Entering the Inner Sanctum

In March 1979, the stars aligned. I secured a coveted seat in MD Medicine at Government Medical College (GMC), Nagpur.

Why Medicine? Not Surgery, not Orthopedics, not Radiology?

There was no internet then. No social media, no career counsellor to sit us down and ask what we wanted. We did what boys have always done — we watched, and we copied. I watched Dr. B.S. Chaubey, S.M. Patil, Abhay Bang, Ulhas Jajoo, Uday Mahorkar — physicians who walked the wards like men who knew something the rest of us didn’t. That is who I want to be when I pass MBBS, I told myself.

Medicine was prestige. Medicine was honour. Medicine was privilege — in that order, and we believed it in that order too.

A Littmann around the neck gave a young man the same thrill an Olympian feels reaching for gold. It said: I have arrived. I have made it to the top. In the rigid hierarchy of Indian academia, an MD wasn’t just a degree — it was a passport to a higher caste. I was no longer learning medicine. I was becoming it.

My journey began in Unit 4, running Wards 37 and 38. The charts were thick, yellowed, held together by rusted iron clips that left an orange stain on your fingers if you weren’t careful. I had barely learned to read them when the summons came: report to Dr. B.S. Chaubey, Professor and Head, a man whose reputation walked into a room before he did.

Whispers followed me down the lime-washed corridors. Why has he called the new boy? Is it a test? I remember the walk to his chamber more clearly than almost anything else from that year — the cool stone floor under my chappals, my heart going like a trapped bird against my ribs, the certainty that I had done something wrong.

I hadn’t. Dr. Chaubey had handpicked me for his own unit. I was to work under the legend himself.

To work with Dr. Chaubey was a rare privilege; to survive him was a daily miracle.

***

The School of Dr. Chaubey

Between 1979 and 1982, my world shrank to two places: Ward 23 and the Kidney Unit. Dr. Chaubey ran both. He was a product of the British school of nephrology, and he carried its discipline the way some men carry a grudge — quietly, constantly, never putting it down.

His routine was a force of nature. Every morning, his blue Fiat turned into the hospital lot at exactly 7:59 AM. We didn’t need watches; the hum of that engine was our alarm clock. By eight sharp he was marching into the ward, white coat pristine, stethoscope slung like a badge of office. Behind him trailed the registrars and house officers — a nervous retinue clutching case sheets, each of us praying to be invisible for one more day.

This was an era before CT scans, before automated analysers. Dr. Chaubey worked with what he had: a sharp mind, a reflex hammer, an ear that missed nothing. Day after day he proved that this was enough to read the pathology hidden inside a man. But he had no patience for fools, and his teaching came Socratic and unsparing — question after question, each one narrower than the last, until you either found the answer or found yourself with nowhere left to hide.

I remember one post-admission round with a clarity that still unsettles me. I was presenting a middle-aged man with paralyzed legs — a textbook case of Acute Transverse Myelitis. I began well, with the confidence of a resident who had actually opened his books the night before. But under the Grand Old Man’s gaze, something in me came loose. When he asked for the diagnosis, I said, “Guillain-Barré Syndrome.”

The ward went quiet. Even the ceiling fans seemed to slow. Dr. Chaubey’s brows came down like a gate. He didn’t shout. He turned instead to Dr. Patil, his Associate Professor, and pointed at me the way a man points at something he’s found under a microscope.

“Patil,” he said, and the word carried to the far end of the ward, “God save this student. Poverty of thoughts. Bankruptcy of ideas.“

Two sentences, and they were enough. It was a harsh judgment for one wrong word, but Ward 23 had no patience for loose thinking. Forty-odd years on, I can still hear those two phrases. They stung. They also woke me up.

***

The Thesis Saga: Science or Fiction?

The MD thesis is a rite of passage — a scholarly contribution, we were told, to the ocean of science. Mine was closer to a comedy of errors, the kind R.K. Narayan would have enjoyed writing.

Dr. Chaubey had a theory. Prazosin, Pfizer’s new drug, might dilate the peritoneal capillaries during dialysis and wash out more toxins. “Find out if it works,” he told me. “That will be your thesis.”

In 1980, a haemodialysis machine in Nagpur was science fiction. We did peritoneal dialysis instead — a primitive, messy, visceral business. We punctured the abdomen with a trocar, threaded in a stiff catheter, flooded the cavity with fluid, and waited for the poisons to seep out into glass bottles, drop by drop.

***

The Kidney Unit, 3:00 AM

The Kidney Unit sat on the ground floor — a place of high science and low plumbing. Dr. Chaubey had trained under Hugh de Wardener at Charing Cross, the man who had written the book on the kidney, quite literally. De Wardener understood renal physiology, but he also understood the human misery bolted to the machine — he had once converted a disused convent into a holiday home for his dialysis patients. Dr. Chaubey wanted to graft that same British rigor onto the humid soil of Vidarbha.

It was the only unit of its kind for hundreds of miles. Patients came from Raipur and Bhilai — pale, bloated, drowning quietly in their own fluid. I was the junior officer in charge of this precarious kingdom.

My nights belonged to Abhichandani, the technician, and his flame photometer — a temperamental machine that flickered like a moody campfire while it measured sodium and potassium. We ran on tea and exhaustion.

At 3:00 AM, without fail, the catheter would clog. The fluid would stop. I’d be hunched over a gasping patient, working the cannula, praying for a gush that rarely came. When a patient vomited blood and the pressure cratered, the decision was mine alone, at three in the morning, with no one to call. Dr. Chaubey wanted “how” and “why.” What I actually had was a lottery of leaking tubes and lab errors.

As the July 1981 deadline closed in, the data told the wrong story. In several patients, urea levels rose after dialysis — the opposite of what the Prazosin hypothesis demanded. To show the Professor these numbers was unthinkable. So I did what frightened young scholars have always done: I adjusted them. Quietly, patiently, until they said what he wanted to hear. Mr. Atre, the librarian, typed the manuscript. The Dean’s office stamped it into permanent existence.

It sits today in some forgotten corner of the GMC library, alongside a thousand other academic fictions — unread, untouched, and mercifully never cited.

***

The Remington Machine Gun

The practicalities of research were their own kind of absurd. I had no training in method — I couldn’t have told you a p-value from a pH value. I hunted references in the Index Medicus, copying abstracts by hand, because a photocopier was a luxury reserved for the rich.

The final typing was a craft in itself. My typist worked an old Remington that clattered like a machine gun and stopped just as often. Atre was a man of leisure. He would type three pages, then vanish for tea, sip it slowly on his veranda, and return with editorial opinions.

“Doctor,” he would say, peering over his bifocals, “this sentence is too long.” I nodded meekly — a hostage to the rhythm of his keys. When the thesis finally came back bound in black and gold, I felt only the relief of an escaped prisoner.

***

The Final Hurdle

As residency drew to its close, the final MD examination loomed like a monsoon cloud that wouldn’t break. To fail was to lose three years of your life. Our batch had become a band of brothers, forged in the wards — we stopped shaving, we barely ate, we turned into hypochondriacs by proxy, examining each other’s livers and listening to each other’s hearts in the library at midnight.

The practical exam was theatre. External examiners arrived like visiting royalty. The viva was the last interrogation — four professors, and questions ranging from the history of medicine to the mechanics of digitalis. It tested more than knowledge. It tested whether you could say “I don’t know” and still hold your ground.

The MD exam was an anticlimax — but not in the way I expected.

For months we had trained to present the long case in neurology across a full thirty minutes: a detailed history, a complete systemic examination, then the neurological exam proper — torch, cotton wool, needle, tuning fork, key — testing reflex after reflex, sensation after sensation. Only then would we offer a differential diagnosis, before finally naming the lesion: what it was, where it sat, what had caused it. We were taught to arrive at the most plausible diagnosis, slowly, the way a case should be built.

We were trained to play like Rahul Dravid — bat and pad together, watchful, a five-day Test match played out in a single patient.

Our examiners were Dr. V.S. Shanbaug from Bombay and Dr. N.P. Mishra from Lucknow. Shanbaug, it turned out, believed in T20. He gave each of us seven minutes, no more, and our neurological case was over before we knew it had begun. He wanted Sehwag. We had trained as Dravid.

The two short cases — cardiovascular, respiratory, heart and lungs — went fine. It was a two-day exam in those days, with the viva to follow the next morning. I went back to the hostel that evening and cried.

The long case simply hadn’t gone the way I’d hoped. Thirty minutes of training, and I couldn’t adjust to seven.

The next day was the viva — all four examiners this time, the two externals joined by our internal examiners, Dr. P.Y. Deshmukh and Dr. H.C. Attal. They asked me to read an X-ray, an intravenous pyelogram, a barium meal, an ECG, and then the questions came rapid-fire. I answered them all. Then came the last one — the one I can still recall, word for word, forty-four years later:

“A young man with hypertension has his blood pressure shoot up each time he urinates. What is the lesion, and where?”

“Phaeochromocytoma, sir,” I said, before he had even finished the question. “In the trigone of the urinary bladder.”

The four examiners looked at one another and nodded. The boy who had batted so poorly the day before, the one they’d marked down as average, had found his form.

I passed MD.

From my batch of 1973, twelve of us sat the MD Medicine examination: Jayant Pande, Shriram Kane, Siddharth Biswas, Aziz Khan, Kishore Kedar, Nandkishore Chandak, Ramesh Mundle, Harish Baheti, Padmakar Somvanshi, Adesh Gadpayale, Vijay Thakre, and I. Pande and Biswas went on to become neurologists, Kane a haematologist, Khan and Kedar cardiologists; the rest of us stopped at MD Medicine and never specialised further.

When the results went up, six of the twelve had passed. The relief was explosive. I was no longer a resident. I was a Physician, with two letters — MD — that I had earned the right to carry after my name. It was the end of a long, hard climb, and the view from the top was worth every scolding from Dr. Chaubey, every drop of sweat shed in the wards of GMC Nagpur.