The Lillies flower two times in a year ! During the rest of the time they just have leaves. During summer months even leaves are not seen! Theirs is quiet existence and exuberant presence!
There is a rush and competition for visibility and prominence in our society. There is palpable envy when someone does better than ourselves.
I have several instances when a clinical diagnosis was made by someone else, which I could not make myself! During the early years in my clinical work, I felt uncomfortable when I could not offer the diagnosis. But over the years, I became aware that the practice of medicine is collaborative.
This dawned on me for the first time, when an Occupational Therapist in 1983, working in MITHRA, Anna Nagar, Chennai, a rehabilitation centre for children, suggested to me about a child whom I referred to her for therapy, that she could fall in the autistic spectrum diagnostically. In fact I had no experience with children who manifested autistic features at that time. I felt embarrassed and felt at a loss!
That was the first instance I recall, when I had to face this reality that others can know better and more and every opportunity is an occasion to learn! It took a while to get into this mould of thinking.
Soon after that, while on a clinical round of the newborn unit at Rainy hospital, Chennai, a junior resident pointed to me some skin lesions in a new born. They looked slightly crusted and bullous. I suggested it to be Impetigo! But he turned and asked me it it could be Incontinentia Pigmentosa! He was right. A second occasion in a fortnight that affirmed the same message about being collaborative.
Shortly thereafter, while in a clinical meeting in CHILDS Trust Hospital, Chennai, I was shown a child who according to them had Keratomalacia due to vitamin A deficiency, but I suggested that the child had Hurler syndrome because of features suggestive of Mucopolysaccharoidosis. That helped me even more to feel that all through the medical journey ahead, it would be co-learning with others!
It was when I was working in CMC Vellore in 1980-82 and 1997-2008 when I sensed the value of openness to learn from others. The clinicians often consulted each other for diagnostic confirmation. The senior professors would most gladly accept the proposal of a diagnosis, which they missed, from a younger member of the team and acknowledge it publicly. A resident made a brilliant diagnosis of Brucellosis in a child who had Fever of Unknown Origin lasting for six weeks and all investigations were proved negative. The professor was profusely glad with with a rare diagnosis, which was later confirmed by laboratory tests. On another occasion, I missed a succution splash, while examining a child with pneumothorax, which the resident later demonstrated to me. On the next bed, a child with convulsion on one side was being treated for hemi-convulsion. I noticed a capillary haemangioma behind one ear. So the diagnosis changed to be Sturge Weber syndrome.
This is the way we all function in clinical work. We continue to learn from each other and are dependent on each other. This is true collaboration.
Professor Malathi, under whom I worked, would take me along with her sometimes, while visiting some children in the ward, whom she admitted to examine one more time, to look for any clinical signs she might have missed! This to me is the openness to learn by re-examining and revising one's own thoughts.
While watching these Lilies in our garden, I felt enthused by its anonymous existence for most of the year. It is not seen or noticed.
Some of us in clinical work might feel that others get the attention because of their diagnostic skills or teaching skills or treatment planning skills. Let us look at them as those from whom we can learn if only we are humble and open! Those of us who are good at some things, ought to be generous to pass on our skills to others.
Of late, because I work in a team of professionals from other disciplines, I get valuable input from them because of which diagnostic and treatment planning have become easier. Some of my colleagues would have noticed the dysmorphic features, while gathering the clinical story of a child, which they bring to my attention. The post graduate trainees point out some observations which give valuable clarity to an ambiguous clinical profile.
While at working at CMC Vellore, we had a sleep monitoring facility in the Hall of Residence. I learned a lot about different parasomnias in children, from the observations which the night nurse would have made about a child!
The two Lillies in the photo in this blog are different in height and appearance. And yet both of them are Lillies.
This to me is true in our professional journey. Some are more able, visible, and accomplished than others. Some of us remain ordinary. But all of us belong to the fraternity of medical profession, who are called to work collaboratively and cordially! A flower is a flower, its largeness or smallness does not make it any less than from being a flower.
I have observed envy, animosity, critical view of others in the fraternity of medical professionals. Some show some carry a reluctance to share medical information with others. There was a cardiac surgeon, who while preparing a patch to seal the Ventricular Septal Defect, would cut and fashion it hidden from the sight of the operating assistants, lest hey learned the technique of doing it. A popular cardiac surgeon trained under him shared this information with me, which according to him is not uncommon even today. Some surgeons who do the coronary bypass surgery would protect the process of anastomosis from being watched by his assisting surgeons, lest they too become skilled.
I remember what two eminent leaders in their respective fields, did to bring their colleagues to lead them to an advanced level of specialty training when they were heads of the department in CMC Vellore. Late, Dr C.K.Job, head of the department of Pathology foresaw the need to get a team of his pathologists trained in different specialties of pathology. He encouraged his colleagues to move into the pathology of Kidney, Gastro-intestinal system, heart and vascular system, Brain, Muscle and Peripheral nerves, Bone marrow and lymph nodes, Immunology, etc. I remember hearing about these specialisations which he initiated. It took about 20 years for his colleagues to be sufficiently trained. By 1995, most of these specialties functioned offering leadership in the country. The latest that I knew was the development of sub-specialty of Immuno-chemistry.
The other professor who gave leadership to develop sub-specialties in Gastroenterology was Dr. V.I.Mathan, who got his colleagues trained in Hepatology, upper and lower gut, interventional endoscopies, Inflammatory bowel diseases, etc. The department has a higher specialty programmes in general Gastro-enterology and Hepatology. He even established a huge endowment fund for the department so that research in all these branches can continue in the Welcome Research Unit.When he was the director of the institution for three years, just before the centenary year of the institution in 2000, he went on to lead a massive development programme of the institution. He brought advanced technology and coined a term to express its purpose, 'compassionate technology'. He added housing facilities for post graduates and young consultants. He established five new specialties during his term in the office. To me this stands out as an outstanding example of how to think proactively for the benefit of others!
It was this, which inspired me when I was responsible to establish the Developmental Paediatrics unit in CMC Vellore in 1997. To foresee the department to develop into a teaching and training unit with sub specialisation! During my term of service, I was able to encourage two of the consultants to move into two different areas-one into perinatal neurology and the other into cognitive neurology. The two year post-doctoral fellowship programme that I was responsible for had three consultants including both of them finish the course creditably. Four had registered for the PhD programme which was initiated during that period. The psychologists in the department got equipped in counselling, cognitive psychology, behavioural psychology and parenting psychology. I took some steps to establish a sleep monitoring laboratory for children, which functioned for a few years even after I left on retirement.
Thinking of others in the team and planning for their professional and personal development is the prime responsibility of those of us who are given responsibility to lead a team. It was necessary for the department which I help from 2012, to find its own funding for some of its activities. The department conducts an annual Christmas cheer sale and a 'Save one rupee campaign' among students and staff. The proceeds from these are used to develop facilities in the department and to offer assistance to families who need help financially. The idea and its execution came from all my colleagues in the department. The students of medicine and nursing take considerable interest in supporting these initiatives. In fact the students helped the department to conduct a staff-student Badminton tournament for three years, which offered a rich fellowship time! I admire my former and current colleagues for their resolve and enthusiasm to make the department vibrant and academically sound. It is an extra effort for each of them, to attend to develop facilities in the department along with offering services to families with multiple needs.
I remember what two eminent leaders in their respective fields, did to bring their colleagues to lead them to an advanced level of specialty training when they were heads of the department in CMC Vellore. Late, Dr C.K.Job, head of the department of Pathology foresaw the need to get a team of his pathologists trained in different specialties of pathology. He encouraged his colleagues to move into the pathology of Kidney, Gastro-intestinal system, heart and vascular system, Brain, Muscle and Peripheral nerves, Bone marrow and lymph nodes, Immunology, etc. I remember hearing about these specialisations which he initiated. It took about 20 years for his colleagues to be sufficiently trained. By 1995, most of these specialties functioned offering leadership in the country. The latest that I knew was the development of sub-specialty of Immuno-chemistry.
The other professor who gave leadership to develop sub-specialties in Gastroenterology was Dr. V.I.Mathan, who got his colleagues trained in Hepatology, upper and lower gut, interventional endoscopies, Inflammatory bowel diseases, etc. The department has a higher specialty programmes in general Gastro-enterology and Hepatology. He even established a huge endowment fund for the department so that research in all these branches can continue in the Welcome Research Unit.When he was the director of the institution for three years, just before the centenary year of the institution in 2000, he went on to lead a massive development programme of the institution. He brought advanced technology and coined a term to express its purpose, 'compassionate technology'. He added housing facilities for post graduates and young consultants. He established five new specialties during his term in the office. To me this stands out as an outstanding example of how to think proactively for the benefit of others!
It was this, which inspired me when I was responsible to establish the Developmental Paediatrics unit in CMC Vellore in 1997. To foresee the department to develop into a teaching and training unit with sub specialisation! During my term of service, I was able to encourage two of the consultants to move into two different areas-one into perinatal neurology and the other into cognitive neurology. The two year post-doctoral fellowship programme that I was responsible for had three consultants including both of them finish the course creditably. Four had registered for the PhD programme which was initiated during that period. The psychologists in the department got equipped in counselling, cognitive psychology, behavioural psychology and parenting psychology. I took some steps to establish a sleep monitoring laboratory for children, which functioned for a few years even after I left on retirement.
Thinking of others in the team and planning for their professional and personal development is the prime responsibility of those of us who are given responsibility to lead a team. It was necessary for the department which I help from 2012, to find its own funding for some of its activities. The department conducts an annual Christmas cheer sale and a 'Save one rupee campaign' among students and staff. The proceeds from these are used to develop facilities in the department and to offer assistance to families who need help financially. The idea and its execution came from all my colleagues in the department. The students of medicine and nursing take considerable interest in supporting these initiatives. In fact the students helped the department to conduct a staff-student Badminton tournament for three years, which offered a rich fellowship time! I admire my former and current colleagues for their resolve and enthusiasm to make the department vibrant and academically sound. It is an extra effort for each of them, to attend to develop facilities in the department along with offering services to families with multiple needs.
None of us is above envy and selfishness! And yet, the message from the Lillies to me is: stay where and how you are placed and be yourself! Each of us has a place and role of our own! We grow ourselves, when we turn our attention to be mindful of others. It is what we do for others which can last and bear fruits!
M.C.Mathew(texta nd photo)
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