Remembering Friends-1

Dr Sunil Agarwal- an outstanding surgeon and a humble human being

Dear Indira,

Greetings. 

Anna and I had planned to come and meet you at your home on the dates you suggested, but because of the travel restrictions due to pandemic corona infection, we could not come. We made arrangements twice, but had to change plans. Instead of waiting to personally meet you and share our thoughts, we want to send you our regards and grateful remembrances about Sunil.

We wonder how the previous weeks have been for you, following the blow and shock in your life. We hope you have been able to return to some order…it is unimaginable for us to think of your situation as everything might have come to a standstill. There is a lot to attend to each day. We think of those lonely moments when you feel bereft and long for Sunil’s physical presence! We bear you in our thoughts as this season brings unforeseen demands on your inner strength. We wonder how your children are adjusting to their loss!

I remember meeting him for the first time after your return from Australia. But I used to hear about him much before that from friends at CMC Ludhiana, when I went there for their governing board meetings. The surgical department at CMC Ludhiana had a difficult phase in the  eighties and early nineties. I remember many comments I heard about him from friends in Ludhiana about the difference he made when he was in surgery while Indira was doing her  higher studies. Sunil’s commitment to care for patients surprised other surgeons and post-graduates alike. They were amazed at his surpassing surgical skills even though he was still young in his surgical career. His conduct and character made him stand out because of his kind-heartedness, thoughtfulness and consideration for others at a time when the surgery department was internally divided. Sunil’s bed side rounds were peaceful, academic with regular teaching comments for the benefit of the post-graduates. The staff when they had a medical need preferred to consult him because he had a listening attitude. His post graduate classes were sought after. One comment moved me: ‘It took a surgeon from Vellore from another faith to start the weekly departmental prayer gathering in the surgery department’.  

This last comment was uppermost in my mind when I met Sunil for the first time. I was keen to hear more about the inspiration for him to propose starting the weekly prayer gathering in the surgery department at CMC Ludhiana. He opened up a lot at that time about his experience at CMC Vellore. It was our first meeting, but the openness and cordiality with which he spoke touched me. He attributed his formation as a person and surgeon to CMC Vellore. He talked about the departmental prayer gatherings at Vellore as an occasion where he learned to grow in respect for all religions. He felt at home being in the Bible study discussions and found some sound values to look up to. What he saw in the surgery department at CMC Ludhiana was different from what he was used to at Vellore, criticising seniors, pulling down others publicly, competition, intolerance, etc. He was disturbed by this and thought that reading from the Bible might help to move the attention of his colleagues to something noble and humane. After the departmental prayer gathering started, there was a definite change in the attitude towards each other. He spoke about this gracefully taking no credit directly or indirectly.

I remember in one of our casual meetings, Sunil referring to a block in the promotion of Senior Readers at CMC Vellore for lack of professorial positions. I had already heard about it from few others when I joined CMC Vellore in 1997 and had mentioned this to Dr Mathen and later to Dr Joyce the directors in succession at that time. They made me feel that till the next cadre revision, this might continue like this. I remember requesting Dr Joyce to give a professor equivalent salary and other privileges to the senior Readers till the next cadre review took place. I sensed that this involved financial implications that CMC was not ready to face as there were about 40 or so in such positions. This discordance remained in my thought. I remember taking up this matter with Dr George Chandy, during his tenure as director, when I was part of his administrative team. That was when I was asked to propose a plan to correct this anomaly. I remember that it got corrected over a period of three years and professor level salary and privileges were awarded to senior readers if they remained in that position after having become eligible to become a professor. What stands out in mind is a few conversations that I had with both of you on this matter and the sense of friendliness you conveyed during those conversations and contacts. It was a genuine loss and grievance, and yet both of you spoke about it with considerable understanding and patience. 

I remember the occasion when our second son Anandit had a nasty gaping wound on his face which was bleeding profusely. Sunil and Dr Philip Korula were the surgeons at the casualty who were called to help. I was amazed the way both of them approached to help with considerable understanding. Anna and I had concern about a long scar that would be left on his chin. Dr Philip was a man of few words, but an exceptional plastic surgeon. It was Sunil who kept in touch with us and prepared us to take utmost care for wound healing to reduce scarring. It was during this time I realised how thoughtful and generous Sunil was with his time and attention. This  left deep impressions within us about his devotion to caring for his patients. 

We watched the lighter side of Sunil during the staff entertainment. He looked reserved, but he was a bundle of creativity and humour on such occasions. The way he danced on the stage and participated to entertain the students gave us an indication of his nature of self-giving to others where ever he was involved.

During the years when the surgical sub-specialities was developing, some surgeons felt the heartache of not being given their first choice. I know of some surgeons who refused to negotiate and took a stiff position for their advantage. I remember Dr Banerjee who was leading this process mentioning to me once, ’the easiest people to negotiate with  are Dr Aravindan and Dr Sunil’. That spoke a lot about the gentlemanly way with which Sunil conducted himself in a difficult situation. I am not sure if Vascular surgery was his first choice. After the new system of six units were started in surgery, it was evident to some of us that some got more benefits than some others. I remember a conversation with Sunil after all this was over. I was keen to know how the department was coping with the changes. He was profuse with compliments to Dr Banerjee and made no reference to any personal loss he suffered on account of some colleagues not being accommodative. That was the time when  some surgeons were loud with their disappointments and did not spare a few who took advantage of the situation. Sunil’s approach to look forward to the future and interest to develop his subspecialty was a sobering example to others.

On one occasion Anna and I came to invite both of you for the wedding of our son, Arpit. To our surprise we noticed that Dr Henry from Bissam Cuttack was staying with you after his cataract surgery. I noticed that you had other guests as well at that time. A few days later when I met him in the corridor, I happened to refer to this generous hospitality both of you were offering to Dr Henry. His response, ‘What we do to others is what really matters’. That gave away his outlook to life and its noble mission. Knowing Dr Henry and his advancing age at that time, he was no ordinary person to look after. He spoke about it with a measure of joy and comfort. 

During my involvement with retreats for faculty at CMC, I happened to know about some inherent tensions in vascular surgery department. There was an unusual pressure on Sunil as his colleagues in his unit behaved unreasonably. There was one occasion, his colleagues even refused to look after post-operative patients operated by Sunil, when Sunil had to be away on short notice. I felt grieved by this. In a conversation with him once, he avoided blaming anyone. To me, that was magnanimity at its best. 

His post graduate residents adored him. Our son and his friends often mentioned to us about Sunil’s habit of giving post graduates hands-on-experience. In fact, he was more than just a teacher, but a mentor to his students. The every fact that he met with this tragedy when he was on his way to help a mission hospital at Kotagiri speaks volumes about his desire to make his skills available to others. 

A nurse who used to work with him in his ward referred to him as a surgeon with high moral and personal values who cared for nurses and their wellness.  He was polite and courteous. He did not compromise on his high standards of hygiene, infection control and good bedside practices. But he got all these done not by demanding or enforcing, but by demonstrating and influencing others. He had immense composure on the operating table even when there were complications. An anaesthesiologist who was commonly posted with him mentioned about Sunil as one who accepted responsibility fully and did not blame others when unexpected situation sprang up during surgery. The lounge at the theatre, where surgeons met in between surgery tended to have an ambience of gossip, but not when Sunil was present. His presence had a restraining effect, which was noticed by a young surgeon who said: ‘Dr Sunil was known for his ability to accept others and affirm them. He was protective of others’. 

I remember some remarks which Sunil made in the CMC Senate during difficult debates. He brought a sobering comment to help us find the middle path. During a debate on whether access roads within the college campus had to concreted to make it easy to for road users the house was divided. Sunil’s comment that, ‘For hundred or more years we had mud roads. What if we had concrete roads now, for the sake of better rain water harvesting!’ That was the turning point in the debate. I recall some of these instances, because they were instances of that created a new collective consciousness. Sunil seemed quiet, but was articulate when necessary.  

Being a vascular surgeon was not easy at CMC Vellore at that time, when an interventional radiologist and a cardiologist with interest in peripheral vascular disease exercised ‘territorial’ claims over patients. On some occasions it appeared to be a competition between the specialists. I remember having a brief conversation with him once, while sitting next to him in a meeting. He too was concerned about the breakdown of communication between specialists, but had something profound to say : ’I have decided to look after patients referred to me rather than canvass for patients’. He had settled this in his mind -what and how he would negotiate with others.

A friend, who is a transplant surgeon in Sydney needed Sunil’s help for his mother, who had peripheral vascular disease with complications of Diabetes. At the end of his time at CMC Vellore, this transplant surgeon told me something most refreshing to hear about the level of care and professional competence he found in Sunil. He placed Sunil at par with the best vascular surgeons he knew in Sydney. In fact according to him, Sunil‘s interventional skills were outstanding. Those of us who knew Sunil would agree with me that he carried this eminence lightly on his shoulders without using it to his personal advantage or for projecting himself. In fact, this transplant surgeon wondered whether Sunil would be happy to relocate himself in Sydney! 

Among surgeons, those who are athletic, musical or artistic have a special status. Many surgeons tend to be overweight and destress themselves in unhealthy ways. But to see both Indira and Sunil walk briskly in the CMC campus regularly was a good example to others. I know of at least three couples in the college campus who were inspired to regard walking as a regular form of exercise and a useful family time, seeing the example of Indira and Sunil. Sunil looked healthy and trim, which is indeed a big tribute to his ability to live an orderly life in spite of being a busy surgeon.

To many of us, who refer to CMC‘s ethos and health care practices as the bench mark, let me suggest that Sunil was an ambassador of this value system to his surgical colleagues, students and the surgical fraternity. He was an extra-ordinary person whose life was cut short by a road accident. We are poorer because he is no more with us in his roles as a teacher, mentor and pioneer in vascular surgery.

Behind a married man there is a woman and behind a woman there is a man. Sunil once told me something that revealed about his keenness for Indira to pursue her professional interest. Indira was already a leader in the sub-specialty of Paediatric Nephrology at that time. Indira was away overseas for a few weeks in getting advanced training in Paediatric Nephrology. I happened to ask him how he was managing on his own. His remark was unlike many men. He seemed happy that Indira had an opportunity to get further training and how that would benefit her in planning to start a kidney transplant facility for children at CMC Vellore. He said something like this: ’I would want to do everything to help Indira develop a full-fledged facility in Paediatric Nephrology’. There was no reference to any difficulty he had in coping  with Indira’s absence. I was touched by his commitment to Indira’s professional development. 

Sunil’s class mates, few of them whom I know personally refer to Sunil as an exemplary person and a friend who could be trusted. Some of his class mates were in administrative responsibilities at CMC Vellore recently. That could have been thought to be a good time for him to get some additional facilities for his department. Such a thought did not cross his mind. 

Many good people have a shorter life span. For Indira and children it is a loss for the rest of your lives. Anna and I stay with you feeling your loss. We look forward to an opportunity to meet with you personally sometime. In the meantime, let this reflection summarise our admiration for Sunil. We have not had a better example of humility than what we saw Sunil practice in his day-today dealings.  

With flowers from our garden,  Anna and M.C.Mathew, 6.4.2020