A tribute to my Mentor

By- Prof Pankaj Chaturvedi, Tata Memorial hospital, Mumbai

It was a hot and humid September afternoon in 1996. It was my 3^rd month in Tata Memorial Hospital, Mumbai as a junior resident and it was the first day in the thoracic surgery unit. I had never seen thoracic cancer patients in the past. I was completely lost and nervous. I was sitting in the OPD all alone while all the seniors were busy in an emergency surgery in the operation theatre. It was already 6 pm and nearly 30 patients were waiting for finalization of their treatment plan. Except for checking their investigations and doing clinical examination, I had zero knowledge of the further management. Couple of patients were getting agitated. The OPD ward boy told me that since none of the senior residents are available, I can call up the Junior Consultant of the unit whom I had never met. It was against the code of conduct at TMH for the JR to directly speak to the consultant that too on the first day itself. I rejected the idea outrightly. However, the ward boy seemed to me very courageous and he called up the Junior Consultant (JC). In 10 minutes, a tall and handsome person walks in the OPD in scrubs with the apron hanging on the right shoulder. I was shivering with fear anticipating a reprimand for my misconduct.

The JC, on the contrary, asked my name and enquired why I was all alone. He sat next to me and I explained him about each patient. What impressed me that he took less than 2 minutes to decide on the treatment plan for most of the patients once I presented the case history. He asked me to keep 3 particular patients to be discussed once we are done with the remaining. One of those was a young patient having recurrence of esophageal cancer and he was brought on a stretcher because of very poor general condition. There was another patient of incurable lung cancer with pleural effusion who was very breathless. Third one was a locally advanced stomach cancer planned for surgery 2 days later. The JC asked me to call the relatives of these 3 patients after we finished other patients. At this point the ward boy rushed inside the OPD and informed the junior consultant that his son at home was having difficulty in breathing. To my surprise, rather than leaving the OPD immediately, Junior consultant continued the consultation patiently. I suggested that I will discuss these cases with the SR and he could go home. He said these sick patients also needed his attention and it was equally important. Laughingly he said, perhaps the good wishes of these patients may enhance the recovery of his son. He looked at the scans of the 70 years old stomach cancer patient and then told me that it was not worth the surgery. I told him that the senior consultant had already opined for surgery and the OT was already scheduled. He gently tapped my shoulder and said “we are surgeon and we should not think we are God”. He told, think that the patient was your father and if you would plan the same for him. He called the relatives of the lung cancer patient with pleural effusion and explained the futility of any further treatment. The patient was advised palliative chemotherapy by the medical oncology team. He convinced them that the chemotherapy will prolong the suffering and not the life. For the young man with the recurrent esophageal cancer, he tried to convince the relatives to take him home. However, the relatives insisted for the admission and they were not able to accept that disease was not curable. We finally conceded and planned to admit him though I could have sent him away by explaining non availability of the bed. Next morning, when I and the JC were taking morning ward rounds, we got a distress call from the 10^th floor Radiotherapy ward where the recurrent esophageal cancer patient was admitted. The patient committed suicide by jumping from the window of the toilet. Several weeks later, the relatives of the patient came to hospital and donated 1 lac in the memory of the patient. The JC often said, a good doctor is the one who continues to be respected even when the patient has died. We should give extra care and attention to the patient once they reach end of their life.

The next day morning I was assisting the senior consultant of the Breast and Thoracic unit in the operating room. JC walked in the OT somewhere in the afternoon. The senior consultant curtly told him that he was not wanted in the OT and he should go and finish the ward rounds. The whole incidence was quite upsetting even for a JR like me. In the afternoon, I was told that the OT list was decided by the senior consultant and JC’s private cases should not be accommodated! In my 3 months of rotation, I witnessed several instances of him being sidelined or ignored. JC never expressed his displeasure publicly at least in front of the residents of the unit. On the contrary, we were greeted by a smiling face whenever we reached him. He ensured that residents never suffered due to his relationship with his senior. While leaving the unit, I gathered the courage to ask him about the secret of his “inner peace.” He calmly told me two things. Firstly, such bosses teach you what not to do when you become the boss. Secondly, no one can take away your talent from you….stoop to conquer.

Three months later, dedicated Breast Oncology unit was formed with JC being one of the consultants in it. I was fortunate to be the first SR of the first dedicated breast unit. I was exposed to a whole new vocabulary such as evidence-based medicine, equipoise,randomized control trial, paradigm shift, logistic regression, clinical research methodology, diseases management group etc. I witnessed the origin of an idea that was going to transform TMH forever and give platform for JC’s meteoric rise.  These memories of working with this extraordinary JC named Dr Rajendra Badwe is still etched in my memory even 27 years later. I had the fortune of having a mentor like him.

After completing my residency at TMH, I moved to a trust run cancer hospital in Bhopal in 1999. Three years later, faculty posts were advertised in TMH and I too applied for it. I was a bit hesitant in appearing for the interview because there were several candidates who were either children of senior TMH doctors or close to them. Moreover, being a typical Bhaiya (a North Indian) by action and thoughts, I never thought I had the caliber and smartness that was needed for a TMH faculty. I met Dr Badwe for his guidance and to get some tips from him. I asked him if he wanted me to read any specific book for preparation for the interview.  To my surprise he handed me a book titled “The Art of Healing.” He said, he is looking for a compassionate surgeon and not accomplished surgeon to build his team. On the evening of interview, I got a call from Dr Badwe that I was selected as a faculty and I should prepare to join soonest. I was choked with emotions. It was a dream come true. I appreciated the humility of Dr Badwe who found time to make a phone call and inform the results to a fresher.

Four years after joining TMH, I decided to engage myself in advocacy for tobacco control. This involved working with the media, politicians, bureaucrats, lawyers, NGOs etc. My critical views against government policies started appearing in newspapers frequently. I started meeting political leaders and IAS officers to push for effective tobacco control especially banning Gutka. Many of them did not like a government doctor indulging in such a lobbying. Once an IAS officer, visited TMH and expressed his strong displeasure against my activities.  At the height of my advocacy, I started getting threats from the tobacco industry. TMH started getting several RTIs seeking detailed information about my funding, activities, meetings, travels, spending etc. Several anonymous letters were sent to the hospital terming me as cigarette industry secret agent unleashed against gutka industry. Those were very difficult days of my life. Dr Badwe stood like a rock behind me and shielded me from the evil forces. He told me if you are honest in your work, you have my full support. It was simply because of his unconditional support and encouragement that I could succeed in tobacco control in India.

In December 2017, he called me and told me on phone that we must rush to Varanasi the next day. What happened subsequently changed the course of my life forever. He entrusted me with the responsibility of building a 500 bedded hospital in Varanasi with support of Tata Trusts in 12 months! This involved renovation of an existing railway cancer hospital and construction of a new hospital inside BHU campus. At that point of time, I had no knowledge or experience of doing such as job. What motivated me was his implicit faith in me and total freedom that he gave me for the next one year. It was a 1100 crore project that was monitored by the Prime Minister office for its completion by February 2019. The challenge was that we started the construction in April 2018! I was thrown into the rough waters and I had to learn to swim. What kept me going was Dr Badwe’s trust in me. Once he told me that no doubt that the leaders are born but someone must identify them! In his stint as the Director TMC, he opened new hospitals in Sangrur, Mullanpur, Varanasi, Vishakhapatnam. He also got the approval for construction of the hospitals in Muzaffarpur, Odisha and Raigad. He also continuously worked from augmentation of TMH as well as ACTREC. Given the system where we work, I can now imagine how stressful this entire journey must have been. His mantra of “delegation” and identifying one senior medical faculty to lead each big project did the magic. He gave opportunity to many senior faculty to demonstrated their leadership skill by giving them big tasks. This led to the emergence of several leaders within TMC that could manage tough administrative tasks and challenging responsibilities independently.

There are other good qualities that we can learn from him. I had the fortune of accompanying him in flights several time when he could not use his phone. One thing that always stuck me that he never criticized or bitch about anyone. He has kind words for to his adversaries too. He is always approachable on phone to an extent that anyone can call him and get a response. His secretary offered 3 options when we went for meeting him in the office – Free, Busy or On Phone. Despite his busy schedule, he gives patient hearing to anyone who meets him. His kindness and “giving” nature created a challenge for the administration. Anyone who was retiring (from housekeeping staff to heads of departments) will make a visit to Dr Badwe and return with an approval for their extension. His communication and care for the patient is exemplary. The Kevat program that he introduced is an example of his patient-centric approach. He has also broken the age old myth that handwriting is the reflection of an individual’s personality. He probably has one of the worst handwriting ever seen in human history.

Despite all the hurdles and complexities, he always maintains a calm and composed demeanor. He exudes positivity and affection. His biggest problem is that he cannot say “no” to anyone (including the offer of sweets). There was a time during my stint in his unit when he sanctioned leave for all 3 senior residents during Diwali Festival that too when he had also planned holiday. We receive multiple requests from politicians or philanthropists for building cancer hospital. He would assure every one of assistance and promptly forward the request to me. Once I asked him, why can’t he be a little pessimist and discourage them? He said, just send them a customized report regarding money, machine and manpower needed for a cancer hospital that itself is enough to discourage them. The last 5 years, I literally worked with him as his executive assistant. I have been working with him on the projects in Varanasi, Muzaffarpur, Odisha, Khopoli apart from several other important assignments. I would draft the letters/responses for him and he will take less than a minute to approve or at times will not even read it. I realized that, this implicit trust forced me to prepare flawless drafts despite my Hindi medium background.

Dr Badwe’s glorious stint as the Director of Tata Memorial Centre will come at an end on 30^th November, 2023. The institution has grown from a 600 bedded hospital to 3000 beds in 6 different states with 6000 employees. From a service (treatment) center, it has diversified into an educational and research giant. The institution will not be the same without him. I am confident that the new leadership will fill the void and continue his mission. I was fortunate that I could learn these unique skills from Dr Badwe while working with him. This invaluable experience has made an everlasting impact on my professional and personal life. We feel blessed that he will continue to inspire us by working as a Professor in the Breast unit.

The true measure of a successful career is not how many awards you have won but how many hearts you have won. True respect is not the one you get when in power but the one you receive when out of power. Finally, whatever you do comes back to you.