The King called Kumar

Picture courtesy:  Wikipedia

Shivaputra Siddharamayya Komkali, better known as Padmavibhushan Kumar Gandharva, leaves you mesmerized, as much with his aphoristic observations on music as with his spirited singing. This Gandharva of gay abandon was terrestrial by choice: he stood tall, firmly rooted to the ground, unlike several of his mollycoddled contemporaries who cruised in the blue skies of resounding reverence and instantaneous knighthood. Their blithe disregard for the need for musical innovation was hardly ever questioned but his single-minded resolve to rescue music from the eddy of blind convention and brazen complacence was almost unanimously dismissed by many a maestro, musicologist, guru, and critic. Even the luminaries who sided with him were discernibly guarded, more politically correct than socially right in their endorsements.

Thankfully, this thought-leader practitioner was hardly perturbed en route his solitary voyage as a non-conformist singer-composer, which is why he has left behind a treasure trove of pioneering thoughts and soul-stirring performances for our benefit. Approach it for the first time, or mull over it a thousand times, oven-fresh enlightenment is always around the corner, one that inspires us to chart our own trajectories of self-discoveries in respective spheres, beyond mere appreciation and adulation. 

Kumarji bares all and shares all without the slightest reserve or discrimination… all that he sensed, saw, felt, heard, transformed or tweaked in his Kabir-like, peripatetic probe into aspects and phenomena that the world simply classifies as abstract and obscure. He may have lost a lung to TB, which severely compromised his breath control and voice pitch, but what he gained from silent introspection enriched music with a vigour and vitality that were amiss in the ornamental Durbar performances of raag sangeet.     

In all his vintage interviews, Kumarji has treated us with a sumptuous diet of myriad concepts and nuances that expose the communal triviality of the extremely revered ‘mainstream tribe’ (and leave the interviewer fidgeting nervously or switching gears for obvious reasons.)  

   

When the world first knew about kumarji, he was hailed as a child prodigy who could reproduce the popular renditions of the time to a tee, almost at will. Back then, he was unaware of his genius. That didn't bother the musical establishment as its roots had not been shaken by this tsunami. They welcomed him in, presuming him to be another loyal practitioner swearing by the 'rules of the game'. 

But when he became acutely aware of his restlessness, which was accentuated by his illness, his vision and innovation gave them nausea and convulsion. How could they grant folk music its place of pride? How could they validate the claim that Raagas are waiting to be discovered? How could they tolerate the charge that the classical music tradition is in dire need of cross ventilation? Kumarji had great respect for his Gurus, and gratitude was an integral part of his attitude. In stark contrast, he was conferred with the title of a punctuation mark for upholding his non-conformism, a question mark to be precise...

Kumarji’s cherubic frame, his endearing, slightly impish smile, and his wholehearted discourse that invariably began with his pet prelude “gammat mhanun sangto” (I cite in a lighter vein) – these are timeless motifs we can’t ever tire of savoring. 

His pithy and prophetic pearls are packed with earthy wit and wisdom: 

• Composers don’t think, they simply run fancy shops and establishments in the name of gharana
• How can one stifle Music in the name of parampara? Music evolves all the time, something of it dies, something of it is born anew…and what is born must die; how can you, and why should you, tame music like a buffalo tied to a pole?
• Shastra stays the same, but Soundarya assumes new forms: Soundarya can vastly differ for the same notations and the same bandish
• Raag assumes new roopa in line with the bhaav of bandish   
• What is Tarana? It’s not manifestly deprived of meaning, it’s only another type of bandish with a bhaav vishva of its own: when the singer feels the need to convey over and above what the gayaki has expressed, he or she finds a potent vehicle in tarana      
• One must put laya in perspective – laya is what gives birth to roop, laya is nothing but aakar
• Remove your tinted spectacles to fathom the bucolic beauty of lok-sangeet which demands a natural voice, not a cultured voice. It seeks involvement, not applause.     
• When I sing, my whole body vibrates as it is deeply connected to the music that springs from within.
• How can you sing without grasping the meaning of the raag and bol – both explicit and implied? To fathom Bhairav, you must sense the early morning sanctity of a sacred place, have you experienced the cow dung-smeared courtyard of a hamlet during early noon hours before venturing into Sarang? Bheempalas means large Palash leaves, seek refuge under the shade of a Palash tree during the late noon hours of springtime and you’ll know what large Palash implies, and what Bheempalas wishes to convey. To relish the sensitivity of Puriya madhyam, imagine the kitchen of a rural household at sunset time: a doting mother is kneading dough following her son’s incessant demand for food; her husband has stepped in after a hard day at work, milk vessel in hand. If you have experienced this tranquillity of pastoral life, Puriya will come alive through your singing. If the dusty purple colour of a dusk sky and the evening star mean something to you, you will get the significance of Gauri, else Gauri will stay veiled. To remove the veil and unleash her, a singer needs courage of conviction, not merely a prepared voice.     

A few desk-bound musicologists, who call themselves cautious admirers, took great pride in highlighting the inconsistencies of Kumarji’s singing post his bed-ridden days: how he falters big time in mandra saptak, how he falls short in vilambit renditions of his dhuna-ugama raags, how he makes meaning only in madhyam and drut, so on and so forth. Wish these greats had spent some time and effort in rendering at least one public performance rather than flaunt the “trained vocalist” tag only as a license to thrill and kill through their loquacious essays in the name of tributes. 

But even this recklessness pales into insignificance compared to the utterly comic and circuitous tribute to Kumarji in a recent Marathi film, supposedly a biopic of the legend P L Deshpande. The portrayal is not merely gaudy, it is downright heinous. Wish the komkali household had refrained from associating with this reeled disaster.

To decipher the essence and credence of Kumar Gandharva, we thankfully have the guiding light of maverick scholars like Dr. Raghava R. Menon, author of ‘The musical journey of Kumar Gandharva’ and genuine admirers like Sunil Mukhi, an IISER physicist of fine intellect and varied interests. We also have Kumarji's son, the reclusive Pandit Mukul Shivputra who inherits his father’s trademark traits: perennial restiveness and unbending honesty.  If one doesn’t read too much into the formative waywardness of his life, one is blessed with great solace, hearing him render “Jamuna Kinare” in his distinct style, very different from his father’s but with a spiritual detachment, just like his father’s.      

Respectful Civil Servant, Masterful Change Architect

A typical Math lecture was in progress, marked by an uneasy calm pervading the classroom with front benchers in rapt attention, middle rows soaked in fearful wonderment, and back benchers lost in wilful oblivion. The teacher was meticulously explaining the formidable fundamentals of Partial Differential Equations (of perplexing orders and skyrocketing complexities) when her eyes fell on a student who was unabashedly relishing the quaint life outside the window, a mischievous expression writ large on his beaming face. Very close to losing her temper, she summoned the student to the blackboard and sarcastically exclaimed, “You seem to have mastered the concept already. Here, solve this problem. The stage is all yours!”    

 

Much to the dismay of the teacher and the rest of the class, the student immediately picked the chalk and, after a few minutes of quiet contemplation, nonchalantly scribbled something on the blackboard. Staring at the answer and the student in disbelief, the teacher was rendered speechless. When she regained her composure, she gracefully asked the whole class to give the student a standing ovation.  

 

This non-conformist student is today well known as G. S. Naveen Kumar, IAS, and Special Secretary, Health, Govt. of Andhra Pradesh and such bewildering situations defined most of his school and college years where he was often pulled up for being too casual about things, for missing key solution steps, for his handwriting which was far from legible, and for his supreme confidence which was often mistaken for arrogance and disdain. 

 

A gifted mathematics student with a flair for the English language, he was academically brilliant but never studious. In a conservative education system where conventions weigh more than solutions, his feats and accomplishments often fetched him stern words of admonishment along with rather restrained accolades. It may seem ironic that such a maverick should make his career in civil services where Protocol is God but going by his prolific strides as a key catalyst of transformation across states, one can sense a ring of destiny in his career choice.      

 

It was indeed sweet coincidence that the seeds of my short yet stimulating telephonic interaction with this busy bee bureaucrat were inadvertently sown in his birthplace Madurai, en route my visit to Rameswaram to spend quality time at the memorial of Dr. Avul Pakir Jainulabdeen Abdul Kalam, towering man of science, social development, secularism, and spirituality, and one of Naveen's mentors and role models. It was a foregone conclusion that this tete-a-tete with  Naveen should begin with a tribute to Dr Kalam. 

   

 

Meeting a towering man you have always revered must be an experience beyond words…

 

Undoubtedly! I first met the legend much before I joined the IAS. This was to get his book autographed and seek his blessings. I was not happy with the way I looked in the snap I clicked with him, so it was my earnest desire to get a better photograph with him. As luck would have it, I got to spend a whole day with him eight years later, all the way from his Rajaji Marg residence in Delhi to Kannauj, UP where he inaugurated 250KW solar projects for two electricity-deprived villages. Not only did I get to click a selfie with this selfless man, I also soaked in the actionable wit and wisdom of his astounding insights into life and work. He fondly spoke about a chapter in his book, which was then in the making, incorporating  an amusing conversation between a buffalo, UAV and Uranium aimed at highlighting India’s core competencies in each of these areas.  

 

On our way back in an IAF helicopter, we encountered heavy rains which made the ride visibly turbulent but he was splendidly unperturbed. I still remember him asking his assistant (who was frantically chanting the Hanuman Chalisa) to raise his voice to help him decipher the spiritual meaning of the Tulsidas hymns.          

 

  

How were your formative years?

 

My parents were quick to notice that I was a gifted child, and so I was kind of pampered a bit and generally allowed to have my way. I was very good at Math, a trait which comes from my mom, but thanks to my terrible handwriting and a habit of skipping key solution steps, I was often at the receiving end of my teachers’ ire.  I still remember how once my father came to school and argued with the teacher when he failed me in the Math paper for skipping steps, although I had solved every question correctly. I was also good at chess, and my ability to checkmate the opponent in three moves was part of folklore. Naturally, there was an air of audacity about me which people invariably mistook for arrogance. 

 

Did you always aspire to become a bureaucrat?

 

I always wanted to join the armed forces. So, I was terribly disappointed when I failed to clear the Rastriya Military School examination. I felt like it was all over for me, when my father counselled me and mentioned civil services as a viable option. Engineering was always my back up option and I am glad I pursued a degree in electronics and communication as it helps me immensely in my civil services avatar, so does my ability in Mathematics.   

 

 

 

What do you reckon are among the biggest challenges facing a civil servant in modern India? 

 

In civil services, there are many jobs that don’t call for extraordinary skills. You only need to do the most appropriate thing at the most appropriate time. You need to be a team player, you must not get entangled in the vicious loop of one-upmanship; in fact, there are times when you need to rope in people who are better than you at doing certain things; you need to smartly coordinate with them to get the best possible results. If your options are not working anymore, you must be ready to change them, and for that, you need to be ready to change yourself, which many are averse to. Lakhs of people read the same books for knowledge acquisition, but what separates the winners from the rest is the attitude.  

 

If you don’t believe in yourself, you can’t move ahead and make a lasting difference to society. Aptitude comes way down the line, although it is also key. There are people who are naturally competent and there are people who can develop their aptitude over time with the right effort, but no one can really teach you the right attitude. Attitude is invariably linked to a negative connotation of arrogance or audacity. Yes, attitude is about having a steely resolve but it is never about stamping your authority with little or no responsibility.    

 

 

 

How should a budding civil servant cultivate the aptitude and attitude to excel at his or her job? 

 

I believe empathy is the most important quality of a bureaucrat. One should have a clear understanding of the purpose of doing certain things in a certain way. There is no point in mechanically doing things, it does not yield any meaningful and lasting results. 

 

Decision making skills are most important. You need to decide on the spur and stand by what you deem is right or wrong, or the need of the hour I would say. Once in a while, you may make a bad decision but that should not deter you from making decisions. This is elementary for making bureaucracy serve its ultimate purpose, its larger goals.      

 

 

How do you look at the highs and lows of your work? 

 

There have been many highs and lows in my career. As the great Kalam sir said, you need to be ready to pack your bags anytime. You should never be too high and too low. Celebrate your highs and keep walking during lows but don’t cling to your emotions of either ecstasy or despondency. I would not like to cite specific instances of successes and failures; my life being in the public domain is an open book anyways. There have been times when I was told whatever I had in mind would never work; and when I made it possible, I definitely felt happy about it, and that ammunition helped me in times when things were not going my way.

 

I have always been a development person. I remember when we were doing the water restoration project in Allahabad, we did about 3000 ponds at one go. Coming from Chennai, I knew the value and worth of water, one of the most precious elements known to humankind. 

Eventually I moved to IT where I worked on a digital system to ensure that the citizen is able to avail of door-step services. I was part of the team which did 5 crore plantations in UP. I grew up reading Guinness book of records so it feels very satisfying that this marquee plantation project has etched a place of pride in it. I was also very happy to secure a Twitter account for Taj Mahal, with the proactive help from Raheel Khursheed, then the top Twitter executive liasoning with the government. Taj mahal welcoming the Eiffel Tower on Twitter was one of our tweets that became a rage on the microblogging platform.    

 

What do you reckon as the defining moment of your career till date?

 

Cancer care has clearly been one of my biggest work domains and a very fulfilling pursuit all the same. Building a mega team, spreading social awareness and impact, working closely with my medical team into preventive care, it has been a backbreaking but a very satisfying journey. As I told before, here too, I made it a point to work with people who know more about the subject matter. I have cherished my interactions with stalwarts like Dr. Vishal Rao, Dr. Norie Dattatraya, Dr. B S Ajaikumar, Dr. Umesh Mahantshetty, and Dr. Darez  Ahamed. On my part, I have tried my best to make the most of their actionable insights within the framework of an administrative setup. I like when my ideas bear fruit, when the ideation yields results. Small or big, the impact counts; it stays close to my heart and keeps me motivated to keep the momentum going.   

 

 

How do you envision India’s socio-economic progression in the coming years? 

 

I have no doubt India would be a superpower in the time to come.  I don’t have an iota of doubt in this regard. However, I feel we also need to cherish our history and heritage and not become a lopsided superpower like the US, devoid of roots and heritage. We should make good room to cultivate an interesting society rooted in our awe-inspiring diversity.

 

 

Looking back, is there something you would have done differently in your education and career if you were to start all over again? 

 

I have done electronics and communication engineering  by choice,  so I wouldn’t have done anything else if given another chance. I love every aspect of technology including coding and development. It has been a smooth journey so far so I have never looked back in time really to make sense of it holistically.  I would prefer to chug along the path destiny has chosen for me. I am a strong believer of destiny. My favorite warrior character is ‘Uhtred’ from the series 'The Last Kingdom’. He keeps telling “destiny is all”. I love his matter-of-fact approach. He is like the vital missing link of a lost kingdom and a strong believer in destiny. 

 

 

What keeps you going apart from work? What are your passion areas?

 

Reading is one of my top passions in life. I mostly read non-fiction. I read 66 books in one particular year, although my per year average is about 30. However, it is not about the number of books you read; one needs discipline to be a good reader.  

 

I am particularly fond of history books. The published Indian history is more about North India, but every state of this great nation has a rich history to be cherished. I think we should accept history as it is, and not color it with our convenient notions and perceptions. We should absorb facts, not react to them. We should never run agendas over history. History was always driven by an agenda, like it or not. Why run agenda on agenda? It doesn’t make sense.     

 

A recent book I read was the ‘Lords of the Deccan’ by Anirudh Kanisetti. He is an engineer who ventured into writing about history. I am an engineer who loves reading about history. That’s the connect maybe. It is about many startling facts of a largely overlooked region. 

 

 

You are an avid traveler…

 

Yes. Also a compulsive foodie. I believe traveling is ‘education in motion’ but one should have an eye for quiet observation and an appetite for learning new things, relishing new cuisine,  and meeting new people. There is an art and science to travel which one must be attentive to. With clear focus, one can easily broad base one’s mind and vision.  There are people who are proud globe trotters but their approach is very ‘touristy’ which doesn’t go beyond clicking snaps and posting on their social walls. Travel should ideally broaden your perspective to help expand horizons, such that we cherish a sense of being and belongingness without pride and prejudice.   

 

Any invigorating trips that come to mind instinctively?  

 

I remember my visit to Thailand where I was delighted to see the similarities and commonalities with Indian culture and heritage, and even terrain. I was overjoyed to note the shared history. Some of the Manipur kings were also monarchs in Thailand. 

 

Our social structures were so similar, so how could they overcome their social constraints while we could not. These are questions no one asks, but we must probe deeper into them through a look back in time. You will laugh at this; but I visited all the museums in Bangkok, given my insatiable appetite for knowing more about world history and heritage, even in a place which is popular for other reasons.

 

My trip to Punjab has also been an eye opener. I got great insights into the greatness of Guru Nanak; I feel this towering man of spirituality was a genius ahead of his time; he was able to think through problems most intuitively and incisively, similar to how Lord Buddha and Mahaveer and many saints across India did during their time. 

 

 

 

Mention the term bureaucracy  and we find tons of sarcasm poking fun at the evils of red tape and other ills of establishment. There is generally very little though spared for the selfless mavericks of this field who are out there to make a lasting contribution to make our governed lives simpler and hassle-free. They are like the vanguards Abhijit Naskar talks about in his seminal work titled When Humans Unite: Making A World Without Borders

 

“I give a call today to the civil servants around the world - yours is to serve, not the government, not the politicians, not even the constitution, but the people. You are the first servants of the society. On your shoulders, lies the responsibility of humanity's present and future. If the armed forces are our last line of defense in any corner of the world, then you are our first line of defense in every corner of the world. Injustice must ask your permission before entering the lives of the people. You, civil servants are the first vanguards of the society.” 

 

G S Naveen Kumar is one such vanguard bureaucrat: a respectful civil servant and a masterful change architect. Wishing him and others like him every success in the selfless and largely thankless mission-critical endeavor to help India claim an enduring Dhruv-like place of pride on the global map.  

 

 

 

G S Naveen Kumar: Awards and Accolades 

 

 

Vertical Warrior Award, DATAQUEST MAGAZINE: For improving access to G2C services 2017 

 

Best Conducive Start-up Policy for Digital Startups, BW DIGITAL INDIA SUMMIT 2017 

 

Planning Team Member, GUINNESS BOOK OF WORLD RECORDS: 50M trees in 24 hours 2016 

 

Top Performer, Team Digital India, SKOCH GROUP 2016 

 

National E-India Award, ELETS MAGAZINE: Promoting digital literacy & entrepreneurship 2014

 

 

Aarogyamanthan

Best Performing state for Highest Health records linked to ABHA. 

Best Performing state for Maximum saturation in Public Health Facility Registry 

Best Government Health Records Integrator 

Best Performing District for Highest Health Records Linked to ABHA First 3 places Bapatla, Alluri seetharamaraju, and Manyam districts 

 

ET Government Digitech Conclave 2022 

National Leader in Digital Health. 

 

Global Digital Health Summit 

Best Performing State in Creating Highest Number of Digital Health Records 

Best Digital Initiative “Consistent Rhythms” 

 

Universal Health Coverage Day 2022 

Best Performing award for Achievement of target for Operationalization 

Oasis: Freewheeling conversations with Dr. Vishal Rao - IV

Random Notes on Surgical Symphony

Scalpel has always been defined by science and never by intuition. If one broadly looks at the tenets and principles of surgery, the art and science of it have always been spoken about, but the role of intuition has not been emphasized much. In this last edition of Oasis, we dive deeper into the mystical aspects of surgery that thrive on the cusp of intellect, instinct, and intuition.   

Your offbeat voyage of self discovery began within the four walls of your college library. Can you look back in time to recount the magical experience of your formative years as a medical student?

I used to hang around the vintage racks of my college library, in the archival section wherein outdated books were stored, nay dumped. The disregarded corridors led me to a unique treasure trove of archaic books and journals. The primary fuel of my offbeat voyage was the long list of unanswered questions to which some of my professors like Prof. Humbarwadi would ask me to consult these secluded corners of the old sections from time to time.

I knew the answers were there to be found in history, if one cared to dig them out, like how in the Egyptian mythology where some of the secrets are believed to have been mummified. One of my great discoveries in the library was this brilliant book by Dr Milton T Edgerton called the “The Art of Surgical Technique.” Dr. Edgerton was a renowned plastic surgeon, and one of the founding professors at John Hopkins University.  His book was a wealth of great insights, adorned with beautiful hand sketches by the author himself. This book spoke about the art and science of surgery while hinting at the role of intuition. 

The earliest editions of the books by another prolific surgeon Dr. Hamilton Bailey were thankfully part of my curriculum. The newer editions have unfortunately focused only on the technological and clinical advancements, leaving out many profound questions posed by the original edition. Presumably, some authority at some point had taken the liberty to overlook certain truisms as having been dealt with and spoken about at length, and hence omitted from the subsequent versions. Consequently, many beautiful aspects of art and intuition were disconnected from the science of it. 

How does this disconnect happen?

As science evolves, there is a transition that happens, wherein many aspects of science are wrongly assumed to have lost their relevance for future generations.  For instance, the first edition of the Harrison’s Book of Internal Medicine had a beautiful elaboration by Dr. Judah Folkman, Father of Angiogenesis, which was omitted in the subsequent editions. He alluded to the possibility of reaching a point in time when we can co-exist with our tumours. This would imply harmony, not conflict, between normal cells and cancer cells. The former would not be affected by the aftermath of the latter, and the latter would stop growing.  In this first edition, Dr. Folkman also put forth the theory that if we cut off the blood supply to the tumour, it will be paralyzed, thereby losing the propensity to grow and spread further. Given the seminal significance of his words, the omission from subsequent versions was needless and heedless.    

In the context of this loss in transition, I recall the amusing experiences of Stan Lee, creator of Spiderman, which he shared in a BBC Radio interview. His publisher had rejected the idea of a teenage Spiderman superhero calling it the ‘worst idea ever heard’. His hardcoded logic was simple: people hate spiders and teenagers can never be heroes, they can only play sidekicks. Lee was dejected and decided to give up on the idea with a fleeting tribute to Spiderman in the last issue of the loss making ‘Amazing fantasy’ comic series. The spider superhero went on to become an instant hit, and it made the fading comic series a resounding bestseller. Needless to say, the publisher came back to say how much he always liked Spiderman as an idea, and the rest of course is history. Stan’s superhero was simple and likeable due to the inherent contradictions – a superhero with spider skills but inflicted with glaring insecurities:  a child raised by his grandparents, bullied at school, and hugely awkward in the presence of the opposite gender.  

From Spiderman to Science,  the same market forces are at play...

Undoubtedly. Coming back to science, it is not often dictated by the stalwarts; at times, the business of it takes precedence, led by the need for market creation. These forces let go of what they presume as foregone conclusions or arguments no longer valid. This popular view disregards the fact that people need to know certain slices of history which provide a deep connect to the future. The intuition of science can be found as much in history as on the way forward. The art and intuition are extremely intermingled as they both have creativity in them, and the science stands tall between them. We talk of science, and we talk of art, but we don’t often think about where they meet. Either our thoughts gravitate towards a ‘No’ or lean towards a ‘Yes’ when it comes to acknowledging the power of intuition, but we are never able to strike a balance. In the whole spectrum of science, intuition has been largely sidelined. 

 

So, you were always drawn to the role of intuition in surgery...

Yes. Although extremely difficult to define in verbal terms, I always make a feeble attempt to put scientific intuition in perspective. We have always been taught about the importance of instruments and equipments, their designs, precision, and purpose; how they cut; how they retract a tissue; how a tumour is opened; how the surgical area is approached and accessed and the like. Of course, these are highly significant aspects beyond doubt integral to surgery. But in Milton’s book, the foreword began with a gratitude to his wife, for the time she allotted him in the kitchen to learn some sewing skills. Elaborating on the art of surgery, he writes, “A surgeon needs to know his ten important instruments – his own fingers.” 

Today we talk of robots, machines and gadgets, but in the ultimate analysis, only these fingers are running the machines. Milton brings out the essence of science to underline the fact that fingers decide how the scalpel or retractor will be used. Milton’s words couldn’t have ring truer. These fingers, I feel, run a surgical symphony in the operating room.  This aspect has to have an intuition to it, like how Mozart composed his music.  Had Mozart followed a book and not his intuition, he would not have been Mozart today. 

You often talk about unanswered questions. Could you elaborate? 

Whenever I read about a surgical procedure, I always wonder what exactly drove the surgeon to adopt a particular technique on the operating table at a particular point in time. There are instances when the surgeon was reprimanded for the proposed choice of technique or approach, which must have perhaps been ahead of its times, and yet he backed his intuition. There would have been some strong reason for the surgeon’s conviction, which has to be something more than science. 

For instance, it was historically believed in the earliest scientific literature that a surgeon attempting thyroid surgery was playing with fire, and the errors he would commit in the surgery were unpardonable given the risk of torrential bleeding and even life. Today, it has become a lifesaving surgery with several instances of successful operations across the globe. Now, if the slice of history related to this bit is omitted from the annals of medicine, the whole context to the surgical advancement is lost. What would have gone through the minds of the surgeons who dared to think different, risking their reputations in the event of adverse consequences, and how did they back themselves and their fingers – all of that would be lost in the missing notes. The very purpose driving the ambition would be lost.  

Like for instance, we always say we keep checking the calcium in the blood. We say calcification can occur in the body, which can cause certain conditions of the parathyroid gland. When this gland creates a tumour, we have been taught to perform a parathyroidectomy surgery if the condition is accompanied by hypercalcemia or excess calcification in the blood. What is intriguing is that we were never taught why calcium doesn’t calcify in the blood under normal circumstances. None of the books would answer that question. But this was addressed in the old books in the library.

Again, the library! Every wonderment of yours can be traced to the library, I presume...

Yes, I vividly remember yet another instance. One late evening, the librarian, a kind-hearted, middle-aged lady, came to remind me that it was time to close the doors and put the lights off. I requested her to give me five more minutes as I was in the midst of poring over some invaluable information in the old racks. She conceded to my request but asked me a favour. She asked me to prescribe some medication for her chronic sinus headache.  I asked her how she was so sure that it was a case of sinusitis. She told me she had been on medication for quite some time and knew her diagnosis well. Out of curiosity, I asked her how often she caught a common cold in a year, and when did she have it last? She promptly told me she had never had a common cold as far as she could remember. 

Her answer left me puzzled, and the next question I asked her on an impulse was whether she had any issues. She again replied in the negative and told me that she was infertile. Now, this was my first accidental but intuitive diagnosis of a condition called Immotile Cilia syndrome, wherein the little cilia nerves in our sinuses and elsewhere do not move, and this disorder is accompanied by infertility. I advised her to meet the physician for appropriate treatment. 

So, intution paves the way for discovery and direction?

You said it! You may have all the algorithms, but you need a peripheral intuition to set you on the right path.  I remember a monk who once told me about the miracle of the healing touch or ‘kaiguna’ as we call it in kannada. He told me that a physician or faith healer who wholeheartedly treats his or her patients gets innumerable blessings from the patients and their near and dear ones, which manifest themselves in the physician’s hands. This positive healing energy can’t ever be used for self-benefit, it can only be transferred to other patients undergoing treatment. This is like distributing your dividends to those in need. Mother Teresa was the epitome of this healing touch. These healing hands, he said, are blessed with intuitive powers. I have no doubt in my mind that these powers guide the hands towards the right approaches and therapies. The universe helps you bring about a surgical symphony. 

The monk insisted that I touch each patient, even those at a stage of no return or inflicted with a supposedly incurable disease, as things could possibly turn for good amid all adverse circumstances. I got a first-hand experience of this truism many a times. Once during my ICU rounds, I encountered a patient who was recovering well but suffered a psychiatric spell all of a sudden during the wee hours of the morning.  He turned violent and tried to physically harm those around him before falling unconscious out of breathlessness. I made it a point to touch him and in that touch, there was as much science as was an earnest plea to help me pass on the dividend of the healing touch. At the same time, I shared my helplessness with his wife, openly telling her about the futility of the treatment being extended to her husband. Both contradictory acts – one to the patient and other to his wife - were guided by intuition, I did not initiate them, I was led to them.          

Why do you call it a surgical symphony?

The symphony I talk of is the symphony of nature. During the 2004 Tsumani wave, elephants, dolphins, dogs, deers, foxes, and rabbits got intuitive signals of the impending danger beforehand. Many among them could plan evasive action well in advance. Similarly, we need to balance the art and science of any discipline using our intuition.  This intuition can only be found with purpose and love. One can define and refine intuition only when a deep sense of intent and benevolence is developed within. I call intuition a fusion of passion and compassion; the former is not to be confused with pride, and the latter is not to be confused with pity. 

You need both grace and gravity– the former is a spiritual, invisible force, and the latter is a scientific tangible force. No book can teach you intuition. This is an aspect you have to probe deep within you, at an elusive point where the surgeon’s ambition will meet his or her purpose. If passion is ambition, compassion is purpose. If passion is perseverance, then compassion is forbearance. If passion is power, compassion becomes a force. Passion may be self-centered, but compassion is always selfless. If passion become intense, compassion becomes inclusive. If passion leads to surrender of desires, compassion will lead to the acceptance of outcomes. Passion and compassion together build the fountainhead of intuition where only love and service remain. 

I remember a patient of mine who was terminally ill, the tumour having come out of the face and neck, badly fungating and stinking. Slowly, it was eroding the main blood vessel that took blood to the brain. Every day, I had to put on a double mask for dressing the wounds. Clearly, the terminal end was expected to be a torrential bleed that would cause death. The patient’s family had given up on him as it was impossible for them to attend to the dressing of wounds at home, with maggots appearing from within. In fact, many of the adjoining patients requested me to shift this patient to another ward, as they could not bear the stench. But there was no isolation ward. I was totally helpless. Amid all this depressing environment, I was doing my duty as I had willfully assumed total responsibility of the patient. Just as I was dejectedly walking down the stairs, thinking about the gravity of the situation, a nurse walked up to me, volunteering to do the dressing several times during the day, so as to reduce the stench. It was as if some intuition had connected us together to resolve the predicament at hand. 

As I thanked her, something inside me connected me with Mother Teresa. I immediately thought of how she used to serve so many similar patients without even putting on a mask. I couldn’t imagine the divinity that she possessed to perform these selfless acts with unconditional love. An act so pure is nothing but godly.  As Mahatma Gandhi put it so beautifully, “The best way to find yourself is lose yourself in the service of others.”  So, the nurse continued to nurse the patient like she had promised – till the last day of his life. 

Intuition comes in moments of calmness, not during an agitated state of mind. It is the wisdom which dawns on us during a meditative trance. You need to lose yourself in your work to let possibilities find their way towards accomplishments. As the Chinese philosopher Lao Tsu says, “When I let go of what I am, I become what I might be.”

Can you share a few more instances to drive home the moot point for the benefit of casual readers?

I had a patient, an IT professional in his mid-thirties, with a complex cancer of the thyroid. The tumour was precariously close to the voice box, and the case was referred to me. I shared the facts and consequences with him, telling him that since a key nerve of the throat region was involved with the tumour, post the tracheostomy, he may not be able to talk again. He was reading Swami Paramhamsa Yogananda’s ‘Autobiography of A Yogi’ at that time. He told me with a smile, “Doc, you do your job, I will do mine; leave the rest to the almighty.” 

Now in cases of peritoneal fibrosis, the general clinical practice is to remove the nerve if found grossly involved, else try and save it. During surgery, I was told by my team that there was no point in saving the nerve since it was badly involved. I still asked for an extra time of 20 minutes, much to their dismay. During those 20 minutes, I located the nerve and found that it was neatly covered by a sheath. Consequently, I could treat the tumour without involving the nerve. Today, the patient is leading a normal life and 12 years have passed since. What happened during those 20 minutes is beyond imagination, leave alone articulation. It was like I was being guided by my fingers towards a surgical symphony. 

 

Every surgeon has at some point similar experiences, just that they don’t talk about it even if they may innately sense it.  Swami Vivekananda has made a very apt observation on atheism. He says an atheist is not someone who does not go to temples, mosques and churches, he is one who does not listen to his inner voice. Now, this patient of peritoneal fibrosis told me years later that a hypnotherapist had told him at the time of surgery that his voice was destined for public speaking.  Of course, I had no clue of this premonition then, but now I am inclined to believe there are dots which are connected in ways we are unable to comprehend.  And it is best to marvel at them, not question them or draw conclusions out of them. Conclusion more often than not leads to confusion.   

Let's end this thought piece with two cases you often talk about...of the monk and the governer...

Seems apt! A senior surgeon friend of mine once shared his predicament post the surgery he performed on a monk who was referred to him by a senior bureaucrat. During the operation, this surgeon happened to tell his team in a lighter vein, “I never imagined a monk could be that huge. Monks are supposed to be skinny and lean.” Just before discharge, when the monk came to thank the surgeon for the successful treatment, he said with a smile, “Yes, it is difficult to believe a monk could be as fat as I am.” When the puzzled surgeon asked if he was awake during surgery, the monk replied, “Your anaesthesia was deep enough, yet perhaps my consciousness ran deeper.” 

Science is repeatedly driven by intuition in ways we can’t imagine. A governor of a global state once came to meet me in the most usual circumstances. He was flying to Delhi for a neck surgery at AIIMS. He had developed a tumour in the neck, but his master had advised him against surgery stating it was likely to turn fatal. For 20 years, the governor lived with the progressive disease until one day, the master said it was finally time for the surgery but only on India. So, the governor came to India in business class, complete with his battalion. He landed at Bangalore first as his physician here was to travel to Delhi with him. 

This physician happened to be in my hospital at that time, so the governor showed up at my hospital. I was delivering a lecture at some institution, but my hospital people asked me if I would like to meet the governor to exchange pleasantries if he was around when I came back from the lecture. He was indeed around, and I had a good chat with him. He shared the prognosis and progression of the tumour. I reassured him that he was going to the right place. Just at that time, he asked whether I could operate on him. He told me that his master had told him 20 years back that he would be operated in India by a surgeon who will find him, not the other way round. He said his preference was Texas, but the master left him with no option but India. Then he told me that he felt from within that I was the surgeon. Would I be okay to talk to his master? I said yes, rather amused at the likely turn of events the governor was suggesting. I did speak to his master on phone who was thousands of miles away. He told me with a smile, “Yes you are indeed the surgeon. And don’t worry if he does not pull through the ordeal. Always remember you did your best.”  

I was terribly puzzled by what he told me, unable to make coherent meaning of the seemingly contradictory messages. Nevertheless, I operated on the governor. During the surgery, my colleague passed out for a while, as he could not cope with the anxiety of this difficult surgery which involved a torrential bleed. This was strange as he is a seasoned professional who never had any such episode in the past. I completed the surgery, and as I sipped coffee during the break, the patient had a cardiac arrest in the ICU. They were trying to revive him, but it seemed a hopeless case. I went up to him, simply held his hand and went back to my work. Soon after, he was completely revived, and in fact we found him cracking jokes with the nursing staff, offering them jobs in his country. 

I don’t know what happened and how it happened. I have simply placed the facts in chronological order, as they happened. How much of it was intuition, how much of it was intellect, how much of it was destiny, how much of it was free will, I have not the slightest idea. What I know for sure is that a surgical symphony had happened, with the scalpel and intuition working hand in hand.