2.20
Residency: The Grind
Work stretched; sleep vanished
Entering the Inner Sanctum
In March 1979, the stars aligned, and I secured the coveted seat in MD Medicine at the Government Medical College, Nagpur. For a young medical graduate in India, admission to a postgraduate course is not merely an academic step; it is an elevation to a different caste. You are no longer just learning medicine; you are living it.
My journey began with a mix of elation and trepidation. On my very first day, I was assigned to Unit 4, servicing Wards 37 and 38. I had barely begun to acquaint myself with the charts—thick files held together by rusted clips—when a summons arrived. I was to report to Dr. B.S. Chaubey, the formidable Professor and Head of the Department.
A ripple of whispers followed me down the corridor. “Why has he called the new resident?” “Is it a test?” I walked to his chamber, my heart hammering against my ribs. Dr. Chaubey had handpicked me to join his unit. I was to be placed directly under the tutelage of the legend himself.
To work with Dr. Chaubey was a privilege; to survive him was a daily challenge.
The School of Dr. Chaubey
Between 1979 and 1982, my world shrank to the confines of Ward 23 and the Kidney Unit. Dr. Chaubey, who had been trained in Nephrology in the United Kingdom, was a man who wore discipline like a suit of armour.
His routine was etched in stone. Every morning, his blue Fiat would pull into the hospital parking lot at exactly 7:59 AM. He did not need a watch, and neither did we; the sound of his car engine was our alarm. By the time he walked into the ward at 8:00 AM sharp, his aura of power and confidence was absolute. He did not walk; he marched majestically, his white coat pristine, his stethoscope draped around his neck like a badge of office. We, his residents—registrars and house officers—trailed behind him like a nervous retinue, clutching case sheets and hoping to be invisible.
Dr. Chaubey was incomparably erudite. In an era before MRI scans, CTs, and automated analysers replaced clinical acumen, he demonstrated time and again how to arrive at a precise diagnosis using only a stethoscope, a reflex hammer, and a sharp mind. He could listen to a heart and predict the valve area; he could palpate an abdomen and sketch the pathology within.
But he suffered no fools. His teaching method was Socratic, but with a razor’s edge.
I remember a post-admission round vividly. I was presenting the case of a middle-aged patient who had been admitted with acutely paralyzed legs. I had spent the night clerking him. It was a textbook presentation of Acute Transverse Myelitis—a sudden inflammation of the spinal cord causing numbness, weakness, and a distended bladder.
I began my presentation with the confidence of a resident who has read the books. But in my nervousness, standing before the “Grand Old Man,” my tongue betrayed me. When he asked for the final diagnosis, instead of saying “Transverse Myelitis,” I stammered, “Guillain-Barré Syndrome.”
The air in the ward froze. The fan overhead seemed to stop spinning. Dr. Chaubey’s eyes reddened, his thick brows furrowed, and his lips twisted in disdain. He did not shout immediately. He turned to Dr. S.M. Patil, the Associate Professor, and pointed a finger at me.
“Patil,” he thundered, his voice echoing off the stone walls, “God save this student. Poverty of thoughts and bankruptcy of ideas.“
The sentence hung in the air, heavy and damning. Poverty of thoughts and bankruptcy of ideas. It was a harsh verdict for a slip of the tongue, but in the crucible of Ward 23, there was no room for error. We were dealing with lives, and he demanded perfection. That phrase branded itself onto my memory. It stung then, but it also woke me up. It taught me that in medicine, you cannot afford to be loose with your words or your logic.
The Thesis Saga: Science or Fiction?
The MD thesis is a rite of passage, a scholarly endeavour meant to contribute to the vast ocean of medical science. Mine, however, was a comedy of errors that would have amused R.K. Narayan himself.
One morning, Dr. Chaubey summoned me with a glint in his eye. Pfizer had just launched a new drug called Prazosin, a potent vasodilator used for hypertension. He had a theory: if we administered this drug to patients undergoing peritoneal dialysis, it might dilate the capillaries in the peritoneum, allowing more urea and toxins to be washed out, thus making the dialysis more efficient.
“Find out if it works,” he commanded. “That will be your thesis.”
It sounded simple. In reality, it was a nightmare.
In the late seventies, Hemodialysis machines were the stuff of science fiction in Nagpur. We relied on peritoneal dialysis. It was a primitive, messy, and labour-intensive process. Patients with advanced kidney failure were admitted, and twice a week, we would puncture their abdomen with a trocar, insert a stiff catheter, and flood the peritoneal cavity with fluid. We would wait for the fluid to absorb toxins and then drain it out into glass bottles.
My task was to run a clinical trial. Ideally, this should have been a randomized, double-blind, placebo-controlled study with rigorous statistical power. In reality, it was just me, a notebook, and a handful of sketch pens.
I had no training in research methodology. I didn’t know a p-value from a pH value. I simply administered the drug to some patients and not to others, often based on who was available or willing. The practical problems were endless. Catheters would clog. Bloody fluid would ooze out, ruining the samples. Patients would develop sudden low blood pressure from the drug, forcing us to abort the procedure and rush for saline bottles.
But the deadline loomed. I had to submit the thesis by June 1981.
I spent hours in the library, hunting for references in the Index Medicus, handwriting abstracts because photocopiers were too expensive. I compiled a mammoth 100-page document, handwritten on foolscap paper, filled with tables that I had drawn with a ruler.
Then came the typing. In the age before Microsoft Word, this was a manual craft. I took my manuscript to Mr. Manohar Gokhale, a typist who lived in the congested lanes of Dhantoli. He was a man of peculiar habits. He worked on an ancient Remington typewriter that clacked like a machine gun.
He would type a few pages, then stop and disappear into his kitchen to make tea. He would emerge, sip it slowly on his veranda, glance at my manuscript, and suggest editorial changes I hadn’t asked for. “Doctor, this sentence is too long,” he would say, peering over his glasses. I would nod meekly, just wanting him to finish. He would eventually return to his machine, the rhythm of his typing dictating the pace of my graduation.
When the thesis was finally bound—a black hardbound volume with golden letters—I felt no pride, only relief. I knew the data was shaky, the methodology flawed, and the conclusions optimistic.
Years later, I found a poem I had written in frustration after submitting it. It captures the essence of that scientific struggle better than any prose could:
The study's design was so poor,
I wonder if I knew what I was looking for,
Prazosin or placebo, who can tell?
It's all just fictitious data to sell.
My data collection was a mess,
No consistency or thoroughness,
Dialysis patients were my population,
But the data was all just variation.
I tried to analyze with the mean,
But the data was too far from clean,
Median and ranges, I did try,
But the results were just a sigh.
So here I am, with my thesis in hand,
Vowing never to conduct such research again,
For I cannot stand the sight of Prazosin,
Or the thought of dialysis, it's my ultimate sin.
I kept that vow for a long time. The thesis sits on a shelf somewhere in the college library, gathering dust—a testament to a time when research was less about science and more about survival.
The Final Hurdle
As the three years of residency drew to a close, the final MD examination loomed like a storm cloud. This was the ultimate gatekeeper. To fail here meant losing three years of life.
Our batch consisted of ten students—a “band of brothers” forged in the fires of the wards. We were diverse in character but united in anxiety. There was the studious one who knew Harrison’s textbook by heart; the clinically brilliant one who could diagnose a murmur from the foot of the bed; and the nervous wreck who convinced himself daily that he would fail.
We spent the final months in a state of suspended animation. We stopped shaving, we barely ate, and we lived in the library. We practiced examining each other. “Listen to my chest,” one would say. “Does my liver feel enlarged?” asked another. We became hypochondriacs by proxy.
The practical exam was a theatre of high drama. External examiners arrived from distant universities, their reputations preceding them. We were assigned “Long Cases” and “Short Cases.” I remember standing by the bedside of a patient with a complex neurological disorder, my hands sweating, waiting for the examiner to approach.
The viva voce was the final interrogation. We sat across the table from four professors, who grilled us on everything from the mechanism of action of Digitalis to the history of Medicine. It was not just a test of knowledge; it was a test of nerve. Could you hold your ground when challenged? Could you say “I don’t know” with dignity?
When the results were finally declared, all ten of us had passed. The relief was explosive. We were no longer residents; we were Physicians. We had earned the right to add those two letters—MD—after our names. It was the end of a long, arduous climb, and the view from the top was worth every sleepless night, every scolding from Dr. Chaubey, and every drop of sweat shed in the wards of GMC Nagpur.