No amount of investigations can replace good clinical acumen.

A tribute to Dr Ashok Mahashur a leading Pulmonologist at Mumbai who died recently.

Ten years back, I was detected with multiple mediastinal nodes and I had loss of weight too. PET CT scan showed classical features of aggressive Lymphoma. All blood tests, mantoux test, ESR were negative. A Biopsy or FNAC was not possible because of the location of the lymph nodes being close to the critical structures.I was completely shattered and hopeless.

I consulted Dr Mahashur to seek his opinion. After detailed history taking, he only looked at my X Ray and the blood tests. I tried to show him the CT scan and PET scan reports. He politely refused to look at them. After 15 minutes of consultation, he put me on anti tubercular treatment ! As an oncologist, in the absence of any pathological correlation, I was certainly not satisfied with this approach. He smiled and told me that I should trust his judgement and see him after 2 months. 

When I started AKT, my symptoms worsened over 4 weeks. I lost 5 kilograms in those 4 weeks. I was devastated. Worried by that, I got my CT scan done again. I was shocked when I saw the report. All the nodes had increased in size! Agitated and frustrated, I went to consult Dr Mahashur again. He looked at his previous prescription and then looked at me. He calmly asked me why I had come back in 1 month when I was actually supposed to see after 2 months. When I showed him the CT report, he enquired about the physician who had advised that scan against his own management plans. I lamented that my symptoms have worsened and there is no radiological improvement following his “empirical therapy”. He calmly warned me and asked to continue his treatment. He went on to explain why this is a normal occurrence in certain tuberculosis patients. I still did not trust him. When I was leaving, he asked me to stick to his instructions and not listen to anyone else.

I continued with his medication. I never listened to my oncology colleagues who were appalled with the idea of Empirical therapy. 

Dr Mahashur just asked for basic blood investigations and X Ray every 3 months. It is a different thing that I never had the courage to get a CT scan. Things improved and I survived ((-;

Dr Mahashur taught me how beauty lies in simplicity. He taught me how to be humble despite being on the top. His combination of confidence and calmness was exemplary. He demonstrated that no amount of investigations can replace good clinical acumen. Attitude is the most important attribute of a successful doctor.

I am alive because of him. His teachings still guide me. Teachers like him are immortal. May his soul rest in peace. 

Prof Pankaj Chaturvedi

Tata Memorial Hospital, Mumbai