CHAPTER XVII HARDSHIPS OF AN MD STUDENT: THE BIOGRAPHY OF A MEDICAL THESIS (1983-85)

Chapter XVII

Hardships of An MD STUDENT:

The Biography of

A medical Thesis (1983-85)

            I completed my senior ‘housemanship’ at the Darbhanga Medical College (DMC) on 17.3.1982, but could join MD (Gen.Med.) course only on 24.5.1983, as my batch had missed the P.G. entrance examination just by 17 days. Those 14 months were long for any incubation period and the prodrome. Officially, I had joined honorary junior ‘housemanship’ in Paediatrics for the first six months, which made me eligible for appearing in it also in the P.G. entrance examination.

            Later on, in 1985, I again competed for DCH and after completing two years in the MD (Gen.Med.) course, I joined DCH in which after an official stay of nine months, I was awarded this coveted diploma, on appearing in the examination. After six months’ stay in the course, I had joined the CCL, Ranchi on 30.11.1985 (and I was allowed to appear in the DCH examination in 1987 after completing the remaining period of three months, when subsequently I came to the DMC on leave). Thus I use to call myself being honoured with this ‘Honorary Diploma’.

            Although I know I am not a man of eminence in any field to receive a degree of doctorate (Honoris Causa) but surely my teachers considered me suitable for this Diploma, giving me freedom from the rituals.  Of course, with the God’s blessings, I was adjudged the best in that batch of examinees, largely on account of the training I had received at Dr. B. N. Das Gupta’s private clinic, which I had joined in the incubation period after the closure of my own clinic on 16.7.1982 in a Darbhanga suburb.

            The experience of that suburban clinic was not that poor. I used to go 4 to 5 km on foot or cycle, yet, I could not compete with the quacks and my earning in the month was only Rs. 20 and that also I spent on Sushil’s medicines for his sore throat. I could have pursued and succeeded but I preferred my preparation for the PG test to earning and so I had joined Dr. B.N. Das Gupta’s clinic.

            After completing ‘juniorship’ in Paediatrics, I had also officially completed six month’s honorary junior clinical assistantship in Medicine under Prof. Mohan Mishra.

            I will never say that the long period of 14 months was not useful to me. It shaped many dimensions of my future achievements and personality but when I look back on the miserable financial condition of those days, I still get fright.

            As per general norms, we should have been employed by that time but unemployment was not meant only for general graduates. I could not even register myself in an Employment Exchange like what I did after my ISc at Ranchi in 1972.

            It was a terrible experience for me to accept money as fees from those who did not have money even to eat, not to talk of their capacity for purchasing drugs. I remember, once I was called to a hut to see a lady patient suffering from Salmonella dysentery, I guessed. I had to bow down while entering the hut, as the entry gate was too low to admit me. After a few days, her old mother came and gave me my fee, Rs. 5, by counting small coins and she said that she used to clean utensils in some houses of Marwaris. I was puzzled for the moment and she went out immediately.

            I started evaluating my personality that it was I, who was thinking of this poor lady that she did not give me my fee. It was true; I did not use that money for myself. It was also true that the patient was cured of the disease by my simple and cheap advice. Yet, the incident shook my mind.

            Later on, in 1986, as Ma. Bala Saheb Deoras in his welcome message to the NMO conference at Jamshedpur put in the brackets ‘to the poor’ after advising to treat minimum 10 per cent patients free, I could find the answer how a man could practice controlling his passions. I also found a doctor ‘correct’ who had suggested to me after I left the Bihar Govt. service that I could do social service, only if I practiced as practice itself was the means of service and added that I would have to be cautious finding the poor among the coming lots. The contemporary state is that most of the doctors not only advise free but they also give samples usually to the influential persons but not to the poor.

             My clinic was provided free by the public there and I had an assistant, Umesh, like a younger brother and friendly Sajjan who had arranged the things, both being good swayamsevaks.

            Earlier Dr. Baikunth Nath Mishra, had also said to Bokada, a ‘compounder’ of  Dr. Das Gupta, that he would provide me space for patients, if I liked to keep the serious patients needing infusion etc. But, I went to Dr. Mishra with Prabhat and requested him to provide space for the NMO office where we used to work in the evening and our registered office is still at Mishra Polyclinic, Laheriasarai. It is my notion that one should never expect any dividend from the social organisations  rather give whatever one can. If one takes benefits, he is likely to leave the organisation in future.

            Dr. Das Gupta probably guessed my condition and so he hinted to me to take some serious patients for infusion. I did go for a case but waiting for 2-3 hours for a sum of Rs. 40 was pinching to me, as I was unable to follow up other patients’ investigation like x-ray, ECG, etc. apart from new cases. I showed reluctance for it and thereafter such cases were sent to a junior of mine.

            “Learning and earning can’t go together,” Dr. Das Gupta, used to say to his previous residents. That he never told me personally but I found this truth experimenting at his feet. However, on one occasion of call, when I accompanied him, a separate token fee was charged for me. Sometimes, in a month 3-4 cases, of rectal examination of children for polyps or diagnostic pleural taps, I was doing in his clinic for which Rs.10 was charged for me but more important was that I learnt these arts perfectly.

            But it was Bokada, hailing from a reputed Bengali Brahmin family of Laheriasarai town who used to provide me with a small earning. It was the custom of that clinic that patients brought the medicines for verification. Bokada used to keep one or two patients who were advised injections and insisted that I should give the first injection then and there for which he used to collect Rs. two from each. For me at times this money was succour of life and sometimes a thing of fun i.e. bringing sweets for younger workers like Anand Murarka from the Sweet Home. Once Anand was caught smoking when I went in the night with the sweets and he later on told me that he had left smoking and that too due to me.

             I did not tell my parents or brother about my hardship. I recall, till the P. G. entrance examination (Nov. 23, 1982), I cooked lunch myself from the rice and pulse sent by my mother and in the evening  I used to eat anywhere and maybe even nowhere.

            I did have to fast several nights in a week but it did not weaken me for the purpose of my study, rather I did not get post-prandial sleep. I also remember that one-day, I had no money at all. I took a receipt book of the NMO and enrolled one or two members to arrange for my simple lunch from the membership fee (Rs. two annual at that time) in a nearby hotel at around 3 p.m. I hope the NMO members will excuse me, for it was like saving a Soul.

            Today, I find that these sufferings were for the higher objectives rewarded to me rather unexpectedly. After marriage, once while narrating a few such episodes, my wife had to wipe out my tears and I told her that these tears were of joys and not of sorrows.

            When my result for the entrance examination for MD was published, I was worried over my future expenses. Those were the days when a P. G. student was given only Rs. 350 as stipend and that too after long gaps of 6 to 8 months. I then thought to take help from teachers. As I had accepted Dr. Das Gupta as my real guru, I thought I should ask (on the advice of Bokada) for Rs.350 from him towards admission fee but I was the same person who had not asked even for a match-stick and had preferred to fast many years back. It took me 2-3 days to tell him finally and he gave it the next morning, the day I took my admission.

            But the problem was not over; rather, it was the beginning of a new cycle. My  friend, Dr. K. P. Deo, took much pain to convince me that I should approach some teacher. Prof. M. Mishra was my guide so I preferred not to go near him. Prof. N. P. Mishra was also very close to me but I did not meet him during a long period of my misery. Then I went to Prof. H. R. Yadav, a saintly soul and a close friend of my guide but when I reached his house, I could know that he had a cardiac attack and I had to appear as if I had come to see him for his disease and as a formality.

              I then recalled my teacher, retired professor of Pathology, Dr. S. N. Varma. I reached his clinic and sent him a slip stating, “Today I have come for a personal work,” and he was, at that time, examining a slide under the microscope. After that work was over, he asked me about the matter. He also asked me about my requirements.  I told him that it was Rs. 175 per month and requested him for his help to the extent possible. He queried as to what I would do for the rest. I told him that I would take it from some student. He told me, “No. You will come, every first day of the month and take the full amount from me.” It was probably the 25th August. Despite my difficulties, I waited for the ‘Teachers’ Day’ to come and from 5th September onwards; I received money regularly for 18 months from him.

            The very next day, on 6th September 1983, Dr. Deo asked me to approach Prof. N. P. Mishra to give medical consultation to his sister-in-law. After consultations were over, Dr. Mishra asked Dr. Deo to go out and asked me about my financial conditions. Probably, he had come to know of my wretched economic condition through another student Dr. Ranjit Jha, who was very close to him and who was living in front of my room.

            When I told him the facts, he asked me as to why I had not informed him directly. I retorted that why he himself had not guessed it, as I was looking upon him like a father. He felt much aggrieved and said that he should have thought about it. Then I told him that my difficulties had been solved only a day before. He asked me whether the money was refundable. I told him, “Probably not.” Then he asked me to work in his clinic explaining that he, in fact, only for helping the P. G. students gave them attachment though as   a physician usually he did not need them. I replied that I was already attached with Dr. Das Gupta who had been his revered teacher also. I also told him that Dr. Das Gupta might think that I had left him because I had taken admission in Medicine and so I had gone to Dr. N. P. Mishra.

            The fact was that Dr. Das Gupta was a distinguished pediatrician as well as a renowned physician. Prof. N. P. Mishra told me that I was right and was at the right place for learning and so I should remain there. Then he started giving me non-refundable Rs.100 per month, as a token of affection without asking any further question which too continued for 18 months.

  

            The first work I had done after receiving money from Dr. Varma in that night was to give Rs.50 to a junior student (later  he joined the Assam Rifles) whose mother had to sell jewellery for his education.

            Later, Prof. H. R. Yadav provided me with his portable typewriter for typing the draft of the thesis and Rs. 500 for purchasing stationery. Dr. K. K. Sinha from Ranchi had also sent a cheque for   Rs. 1500 for the expenses on thesis work. The cheque at that time could not be encashed for technical reasons and so he later on gave me the amount in cash, and out of that money, I purchased a bicycle which was also later used by the NMO worker, Dr. Ksh. Birendra and subsequently by a Maithili worker, Ram Ekbal Singh ‘Vineet’ when his son had lost his bicycle in the Mecon’s Ispat Library premises.

            I did not dare return the money to those great teachers when I started earning. Even before I received my scholarship, I had given Ksh. Birendra Rs. 2000 to pursue his post-graduate studies and later I maintained him at Ranchi for a year when I started earning. I also helped Abhay Kumar Asok with Rs. 100 per month for a year or so and to Vijay Raj for a few months.

            When I wrote to my teachers of Darbhanga that in that novel way, I had circulated their scholarship, what Prof. N. P. Mishra after knowing my academic and social activities wrote is rather a testimonial, unparalleled, I ever had: “I am very happy and fully satisfied with your work and ideals of life. I wish and pray that mother India and we should have many more sons like you. We are proud of you, blessings to you and best wishes.”

            I know it was his greatness, not that I deserved such appreciation. Yet, I decided that about 25 per cent of my income, I

would spend for social work in future, even 10 per cent is an ideal, as suggested by Max Mueller also.

            Thus my financial problem was solved by September 1983 to a large extent and I started my regular social activities of the NMO as well but the money was not sufficient for an ambitious research work and for the thesis, of which my guide, Prof. M. Mishra, was fond of. He used to preach for sincere and honest work and to publish the paper truthfully on it.

             For me the topic should have been such which did not need much financial resources. I remember, in the Orthopedics department some P. G. students in previous batches had to sell the jewellery of their wives to purchase costly equipments but then I had not even a wife not to talk of her jewellery. So, I chose a topic of dietetics in diabetes, which only needed some rice, pulse i.e. green gram (moong) and sugar. For the estimation of true blood glucose also, I decided to do it by a biochemical method, provided in the Biochemistry lab. One student had done such work previously and my guide had also presented a paper at the API conference Hyderabad (1984), where I was present. That paper was very much applauded.

            When I started my work, I found the patients were reluctant to have 20 pricks for blood samples to perform glucose tolerance test after intake of 50 gram sugar, and rice, dal and khichari, all having the equivalent amount of glucose. I stated my difficulties but my guide interpreted that I did not want to exert. Biochemical readings were equally difficult. I wished to change the topic but my guide warned me that I might lose the scheduled examination.

            I was so much depressed that I started thinking of dropping out from Medicine and to appear in the P.G. entrance for Paediatrics to join that course in the next session. It was a difficult proposition. Yet, later on, in the name of research like most of the students I did the same work, which need not be described here. As soon as my thesis was signed,        I left for Kashi not for any confession but for attending the neuro-conference. I kept up the sayings of my guide that no paper should be published, if one was not satisfied with the results and, therefore, I did not do that for mere gains of some points in future career. I think these points and percentage of the result have harmed more than the development of knowledge. Satyen Bose had fewer but remarkable papers. Emily Bronte had written only one novel, Wuthering Heights.

            I had also sought advice from Dr. K. K. Sinha who suggested to me to complete the thesis work somehow. Everyone feels that thesis is useless, at least in the present form but none dares to come out boldly for stopping this menace, not only in Medicine but everywhere. I saw a poster on the walls of the IIT, Delhi, ‘Research Scholar or Bonded Labour’. My teacher of Surgery, Prof. H. N. Dwivedi used to say, “Research means re-search a thing already searched and so, at first procure a thesis on the subject from somewhere before submitting a synopsis.”

                     One more thing is that a negative thesis is not accepted. I wonder if you are to produce a work in a time-bound session, where clinical acumen is more important than the investigation tagged with laboratory findings (without which support, your thesis or even synopsis will not be accepted) even if it is 100 per cent true, why do you insist on positive results?

            If the thesis is aimed to teach you the research methods, let us allow the negative theses. I would also plead for the coming few decades that the P. G. students  can re-evaluate the past theses and you will find hardly anything substantial will remain, if garbage is to be swept off, honestly.

            We have been copying the systems of the West without knowing what we need or what we can provide in our atmosphere. I will put my own model of whole medical education as an epilogue to this thesis of my life, here as an epilogue to the biography of a thesis,  I suggest, if it cannot be abolished for medical faculty, at least convert it to the old pattern of important case histories, as an adjunct to the training of future consultants. For true research, rather PhDs may be awarded which only may require elaborate research.

            Many medicos, seniors and juniors, helped me much for the thesis and other work during my MD. They also provided accommodation. Dr. Kamla Prasad Singh provided me with his bigger typewriter also on which I typed my thesis finally. I am grateful to all.

            I was like a class assistant during my MD course and I used to speak well in seminars. Teachers were regular in class and were not fond of buttering. Our result was the best.

            Once, I insisted on my signature in Hindi for attendance despite objection by a teacher, Dr. P. K. Bhattacharya, who was to be our internal examiner but he did not mind it. I was right as the office work was to be done in Hindi as per the Bihar Government’s directives but one could have made it a prestige issue. My friends felt deep sorrow when I left for the editorial job at Ranchi despite my examination being very close.