DR. FAROKH UDWADIA - HIS VERY NAME SPELLS COMPASSION

Rotary and Public Awards Committee Chairman PP Sandip Agarwalla extols Dr. Farokh Udwadia, recipient of the 'Citizen of Bombay' Award

Rotary and Public Awards Committee Chairman PP Sandip Agarwalla, who introduced Dr. Farokh Udwadia, decorated with the .Citizen of Bombay. Award, paid glowing tributes to the man whom every informed citizen knows as one who sets an example and leads from the front rather than merely spouting theory.

The most vivid example of this was the scene at the end of a clinical meeting at the J.J. Hospital way back in 1986. After the first case was presented, he walked out of the Seminar Hall and returned a few minutes later, leading a patient by the hand. Everyone wondered why, even though he had hordes of residents to help him, Dr. Udwadia went out to personally escort the patient into the room.

Soon, realisation dawned and it became clear that the young woman, probably in her .twenties, was the first patient with AIDS that JJ Hospital had encountered and also one of the first cases in India.

The point that Dr. Udwadia was making was this . although AIDS was just appearing on the horizon and all doctors were interested in seeing such patients, learning the symptoms, signs and pathology, it was important not to treat them as exhibits. They were human beings and deserved to be treated with dignity.

Apart from this, Sandip said, Dr. Udwadia also showed that love and kindness were a very important prescription. He believed in what the Dalai Lama had said, viz., .If you want others to be happy, practice compassion; if you want to be happy, practice compassion..

Dr. Udwadia, who was rarely late for a meeting and who had no compunctions about bounding up six flights of stairs, graduated from the University of Bombay with distinction in Medicine and many other subjects in 1953. He obtained his M.D. in 1955 and was awarded almost every medal and scholarship of the University of Bombay.

Trained at the Brompton and Middlesex Hospitals in London, he was on the house staff of City Hospital and Northern General Hospital, Edinburgh, in Prof. John Crofton.s unit. He was the youngest Indian to be elected Fellow of the Royal College of Physicians, Edinburgh, at the age of 38 years. Since then, he had risen to become a colossus in the field of medicine.

Sandip said most Indians, specially Bombayites, remembered the doctor for successfully treating the popular superstar Amitabh Bachchan when he was critically ill in 1982 and also former Prime Minister Atal Behari Vajpayee when he underwent knee surgery.

Dr. Udwadia pioneered critical care, especially intensive respiratory care, in India and published over 50 papers, especially on respiratory medicine, tropical eosinophilia, respiratory care, tetanus and rabies. He was a kind, caring and knowledgeable physician and a master of the art and craft of respiratory medicine and critical care.

He had published a large number of books, most of which had become standard texts. Therefore, it was all the more surprising that he possessed deep historical and philosophical knowledge and found the time to write a remarkable book, .Man and Medicine: A History..

Dr. Udwadia had said that he wrote the book because he felt that most doctors had only a vague idea of medical history and their knowledge was generally confined to names like Hippocrates, Galen, Sushruta and Fleming.

He believed that it was important to be aware of not only the spectacular events in medicine.s progress, but also of the mistakes in its history. .We should not view these events only in a narrow medical perspective but set them against the background of the social, religious and cultural environments of time..

Further, Sandip said, Dr. Udwadia believed that a doctor familiar with the history of man and of medicine .adds wisdom to knowledge, art to science and humility to his prowess..

Man had influenced medicine through the ages as much as medicine had influenced man. However, there were limits to medicine and the expectations of patients were nearly always more than medicine could provide. Besides, medical truth was relative and what was true one day could be debunked as complete rubbish a few years hence, only to be resuscitated as useful even later.

.Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic. There is, however, no mistaking the wizardry of Dr. Udwadia.s legendary skills,. Sandip added.

Among the many international awards, prizes, medals and distinctions conferred on him was the .Dhanvantri Award. and many remembered his speech while accepting the award as a masterpiece that kept the audience spellbound. He was the only Indian to be honoured as a .Master Fellow. by the International and American College of Chest Physicians and one out of only eight given this honour.

Sandip, who said that Dr. Udwadia had looked after the members of his family for many years, then read the Citation for the .Citizen of Bombay. Award: The Rotary Club of Bombay presents the .Citizen of Bombay. Award to Dr. Farokh Eruch Udwadia in recognition of his pioneering work and inspirational achievements in the field of medicine.

This citation celebrates a living legend, recognises his exemplary work and humanitarian approach, for the well-being of the citizens of the city, our nation, and towards the understanding and advancement of medical science itself.

Pioneering, because Dr. Udwadia has done and continues to do, original, internationally-acclaimed work in tetanus, respiratory medicine and tropical eosinophilia, for the last four decades and his work remains unparalleled even today.

He pioneered critical care medicine and set up the first respiratory intensive care unit in India. He is widely acknowledged as a master in respiratory medicine and intensive care.

Dr. Udwadia.s numerous path-breaking accomplishments are worthy of a scroll of excellence so formidable that the format of this citation cannot begin to enumerate. These include several papers published in worldwide publications, books on medicine now regarded as standard textbooks and chairing national and international conferences in medicine. His passion for teaching has taken him to renowned universities in India and around the world.

Dr. Udwadia.s many distinctions include Master Fellow of the American College of Chest Physicians, Member of the Scientific Committee of the Indian Council of Medical Research, and Regent of India for the American College of Chest Physicians.

He received the Dhanvantri Award in 1996 and the Padma Bhushan in 1987. Inspirational. because to his patients over generations, Dr. Udwadia has embodied perhaps the ultimate personal trust by virtue of his professional excellence, humanitarian principles and strength of character.

Inspiration to medical practitioners. because Dr. Udwadia is a role model, a unique individual who possesses a rare philosopher.s understanding of medicine from a studied, historical perspective and its application in modernday practice.

Finally, this citation is an expression of immense gratitude to Dr. Udwadia for making our lives so much better by leading the life that he has led.

Riding round the Oval, dressed in riding habits... those were the days

On Sundays there were tents from where boys from schools played cricket. There was a dirt track surrounding the Oval on which people rode, dressed nicely in riding habits.

There were lovely promenades. I particularly remember Cuffe Parade because we used to go there on Sunday to walk and have lots of fun. Alas, it.s no longer there. It was beautiful.

Forgive me for a memory which I cannot shake off. During my visits to Cuffe Parade on Sundays, I still remember a gentleman, suited and booted, with his neck twisted to one side. I never knew what it was till I went to medical school (it was called .spasmodic tortiquolis.).

He used to walk like a king and everyone used to scatter when he walked. He would walk up and down, and up and down, for an hour and then disappear into the twilight.

And there were the chanawallahs spaced out on the roads and they would place their hands across the chanas, because mischievous boys would grab them and run away. I was one of them, I well remember.

Smiles all round. Dr. Farokh Udwadia poses for a keepsake with PP Sandip and former First Lady Malini Agarwalla (left) and with PP Dr. Adi and Dr. Nayna Dastur (right)

Worli and Marine Drive. both were quiet places in those days, specially Worli, which used to be very quiet after 8 o.clock in the evening.

Some lovely eating places which no longer exist. There were no five-star eating restaurants. perhaps there were in the Taj, but I didn.t go to them. But the ones which I really enjoyed were the Gourdon (I used to go there for a meal with my grandfather, I well remember) and, most interesting of all, a lovely little café called Bombelli. It started at Churchgate and then opened at Breach Candy.

It reminded you of one of the cafés in Europe; there was a sweet old Italian called Mario, who used to spin out sweet little songs on the piano; he had a signature tune for each couple that walked in; he had a special signature tune for us in those days. You could sit with a cup of coffee for three hours and nobody asked you to get out.

Alas! Poor Mario ultimately ended up at JJ Hospital when he was dying. Nobody looked after him except his band boys who hovered around him and I remember him muttering away and imagining that he was back in his hometown Venice. I.ll never forget that. He was a nice, gentle man.

Well, what about the people? I think the people were gentler. I think they were more civilised. Mind you, it wasn.t that Bombay wasn.t busy or bustling. But nowhere as frenzied as the Mumbai of today.

As for the women, they all seemed to be clustered together. In college they would always be huddled in the first row. They used to oil their hair heavily and I could smell coconut oil from a distance. But they are emancipated now. And that.s a very good augury.

I think the emancipation of women is indeed a good augury for the emancipation of a city, a state or even a country. I certainly welcome that. Perhaps they are more emancipated in some ways than they should be.

And then, slowly, imperceptibly, Bombay changed. She changed her face and, inevitably, and sadly, she changed her name.

What do we find now? A bustling city, bursting at the seams, frenetic, always on the move, never sleeping; there is always something happening here; it.s alive of course, reminds you sometimes of New York. There might be a Shiamak Davar show on today, even an opera comes to Bombay nowadays. And there might be a rasta roko. or a .rasta bandh. the next day.

I have a love-hate relationship with Bombay now, says Dr. Udwadia

I have a love-hate relationship with Bombay now. After working for three or four months, I hate it and want to get away from it. And I do. But then Bombay pulls me back. I.d love to visit London, New York, Paris, Venice, what have you, as and when the time or the opportunity arises. But yet I return to Bombay. I think my heart really belongs to Bombay.

Now let me go back to my profession and see what changes have come over during this period of time, when Bombay turned to Mumbai.

When I was a Registrar and did my M.D. in 1956, the medical profession was the most respected of all. Doctors were treated like gods. They could do no wrong. Of all the professions, it was the most admired, with the maximum reputation.

But what do we see now? There is a change in the scene. No longer are doctors as respected as they were. In fact, sometimes one senses hostility, antagonism and mistrust with the medical profession, and we wonder why. I think there are several reasons for it. But I shall just pick on one.

During this period, 50 years and more, science has burgeoned and advanced tremendously, so that medicine has wrought near marvels which would have been deemed incredible and unbelievable during my early days as Registrar and doctor.

Medicine has always been an equal measure of art and science. And the great burgeoning of science in these 50 odd years has buried the art within medicine. Therefore, I think, medicine has lost its way.

Doctors seem to relate more now to machines and the science behind the machines; and patients are also made to relate to machines. The machine becomes the interface between the doctor and the patient. What happens then? The doctorpatient relationship is eroded. And the doctor-patient relationship has always been the core of medicine.

It seems to be forgotten that medicine is learnt at the bedside, practised at the bedside, not just from reading books, not from reading machines, nor from sophisticated gadgets, or from the rapturous images seen from CT scans, MRI machines and the other advances of science.

I therefore want to talk today on the art behind medicine. A few stray thoughts that come into my mind.

It is indeed difficult to put the art of medicine into words. Why? For one thing, the art is intrinsically mixed with the science. For another, you can.t quantify it. These are qualities of the mind and heart.

Perhaps one of the most important facets of the art of medicine, if I may say so, is the .history-taking.. It is a neglected art today. People don.t seem to have the time. This is an art you can never perfect in a lifetime. Not the most experienced physician, not even if he lives two life times.

And the reason is obvious . diseases do not generally run to type, so the same disease may manifest in different ways in different patients. And each patient is a unique individual and responds in a unique way. The response to disease is dependent not only on the disease process, but also upon the physiological changes wrought in the body and the adaptation of the body to those physiological changes.

These vary for different patients. It depends upon the genetic makeup of an individual patient, on his constitution, environment, age, mental and emotional features and many other unknown factors. Therefore, .history-taking. is indeed a difficult art, yet it is so important because a good .history. very often gives you a diagnosis (perhaps six or seven times out of ten); or if it doesn.t give you a diagnosis, it gives you a clue so as to where to proceed and how.

The art of a good .history. is to listen. Therefore, the art of listening is an art within an art. Ideally, the doctor should listen, and make the time to listen, not just with his ears but with all his senses. For then only will he make out an unspoken problem, or latch on to a hidden clue.

After the listening comes the questioning. Listen, question, listen, question. to give pace to the story. and that helps to find out what exactly ails the patient.

I think the art of medicine is also to look at medicine in a holistic fashion. Disease is no specialist. A patient doesn.t come with a liver or a kidney in his hand and say, this is my problem. Especially in the early part of a disease, symptoms are very vague and it takes a fair amount of experience, with the backing of science, to know what exactly is transpiring.

Again, it.s very important to realise the relationship between the mind and the body. The mind and the body complex is a relationship that hasn.t yet been worked out. The mind can influence the body in many ways. In medicine, the mind can produce symptoms which mimic disease. And if we don.t realise that, we are led up the wrong path. or, even if a patient has an organic disease, the mind can colour that disease and produce a rather bizarre picture.

Many patients come to us not because they have organic disease, but because they have symptoms related to anxiety, to stress, to conflicts within them. I.m tempted to give you an example because it took place just a few weeks ago.

A young woman, aged 23, was brought by her employer who ran a software business; the girl was doing extremely well, drawing a good salary, but she was brought in because she had abdominal pain and fever for two or three years. She was thoroughly investigated. and had been to several doctors.

She was diagnosed ultimately as a case of abdominal TB. She came to me because a laparoscopy was to be performed on her and she was to be started on anti-TB drugs. The employer brought her and they sought my advice.

She had a sad, wistful, Modiglianilike face. very taciturn. I could get nowhere in our discussion. So I decided to ask things outside her complaints. I asked how she had managed to get her degree; she had done her graduation and post-graduation through correspondence. I congratulated her on having won a plum job and earning so well.

I asked her whether she had any hobbies and she said no. Did she have any other objectives in life? She said she wanted to get on with her work and had been promised a raise. She was happy about that and for the first time started to speak.

I got a little irritated and asked, isn.t there anything else you would like besides doing your job and getting more money? She remained quiet. I said, shouldn.t a girl as young as you want to get married, have lovely children, have a home of your own?

There was silence, and I could see that there was a tear in her eye. And she said, that.s not possible. To which I answered, if you tell me why, I might be able to help you.

And then she came out with a gush. Her father was uneducated, an untrained electrician who earned nothing for all practical purposes. Her mother was the pillar of the house, the one who kept the house together.

She had two sisters whom she had put in a good school, a much younger brother who was also put in a good school. And she said that if she got married and had a home and a family, her own family would go into abject poverty. She was weeping by then.

It was obvious that the conflict lay between her duty to her family and her wish for fulfilment as a human being and as a woman. I explained that to her, as I do to many persons with a conflict. If you have problem A, you can.t possibly solve it if you are looking at problem B which simply does not exist. And most people seem to understand that quite well.

Well, I examined her, nothing found; I looked at her tests, nothing found. I then stressed the importance of her mental conflict in the production of her symptoms.

The employer was obviously a kind lady for she had taken the appointment and brought her. I turned to her and said, the happiness of this family could lie in your hands. Perhaps you could employ the father as an electrician and train him. It would make a great difference to her family and add to her happiness.

She seemed to acquiesce. And they all went away rather happily. I felt uplifted, I must say, and couldn.t stop smiling when I drove back home.

This is just to give you an example of what a good .history. can do and also the relationship between the mind and the body.

The basis of clinical medicine is a proper diagnosis. And diagnosis depends on history, a physical examination and investigations. Physical examination is also a much neglected art. One must learn to use one.s eyes, ears and hands, so that one sees, one hears and one feels.

It.s important, after you have run a particular examination and .history ., to be able to get a shrewd idea as to what is wrong with your patient and then to go on to relevant tests.

Over-investigation is an unfortunate habit; I have also been guilty of it. To my mind, over-investigation is a form of mental bankruptcy. It is one of those things that science has brought along in its stream. you have machines, (so) you need to use them; it.s as simple as that.

Let me talk to you now on clinical judgement.

A doctor must needs be a judge. It has been aptly said that medicine is the art of coming to a conclusion on insufficient evidence. And therefore mistakes in judgment are bound to occur.

Clinical judgment, mind you, doesn.t come in the purview of either art or science. It is a quality which you either possess or don.t possess. You can.t equate it with intellectual capability. People who are brilliant, even positively brilliant, may not have good clinical judgement. And people who are intellectually inferior, may have sound clinical judgment.

A wise English physician, who wrote a book on the symptoms and signs of medicine many years ago, said that in his opinion good judgment is really nothing but good common sense.

Being an Englishman, he added further that it is akin to humour, which is again akin to a sense of proportion.

The art of medicine is the art of healing, not just treating, nor even just curing

To tackle a dangerous, life-threatening illness, I think a doctor needs much more than factual knowledge, skills, expertise and even experience; he needs good clinical judgment.

Clinical judgment is a happy blend of all the above attributes. But it also has an intangible, indefinable quality.

It is the quality which encompasses compassion, charity, hope and faith; it is the quality which can reach out to the broken spirit of a very ill individual and sustain him through the course of his illness; it is a quality which gives the physician the wisdom to know what to say and what not to say, what to do and what not to do; to fight death to the bitter end, or to give in; to seek a cure or to settle for palliative relief.

It is also the extra-special perception that some clinicians have of being able to spot a clue, where some of their less fortunate colleagues have missed to process that clue, and to give it the right import both in diagnosis and management.

A physician who can combine this extra-special perceptive ability with the wisdom of learning and experience, with compassion for human suffering, and who also has good clinical judgment, is indeed blessed by the gods. For he then has qualities which no machine can duplicate and no science can invent.

So that is the art of medicine. It is an art which is capable of sifting the evidence in front of the physician so that he can come up with the right answer of the many possible answers to a pertinent question.

The art of medicine, as someone has beautifully put it, is the art of healing, not just treating, nor even just curing. But please do remember that it is only when art and science join hands that the patient.s interests are best preserved. It is only then that a physician can reach out and engage the individuality of a patient as a whole, so that he looks upon the patient not just as a disease or an illness that needs to be treated.

It is only when the physician enters into a broader engagement with his patient that his judgment, his skill and decision-making, that difficult province, is easy. The bond then between the doctor and the patient is strengthened, reinforcing an unwritten covenant held sacred by time and tradition. Thank you.

Of Rumi's mom' 'ulaab' and castor oil

Perhaps enthused by Dr. Farokh Udwadia.s walk down memory lane, President Dr. Rumi Jehangir decided to follow suit. And he came up with such a brilliant chestnut, that he brought the house down with a devastating punch line.

He recalled an incident that occurred way back in 1959 when he and his brother were subjected to a monthly ordeal by their mother who firmly believed that one measure of castor oil every month would keep them in good health.

"It was thick, gooey and obnoxious . As mother was growing older and we were getting bolder, we resisted the ordeal; ultimately, she decided to buttress her views by taking the opinion of a brilliant young M.R.C.P. just back from England.

"She asked Dr. Udwadia: 'Isn't it a fact that every month you should take a vati (measure) full of castor oil?"'

Rumi and his brother waited with bated breath, dreading the doctor's answer. Dr. Udwadia settled the issue with just two words: "Certainly not!"

"We were let off the hook. But retrospectively, I do feel that mother was right in certain ways, because quite often nowadays even I feel like giving a good dose of julaab to the children, but not for reasons of health!"

It took a long time for the huge guffaw that went up to die down.

Adding to the mirth and laughter was a comment by Dr. Udwadia himself . to the effect that even he, as a young boy, had faced the same ordeal.

Rumi added: "Ever since, my respect for Dr. Udwadia's clinical acumen has grown by leaps and bounds. And as we have just heard, his respect in the medical fraternity is enviable. He has inspired many of us with the adage that 'You may cure sometimes, but sympathise always '."

Earlier, responding to a query from Burjor Poonawala on stem cells being touted as the cure-all for all diseases, Dr. Udwadia said there had been instances when stem cells had been used to repair damaged organs. But much more work needed to be done before it could be put into clinical practice on a large scale.

"There is no doubt that it is a future avenue of important research which may be of great help to medicine," Dr. Udwadia added.