2.14
Internship: The Wards
Long nights, sharper instincts
District Hospital, Yavatmal
After passing the final MBBS examination, the next step was a compulsory year-long internship—six months in an urban setting and six in a rural one. At that point, I faced a choice that appeared simple on paper but carried its own weight: should I remain within the familiar walls of Government Medical College, Nagpur, or should I step out into the districts of Vidarbha?
Staying back meant comfort—known corridors, familiar faces, predictable routines. Yet, somewhere within me, a quieter voice suggested otherwise. It urged me to leave what I knew and test myself elsewhere. I listened to it.
And so, I chose the district hospital at Yavatmal, over seventy kilometres from Wardha. I do not recall the precise reasoning that led me there, but I remember the feeling clearly—a pull towards the unknown, and a belief that medicine, if it was to teach me anything lasting, would do so away from convenience.
Yavatmal was not entirely unfamiliar. My elder brother Ashok lived there, which softened the edges of relocation. For meals, we depended on a mess run by a Jain lady, Mrs. Lodha, whose simple vegetarian food sustained us through long days and longer nights. It was not memorable cuisine, but it was dependable, and that mattered.
Each morning, after breakfast, I walked to the district hospital, prepared—though not fully aware—for what awaited me.
Three of my classmates also chose Yavatmal: Atiya Mamdani, Mohan Gupte, and Omprakash Singhania, all of whom had family homes there and were day scholars. Together, we stepped into a hospital that was busy, under-equipped, and relentless in its demands.
We worked under Dr. Phalke, the Civil Surgeon, and alongside a dedicated group of medical officers—Dr. and Mrs. Dharmadhikari, Dr. and Mrs. Ranade, Dr. Bhalme, Dr. Gadekar, Dr. Tayade, Dr. Kedar Rathi, and Dr. Baheti. For a young intern, the pace was unforgiving. Patients arrived continuously, and the hospital never truly rested. Neither did we.
The outpatient department began each day with consultants who were experienced clinicians but far removed from academic medicine. Prescriptions reflected the era: tetracycline, sulfadiazine, and anti-amoebic drugs were commonly used. Quinolones had not yet appeared; cephalosporins were unknown. In the wards, injection procaine penicillin and strepto-penicillin were the mainstay for a wide range of fevers.
Facilities were rudimentary. There were no ECG machines, no ultrasound, no CT or MRI scans. The hospital had no ICU, no NICU, and no dedicated accident unit. Specialists were absent—no cardiologist, no neurologist, no cardiac surgeon. Dr. Belsare, a BAMS physician, doubled as the anaesthesiologist, a role he performed with calm confidence.
The hospital catered to a vast catchment area—Pusad, Darwha, Digras, Umarkhed, Kelapur, Ralegaon, and Wani—places with little or no access to medical care. The flow of patients was constant. We worked almost round the clock, learning quickly that fatigue was a luxury we could not afford.
What the hospital lacked in technology, it compensated for in lessons. Diagnosis depended entirely on history-taking, physical examination, and judgement. There were no investigations to hide behind. We relied on our senses, our reasoning, and sometimes our instincts. It was here that medicine shed its academic polish and revealed its bare essentials.
Over time, my dedication did not go unnoticed. The medical officers grew fond of me. The Dharmadhikari couple often shared their tiffin with me—a gesture that meant more than the food itself. Gradually, I was entrusted with more responsibility.
I learnt to perform lumbar punctures and venesections with growing confidence. I assisted in several surgeries and once came close to performing an appendicectomy on my own—a thought that would alarm me today, but thrilled me then.
Diarrhoea was among the most common—and dangerous—conditions we encountered. Patients arrived dehydrated, with sunken eyes, feeble pulses, and collapsing blood pressure. Renal failure was an ever-present threat. Establishing intravenous access was often impossible. Venesection became the only option.
I performed it repeatedly, so often that my hands learnt the procedure before my mind did. Eventually, I could do it with ease—even in newborns, where precision mattered immensely. With each successful attempt, my confidence deepened, not arrogantly, but steadily.
One skill I took particular pride in acquiring was the writing of patient progress notes. Every morning and evening, I carefully documented vital signs and clinical changes, paying close attention to clarity and handwriting. Slowly, my notes began to stand out. Colleagues noticed. I felt, for the first time, that diligence itself could be a form of competence.
Looking back, the Yavatmal internship was neither comfortable nor glamorous. But it was honest. It taught me how to practise medicine when resources are scarce and expectations immense. It shaped my clinical instincts and my resilience.
More than anything else, it confirmed what I had suspected when I chose to leave Nagpur: real learning often begins when comfort ends.
Learning the Art of Lumbar Puncture
During my internship at the district hospital in Yavatmal in 1978, I encountered a moment that remains sharply etched in memory. A twenty-six-year-old man was admitted with classical features of bacterial meningitis—high fever, altered sensorium, and neck stiffness. A lumbar puncture was essential.
I had never performed one before.
I approached a medical officer for guidance. He was a surgeon, senior to me, and technically responsible for supervising interns. Without even looking up, he refused. There was no explanation, no reassurance, no alternative offered. I was left alone—with the patient, the needle, and my own uncertainty.
I had little choice. I reviewed the steps carefully, positioned the patient, identified the landmark, and paused for a moment. A brief prayer escaped my lips—not out of ritual, but necessity. Then I advanced the needle.
When clear cerebrospinal fluid began to drip, I felt a quiet surge of relief—not triumph, but gratitude. I sent the CSF for cytology and biochemistry and started the patient on penicillin. Over the next several days, I followed him closely, recording his temperature, level of consciousness, and neurological signs with care. Slowly, steadily, he improved. On the tenth day, he walked out of the ward.
Only later did the larger question surface: how does a medical officer entrusted with patients and trainees refuse to teach a life-saving procedure? Such indifference was not unusual in government hospitals of that era, where poverty often dulled expectations and neglect passed quietly as routine.
The incident disturbed me, but it did not deter me. If anything, it reinforced a belief that would guide me throughout my career—that medicine demands responsibility not only to patients, but to those who are still learning its craft.
An April Fool’s Lesson
Memory has a way of softening embarrassment. Over forty years later, I can now recall a foolish prank I played during my Yavatmal internship with a mixture of amusement and unease.
It was April Fool’s Day. In what I believed to be harmless fun, I wrote a short note asking Dr. Dharmadhikari to report to my chamber, signing it with a careful imitation of the civil surgeon’s signature. At the time, the forgery seemed impressive; the consequences did not.
Dr. Dharmadhikari, unsuspecting, presented the note to the civil surgeon himself. The reaction was immediate and bewildered. The civil surgeon denied writing it—but could not deny the signature, which matched his own alarmingly well.
Realisation dawned quickly. Dr. Dharmadhikari traced the mischief back to me and led me quietly to a corner of the hospital. There was no shouting. Only a firm instruction: I was to apologise at once.
As I walked into the civil surgeon’s room, my imagination ran ahead of me. I expected anger, humiliation, perhaps even disciplinary action. Instead, he spoke calmly. He told me, gently but firmly, never to repeat such behaviour.
That was all.
At the time, I felt relieved. With distance, I felt chastened. What I had considered harmless amusement was, in fact, a breach of trust. Medicine leaves little room for frivolity masquerading as wit.
The lesson stayed with me. Professionalism is not learned only from textbooks or wards; sometimes, it arrives quietly, in the aftermath of one’s own foolishness.