Founders of Indian Neurosciences: Professor Vijay Shanker Dave-The inspiring initiator of neurosurgery in Uttar Pradesh
Dr. Vijay Shankar Dave, lovingly known as Vijaybhai, spent his childhood in Bundi, a small princely state now in Rajasthan. His maternal grandfather was the Dewan of Bundi. Due to a disagreement with the king, he had to leave Bundi for some time and settle in Agra. Vijaybhai was, therefore, born in Agra in 1927. Although the family moved back after a few years, Bundi state was, thereafter, administered by Major W. F. Webb, a British Dewan, and later, Mr. A. W. Robertson. Thanks to them, Bundi had the King George V Jubilee High School, where Vijaybhai studied up to class ten.
He says that as a child, he was very shy. He would spend a lot of time in his maternal grandfather's library, which had books on varied subjects. He remembers reading Gray's Anatomy from this library. He was the first child in the family (as his father was the eldest amongst his siblings) and also the first grandchild in a large family. He proved himself to be good in studies and participated in a lot of activities like hockey and kite-flying. His maternal grandfather provided him training in some martial arts, like using a lathi, a dagger and a shotgun. He developed his love for gardening and nature from his paternal grandfather who was the Garden Superintendent in Bundi.
Most people of his community were either teachers or lawyers and, very rarely, doctors. His own father, Justice Durga Shanker Dave was in the legal profession and retired as the Chief Justice of Rajasthan. His younger brother, Justice Vinod Shanker Dave, followed his father's footsteps and became a judge in the High Court of Rajasthan.
Vijaybhai, however, did not have an aptitude for law. Bundi being a small place had only LMP (Licentiate in Medicine and Surgery) doctors at that time. He remembers one Holi festival day, when he fell and got a deep cut over his chin. The wound was only dressed and not stitched. Epidemics were also common, and both he and his brother suffered from malaria almost every month. As the medications were very limited, they were only allowed to have whey. His paternal grandfather had developed paralysis of one side. His only treatment was the application of massage of herbal oils. All these things made him aware of the deficiencies in medical care in Bundi, and therefore, he decided on medicine as his profession.
He passed in the first division in high school. This was very rare at that time. Mr Robertson, the British Dewan, wrote a congratulatory letter to his father. Vijaybhai joined Saint John's College, Agra, and passed the intermediate science examination in 1944. In 1946, he joined the Agra Medical College. It had earlier been a medical school to train only Licensed Medical Practitioners. It was upgraded into a college in 1939 and named the Sarojini Naidu Medical College in 1947.
In his third year of medicine, he became the general secretary of the students' union and later also became its president in the fifth year. Taj Mahal was his logo with a comment - Taj Mahal stands for beauty - V S Dave stands for duty. His work as president drew the attention of his Principal, Dr. Bhatt. As a part of his responsibility as a president of students' union, he led a lot of programs and introduced many famous guests, like General Cariappa, Sir C. V. Raman, and Dr. Amarnath Jha (the Vice-Chancellor of Allahabad University). The British Council was shifted to Agra for a brief period in those years. Their films division was happy to show medical movies at the college every fortnight.
He worked as a house surgeon under Dr. R.V. Singh, chief orthopedic surgeon, who later became the Principal of the King George Medical College, Lucknow. The antibiotics era was yet to arrive. A lot of injured people were brought in from the areas around. Dr. R.V. Singh was of the view that a proper plaster cast should be given to all patients with fractures, and if there was also an associated compound injury, then the patient should be operated as soon as possible to save him/her from infection. The residents would be, therefore, be operating all through the night. Cranial operations were uncommon at that time.
He remembers an occasion when a team of journalists from Reuters was visiting Agra. One of them injured his shoulder. Dr. R.V. Singh treated him and later received a letter of appreciation from Sir Reginald Watson Jones, the famous English orthopaedic surgeon stating, ‘I could not have done this any better.’
He obtained his M. S. from Agra Medical College in 1955. During this time, he worked under Dr C. B. Singh and Dr S. P. Srivastava, both Fellows of the Royal College of Surgeons. Dr C. B. Singh's son, Dr. Yashpal Singh, was his class fellow.
In 1950, when he was in his fourth year of medicine, he got married. Perhaps he was not mentally ready to be married, but could not go against the wishes of his father. He showed his displeasure by wearing a khaki pant. Belonging to a very conservative Nagar Brahmin family, his father was worried that he may marry out of caste, which was not acceptable at that time. The marriage turned out to be a great success, as his bride, Sudhaben, was every bit as affectionate as was Vijaybhai.
On completing his Master in Surgery (M. S.), he joined as a civil assistant surgeon in the Mahatma Gandhi Hospital in Jodhpur, earlier known as Windham Hospital. He worked under Dr. D. G. Ojha, M. S. from Bombay, and an outstanding general surgeon. From Jodhpur, he was sent to Bundi for four months as Chief Medical Officer in the government hospital. Here, he performed many major surgeries with limited facilities. He won friends and respect by his work.
Dr B. N. Sharma, general surgeon at the same hospital, was an excellent administrator and surgeon. It was also known that he would visit Vienna every two years to observe advances in surgery. As a student, Vijaybhai would observe Dr Sharma's surgeries. Many of them were done under local anaesthesia. At that time, the Government Hospitals at Jodhpur and Bikaner were recognised by the Royal College of Surgeons of England for training for their Fellowship, while Agra Medical College did not have this facility.
Vijaybhai wished to train in neurosurgery under Dr. Jacob Chandy in Vellore. He was disappointed when he was told that there was no vacancy there. About the same time, Dr. Wilder Penfield, Director, Montreal Neurological Institute (MNI), was honoured with a doctorate degree by the University of Bombay. Vijaybhai read about him in the newspaper. Thereafter, on his request, Dr. D. G. Ojha wrote to Dr. Penfield and recommended Vijaybhai's name for training. To his good fortune, Vijaybhai was invited to join MNI a year later for a three-year training program.
Just before leaving for MNI, Vijaybhai joined as Tutor in Surgery at the Sawai Man Singh (SMS) Medical College, Jaipur (in June/July 1958). He took study leave for joining MNI, and on return, rejoined in the same position.
The founders of Montreal Neurological Institute (MNI), a part of McGill University, were Dr. Wilder Penfield and Dr. William Cone, both Americans, who got funding from the Rockefeller foundation to build the institute in Canada. This upset the Americans. The MNI soon acquired a formidable reputation and students flocked to it - one-third from America, one-third from Canada, and one-third from other countries. Every important neurosurgeon or neurologist of India at that time had been to MNI as a visitor, observer or a trainee in one of the departments. Dr. Jacob Chandy from Vellore was a student of Dr. Theodore Brown Rasmussen, and Dr. B. Ramamurthi from Madras as well as Dr. Baldev Singh were visitors. Dr. D. R. Gulati from Postgraduate Institute of Medical Education and Research, Chandigarh, stayed in MNI for four years. Dr. Prakash Tandon from Lucknow stayed there for two years. Vijaybhai spent three eventful years there.
On reaching the institute in October 1958, Vijaybhai first met Dr. Cone, neurosurgeon-in-chief, who was in overall charge of the discipline in the institute. The caretaker showed Vijaybhai his room and made him familiar with everything. It was snowing outside. Like a true Indian, he opened the window for some fresh air, only to be hit by a freezing cold blast of air. It was a lesson for the future, especially in the winter months, when it snowed continuously. Initially, he shared a room with a Belgian colleague.
MNI was beautiful. It had a swimming pool with a backdrop of the mountains, used only by the doctors and nurses in their free time. The institute overlooked a sports stadium. All matches could be seen from the institute windows. The dining hall was huge and could accommodate 2000 people at one time. Everyone from the ward boy to the director ate in the same place. The menu for the next six months was displayed there. Vijaybhai was a vegetarian. Dr. Matheson, Head of Medical Neuropathology, predicted that Vijaybhai would die within six months if he remained a vegetarian. Vijaybhai remained a vegetarian and received special attention from the dietician on duty. He remembers the large helpings of ice cream and milk shakes that he received. Dr. Prakash Tandon, who was also a fellow in the institute, had taken up a private residence and would cook on his own. He would frequently invite Vijaybhai over and serve him vegetables with bread. Vijaybhai, too, tried his hand at cooking later. He discovered that on the sixth floor of the building, there was a kitchen which had an oven that was ideal for making baati (a type of round bread).
When Vijaybhai joined the MNI, he was posted first in the Neuropathology department. Fellows were posted in different departments where they had to stay for at least six months. This schedule was predetermined.
In the Neuropathology department, Vijaybhai was made to go through the entire process of fixation of tissues (including the entire brain obtained at autopsies), sectioning them, staining them and then interpreting the findings. These findings were discussed in periodic meetings.
At the same time, in the main amphitheater, almost every day, they had a guest lecture and interesting cases were presented, but as Vijaybhai and his fellow-trainees were kept busy, they would have to miss these lectures from time to time.
Every resident in the wards had to write the patient's history in detail, discuss the investigations required and suggest treatment. The progress of the patient had to be meticulously recorded. Everything had to be done by the fellows themselves, from taking blood pressure, assessing fundoscopy, charting field of vision, and so on, unlike in India where the doctors were not required to do such things at that time. They also had to help in wheeling beds around! Patients were admitted into the hospital at all times, so the fellows were always kept busy.
Each doctor was rotated through the subspecialties. The senior neurosurgeons had special instruments and would not tolerate a change of instruments for their cases. Dr. Penfield used silver clips to control the bleeding vessels. He would never use electric cautery, as was used by other surgeons.
Before any operation, frequently on the rounds, the operating surgeon would take the opinion of his colleagues. In a particular patient, Dr. Penfield had made a diagnosis of an angioma. He felt that it would be difficult to remove it due to the presence of a tangle of abnormal blood vessels, more so as he did not use electric cautery. He asked Dr. Arthur Roland Elvidge his opinion on how he would handle this case. As Dr. Elvidge suggested surgery, the case was transferred under his care. Dr. Penfield sat in the gallery to watch the surgery. Dr. Elvidge very gently and slowly proceeded to operate without using an electric cautery, as Dr. Penfield was against its use. He waited for Dr. Penfield to leave and then quickly removed the malformation using his own technique with the electrocautery.
Operations on patients with epilepsy were mostly done under local anesthesia with the help of an anesthetist, who would sit towards the head end of the patient. As a part of research, the motor and sensory areas of the patient were stimulated with very low electric current and the response of the patient was recorded. This was how mapping of the brain was done at that time.
In one case, a child who was having continuous fits was admitted in the hospital. Dr. Rasmussen, the operating surgeon, removed a large area of the brain. Despite that, the electroencephalogram (EEG) was showing spikes. Therefore, he further removed more areas from the brain, ending up with a hemispherectomy. The patient (from a South American country) made a miraculous recovery and was free from seizures. He was found happily moving around the ward after three days of the surgery.
The operating time was very long and would sometimes extend beyond 7 hours. The operating surgeons were offered milk or juice through a straw, which they took in without removing the mask.
Dr. Penfield, who was also the Director of the institute, had to be admitted for a tonsillectomy. Dr. Cone came on his rounds and enquired if his rectal examination had been done. Dr. Penfield resisted and said there was no need for this. Dr. Cone gleefully insisted that it had to be done, quoting the adage, ‘If you do not insert your finger in, you will end up putting your foot in'. Dr. Penfield could no longer object to the rectal examination!
Vijaybhai also recalled that on one occasion, Dr. Cone examined a patient with severe sciatica around 10 p.m. and concluded that urgent surgery was required. He asked for a myelogram and Dr. Donald McCrae was summoned around midnight, much to the annoyance of Mrs. McCrae. Dr. Cone completed the operation early in the morning and helped to clean up the theatre after surgery so that it would ready for the scheduled operation in a couple of hours.
Vijaybhai mainly worked under Dr. Rasmussen, who later became the chief of MNI after Dr. Penfield retired. Whenever Dr. Rasmussen went out of station, Vijaybhai was left in charge of his patients. Dr Rasmussen kept in touch with Vijaybhai even when he was back in India. He sent him reprints of all his research papers.
Dr Elvidge used to go out for a holiday every year. On his return, he would give an interesting talk of the places that he had visited and what he had done during his vacation.
The time spent in MNI was indeed memorable for Vijaybhai. Besides the training, he remembers visiting Ottawa with Dr. Elvidge to see the famous tulips (sent in gratitude by the Dutch royal family as their future queen had taken shelter in Canada during World War II); a 15-day yoga camp in the mountains with Swami Vishnu Devananda, a disciple of Swami Shivananda; and, a visit to the Niagara Falls with Professor Gulati from the Postgraduate Institute of Medical Education and Research, Chandigarh.
Why did Vijaybhai return to India when he had an option to stay on? Vijaybhai had got married when he was in his fourth year of medicine. His wife could not accompany him to Montreal. In his three years in Canada, he spoke to her just once on the telephone. They did exchange a lot of letters though. His wife and two sons were the reasons for his not staying back in Canada.
On returning from MNI, he joined the surgery department of the SMS Medical College in Jaipur but did not stay there for long. As it happened, the younger brother of the superintendent of the hospital, Dr. M. G. Sarin had studied neurosurgery from Vellore. Vijaybhai was not given independent charge but was asked to assist him. No facilities were given to Vijaybhai and his request for five independent beds was turned down. This frustrated him, and he finally resigned.
Dr R. G. Ginde, the leading neurosurgeon of Bombay, had visited MNI when Vijaybhai was studying there. He had offered Vijaybhai the post of his assistant in Bombay on completing his training, at a promised sum of Rs 800 per month. This offer was revived when Vijaybhai met Dr Ginde at a neurological conference at Indore. At that time, Dr. Ginde was operating in Bombay Hospital and seeing patients in Breach Candy Hospital. He had a consulting room in this hospital, which was only meant to treat Europeans at that time.
On resigning from SMS Medical College, Jaipur, Vijaybhai shifted to Bombay as an Honorary Assistant Professor in Neurosurgery at the Grant Medical College and as Honorary Assistant Neurosurgeon in the allied Sir Jamsedjee Jeejeebhoy (JJ) Hospital. He worked with Dr. Gajendra Sinh. He proved to be an asset to Dr. Gajendra Sinh (as he was, later, to Dr. Ginde). His gentle, pensive approach to any puzzling neurological problem, coupled with the fruits of his experience at Montreal, made him an ideal colleague. One of his residents at J. J. Hospital recalls the following incident.
J. J. Hospital was frequented by very poor patients who often came long distances seeking succor. Run by the Government of Bombay, it had limited facilities. A patient known to have haemophilia was admitted to the Neurosurgery ward in an abnormally drowsy state with one-sided weakness. Vijaybhai was on emergency call that evening. He came to the hospital and after examination of the patient, made a diagnosis of bleeding into the subdural space. He spoke to the patient's family of the need for urgent evacuation. On obtaining their consent, he took the patient to the operation theatre and evacuated the blood through burr holes. The family was relieved at witnessing the patient's return to consciousness. The weak limbs also showed an early recovery. Two days later, the patient's condition worsened and he lapsed into a semi-comatose state with hemiplegia. It was obvious that fresh bleeding had occurred due to the inherent inability of the patient's blood to clot. Once again, the blood was evacuated through the burr holes drilled earlier. The patient recovered consciousness and started moving his limbs, only to undergo the same cycle a few days later. Vijaybhai knew of the need to infuse factor VIII but this had to be imported. The hospital did not stock it and the family was too poor to import it. Undaunted, Vijaybhai approached Dr. Jaggubhai Parikh, the Professor of Haematology in the Hospital and its affiliated Grant Medical College. Dr. Parikh commiserated with him on the dilemma faced by Vijaybhai and the patient but had no access to factor VIII. Recalling a patient, he had treated earlier, Dr. Parikh told Vijaybhai of how, under somewhat similar circumstances, in desperation, he had injected blood withdrawn from a healthy volunteer into the knee joint of his own patient, which kept filling with blood. The bleeding had stopped. Vijaybhai spoke to the patient's family and suggested a similar course of action for their patient. They willingly agreed. The patient was taken to the operation theatre and 20 ml. of blood was withdrawn from a resident doctor and directly injected into the subdural space after the accumulated blood had been evacuated. The patient made a smooth recovery thereafter, as the coagulation factor in the donated blood assisted in coagulation of the bleeding vessel. Somehow, Vijaybhai did not write this experience up in a medical journal though he often spoke of it to colleagues and whilst teaching students.
A few years later, Dr. Ginde was appointed Director of Neurology and Neurosurgery, Government of Maharashtra, with an office and appointment of Honorary Professor and Consultant Neurosurgeon in J. J. Hospital. Dr. Sanat Bhagwati was appointed as Dr. Ginde's assistant. Dr. Ginde requested Vijaybhai to move from Dr. Gajendra Sinh's unit to his own unit, and Dr. Bhagwati was to be transferred to Dr. Gajendra Sinh's unit. This request proved to be embarrassing for Vijaybhai. He discussed this with Dr. Gajendra Sinh, who graciously suggested that in view of all that Dr. Ginde had done to help him, this change might be beneficial. Thus, it came about that Vijaybhai worked with Dr. Ginde both at J. J. Hospital and at Bombay Hospital. After Dr. Ginde suffered a heart attack, Vijaybhai attended to his patients.
Vijaybhai recalled an interesting experience when Dr. W. B. Scoville spent a few days with Dr. Ginde in Bombay. Dr. Ginde was wary of Dr. Scoville. Before taking him around his ward in J. J. Hospital, Dr. Ginde told Dr. Dave: ‘Don't let him get his hands on any of my patients when I am out of Bombay.’ Seeing four patients with atlanto-axial dislocation under Dr. Ginde's care in the ward, Dr. Scoville exclaimed: ‘These are very good cases for trans-oral surgery. Let's do one tomorrow.’ Dr. Ginde asked: ‘Have you done these operations earlier?' ‘No’, replied Dr. Scoville ‘but it should be a cinch.’ Dr. Ginde suggested they try out this operation in the autopsy room instead and off they marched to the pathology department. After studying the anatomy there, Dr. Scoville was prepared to go ahead but was frustrated by Dr. Ginde.
Vijaybhai also spent several hours sitting with Dr. Darab Dastur, Professor of Neuropathology at J. J. Hospital, poring over the histology slides and discussing unusual findings.
His four years in Bombay were not easy. His wife was happy to join him in Bombay even though they could only afford a one-room flat. He earned very little and his self-respect would not allow him to take help from his family. He travelled in the local buses and trains, and changed his residence every 11 months, as he could not afford to pay the pagri (a lump sum deposit required for getting rented accommodation). Two of his sons lived with his parents in Jodhpur and his youngest son and niece lived with him.
His affable nature enabled him to make friends with his colleagues. He recalls with joy, his association with Dr. J. C. N. Joshipura, Professor of Orthopaedic Surgery at J. J. Hospital, with whom he spent several hours visiting art galleries in the afternoons after completion of work at the hospital, and before starting work at their respective consulting rooms. He was also befriended by Dr. D. S. Dadhich, consultant neuroradiologist at Bombay Hospital and Dr. Vijay Daftary, Professor of Neurosurgery at Topiwala National Medical College and Bai Yamunabai Nair Hospital in Bombay.
Vijaybhai was offered the full-time post of Professor in Neurosurgery at Grant Medical College. Dr Gajendra Sinh advised him not to accept the position, as at that time in Bombay, the Honorary Surgeons were given more importance than permanent faculty. About the same time, he received a telegram inviting him to join as Professor of Neurosurgery in King George Medical College (KGMC) Lucknow.
Vijaybhai was appointed as Professor of Neurosurgery at KGMC, Lucknow in 1966 and headed the Neurosurgery department up to 1988. He had not applied for this post. It so happened that Dr. Prakash Tandon, on his return from MNI, Montreal, had joined KGMC Lucknow as Professor of Neurosurgery. He then joined All India Institute of Medical Sciences (AIIMS) in Delhi, and the post at KGMC was unoccupied. Dr. Ginde visited Lucknow for the selection of his replacement but did not find any suitable candidate. While leaving Lucknow, he suggested Vijaybhai's name for the post. Thus, Vijaybhai received an appointment letter without appearing for an interview.
At KGMC, Vijaybhai developed the Neurosurgery department, obtained necessary instruments and started a full-fledged service that treated all patients needing neurosurgical care, including those with injuries to the brain and spine. He was instrumental in getting a computed tomography (CT) unit set up at KGMC.
When Dr. D. K. Chhabra joined Vijaybhai as a young resident, the department got a big boost, as Dr. Chhabra had an innovative mind. His hard work, ingenuity and selflessness were immensely helpful in making further improvements in the department. Dr. Chhabra was later to earn international renown as the person who designed and fabricated the cerebrospinal fluid shunt named after him. He went on to become the first Professor of Neurosurgery at the newly created Sanjay Gandhi Postgraduate Institute in Lucknow.
Vijaybhai's honesty and ethical practice were legendary. Here is just one example. A former student of his from Bombay recalls visiting him in his home in Lucknow on a Sunday when a greatly agitated person was ushered in. This person's son had a severe head injury in a town at some distance from Lucknow and he wished Vijaybhai to come with him on a visit. He offered a generous fee for this service. Vijaybhai asked him to sit down and gently explained why it was preferable to bring the child as soon as possible to his department at KGMC. On admission, Vijaybhai would examine him and, if needed, get an urgent CT scan done. Treatment would be instituted on arrival of the child. If surgery would be needed, Vijaybhai offered to do it himself. Since KGMC was a state hospital, no fees would be levied. He also did not charge the father for this consultation and advice.
Many others have recounted similar experiences with Vijaybhai. Due to his long contribution to Neurosurgical services of Uttar Pradesh, The Dave-Newton oration of KGMC is conducted every year in his honor [Figure 1], [Figure 2], [Figure 3]; Dr. Newton, trained at Christian Medical College, Vellore, and was the other faculty member in Vijaybhai's department in KGMC].
After retirement from KGMC, he joined Krishna Medical Centre (KMC), a private nursing home in Lucknow. This center was created by his colleagues Dr. Chandravati (Professor of Obstetrics and Gynaecology at KGMC) and Dr. Maya Mathur (Chief Medical Officer at KGMC). These two amazing ladies had a profound respect for him. They created a separate operating room for Neurosurgery and supported him in every way. Dr. Piyush Mittal, who had been his student, joined him as an associate and later took over his surgical work as Vijaybhai developed painful knees, which made it difficult for him to stand for long hours at surgery
He required knee replacement surgery. Conflicting opinions from orthopedic surgeons, including Dr. P. K. Dave from the All India Institute of Medical Sciences (AIIMS) and his very good friend, and the eminent ‘Jaipur Foot doctor’, Dr. P. K. Sethi, opined that he could do without the surgical option. He followed their advice. However, his movements became difficult. The painful knees did not permit him to continue his daily walks in the Botanical Garden of Lucknow close by his house. He enjoyed these walks amidst friends and old trees, and he did persevere as long as possible until the pain was such that he was forced to limit his walks to his own garden. Over the years, he continued with his consultancy, stopping his surgical work. Vijaybhai remained with KMC till April 2012, when he moved to Delhi.
Sudhaben passed away suddenly in the year 2009. This was a great loss, as they were an extremely affectionate couple and he was dependent on her. Thereafter, he lived alone in Lucknow till 2012, when he developed severe meningo-encephalitis. He was admitted to the All India Institute of Medical Sciences (AIIMS), Delhi, where he remained as an inpatient for almost three months. He recovered fully due to the excellent treatment at AIIMS and his own will power and determination. He now lives with his son and daughter-in-law in Delhi.
His routine includes exercise, walking around in the colony, interacting with friends, and a constant attempt to keep up with the new digital world of WhatsApp and email. He is fortunate to have a large family living in Delhi. He feels especially supported by his brothers. While he has several regrets, the main one remains that for much of the first fifteen years of his married life, he could not be with his wife.
He says he had no time for writing as the hospital work kept him very busy. He had intended to write after he retired. He documented and stored a large volume of his clinical notes in short hand. These documents were possibly undecipherable to most of his associates and students. He thought that he could get time later on to rewrite them after he retired from KGMC. However, the dusty piles of papers had to be finally consigned to flames as he was very allergic to dust and mites. This is something he regrets.
Vijaybhai has led a very active and productive life. He has the satisfaction of seeing his students holding professorial and even directorial posts in reputed Indian medical colleges, hospital and institutes.
He has helped countless medical students.
His colleagues always remark about his gentle nature, ability to steer clear of controversies and his gentlemanly qualities that made his seniors, fellow professors, residents and students look up to him with respect. He has proved, both in Bombay and in Lucknow, his skills as a clinician and as a neurosurgeon.
He has always preferred to stay in the shadows and has shunned the limelight. He sought no recognition and preferred the love and affection of his patients and approbation of his peers to felicitations and awards by organized bodies.
Most of all, he has inspired honesty and ethics in all those who have had the good fortune of training with him.
Dr. Devendra K. Chhabra, Department of Neurosurgery, Vivekanand Institute of Medical Sciences, Lucknow
I had a very deep and intimate professional understanding with Professor Dave. Professor Dave would say, ‘Doctor Chhabra, us patient ka woh karva dijiyega' (‘Please get this done for that patient’) without specifying any furthereither the work to be done or the patient on whom the instructions needed to be carried out. I would immediately know what exactly Professor Dave wanted to be carried out for a specific patient. We shared an extreme degree of mutual trust for each other. On every Teacher's Day and on Professor Dave's birthday, till today, I have always had the privilege and honour of greeting him.
I lost my mother at an early age and was naturally disturbed. To overcome my grief, I joined duty after the fourth day ritual. Professor Dave sent me back, with instructions to join the department after the thirteenth day. He explained to me that it would not be fair to the patients if I cared for them when I myself was upset. That was the level of his commitment to the cause of patient care. Another statement that Professor Dave often made when I was troubled by the politics of the General Surgery department, of which Neurosurgery then was a unit, was, “Have patience, truth will prevail”. I have never forgotten this statement. This is also the mantra that is followed by me till date.
Dr. A.K. Singh, Department of Neurosurgery, Max Super-specialty Hospital, Dehradun
I first became aware of Professor Dave, Head of Neurosurgery Unit, Department of Surgery, King George Medical College, in 1973 when I was posted for 6 months as a house surgeon. Our contact was largely with Dr. D. K. Chhabra, then a lecturer, as house surgeons reported to him. Professor Dave was in a stratosphere for us. But, there being no one between house officers and Dr. Chhabra, we did get to scrub with Professor Dave as a second assistant. He has been very dignified, never seems to lose his temper and has a beautiful smile, which lights up his face from ear-to-ear; he also possesses twinkling eyes full of warmth and charm. His face sometimes turns bright red in mirth, and rarely, he breaks out into a hearty laugh.
After completing my MS in General Surgery, Dr. S C Tandon (at present, the senior neurosurgeon from Varanasi) and I joined as postgraduates pursuing the MS degree in Neurosurgery. Most of my memories relate to the period from January 1976 until March 81, after which I left Lucknow and joined the GB Pant hospital in Delhi. Dr. Dave was the soul while Dr. Chhabra was the body of our existence in those years. I am going to recollect some events that loom large even after so many years. They are not in any chronological order. Kindly bear with me. These are impressions.
What he taught us was to focus on small things and larger things will take care of themselves.
“Treat patients as human beings.” he would often remind us; and, he would even berate us if needed, that all patients are human beings with problems for which we may have a solution. I vividly remember a time when I had tried putting in a venous canula in a child and was unable to do so in two attempts. Dr. Dave was quietly watching. After the second failed attempt, he looked at Dr. Chhabra and indicated that he take over the procedure. His words, after we moved away from that patient, were, “How would have you reacted had that been your child?” It hurt badly (I was unmarried then!) at that time, but after the heat of the moment, it dawned upon us how profound that simple statement was. We, as doctors, often look at patients as mere numbers, and as depersonalized problems, solely focusing on their ailments, the diagnosis of which needs to to be established.
One day, we went on a round in the general ward. Dr. Dave noticed that the sink, which was located right opposite the door, was dirty. He gently told the sister in-charge to get it cleaned. After the round of 6 beds was over, we again passed in front of the sink. Dr. Dave noted that the sink was still dirty. He stopped, took off his coat, hung it on the chair, rolled up his shirt sleeves, and quietly proceeded to clean up the sink. After that, he dried his hands, put his coat back on and continued with the round without a word to the sister. I noticed her crying as we moved past her. Never again was the sink ever found dirty.
In those days, we had very few nurses and orderlies in the operating room. Often, the nurses would be busy arranging trolleys or cleaning up instruments after an operation. Mostly, Dr. Chhabra or one of us would help out the nurses. But if we were busy elsewhere, Professor Dave would pitch in without an iota of ego.
At times, he could be very short-tempered too. I remember an episode on a Sunday morning. Dr. Tandon and myself had finished our round of the post-operative ward when Professor Dave turned up for his Sunday round. One of the patients who had been operated the previous day for a prolapsed lumbar disc sat in bed. On being asked by Professor Dave how he was, he replied that he was okay but the bed was very uncomfortable and he could barely sleep at night. Professor Dave bent down and found a loose spring hanging down. He straightened with his face red with anger and eyes blazing and promptly stormed out of the ward and the building. Both of us ran after him. He was boiling with anger. He said that neither of us deserved to be neurosurgeons, or surgeons, or even doctors. And he stormed off the hospital. The patient had, of course, not mentioned anything to us!
Once, when both of us went for evening rounds, the intern posted in the postoperative ward stated that Professor Dave had already conducted his evening round and had told him to start chloramphenicol for a patient but had instructed him to seek our permission first before doing so. We were both confused as to why he did not simply order it! After all, he was the boss! Then it dawned upon us that that was his way to force us to think for ourselves and to defend our decision. Sure enough, we were asked the next morning why we had agreed to start chloramphenicol and whether or not we knew the side effects of the medication.
One day, although I do not remember the reason that triggered the reaction, he thundered that he could train our fourth class-failed operating theatre orderlies in 3 months to be better surgeons than us. We were being trained not to be technicians but to be neurological surgeons. I am often remined of the wisdom of those words as I see a whole lot of junior colleagues heavily focused on learning newer techniques and being neglectful of the reasons for doing so.
He had a habit of asking on rounds, “Aur doctor saheb, uska kya hua?” [“And doctor, what happened to him”] without ever specifying which patient he was referring to! No matter how hard I tried, I could never guess which patient he was alluding to! What made the matters worse for me was that both Dr. Chhabra and Dr. Tandon almost invariably knew which patient he was referring to! I felt as the outsider, as the one being kept deliberately outside the charmed circle. It was much later that I understood, with a lot of help from Dr. Tandon, that he expected us to keep thinking of any patient who had any unsolved problems or of rare occurrences. It was not a game with him. It was a ‘Zen' way of teaching to keep working at problems until a solution presented itself.
He was very inquisitive about everything. Once we were going from the Surgery department towards the Medicine Block to see a referral. On the way was a cold-water vendor. Dr. Dave casually asked out loud if anyone knew how the water was kept cold despite the sweltering heat? None of us knew the answer. We thought it was an idle enquiry. But the next day, he again asked if we had found the answer. Dr. Chhabra then found out the answer and had to explain the process in great details before Professor Dave was satisfied. Professor Dave was making a subtle point that an inquisitive mind does not restrict oneself to a narrow range of topics. Anything not understood needs to be enquired into. He inculcated in all of us the spirit of developing an inquisitive mind, which has been a source of great pleasure for all of us while performing our work over all these years.
He was very demanding when it came to patient care and other patient related activities. The person who joined the department after we left had to leave the course after 3 months because he could not examine fundus and blamed us, the seniors, for not teaching him the technique. The next candidate had to leave because he confided to one of us after 3 months that he was colour blind. The next candidate had to leave after 2 years because of death of a patient from a preventable cause during his watch.
Dr. Chhabra had been assisting Professor Dave for over a decade in all the major cases like vestibular schwannomas. Professor Dave kept on telling him to go ahead and do one himself but Dr. Chhabra, out of deference to him, kept on refusing. Then one fine day, he asked Dr. Chhabra to start the suboccipital craniectomy and said that he was going out for some time and would be back soon. After the dura had been exposed, a search for Professor Dave was initiated. But no one could find him at any of his usual haunts. Dr. Chhabra waited for almost an hour and then went ahead with surgery. It was conducted without any problems. Professor Dave reappeared at around 4 pm with an impish smile on his face to enquire how everything went. He knew that the only way to force Dr. Chhabra to go ahead and operate independently was for him to disappear at the last moment.
Professor Dave's attitude toward bureaucrats and politicians was, at best, dismissive. He would often say that all of them deserve to be thrashed after throwing a blanket over their heads for all their misdemeanours. After saying that, he would break out in guffaws. But he was never ever disrespectful towards them in personal interactions. In fact, he was widely respected not only for his professional acumen but also for his exemplary honesty, straightforwardness and gentlemanliness. He despised double speaking and dishonest behaviour.
His attitude towards publishing cases was the one most intriguing. Dr. Chhabra had perfected the technique of percutaneous selective third ventriculostomy and taught both of us as well. Our success rate was over 90% with a complication rate below 1.5%. We wanted to publish it. Professor Dave refused permission on the ground that while we were adequately trained, once the technique was published, many would also try it without the necessary preparations and land in trouble, possibly causing damage to their patients. We were using ‘Conray’, an ionic preparation in those days, which was an irritant to the cerebral cortex. Another time, we had a young female patient who had a large chondrosarcoma which was safely removed. The world literature had less than 10 reported cases until then. We were keen to publish it. Professor Dave dismissed it by stating that this would add nothing to the existing knowledge about the problem and only add to ‘increasing the pollution'. After I moved to Delhi, in 1982, I started performing microvascular decompression for trigeminal neuralgia. The vascular decompression was carried out by the retro-mastoid craniotomy. The results were gratifying. The technique had been published by Peter Janetta only in 1981. On my next visit to Lucknow, I excitedly mentioned to Professor Dave about this new and successful technique. Professor Dave asked me to wait for 5 years for the long-term results to accrue before promoting the technique. The habit of not publishing results of a procedure in a hurry has been with me ever since.
After we had passed our examinations, we started looking for a job, since King George Medical College had no vacancies for a neurosurgeon. A job had been advertised in the Postgraduate Institute of Medical Education and Research, Chandigarh. Professor Dave was supposed to be an interviewer. He withdrew from being a selector once he knew that we had applied for the job. Both of us were quite upset and could not help cornering him. His reply was, “I trained you people. I cannot not select you… but if I were to select you, not only will I be accused of bias but you too will start on a wrong footing as no one will believe that you had got the job on your own merit.” He withdrew himself from many other selection boards as well, until both of us obtained our respective jobs.
I never was aware of his funny side. This was due largely, perhaps, to my own dour nature! That has been one of the biggest losses of my life. I have, over the years, learnt from many of his other students about the lighter side of his nature. His ability to crack jokes, to enjoy a small drink now and then, to be just human.
He has been a very self-effacing person. He has always been content to be a good clinician and a good human being. The stage has never held attraction for him.
Dr. I.N. Vajpayee, Department of Neurosurgery, GSVM Medical College, Kanpur
In the year 1976, when I was an intern in Neurosurgery and posted in the intensive care unit, a patient was admitted with a head injury. Her carotid angiogram was showing a temporal contusion. Professor Dave came on the rounds in the evening and asked me about what could be done in this case. I replied and suggested that mannitol be given to reduce the brain oedema. He asked about the side-effects of giving mannitol to which I replied that the intracerebral blood clot may expand, and that the brain swelling may also paradoxically increase with a prolonged usage of mannitol. Professor Dave then asked, “What should now be done?”
I replied, “Well Sir, we have to keep a close watch and if there is deterioration in the clinical status then surgery may be undertaken.” He left the ward with the instruction that if there is deterioration in the clinical status of the patient then he may be informed. In the night, I observed deterioration in the clinical status of the patient and immediately informed him. He immediately came and operated upon the patient. The lessons that I learnt from this episode was on how to teach decision-making to students; to make them feel responsible for their cases; and, also to seek cooperation by sharing.
In the year 1977, I was doing my M.S. in General Surgery. My thesis was entitled ‘A clinical study of extra-dural haematoma’. In that thesis, I made an observation that those cases in whom surgery was performed within eight hours had a higher mortality rate than those operated otherwise. Professor Dave asked me, “Why should you operate within eight hours?”
I replied, “It is because of the patient's clinical deterioration.” He said, “Write that, ‘When you are compelled to operate it is because of clinical deterioration of the patient.’”
This episode illustrates his keen analysis of every sentence and a meticulous examination of the thesis. I still remember his comments on the review of literature, and the appreciative comments which he made, stating with humour, “Has this thesis been written by Dr. Vajpayee or by someone else.” This episode illustrates his keen analysis of every sentence and a meticulous examination of the thesis.
I joined the Department of Neurosurgery, King George Medical University in 1980. At that time, he was offered the post of Head of the Department of Surgery and also Principal of the College, as he was the senior-most Professor. He declined the offer. This shows his commitment to neurosciences. He told me, “A surgeon writes with his knife and not with his pen.”
There were specific instructions from Professor Dave that all the spinal plasters had to be done by the neurosurgical residents. After he gave his instructions, he came to know that a plaster was done at the Orthopaedic department. He became so angry that he took ward rounds alone with the sisters and did not allow residents to be with him for those three days. This demonstrates his level of discipline.
Most of the times, Professor Dave started his round from the toilets. If the toilets were unclean or the ward was dirty then he kept the keys of the operation theatre and did not allow any operation to take place until the ward and the toilets were clean. He was extremely particular about the cleanliness and use to say, ‘Infection is the graveyard of neurosurgery'.
After my M. Ch. (Neurosurgery) examination and the viva voce were over, there was an informal session which was organised with the examiners. Finally, the result was declared with his statement, “Till this day, you were the trainee in Neurosurgery. We are, today, humbly making you a student of Neurosurgery, as nobody can become the master of a science.” This showed his keen desire to continuously learn; and, he also wanted his students to carry the same desire.
While I was working with him in his private clinic, on numerous occasions, the attendants would ask for concessions, and mostly the Professor said, ‘Don't charge my operation fee.’ This illustrates his immense compassion and concern for his patients.
I was posted in Kanpur as an Assistant Professor in the medical college in 1986. I had a premature daughter at that time and she was kept in the intensive child care unit in Lucknow. Professor Dave and Mrs. Sudha Dave provided all the care and support to my wife and child as I was able to only get away once or twice a week from Kanpur to visit them.
On the lighter note, once I was talking to my colleagues and Professor Dave was sitting beside me. Suddenly my wife entered and I became quiet. My colleague said, “[INSIDE:1]” [“He has had a speech arrest”]. Professor Dave imediately quipped, “This is a universal fact. Why are you focusing on him alone?” He would hardly take any drinks. After taking half or one peg, however, he would start enjoying himself, and sometimes, sang too. While I was leaving for Kanpur, he gave certain guidelines which I believe are relevant for everyone: 1. There are no shortcuts in Neurosurgery. 2. Never compromise the quality for the sake of quantity. 3. A greedy professional loses grace. 4. I have taught you Neurosurgery but I could not teach you how to make money. This you will have to learn yourself.
Togetherness with Prof Dave and Professor Chhabra was complete. One was full of wisdom and knowledge, and the other was having great organisational skills. They created a wonderful department with a family-like atmosphere.
Dr. B.K. Ojha, Department of Neurosurgery, King George Medical University, Lucknow
Recently (18th November 2017), I had a chance to meet Professor Dave at his residence in Delhi. where he now lives with his son, Dr. Ajay Dave and his family. We talked for more than 2 hours. Professor Dave told me a lot of things. He grew up in Bundi, a small town in Rajasthan, 220km away from Jaipur. He was very shy during his childhood and used to speak very less. The people used to tease him by calling him dumb ("Gunga”) but his Nanaji used to cheer him a lot and used call him as Vijay Bahadur. He remembers the enjoyment of his childhood days when he used to sit on the wall of the forts in Bundi and used to revel in the scenic beauty of the hills, the birds and everything natural around. He used to enjoy the echoing sound from the hills, after he shouted standing on the top of the hill. He used to see the birds in the sky from the walls of the fort on the hill, forming different but very interesting patterns. He recalls seeing a sky full of stars and had developed a lot of interest in astronomy. He also recalls that despite his shy nature, he was forced to have training in musical instruments and in handling a knife, a laathi (a long and thick wooden stick), sword and guns. First, he was given an air gun, then some other gun, then an Afghani gun, then a proper gun which was called as “Topi Wali Bandook” (a gun with a cap). During one session with this new gun, the bullet exploded within the gun, scaring him. Thereafter, his Nanaji allowed him to leave his gun practice.
He remembers that the administration was very good, and that the roads used to be of very good quality. He recalls the name of Mr. Rustam Ali and Mr. Buland Khaan, who were the ‘sipahsalaar' (the bodyguard to his maternal grandfather who was the Dewan of Bundi), who used to check and report on the quality of roads in that area. His father had a limited income and he had to manage a large joint family. Dr Dave recalls how his father used to maintain the account book by entering details of all the money spent by the family.
After joining KGMC, Professor Dave's life got settled and he has fond memories of his Lucknow life. He had a large bungalow and the gardener Jai Jai Ram was very good. Almost all of their daily needs of vegetables and fruits were fulfilled from their own garden. He used to send fruits and vegetables to other faculty members of KGMC too. Professor Dave became very emotional when I asked him about his wife. He said that his memory has become very weak but he still remembers the date of his marriage because his wife used to make him memorize the unique date of their marriage, which was 5-5-50, that is, 5th of May, 1950.
At KGMC, he used to visit Professor P C Dube (former Head of the Department of Surgery, KGMC from 1982-88) frequently for meetings, always having a cup of coffee with him. He had great regard for Professor P C Dube, who had translated ‘Gita' in Hindi and English. When Professor Dave was offered the position of Head of General Surgery, he had refused the offer stating that he was content to serve in the Neurosurgery unit and did not want to take up the additional burden of being the Head of the Department. Similarly, he was offered the post of Principal of KGMC, but he refused on the same grounds. Professor B B Sethi (former head of Psychiatry department, KGMC, who later became the founder Director of SGPGI, Lucknow) became the Principal of KGMC. Professor Dave has a great respect for Professor BB Sethi, too. Professor Sethi, used to take frequent official leave from office and ask Professor Dave to look after the work of the Principal, KGMC.
When Professor Dave joined KGMC, he was directly appointed as Professor of Neurosurgery. Dr. G.B. Newton had been working at KGMC since 1965, and he was on the post of lecturer. Professor Dave used to feel very bad about this fact. He tried very hard to get a post of Professor for Dr Newton but the government officials did not help him. One day, he asked for an appointment with Mr. N D Tiwari, the Chief Minister (CM) of Uttar Pradesh at that time. The CM immediately called him the next day at his home for breakfast. At breakfast, the CM asked Professor Dave what he could do for him. Dr Dave informed him that for many years, he had been trying for another post of Professor in the department but that no one was helping him to create a post. Mr. N D Tiwari assured him that the job would be done, and to Dr Dave's surprise, the order came on the very same day, in the afternoon.
Mentioning and remembering such small but important events, he was appearing very happy and very satisfied. He said that if he is given a chance in his next life, he would like to become a faculty member of the Department of Neurosurgery again at KGMC because his life had become joyous and beautiful after joining KGMC.
Dr. Sanjay Behari, Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow
My father, Dr. Pramod Behari, was a Neurosurgeon in Jaipur, Rajasthan. During the years 1961-62, after completing his MS in General Surgery, he had worked as a neurosurgical trainee with Professor Ram G. Ginde at Bombay Hospital. My father, thereafter, joined as one of the founder faculty members of the Department of Neurosurgery, SMS Medical College, Jaipur and subsequently took further training in Neurosurgery at Berlin in Germany. I have had the good fortune of meeting Dr. Ginde at Jaipur as a young student, when he visited our home. My father also often spoke to me of his immense respect for Dr. Dave, whom I had never met before joining SGPGI, Lucknow. To me, even as a young boy, the immense reverence with which my father held both Professor Ginde and Professor Dave was crystal clear. Destiny ordained that I spend my neurosurgical career in Lucknow, being a trainee of Dr. Dave's student, Professor Chhabra. During my foundation years in Neurosurgery in Lucknow, I immediately could understand the reason for my father's immense respect for Professor Dave. Professor Dave along with Professor Devika Nag, the eminent neurologist and former Head of Neurology, KGMC, Lucknow, have been the epitome of grace and courtesy. They used to participate in every single neurosurgical meeting, even years after their superannuation. The grace and mutual respect with which both of them led every monthly neuroscience meeting was an inspiration for all of us young students. It has been amazing to note that the inspiration that these two leaders have provided to the Neurosciences group of Lucknow has percolated down to several generations. Even today, the monthly Lucknow Neuroscience meetings are being held regularly with the same amazing grace and camaraderie.
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[Figure 1], [Figure 2], [Figure 3]