called Waltair by the British). He correctly predicted various buildings in the campus. The same engineering team would have constructed both the hospitals. The first Indian woman cardiologist Dr Padmavati (1917-2020) studied here. Her photo was placed in the conference hall.
Sitting through the long sessions with Dr Kyaw Myint, the learned Health Minister of Myanmar, who had three FRCPs in Medicine (London, Glasgow, and Edinburg), General Tin Maung Aye, the Chief Cardiologist at the Military College of Medicine, and other doctors, I learnt that medicine had been more of an art and only very recently with the advent of interventional technology, was becoming a science.
Any medicine is essentially a poison and what dose was good for a patient had emerged over years of scientifically collated “practice” of thousands of doctors across the world. Also, any new procedure that was not possible earlier is pregnant with long-term consequences, which must be anticipated for and taken care of through rigorous clinical trials.
I have seen first-hand, how after the advent of computers, medicine was turned into a process-driven process with clinical guidelines, evidence-based treatment, and the diagnosis-related group (DRG) system, which turned hospitals into an industrial enterprise. Later, terms like “packages” started being used and finally medicine became a business enterprise driven by insurance companies ensuring that you get only this much treatment, and hospital owners ensuring that you are provided “all the possible services” that you can be billed for.
So, what does a doctor do now? Is he destined to be a mere cog in the wheel of this money-making machine? The two biggest threats to medicine are doctors who buy their medical seats at a high price and then “recover the investment” lifelong from their patients; and private hospitals owned by faceless investors, mostly foreigners. These two are indeed a curse on the Indian healthcare system.
Dr Krishnam Raju feels that the doctor-patient relationship is sacrosanct. As a doctor, if you lose the trust of your patient, you are finished. He feels that though things are not very good at present, India has not yet become as bad as other countries in this regard. Indian doctors indeed put patients’ care first, before profit. As we can see during the current pandemic, they are also putting their lives at great risk to save ours.
About the biggest health issue of our times, Dr Krishnam Raju quotes Mother Teresa, “The greatest disease … today is not TB or leprosy; it is being unwanted, unloved, and uncared for.” He feels that children are not caring enough for their parents and perhaps it is a backlash of the neglect of the ambitious people who chased their careers over their children when they needed them. There is hurt everywhere, like an overcast sky, and it is time to give priority to healing, loving and caring starting with our own selves and our families, friends, neighbors, colleagues at the workplace, acquaintances, strangers, humanity as a whole and extending to every creature living on the planet.
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