Prof. M Sambasivan (1936-2018)
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.236980
Source of Support: None, Conflict of Interest: None
Prof. M. Sambasivan, one of the great teachers in Neurosurgery in India, passed away on 19th May 2018 at the age of 82 years after a brief illness. He was an unusual person, who received great accolades from the public, his students, his peers and the professional bodies, both in India and abroad.
Born in a very orthodox Brahmin family on 1st May 1936, he had his Sanskrit and Vedic education from his early childhood along with his routine school studies. He was a very bright student in both Vedic and school studies, aggressively active in extracurricular activities including sports, martial arts, National Cadet Corps and social service associations. His academic achievements were brilliant. Though he wanted to take up Medicine after his preliminary college studies, which he passed with distinction, his lawyer-father suggested to him to pursue his science graduation and to continue his Vedic studies so that he would become a traditional 'Tantri'. After passing his Bachelor of Science degree, scoring the first rank, he joined in the newly opened Medical College in Trivandrum in 1955, the 5th batch of MBBS, promising his father that he would pursue his Vedic studies uninterrupted [Figure 1].
His passed his MBBS with more than half a dozen gold medals (in various subjects like Surgery, Obstetrics, and basic sciences) and secured the prize for the best outgoing student in 1959. It was during his student days that he rose to the very top of National Cadet Corps (NCC) in Kerala and led the Kerala contingent of NCC at the Republic day parade in New Delhi [Figure 2] and [Figure 3].
His flair for surgery was keen and he devoted most of his undergraduate period in the surgical wards and operating theatres, where he learnt the art and practice of surgery under doyens like Prof. R. Kesavan Nair and Prof. Raman Nair (the first pediatric surgeon in India). Both the teachers were confident of his surgical skills and he was allowed to do minor surgeries even during the time he was only a house surgeon. After his MBBS (Bachelor of Medicine, Bachelor of Surgery) course, he joined as a Tutor in General Surgery in Trivandrum Medical College in 1962. It was during this period that Prof. K. Mahadevan Pillai (the first neuro-radiologist in India) was brought in as a Professor of Radiology in this College on a contract basis. Dr. Sambasivan became a willing assistant to him and learned angiographic studies by catheterizing major vessels. He was quite deft with his hands and soon became a sought-after, young, surgeon-radiologist who was often called to conduct angiographic studies on vascular lesions of the brain, heart and kidneys, although he was only a MS Surgery student then.
He passed his primary Fellwship of the Royal College of Surgeons (FRCS), conducted in Calcutta in March 1963 but did not go to London although he was offered some help by Sir Clement Price and Prof. RJ Last. He passed his Master of Surgery (MS) in General Surgery in 1964 and proceeded to Christian Medical College, Vellore for pursuing his MS Neurosurgery. The taciturn professor, Dr. Jacob Chandy became his guru. When he appeared for his MS (Neurosurgery) examination, the external examiners, Prof. B. Ramamurthi, Prof. Ram S. Ginde and Prof. R. M. Varma were only too happy to confer on him a distinction and a gold medal for his MS (Neurosurgery) degree [Figure 4] and [Figure 5].
He returned to Trivandrum in 1966 to organize a small neurosurgical unit with 2 beds. In doing so, he had to overcome many service hassles, organizational hiccoughs and paranoiac feeling against cranial surgery. He was all alone in his unit without even a single assistant or houseman. Though there were plenty of neurological and neurosurgical outpatients, his surgical colleagues refused to refer patients to him.
As a child, I have seen him many times even before his entry to Medical College as both of us are from Trivandrum City. He would come with his father to a famous temple in my native place, Karamana, to chant Vedic Houtrams when his father would do the priestly duties there. Even during his adolescence, he was known as a brilliant student leader in NCC and as a very good equestrian.
But our friendship started rather abruptly in 1966 when I was pursuing my Doctor of Medicine (MD) Medicine course. I was in the first medical unit of Prof. K N Pai when I admitted from the casualty, a deeply comatose middle-aged man, almost dying. There were no definite lateralizing signs and we were almost certain he would die soon. It was by about 6 pm when Dr. Sambasivan came to the ward and asked me what that patient had. I did not know that it was his routine then to do an extensive search of all the wards to see if there was any patient worth transferring to his side. He made a quick examination of the patient and asked me how I planned to proceed.
The ward was over crowded already and there were at least five or six more emergencies waiting in the casualty to be admitted in the ward. I was curious to see what he would do with this patient and hence wrote the transfer note immediately. He took the patient directly to the radiology room, coaxed an unwilling radiographer to set up the equipment for an angiogram. A percutaneous carotid angiogram was done with the only autoclaved set available in the ward. It had only a thick lumbar puncture needle and some syringes and cotton. The deftness of his work amazed me and after seeing the first picture, he asked me to come and perform the cross compression of the opposite carotid artery so that the cross flow and the blood vessels of both sides could be visualized.
The apparently 'hurry less- hurry' in transferring the patient to the operating theatre further surprised me. He asked me if I had had any surgical training, to which I agreed. With an almost hostile theatre sister and neither an anesthetist nor an assistant (other than me, a postgraduate [PG] student in Medicine!) he coaxed the relatives of the patient to give the consent for surgery and drained a large subdural hematoma under local anesthesia. Within minutes, the respiration of the patient was better, and in an hour's time, he opened his eyes. This, in 1966, was a miracle of sorts in Trivandrum, brought on by a simple evacuation of a massive subdural clot. This apparently minor event made a host of Medicine PGs his ardent admirers.
As in the case of any primitive neurosurgical set up with no investigational facility, the surgical victories he achieved, were admixed with occasional failures as well. In an unsympathetic environment, these failures were highlighted. His surgical colleagues were often not too happy to see his popularity among the medical students in general and people at large. The phenomenal energy of this surgeon was seen to be believed. Even during the heights of his professional work, he was quite keen to practice Vedic rites for which he would be ready by 4.30 am onwards. After his early morning studies, he would start his hospital work, which would go on some times until the late hours. His wife would lament that even his Vellore days under the hard task master Prof. Jacob Chandy had been better and easier. The almost daily emergency surgeries, routine work of admitted patients, seeing the outpatient and referred patients with no trained assistants formed an assiduous task. Though all patients who sustained road traffic accidents were admitted under the department of General Surgery in those days, he had to manage them daily by going to different wards. It took a few months before an MBBS tutor was allotted to him on a permanent basis.
Such was his stupendous effort that among the super-specialties, Neurosurgery was the first to get an independent status in Kerala. He was promoted soon as Professor of Neurosurgery and by then a couple of his assistants returned with MCh Neurosurgery from Christian Medical College, Vellore. MCh training in Trivandrum Medical College was started in 1979.
Among the routine emergencies, referred mainly from the General Medical side and from Neurology, there were a few patients with hyper-acute onset of severe headache and sudden loss of consciousness without any other problems. The diagnosis of subarachnoid hemorrhage could be made on clinical grounds and by the blood-tinged cerebrospinal fluid. Since most of them were normotensives, the cause of the hemorrhage could not be guessed.
It was here that Dr. Sambasivan had a definite role to play, and by his angiographic studies he could prove that the intracranial haemorrhage in these patients was caused by the presence of intracranial aneurysms at very many different sites, some almost inaccessible. These patients were taken up for surgery within an hour or so. The outcome was mostly successful, though patients coming in quite late after the ictus did not fare well. His initial reports of a rather high incidence of aneurysmal subachnoid hemorrhage (SAH) in Kerala were seen with scepticism by all his colleagues both from India and abroad. I have heard a very senior and respected academic neurosurgeon questioning his claim in an open conference session. Dr. Sambasivan's very polite rebuttal was, 'Sir, if you look for it even among your patients with SAH, you too would agree with my contention, as I am getting a lot of patients from your region also'.
Another disbelieving great vascular surgeon from Canada, Prof. Charles Drake, visited Trivandrum to actually confirm with his own eyes the types of cases Dr. Sambasivan had described. By sheer chance, there was a patient with a large aneurysm of the anterior communicating artery on the first day of his arrival. As would happen usually, he had to perform the surgery in an emergency under local anesthesia, and that too, a bit late in night. The pleased visiting surgeon was convinced about Dr. Sambasivan's cases and his treatment protocols and its successes, even in a very much less sophisticated set up that we had in Trivandrum Medical College at that point of time. His words of appreciation were carried all over neurosurgical fraternity.
With quite limited facilities, he took up very high risk neurosurgical procedures of third ventricular region and pineal body tumors. His paper, when presented in Munich, was immensely applauded and was taken up for publication in 'Modern Neurosurgery'.
He was a daring surgeon who saved a lot of lives. I still remember a 73-year old unconscious woman who was seen by me in 1983 in Government General Hospital, Trivandrum, who was practically dying with recurrent seizures and raised intracranial pressure. The computed tomographic (CT) scan facility had by then become available in Trivandrum in the private sector, and with great difficulty, we got her scan done which showed a large falcine meningoma. She had a lot of co-existing morbidities like severe asthma, psoriasis, and high blood pressure. She was the mother of a very senior police official who initially agreed to accept whatever I suggested as treatment.
On transferring her to the Medical College Hospital the same evening, the officer rushed to me requesting the patient to be discharged as he was told by his friends and superiors that the surgery would invariably be fatal. I had to coax him to get his consent. The anesthetist saw the patient and reported that the patient was unfit for general anesthesia because of her asthma, high blood pressure and generalized psoriasis. Dr. Sambasivan also heard these stories but did not refuse my request to operate. The patient underwent tumor removal in the same evening under local anesthesia. She lived for another ten years to tell the story of her brain tumor to all her kith and kin.
From his early days in Neurosurgery, he was quite active in the Neurological Society of India (NSI). The highest point of his career in NSI was his two terms of Secretary of the society from 1984 to 1990 when India hosted the International Conference of World Federation of Neurological Surgery in 1989 in New Delhi. It was a grand success by any count. He became the President of the Neurological Society of India in 1996.
He trained scores of young surgeons for their Neurosurgery examinations and was as an examiner for MCh Neurosurgery in many Indian Universities. He was a regular delegate, invited speaker, organizer of many international conferences and gradually became a very familiar face in international neurosurgery fora.
He was the Director-Professor of Neurology and the Vice Principal of Trivandrum Medical College for a long time. In those days, it was exceedingly difficult for any of us to get Governmental sanction to go abroad for international conferences even though we paid our expenses. Occasionally, some very unexpected funny events would also arise. Sometime in the early 1990s, the Principal of the Trivandrum Medical College was given permission to attend an Epidemiological Conference in USA. I, too, was given permission to go and present my paper in another conference in USA. The Principal gave charge of the administration of the College to Prof. Sambasivan, the Vice Principal, to whom I applied for necessary leave and permission to leave Trivandrum for a few days.
The Principal and I landed in Los Angeles (LA) airport by different flights on our return trip to India. To my surprise, I found the bald pate of Prof. Sambasivan in a far away seat. Quietly I went to him and asked how he had managed to arrive in LA when he was supposed to be in Trivandrum. He then told the story of how he too succeeded in getting the governmental order permitting him to hand over the charge of the Medical College to his next junior faculty member and to leave station to attend a neurosurgical conference in USA. The Principal was not too happy to hear all these stories but could do nothing as his leave was already granted by the Government.
Prof. Sambasivan was an all-rounder, a much appreciated teacher, a leader among students, an orator par excellence, an organizer with great capacity to get things done when nothing was available, a brilliant neurosurgeon who would take risk to do surgeries, and a wonderful co-worker and friend. I still remember when just the four of us organized the 28th Annual Conference of NSI in Trivandrum in 1978. There were no persons to provide help, both physical or financial, to us. But like a magician, he charmed doctors, industrialists and the government to give us everything we needed to organize a major national conference. The 1978 Trivandrum session was an excellent success.
Again in 1998, we organized the national Annual Conference of the Neurological Society of India (NSI) in Trivandrum. I have very pleasant memories regarding this conference. It was the time when I was elected President of NSI. I wanted to do something worthwhile for our society during that time. I had the pet idea to bring out the history of neurosciences in India and I had all the help initially from only one person, Prof. Sambasivan. I collected most of the data and could get a lot of missing links from him. Despite all the heavy workload of being the Organizing Secretary of the 47th Annual Conference of NSI, he gave me his autobiographical notes in time. I am sure that our book 'Evolution of Neurosciences in India' will remain as a great reference book on the history of neurosciences in India [Figure 6] and [Figure 7].
It is again so pleasant to remember that we- the Department of Neurosurgery and Department of Neurology in Trivandrum Medical College, could work together having the most cordial relationship, unlike the scenario at in many other places. He got plenty of honors and awards both from India and abroad and was elected to World Federation of Neurosurgical Societies. Locally also, he had plenty of honors bestowed upon him.
Even after retirement, we worked in the same hospital for more than 22 years, and in our leisure moments he would recite Samaveda in the most traditional manner. He had a fall and developed multiple problems from which he had almost recovered when the sudden end came on 19th May 2018. I am sure that he will be remembered for a long time as a great name in neurosciences in India [Figure 8] and [Figure 9].
Prof. M Sambasivan is survived by his wife Mrs. S. Gomathy, his children, Dr. Mahesh Sambasivan (neurosurgeon, Cosmopolitan Hospital, Trivandrum), Mr. S. Kumar (Master of Business administration) Mrs. Sreevidya Sivakumar (Master of Arts) and their families and grandchildren.
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Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]