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Book Reviews
More than just Surgery. Life lessons beyond the O.T. Tehemton Erach Udwadia. Gurugram, Haryana:Ebury Press (Penguin Random House), 2021. Hard cover. 191pp, ₹639, ISBN–13:978– 0670096510.
As the title of 87-year-old Dr Udwadia’s autobiography suggests, he has several interests beyond surgery.
He has served in a number of teaching institutes. He studied medicine at Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital in Parel, Bombay (now Mumbai). He also worked in the nearby Bai Jerbai Wadia Hospital for Children. After postgraduate studies in England, he returned to Bombay and was appointed on the staff of the Grant Medical College and Sir Jamsetjee Jejeebhoy Hospital. As his qualities gained recognition, he was appointed on the staff of Bai Jerbai Wadia Hospital for Children, Breach Candy Hospital, Parsee General Hospital and Hinduja Hospital. He made it a point to study the history and development of each of these institutions and has unpublished notes on them. We hope that we shall be able to study them in print.
In the preface of this book itself, we find this statement: ‘…I am appalled at how fast the memory of mentors, as also that of my colleagues, is fading—that generation of surgeons laid the foundation of Indian surgery. If we forget our roots, we have no heritage…’ He has set an example to others by providing notes on his own teachers and senior colleagues. He has also paid tribute to residents, students, nurses and patients who have enhanced his understanding of medicine and helped him develop the empathy that characterizes all his dealings with colleagues and patients.
Teaching youngsters, inspiring them and helping them develop into ‘compleat’ surgeons has been one of his passions. This zeal has made him travel to villages and towns (small and large) to help surgeons deprived of opportunities to learn and develop the art and craft of laparoscopic abdominal surgery. But I am getting ahead of my narrative.
His description of his first mentor in medicine—his own father—is worthy of study. I do not wish to rob you of the delight I experienced as I read it. Suffice it to say that this general practitioner, who served the poor in the mill district of Bombay set an example on concern for patients and a healthy disregard of their ability to pay. Apart from references to Dr Erach in various parts of the narrative, we are provided a substantial account in the final chapter devoted to ‘My ultimate mentor’. You can see the efficacy of the lessons taught to him by his father in the chapter ‘Surgical care for the poor’.
As we start from chapter 1 (‘My first surgery’) we are soon under Dr Tehemton Udwadia’s spell. It is almost as though he was talking to us. Anecdotes—at times those showing him at a disadvantage—abound. Indeed, in this chapter itself, he describes how on New Year’s Eve in 1957, the theatre sister guided every step in a life-saving operation.
For those of us old enough to remember Bombay as it was before it was converted into Mumbai, Dr Udwadia reawakens fond memories. The brief reference to the blast in 1944 on S.S. Stikine—which caused bars of gold to fall like rain in the neighbourhood of the Bombay docks—should make curious readers turn to the internet for more details on this devastating event.
I must confess to experiencing considerable sympathy with Dr Udwadia’s description of how he faced the crucial Intermediate Science examinations, having undergone similar palpitations myself.
All was not study in medical college and we are provided glimpses of Dr Udwadia’s performances on the sports ground. (The narrative on his father’s achievements on the cricket field evoke admiration as he led his medical college team to its first victory in the inter-collegiate tournament.)
Likewise, we are provided delightful accounts of the mischievous Dr Tehemton. I especially call your attention to the tricks he played on his teacher, the surgeon, Dr R.H. Karmarkar (p. 25). Dr Udwadia paid a fulsome tribute to this teacher in his obituary note in this very journal (Natl Med J India 2000;13:219).
We make more than a nodding acquaintance with Dr G.B. Parulkar, Dr Praful Desai, Dr Subhash Dalal and others who were his contemporaries in the medical college and also gained national and international prominence through their contributions in their chosen branches of medicine.
Of the descriptions Dr Udwadia provides of his other teachers, I was especially captivated by those of Dr P.K. Sen. Chapter 6 (‘My surgical registrarship’) is principally devoted to Dr Udwadia’s interactions with this polymath. (Also see pp. 70, 72, 81 and 82 for an especially poignant episode.)
There is much more of interest. His account of research while a resident in surgery and after his return from England should stimulate our younger colleagues. The chance witnessing of the use by Dr Nergesh Motashaw of a laparoscope in the gynaecology operation theatre, favoured his prepared mind and led to the development for which he is best known. It is chastening for us to read of the initial ridicule to which Dr Udwadia was subjected as he tried to show other surgeons the advantages of surgical endoscopy. As this technique gained favour, Dr Udwadia recognized the boon it could prove in the hands of rural surgeons who lacked sophisticated tools for diagnosis. The accolades heaped on Dr Udwadia by the Association of Rural Surgeons and its members are proof of the success of his endeavours.
In the chapter ‘A surgeon’s journey’, he provides us the history of the creation in 2012 and development of the Center of Excellence for Minimal Access Surgery Training (ceMAST) in Mumbai—his most successful endeavour to help young surgeons. It is cheering to note that its mission will continue under the stewardship of Dr Suchitra Bindoria.
I am emboldened to draw your attention to the chapter titled ‘The making of a surgeon’. In it, Dr Udwadia passes on to us the lessons he has learnt over the decades.
I cannot help quoting Dr Udwadia’s own words, used to describe Dr Karmarkar, as they are equally applicable to himself: ‘…soft-spoken, gentle, self-effacing to a fault, courteous and considerate, devoid of false pretensions, tall claims or histrionics…as also a technical surgeon par excellence…whose reading went beyond journals…to philosophy and history; innocent of surgical gimmickry but strong in surgical principles; artless in fee-splitting but always ready to share what he could with patients, residents and students…’
I was dismayed by the absence of any reference to the work done by Dr Udwadia as Hunterian Professor of the Royal College of Surgeons of England (1984–1985) or as Sir James Paterson Ross Lecturer at the Royal College of Surgeons of Edinburgh in 1991.
It is, of course, in keeping with his character that there is also no reference to the Padma Shri and Padma Bhushan awards by the President of India.
I also regret the absence of photographs and an index. These would have greatly enhanced the benefits we, the readers, would have obtained from this inspiring account.
I found the study of the contents of this book richly rewarding and commend it to you.
Closed Doors, Open Windows––My autobiography (P.N. Tandon). Deepak Gupta and Sunil Pandya (eds). Wolters Kluwer, New Delhi: 2019, 414 pp, ₹ 500. ISBN-13: 978–89335–32–3.
There is a relative paucity of medical autobiographies in India, which is something that Dr Sunil Pandya (who is well known to readers of this Journal) and I have often discussed in the past. This is a great pity, because reading autobiographies is rewarding in many ways—they illustrate the interesting lives of unusual people and often offer solutions and hope to the reader. Thus, it was with great interest that I picked up the autobiography of Dr P.N. Tandon, the pioneering Indian neurosurgeon. Dr Pandya, I was pleased to note, was one of the two editors of the book (the other being Dr Deepak Gupta, Professor of Neurosurgery at the All India Institute of Medical Sciences, New Delhi [AIIMS]).
A disclosure at this stage: Dr Tandon’s son, Nikhil (who features in the book), is an editor with this Journal. The Journal itself, of course, is also published from AIIMS.
The autobiography deals with downs and many ups (and hence, the title of the book) of Dr Tandon’s life, in his two successful avatars—first, as a neurosurgeon and then as an administrator–mentor. In considerable, but just appropriate detail, Dr Tandon takes us right from his childhood to his years in medical college, his work as a fledgling surgeon in Delhi and then in Oslo and Montreal before returning to Lucknow and finally, to AIIMS. His career after AIIMS has been entirely academic and has included becoming a Bhatnagar Fellow, contributing to various scientific societies in India and abroad, helping set up the National Brain Research Centre at Manesar, and being appointed a National Research Professor. Dr Tandon did return to AIIMS, but as a patient in his own department, where he chose to get operated for a pituitary adenoma in 2019!
His trials and tribulations in dealing with the bureaucracy and in setting up the department of neurosurgery at AIIMS from scratch are best exemplified in one episode—that of the rubber stamp. Yet, as he himself points out, if you persist with your dream and your drive, and if your cause is a just one, you can convince even the most hardened bureaucrat of your intentions and plans.
Most chapters begin with an appropriate quotation, which reflects the knowledge and wide reading of the author—as is, indeed, seen in the entire book. It is fascinating to read some of the anecdotes. I particularly liked the part about the clinico-pathological conference that he was a part of, in Montreal Neurological Institute in 1960. Remarkably, after more than half a century, Dr Tandon remembers the diagnosis of two of the three cases (and he got all correct, when he was expected to get all three wrong!).
His family and the support that he received from all of them, especially his wife, Leela, who sacrificed her career for his, and the father figure, Dr Leon Volodarsky (Papa Volo) as well as his mentors at Oslo and Montreal and the intellectual contributions of his many colleagues and friends over the years is gratefully acknowledged. Much of his success is because he took many unconventional and brave decisions, rather than ‘safe’ decisions. There are far too many such amazing people and wonderful stories to be elaborated on in a book review. No book review can impart the pleasure of reading a book, particularly such an inspiring book (see ‘Personal convictions’, on pp. 354–5 for an example. It is also heartening to see references to Gandhiji, Nehru, Patel, Bose, etc. for their sacrifices for the nation).
I understand that this is meant to be a ‘warts-and-all’ book and it is to Dr Tandon’s credit that he admits that while he was pleased that his colleagues were proud of him when he received his many awards and honours, he himself may not have been so generous in his thinking had it been the other way around. He is also undoubtedly magnanimous when he shares, on many occasions, the credit for all his successes with all his colleagues, all through the years. Yet, I think that his criticism of some colleagues from neighbouring hospitals is not justified. Even if his opinion of them being inept neurosurgeons is correct, I see no point in naming them.
A list of Dr Tandon’s lectures and publications is included at the end of the book and illustrates the spectrum of his interests—not just neurosurgery, but also biomedical ethics, neural transplantation, neurobiology of plants (with reference to Jagdish Chandra Bose), history of Indian neurosurgery, etc. At least two lectures seem to be appropriate for articles in the ‘Speaking for myself’ section in this journal—‘To develop a scientific program for research in rare diseases’ and ‘What is an institute and its purpose’. May we hope to see these articles?
The book is enhanced with many black and white photo-graphs—not just of the 1950s, but even from recent years. An index would have augmented the book.
