A Passion Named Life: Memoirs of a physician

A Passion Named Life: Memoirs of a physician. Vallath Balakrishnan. Folio, Thiruvananthapuram, 2014. 260pp, Paperback, ₹300.

Fire in My Belly: The travails of a gastroenterologist. Vallath Balakrishnan. Published by the author, Kochi, 2015 366pp, Paperback, ₹250.

Both volumes are autobiographical. The first one concentrates on Dr Vallath Balakrishnan's life, work and his family. The second focuses on his life-long effort to learn about diseases of the gastrointestinal system and measures to afford cure when possible and relief when cure was beyond human reach. His work is centred round Kerala but generalized all over India.

Inevitably, there is some overlap. Here are two examples. The account of the national workshop on pancreatitis in India (Chapter 29, the first volume) and experiences in Britain as a WHO Fellow are dealt with in greater detail in the second volume. The meeting with Dr Joan Braganza is described in a little greater detail in the first book, A passion named life.

Let us take the first book first. In the preface, Dr Balakrishnan tells us with disarming honesty: ‘I recall my life with nostalgia, sometime laugh at my follies and look back on my fate stoically and dispassionately. These anecdotes tell about my childhood dreams, struggles, my seeming successes, disheartening failures—a life lived with basic honesty and a story retold with sincerity.’

The account starts with his life-threatening experience. We meet him as he is being taken on a trolley into the cardiac catheterization laboratory and share his thoughts as he is told that the saphenous vein graft inserted to bypass his coronary artery block 6 years earlier was on the verge of a shutdown. Placing a stent across this vein was a tricky procedure. Dr Balakrishnan takes us through his thought processes as he received this information and makes his decision to go ahead with his cardiologist's recommendation. The stent was placed successfully and all was well.

We are similarly permitted to be part of the family as Dr Balakrishnan suffers other illnesses and as he returns home each time, repaired and enabled to continue his work. Dr Balakrishnan has not referred to Dr Albert Schweitzer's work describing the fellowship of those who bear the mark of pain, but he has shown by his deeds that he is an active member of this band:

‘Those who have learned by experience what physical and emotional pain and anguish mean are a community all over the world. They are united by a secret bond. One and all, they know the horrors of suffering to which mankind can be subjected. One and all, they know the longing to be free from pain.

‘He who has been delivered from pain must not think he is now free again and can live his life just as he did before.

‘Having come deeply to know pain and anguish, he must help to take a stand against pain and anguish so far as human power can control them, and to bring others the deliverance which he himself has experienced.

‘Such is the fellowship of those who bear the mark of pain.’

Chapter Two onwards, we see him as a school-going student in Thrissur ‘in the tiny princely state of Cochin’, visit his ancient-looking two-storied home, and meet his parents, siblings and other relatives in a typical middle-class Nair joint family. He has inherited excellent genes for survival, his grandmother passing away at the age of 96 years.

His medical history starts from childhood—a severe and painful skin infection laying him low while he was in the first form. Asthma and respiratory infections added to his woes. Enforced, prolonged rest at home made him introspective and a dreamer.

This is when poetry and other forms of literature started exerting their fascination—an enthrallment that persists unabated. Chapter 27 describes an interesting hunt for Helen Clapesattle's The doctors Mayo, rewarded by a chance visit to the Mayo Clinic bookshop in Rochester, Minnesota long after he had lost his earlier second-hand copy and after vain search over years for another copy. Further evidence of his erudition is to be encountered in the poem he wrote when America and its allies invaded Iraq and mutilated what was once a cradle of civilization and in the quotations that precede each chapter in the second volume reviewed here. It is salutary for us to learn that he studied the technical details of how a book is made and completed a course on book publishing conducted by the Bharatiya Vidya Bhavan.

The development of spinal caries in a beloved aunt while he was still a child enhanced his acquaintance with the world of drugs, medical care and hospitals in a dramatic manner. Dr Varghese, his aunt's physician, saw young Balakrishnan's keen interest in everything that was being done for his aunt and encouraged him to take up medicine as a career. Like his grandmother, his aunt is going strong at 94!

His encounters with illness and enforced rest had a positive consequence. ‘Often, I would lie awake late at night or in the early mornings and think of some project … scribble my thoughts … a relaxed mind is a fertile ground for the birth of creativity.…’

Chapter 22 describes his first heart attack (September 1985). The clinical description and the manner in which he took it in his stride are noteworthy. Chapter 34 describes the poorly understood pains in his neck and joints that were eventually treated by his physicians with drugs against tuberculosis. Chapter 37 describes the severe bilateral pneumonia in 2012, which was initially suspected to be a consequence of left ventricular dysfunction. This prompted his eighth admission to the Amrita Institute of Medical Sciences in Kochi in 11 years.

His organizational skill was already in evidence while he was in school. He formed a society consisting of relatives and friends. As part of their activities, he wrote to Jawaharlal Nehru in 1949. The subject of the letter and the response to the reply he received make interesting reading (chapter 6). As a medical student he participated in the making of Newspaper boy—the first realistic film in Malayalam. While it received critical acclaim, it was a flop at the box office.

His descriptions of his teachers in medical college, especially the section dealing with Dr Raghavachari, Professor of Surgery, will evoke chuckles and introduce the reader to the gravity with which Dr Balakrishnan viewed duty (Chapter 8). Dr K.N. Pai, professor of medicine, is dealt with much later (Chapter 24). ‘It was Pai Sir who first proposed the starting of a gastroenterology department in the Thiruvananthapuram Medical College.’ It was also Dr Pai who, as Dr Balakrishnan was retiring from service, invited him to join the hospital in Kochi where he was chairman.

Chapter 10 introduces us to Sarala, who entered his life during an ‘exchange marriage’. (I will leave you to learn about this interesting procedure from Chapter 10.) Shortly after their wedding on 5 September 1965 and his appointment to the Calicut Medical College, he was asked to report to the Army Medical Corps to enlist as a short-term commissioned officer. Pakistani infiltration across India's western border had resulted in an emergency. Leaving his young bride behind, Dr Balakrishnan travelled to Ferozepore after military training in Secunderabad. Chapters 11–16 describe his life in the army, how he organized a Kerala wedding on Hospital Day in Ferozepore, encountered Mrs Indira Gandhi, and helped in the delivery of his daughter Viju.

A WHO Fellowship enabled higher training at the Western General Hospital in Edinburgh. His initial experiences in Britain will elicit nods of understanding from many readers. His experiences in France in 1985 are dealt with in greater detail in his second book. It was during his visit there that his father passed away after a severe bout of asthma in Kerala. When he spoke to his mother on the telephone and talked of returning home at once, she counselled him, ‘Your father would not have approved of such a decision… Complete the work you have gone to do and return then…’

Chapter 23 sums up his thoughts on the making of a physician. It should be required reading for all medical students and residents. The last paragraph (p. 161) is especially relevant.

The unnerving experience of an enquiry by the Kerala government in 1989 on the basis of a complaint of insufficient care by an IAS officer is described in Chapter 33. Dr Balakrishnan describes how ministers, MLAs, other politicians and bureaucrats who had been his patients over years gave him the cold shoulder as he faced this unjust accusation. Even after the complaint had been dismissed by the authorities, official behaviour remained devoid of grace. The Dr B.C. Roy award to Dr Balakrishnan at the hands of President of India elicited no response from the health minister, health secretary or any other functionary even as the staff and students of the medical college and hospital felicitated him.

Chapters 39 and 40 provide a summing up by him of his career.

Fire in my belly describes how Dr Balakrishnan put Kerala on the gastrointestinal map of India on a sure footing.

In 1969, after 4 years in the army, as he pondered his future he came across an advertisement inviting applications for training in the newly established DM Gastroenterology programme at the Postgraduate Institute of Medical Education and Research in Chandigarh (PGI). He was one of the first two candidates selected for this training.

Chapter 2 describes how he and the other candidate, Dr C.M. Habibullah went on to complete their training and obtain the coveted DM degree—the first to do so in India. The amazement he experienced when first studying the gastric mucosa through an endoscope can only be understood by someone who practised medicine in the era before these wonderful instruments came into use.

Dr Balakrishnan's comment on autopsies at PGI is apt. ‘The autopsies were most exciting and challenging. Many clinical reputations were shattered on the autopsy table.’ He describes the glee with which Dr B.K. Aikat, the veteran head of the department of pathology would deflate pompous clinicians… There is so much that is to be learnt from autopsies. It is a shame that the number of autopsies and the associated clinico-pathological conferences in most Indian medical college hospitals continue to show a sharp decline. As Dr Balakrishnan puts it so well, autopsies make us realize the fallibility of our knowledge, our limitations as clinicians. They inspire us to remain humble and endeavour to improve our understanding of disease processes and their treatment.

Dr Balakrishnan was to model the teaching programme in his departments in the Trivandrum Medical College and Hospital and later at the Amrita Institute of Medical Sciences in Kochi on that at the PGI.

Encounters with giants in the field of medicine are described with admiration and humour. Dr Dennis Burkitt's talk is an example (pp. 21–22). Not many are aware that Dr Burkitt lost his right eye in an accident at the age of eleven.

After obtaining his DM, he returned to his alma mater, the Trivandrum Medical College and Hospital, with a powerful sense of determination. The slow and often irregular progress from a small unit dealing with a handful of patients with abnormal gastrointestinal function to a department of national and international repute unfolds from Chapter 3 onwards. The travails in getting a proposal past the ranks of babus in government is graphically described on pages 44–50. It is unfortunate that similar frustrations persist in medical college hospitals run by the government and quasi-government institutions. The description of how it was necessary to get Prime Minister Morarji Desai to intervene to permit import of an endoscope is of interest (p. 118).

The study of tropical pancreatitis is dealt with in considerable detail from Chapter 5 onwards. Chapter 9 describes his work with Professor Sarles of Marseille and Chapter 11 tells us how he organized the National Workshop on Pancreatitis and founded the Indian Society of Pancreatology.

These two volumes are both complementary and supplementary. While the first book has an index, making it easy to search for specific items, the second lacks this facility.