CHANGES IN MYSELF

1. Adding Music

     When prof Gopinath was in a good mood while operating he would hum, and ask if some music could be played in the Operation Theatre (OT). The nurse would turn on the radio and it would be put off if there was any problem during surgery. I spent a year in Milwaukee training as a fellow. My mentor Dudley Johnson listened to operas by Wagner and Debussy while operating. He would do a superb operation calmly. When he was not in the OT the perfusionist or nurse would listen to rock, jazz or other genres. There was always some continuous music to enjoy while driving. When I returned to India I had a tough time to introduce the Music. On one of my trips to US I bought an I Pod and a portable system that could play music from the I Pod. I copied a lot of music of my taste and started playing it in the OT during surgery. I would take the system and lock up in my cupboard to prevent stealing/hiding. It became so popular that the staff requested contemporary Hindi film music.  I copied a whole lot of them on instrumental music and  it played  always.  I introduced music in the ICU but it was always interrupted.

2. Mentoring

   I had been taught surgery and cardiac surgery by patient mentors. Dr. Kapur (and Dr. BK Moulik) told me that he could hold my hands and teach, or throw me in the jungle and let me survive. I survived and developed confidence. Prof. Gopinath, Dr. Janak Talwar, Dr. Prusty, Dr.IM Rao, Dr. Venugopal and others also gave me opportunities to perform cardiac surgery and learn. My best mentoring was in Milwaukee, where Dr. Shore, Dr.Kamath and Dr. Johnson patiently taught me the nuances of cardiac surgery. When I returned I was privileged to have the most junior residents to train with me, because seniors wanted trained residents to help them. I enjoyed teaching the newcomers who were eager learners. They had variable degrees of skills and I took it upon myself to train them. After a year of training they would be asked to go to other OTs. It is only towards the end of my tenure that I would have the privilege of having one junior faculty along with the resident. The junior faculty had the best chances of honing their skills with me. They also published a number of articles in reputed journals as first authors. Many years after I retired my students would tell me how much they learnt under my guidance.

3. Socialising

    In the early years as a house surgeon our relations with the faculty was only official. When I joined general surgery as a resident the first year was just work and no play. When I joined Prof Kapur’s unit we tasted some social activity and get together. He always invited all of us to dinner and cards play at his home at Diwali festival. I had a more cordial relations with him during the next two years. At the MS examinations he would invite us, the residents to join for fellowship and Dinner at his home. When I moved to Cardiothoracic surgery these occasional social gatherings continued. When I joined the faculty there were a few more until Prof. Gopinath retired. I carried on the legacy and continued to socialise inviting friends, colleagues and even nurses especially at Christmas time with an open house. There were family functions like children’s birthday and marriages which I made sure to join in. In the later years I would invite the residents to my house for a special B/F on a chosen Sunday. Since most of the nurses were Christians I would invite them home for Carol singing and plum cake. Every year I would take a big cake for the staff in the hospital at Christmas. Every time I went abroad I would bring a big pack of chocolates for all the staff including students and technicians. 

4. Being available

   Among the faculty, it seemed I was the only one with whom my colleagues, students and staff and even anaesthesia staff confided their problems and sought help. They would seek me out to hear their problems, mostly, due to the personal incompatibilities and aspirations. They would complain about being ill-treated in the open. However none of them complained to the authorities. They would come to me to seek a remedy.

In surgery, I never hesitated or delayed help to a colleague who was in trouble. I would rush to his help, because it involved an innocent patient. In this state of affairs I became the only source to seek help and I did not hesitate to help them recover their pride, opportunities and self-confidence. I would go out of the way to help residents who completed their training and were looking for good positions. Many would even seek my help for their family problems without hesitation.

5. Gratitude

   I had grown up in a large family and learnt the virtues of gratitude. We lived as lower middle class family sharing everything like food, clothing, books, play toys and  comics etc. My parents taught us humility, and gratitude. We were taught to say Please and Thank you, as civility requirements. We never forgot that lesson. I was quite shocked when I entered AIIMS;  how my fellow students took liberties in taking my belongings without even asking.  One blatant example was my senior colleague and neighbour who  used to pick up my journal in the mail and not even tell me. When I got a chance I taught everyone the simple manners of asking with a please and returning with a thank you. I ensured that everyone who had ever worked or contributed to the Centre got a letter of appreciation. This was included in the records of the Centre. I ensured that at some circumstances I was the only person  who thanked someone, who had contributed to the success of our endeavour. My secretary learned to write letters in polite language with gratitude for services rendered. These went out to the industrial partners as well. Personally I felicitated my colleagues who were ignored at retirement. My wife would go out of the way to pick up trinkets as gifts to my friends, staff and my secretary.  Ironically when I left the department there was not even a handshake and gesture of gratitude for all that I had contributed. This had happened to my predecessors as well, who left the department with bitterness.

6. Empathy

  A very human emotion, to share the agony of a distressed person. I had been ill-treated, humiliated and neglected during my training and as a faculty. I fought for my rights. It is here that I learnt empathy. It came form Prof. Gopinath, when I lost my father; my parents in law when I got married; My mentors,  my neighbours, administrative officers, other colleagues and office staff. This lesson I carried as a responsibility to ensure and empathise with everyone including my patients, Industrial partners and all others with whom I worked. This one emotion changed me largely in realising human values.

7. Record keeping and a daily diary of events

     I heard from very eminent surgeons from around the country that publishing was difficult because of the lack of good records in the hospital. It was an eye opener because when I looked at some records, I realised that the entry of  essential details like address, telephone nos, contact information and even missing  age and sex entries. I could not change the practice in the whole hospital or with all my colleagues. However I could change myself. From the beginning I kept a register of all my patients, surgeries, essential details  making the entries myself. I would also enter the complications and deaths of each of my patients. I made a simple follow up data sheet, took these with me to the outpatients and filled up their information. This I gave to my secretary, who entered the data in the relevant page of the patient on the computer. This helped me write a large number of articles on the surgeries I had performed with authentic follow up data. 

   The other record I kept was a diary entry for each day of the surgeries, events, deaths, complications, interactions and my own internal thoughts. These records began in 1978 when I joined as a faculty and has become a store house of information for my biography. I have compiled all such important events on a day to day record and written my autobiography. Although I have put in a lot of effort it has been gratifying to look back and learn.

8.Charity

      This was one virtue that was influenced by my wife and her family. In my college years I received charity in terms of  books, instruments and an open opportunity to use my friend’s residence for my studies. We had no means of being charitable with all the debts. I realised in AIIMS through Fr. Colaco ( our Parish priest), what charity really meant. My God mother Lucille Hintz, in whose home in Milwaukee, USA, I was a paying guest for a year, was a widow living on welfare. Her nature of giving until it hurt was astonishing. When I visited Pam’s parents during vacation, I realised how much charity meant to the recipients, when I saw her mother set up scholarships for children’s education and provided help for uneducated young women to learn crafts and become independent. It pushed me to make sure that those who could not afford treatment got free medicines, free surgery, free valves. I went further to help my patients and staff for their children’s school education, finding a job and give them warm clothing for winter. My wife even now continues with this habit of giving freely and to alleviate hardship. I followed her family example and my mother’s blessings to help the poor and underprivileged. In the years after my retirement I realised that our combined income was more than sufficient for our needs and began assisting poor patients in private hospitals.

 I was one of the early donors for a good cause for  my alma mater, The Bangalore Medical College” where we built a digital library, an auditorium, a Biochemistry lab and the Bone marrow registry. The same efforts pam has made to for her medical school as well. I have given my time and efforts to charitable hospitals like the Sree Sathya Sai hospital in Puttaparthy, Bangalore and Raipur. I have worked in Leh, Ladakh for more than a decade to help those patients, and establish heart surgery at high altitude in Leh, to provide free treatment for the patients there. This charity of giving with no expectations is what makes this profession Noble.

9.Courage

  The flow of patients at the AIIMS was heavy and continuous. In the four years of general surgery training, I was lucky to have a free hand in many surgical procedures. This continued with my training in Cardiothoracic surgery. While respecting the basic surgical principles I decided to change some steps to help the patients get a better  outcome. These changes required on the spot decisions and gave me the courage to make them.  I used a famous quote from Dr. Denton Cooley of Texas; “Simplify, modify and apply” in my practice. For example the simple technique of Mitral valve repair. I had to improvise to our conditions and perform without compromising quality. After this I did not hesitate to try new approaches, bold decisions and to bring in changes that were established and found to be beneficial. Examples are Valve repair, Right Thoracotomy, Blood conservation, normothermic perfusion, right atrial free wall as a patch, Aortic valve repair and TOF correction through the Aorta. A surgeon is supposed to have  “Eye of an Eagle(no headlight/loupes), heart of a Lion(Courage and fearlessness) and the deft hands of a woman”(Technical skills). It was precisely these characteristics that I developed over the years. Both myself and my wife worked with overbearing heads of department. The  lessons we learnt were more of what not to do, when you reach a high position. That was also learning. Quitting such a situation would only have made us struggle to progress. Staying and solving interpersonal reactions was primary to achieve  success. I developed fortitude, guts to confront adversaries and a tenacity of purpose to succeed.

10.The art of teaching

     Teaching is an art. It makes you learn to be able to impart knowledge. It is the art of communication. Simple narration or a didactic lecture with scientific jargon is usually futile in imparting the essence of the lesson. My teachers in Medical schools used unusual methods to make us understand and learn, hear sounds of the heart, lungs and intestines with care. They used comparison with ordinary objects to make us understand. When teaching students one must get down to their level. A colleague of mine who was a qualified cardiologist lectured to medical  students giving them statistics and numbers. The students were confused and could not understand what it meant. Such teaching is sometimes boring. I used diagrams, pictures and video clips to teach which were very effective. At surgery I had to assess the students basic skills and help them to develop new and important ones for success. My contributions to teaching included mentoring at surgery, publishing my experience, writing an illustrated textbook, Textbook chapters, making good illustrations and slides for presentation, producing surgical videos for all procedures, the art of scientific publication and the development of computer learning  methods. This was in addition to traveling and demonstrating the techniques in several institutions.

CHANGES IN  CARDIAC SURGERY

1.Abolishing Bone wax

      As a first year resident in training I saw the horror of sternal dehiscence in a young woman who finally died. When I began operating independently, I refused to use bone wax in my operations. I realised that it was the primary cause of infection in the wound and caused non healing in published articles. I did not allow my residents and assistants to use bone wax in my surgical cases. The result was I had the lowest (0.5%) infection in my surgeries and published the same. Guidelines for reducing sternal infection included bone wax use as a cause. I substituted this with blood clots of the patient which was freely available at surgery, no cost and very effective. It has been like that for 50 years of my practice.

2.Interlocking Sternotomy.

While reading one of the professional journals I came across an article on a new method of splitting the sternum to approach the heart. It was termed Interlocking Sternotomy(ILS).The method appealed to me as it was suggested by an Orthopaedic surgeon. I tried it once and found it very effective in reducing bone pain to a large extent. Patient was able to tolerate the pain and did not request pain medication like others who had a standard sternotomy. They also had no respiratory complications. The  physiotherapist who worked on these patients reported superior results and published the same. I made it routine in my surgeries and taught my students. 

3.Closing the pericardium

     Nature designed and provided our hearts with a protective cover. It served the purpose by lubricating a moving organ, on its surface and also to protect the heart in chest injuries. It was a barrier against infection. These were taught to us in anatomy in the first year of medical school. Surgeons who performed cardiac surgery were very casual and left the pericardium open after completing the surgery inside the heart. This caused many problems. The heart became adherent to the back of the sternum and at reoperation many patients died by injury in attempting to do the operation. It also allowed any infection to cause catastrophic bleeding from the heart suture lines. My mentor Dr. Johnson showed me how important it is to close the pericardium in all cases. I follow this and protect the patient’s heart from injury at a second operation. Surgeons offer numerous reasons for not closing the pericardium. In 1946 A famous surgeon from USA had given simple instructions for successful surgery. One of them was reconstruction tissue planes  as normal. Surgeons who do not close the pericardium leave the patient with a higher risk at reoperation.

4. Cosmetic surgery

     Heart surgery is usually performed by splitting the breastbone (Sternum) vertically from the neck down between the breasts up to the pit of the stomach. In children and adult men this scar may get hidden by hair growth. However in women this ugly midline scar is a sure sign of heart surgery and marriage becomes a problem as the scar shows up above the blouse. Women become very self-conscious of this and wear garments to cover up. A 43 year old lady requested me if I could do the surgery without the scar showing above the blouse, since she was contesting for The Grasim Woman of the year. I managed to reduce the size of the scar by nearly half ,and it was hidden. She won the contest. It prompted me to make it easier for women to hide the scar completely. After reading published articles on the subject, I decided to do the operation by an incision below the curve of the right breast. This approach provided safe and effective exposure of the heart for surgery. I used this for many operations and especially in women and young girls. The scar of surgery was entirely invisible and patients had a better opportunity to find grooms for marriage,  in addition to being satisfied with the final result. I have taught my students to help patients when they need to do surgery on their hearts.

5. Cooling the body

      In the beginning heart surgeons used a technique known simply as hypothermia. Here the patients body temperature is reduced to 28∞C degrees centigrade (normal 37∞C). This reduces the metabolism and helps the surgeon to do the surgery unhurriedly. However, this causes many problems. The surgery takes twice as long to cool and rewarm the patient. It  interferes with the patients blood coagulation resulting in post operative bleeding requiring  blood transfusion. In my early years of practice I read many publications on the safety and advantages of operating on the heart without active cooling. This technique was known as warm body, cold heart technique. It appealed to me as more physiological with avoiding the complication listed above. I adopted this in all my surgeries. I persisted and my surgeries took less than half the time compared to others for the same procedure, with less bleeding and absence of blood transfusion. Only some very difficult procedures required cooling the body to reduce the blood flow to safely perform such complicated surgeries. It  became popular with many of my students who adopted this in their practice.

6. Valve repair

     Nature provided our hearts four valves to ensure unidirectional blood flow. When these valves become diseased due to various causes, they need to be corrected. From 1961, man made artificial valves were used to replace these valves. The artificial valves introduced many problems after surgery. Other surgeons looked for an answer   and attempted to reconstruct the diseased valves and return them to normal function for as long as possible.
        A French surgeon and a Spanish surgeon devised methods to repair these valves and published their results. I learnt this in my fellowship training in USA. When I returned I realised that valve repair or reconstruction was  a better solution and more suited to the problems seen in India. I attempted this operation with a slight modification as suggested by an American surgeon. The first successful surgery prompted me to continue and over the years I have performed valve repair to the best of my ability for thousands of patients with enormous reduction in cost. This technique retains the natural valve, avoids complications related to valve substitutes, allows growth in children and  offers many other advantages. I became proficient and adopted this to repair other valves as well. I published my technique and results in many articles and became well known in India and abroad as an experienced valve repair surgeon. This helped me to travel and teach the techniques to a large number of surgeons in India and abroad. It gave me immense satisfaction of having improved the lives of thousands of patients. 

7. Spare parts

Holes in the heart were traditionally closed with synthetic patches in the majority of patients. These were expensive and not 100% satisfactory. They were a source of infection, they dehisced, calcified and caused jaundice. Patients pericardium was also used but after many years it calcified and caused problems. While operating on a young child where a patch was needed, I Cut out a part of Right Atrial Wall as a patch and used it to close the hole. After following the patient over a  period of time I realised the patch was ideal material. It was autologous (patient’s own tissue),living and had blood friendly surface. It then became routine and I used it to close all septal defects in the heart. My colleagues used the free right atrial patch to expand the Right ventricular outflow tract in some operations. We published our experience and many surgeons agreed that this was a new innovation.

8. Blood conservation

      As a house surgeon in 1969, I had to fill forms for arranging 16 units of blood for an open heart surgery. It was difficult and caused a lot of problems at and after surgery. By 1990, improved techniques allowed surgery with less blood, 4 units only. Now the blood was supplied  as components such as RBC, Plasma and platelets. I found that many patients received more than 4 units of RBCs and developed many complications including kidney failure , jaundice and death. A thorough search of published articles showed how open heart surgery could be done without blood. I thought we could implement this in our surgeries. I wrote up a protocol that included pre operative, operative and post operative instructions. I was the first one to begin in our department. As I succeeded in a few cases. I made it routine in my surgeries. 

I involved the anaesthetist, assistant, residents and ICU  nurses. The result was extraordinary. Of the first 100 patients we had not used any blood in 85 patients. The procedure became established and a later audit showed 90% of patients operated did not receive even one unt of blood product in the first one month after surgery. 

9. Surgical cost cutting

     The AIIMS offered the lowest surgical cost for heart surgery in India. Even this was beyond the means of many people. We tried our best to reduce the cost of surgery and also to ensure no patient was refused  for want of money. In this scenario, I made several changes in surgical technique that resulted in reducing the burden on patients. The preoperative  advice on building a higher haemoglobin, Dental clearance to avoid infection and advice on nutrition were effective. At surgery avoid use of Bone wax, just three sutures to close the sternum, avoiding expensive stainless steel sutures, using autologous tissue in place of expensive synthetic patches and grafts, blood conservation, minimal antibiotic  usage, reducing hospital stay were the major changes. I also standardised  valve replacement surgery by using just the minimum of sutures. The establishment of a state of the art homograft valve bank reduced the cost of valve replacement drastically. The introduction of valve repair instead of replacement reduced the cost of surgery and post operative medication to a great extent. I requested the industry partners to provide free valves,  the disposable equipment for at least 10 patients annually. This helped us to do free surgery for poor patients.  In the first year after I became head of department I had provided more than 120 patients  free heart surgery including valve replacement. It was good to fulfil my mother’s wish to serve the poor.

10. Single use devices (SUD)

      As heart surgery became routine many industrial partners Produced single use devices, which were to be used and discarded. This was intended to reduce infection and avoid transmission of viral diseases such as Jaundice, AIDS, and blood incompatibility. This was strictly enforced by the Food and  Drug Administration (FDA)in the USA. In India all hospitals began to resterilise such items and use them repeatedly to reduce cost and get more profit. The patients were unaware of such practice. This was also done at the AIIMS heart Centre. As an advocate of patient safety and patient’s rights I refused to follow this malpractice. For the surgeries that I performed all patients received SUDs once. The only permitted items that could be reused were metallic surgical instruments that were autoclaved which was the accepted practice all over the world. When patients pay for the disposable items it is unethical to give them resterilised items without their knowledge. Even after my retirement and in private hospital I refused to use such items for patients. 100% of hospitals and surgeons use these SUDs resterilised many times with little concern for patient safety.

11. Ross procedure/Homograft valve replacement

      The Ross procedure is a complicated valve surgery introduced by an English Surgeon; Dr. Donald Ross in 1967. It was based on a sound principle and gave the patient an extremely superior outcome for both Aortic and mitral valve replacement. It was the ideal operation for patients. To do this operation a homograft valve bank was essential. In 1993 I established a state of the art tissue valve bank at the Centre in AIIMS. Following this development, I Performed a large number of these operations for the first time in India. I had to make a few changes in the original technique and Dr. Ross complimented me on the innovative changes. The valve bank was a great boon for patients who could not afford commercially available valves. Over the last  16 years of my work at AIIMS I have performed more than 500 such operations and nearly 3000 patients benefitted by the valve bank in other surgeries as well. I also adopted another technique of shaping the patient’s pericardium as a valve substitute. This technique was not used by any other surgeon till now. These  5 new techniques in Ross procedure for AVR, for MVR, homograft Bentall operation, homograft MVR and pericardial valve for AVR became possible after establishing the valve bank. These were  and still are a very satisfying achievement for me. I have shared these techniques in my publications and produced videos for surgeons around the world to see and learn to do these operations.

12. Large size valves

     I have seen many patients who underwent Aortic valve replacement with a small valve leaving them in the same condition as they were before surgery or worse. I wondered why this happened. Surgeons were quite satisfied by a successful operation without considering the poor outcome for the patient.  In order to change this I studied the normal size of the natural valve in men and women in India,  in the hearts that were donated to the valve bank. Then I decided to try and match the heart valve substitute to the size that the patient would require. I became the only surgeon who could do this operation to the full satisfaction of the patient. I published my results and taught my students the technique to avoid Prosthesis-Patient Mismatch (PPM). However, even today surgeons put in a small valves insufficient for patients’ blood flow and leave them with same or worse symptoms.

13. Technique of Coronary bypass surgery

       I spent one year with my Mentor Dr. Dudley Johnson in USA learning his technique of doing bypass surgery. It was based on sound surgical principles in heart surgery. He was meticulous in following the technique and produced excellent results. He was a craftsman and created new coronary arteries for patients. When I returned to Delhi, 

I used these techniques for good results. Another technique that used cardioplegia, damaged the heart with poor function after the surgery. When I  had done a reasonable number of patients, I did some tests and published them to show how to do this surgery. I also made a good video of the operation. On the advice of a friend of mine I produced an E learning module where the student can practice the surgery on the computer. This was very expensive but I spent my money to make it for teaching.

14.Ventricular remodelling

     Before my training in USA my colleagues had attempted to remove the scar in the heart after a heart attack to make it better for pumping blood. These attempts were unsuccessful. My first patient who underwent Coronary bypass had a large heart scar (LV Aneurysm). I successfully corrected it for a very good result. Subsequently I have performed this remodelling (Anerysmectomy) in many patients with  good results. In one of my patients I replaced the Mitral valve through the open left ventricle before closing it. My technique was the same that I learnt in USA. This was another contribution in AIIMS.

15.Antibiotic use

     For surgical procedures on the heart there are guidelines for antibiotic usage, which?, how much? and how long? is all explained. Most surgeons prescribe Strong antibiotics for too long and in high doses resulting in some serious complications. This indiscriminate use of antibiotics makes them less effective as the hospital organisms develop resistance.  I studied the problem and the published guidelines and fixed a protocol. For simple operations the antibiotic was given for just one day and for open heart surgery for 3 days unless there was evidence of infection. This was audited by a nurse to see superficial and deep infection in the patients operated by me. The information was carefully recorded. When we analysed I realised that the protocol we had set was very effective and the rate of infection was the lowest  for my patients. We published this and until I retired these instructions were followed regularly.

16. Mitral valve replacement (MVR)

      The father of Open heart surgery Dr. Walton Lillehei in 1954 emphasised the need to preserve some structures known as chordae( sub valvar apparatus) in all patients at the time of Mitral Valve Replacement. However  in the following years many surgeons ignored this advice and removed all the chordae resulting in poor heart function for patients. It also increased the mortality few years after surgery. As  teacher and academician, I taught my students and colleagues the need for preservation of these structures during MVR. I followed these and  published many articles on the virtue of following this practice. I wrote an illustrated textbook on valve surgery and made a video and an E learning module to explain the technique. All My patients who underwent MVR(100%) did extremely well even 20-25 years after surgery with good heart function. 

17. A  new technique for blue babies

     Blue babies have low arterial oxygen saturation because of a birth defect known as Tetrology of Fallot. At open heart surgery these patients have extensive intracardiac repair.  The operation produces many problems for patients. They may develop poor right heart function, heart block and heart failure. In order to overcome these complications many surgeons use a different techniques. In the process of learning and doing Cadaver heart dissections I learnt that a new technique could be used to correct these anomalies inside the heart avoiding all these complications. I had to be careful not to jeopardise the patients life. A cardiac surgeon is expected to be fearless and to perform operations that benefit the patient. So I went ahead and performed the entire correction through the Aorta. Although apprehensive during surgery, I realised that this approach was extremely good and avoided all the complications. After the first success I did a few more  such operations and published the technique in professional journals. I also made a video recording to help others learn this  approach.  I felt extremely satisfied to have contributed a new technique in heart surgery. 

18. Endocardiectomy

     While operating inside the heart of a young girl of 12 years I realised that I could not complete the operation as required. I drew upon my experience in other operations and took a decision during surgery to use a new approach. The disease caused a thick scar inside the heart and did not allow the ventricle to fill with blood and is known as Endomyocardial Fibrosis(EMF). The scar had to be removed completely. I could remove only a small portion of the scar and quick thinking at surgery, I chose another route to remove the scar through the Aorta. This was a new approach and had never been published. When the child recovered and the tests showed a successful result, I published this as a new technique and received good response. It was highly gratifying to have found a new way of doing a complete operation for this rare condition.

19. Peeling

      This particular discovery happened serendipitously. After having successfully done mitral valve repair in a good number of patients I thought I had seen it all. When I opened up this young patient for mitral valve repair, the  first impression was that It is not repairable. I thought I would try and went about doing the steps. When I had finished I found the valve cusps were not mobile and I considered valve replacement. As a first step I held one of the leaflets in the forceps, and something happened. The leaflet started to peel off and I thought that the underneath cusp seemed like a normal leaflet. I thought I had torn the valve and would have to replace it. I began to pull on the forceps holding the cusp and it continued to peel off the superficial thickened layer. It was  a great surprise. I continued to peel and seconds later, I realised I had done something miraculous. The cusp underneath was thinner and glistening like a normal leaflet 

    I took care to peel this layer from the entire leaflet and shaved it off the free edge. Now It was for me to be surprised. The leaflet appeared larger, thinner and more mobile. I then attempted to do a similar peeling of the other leaflet and saw that I could take off a thick layer of fibrous thickening that imprisoned the cusp. It was a remarkable  happening. The valve now appeared almost normal and I found with the saline test that it was competent, mobile and thin almost like the normal valve. 

   By sheer luck this procedure had been captured on video. When I reviewed it after the surgery, I was pleasantly surprised that I had done a procedure for the first time in valve repair.  After this I went on to peel all the mitral  valves, I undertook to repair. I published the results and it became very popular with surgeons trying to repair Rheumatic valves. This got extended to the Aortic valve as well with excellent outcomes for the patients. It has remained one of my best contributions to Valve surgery.

20.Homovital valve

    My senior colleague called me one afternoon when he was planning a heart transplant. He suggested that I could harvest  the valves from the recipient’s heart that usually went to pathology. The pre operation echo had suggested that the valves were normal but the heart muscle was nearly depleted  causing heart failure. I went and looked at the Echocardiogram and found that it may be suitable for use as a homograft. I had under my care a patient  awaiting  aortic valve replacement. It seemed to me that this was a good opportunity for the waiting patient to have a freshly explanted living valve almost similar to the Ross procedure. I discussed with my senior colleague who suggested that I could do the operation simultaneously. 

   The heart  donor was in one OT where his heart was being prepared for explant. In another OT the sick patient was to undergo the heart transplant. I set up a third OT where my junior colleague was starting the surgery on the my  patient for a valve replacement. As soon as the recipients heart was removed, I brought it in a sterile basin and dissected the Aortic and Pulmonary valves. I joined my junior colleague and we used the fresh living Aortic homograft (homovital) to replace his Aortic valve. The operation was successful. The pulmonary valve was immediately frozen with cryopreservation. There was no need to do any tests and all had been done in the recipient who had the heart transplant. We observed the patient regularly over a 6 week period after discharge and found no problem of Rejection. This procedure was done in the next few heart transplant surgeries as well. We got the microbiologist to study the compatibility and published this as an article. This is another new technique that I had introduced in AIIMS and it became known as the Domino procedure, since three surgeries resulted in a cascade.

21. The Vineberg operation.

      While training in USA I had assisted Dr. Johnson for an extraordinary and abandoned procedure. Arthur Vineberg had described this operation in 1945, before Coronary Bypass(CABG) became possible. He had taken down the internal mammary) artery (one or both, cleaned it of all fat and other tissue. The bare artery was tunnelled inside the left ventricular(LV) muscle, with the branches open. A small suture anchored the artery in place. When it was opened blood flow spilled into the tunnel via the branches and the bleeding stopped after a few minutes. This procedure did not relieve Angina immediately, but six months later it seemed like new coronary arteries had grown inside the LV muscle and the picture suggested a great network of tiny arteries almost like a screen. This was the only treatment for patients with blocked coronary arteries before CABG was started. The evidence came when mason Sones performed selective coronary angiography. Hundreds of patients benefited from this. Dr. Johnson did a few of these in patients who had diffuse disease in their coronaries not suitable for bypass. I had assisted and knew the technical details.

  My junior colleague while doing a CABG asked for my help. I joined him and after assessing the coronary disease I suggested him to do the Vineberg operation. He had not seen it. I scrubbed in  and showed him how it was done. Although sceptical about the final result he did the procedure. The patient recovered and went home. I suggested to do another angiography after six months. It was not done.  This was also the first time this procedure was done in India and at the AIIMS.

22. Inner vision

     My first mentor was prof. Gopinath. I spent 6 months as his house surgeon and three years of residency under his tutelage. He never wore Magnifying loupes or a headlight, despite having been trained by the legendary Walton Lillehei who used a miner’s headlight. It was also very expensive and not freely available in India and had to be imported. I spent 8 years with him in CTVS before he retired. I went to train with my second mentor, Dr. Dudley Johnson in Milwaukee, USA. Throughout the one year I spent with him I never saw him use loupes or headlight. He operated with his reading glasses. He was perhaps the only surgeon at that time in  USA who did not use the loupes and headlight.  Before I returned to Delhi  I bought a pair of Keeler magnifying loupes for myself.  When I began to do surgery independently, I never used the loupes. There was one  expensive headlight bought for the department, Which became the professor’s property and was not available for juniors unless he was out of town. I never used it either and got used to operating without the headlight or the loupes. By 1995 all my colleagues had got their own loupes and headlight. There wasn’t one in my operation theatre. It was an eye opener for me, when I found my colleagues and many other surgeons who could not see the obvious, inside the heart despite the loupes and headlight. They found it difficult to identify epicardial coronary arteries. One surgeon anastomosed the vein graft to a coronary vein instead of to the blocked artery, with the headlight and loupes to magnify for his surgery. All this led me to coin the term “Darkness of the mind and illumination of the patient”. I realised that these expensive gadgets were unnecessary, if you had the Clear knowledge of anatomy of the heart inside your head. Even Today in 2024, perhaps, I may be the lonely surgeon who operates without these gadgets. 

23. Abolishing Air embolism.

     During my  Residency training I witnessed a massive air embolism during open heart surgery that was fatal. After  another 10 years later (in 1985) It happened again, Twice in my surgery for a valve replacement. I had read about the complication  and took necessary steps, with a good outcome for the patient. I tried to publish this experience, but the reviewers were not convinced that it could happen and wanted experimental proof. It took me 2 months to reproduce the accident in a set up in the laboratory. This was published. After reading my article, the industry devised a one way valve and incorporated it in the heart lung machine circuit to abolish this catastrophe. This became standard practice. This event has not happened in the last 5 decades since my publication and subsequent modification in millions of heart surgeries all over the world. No one has published a similar accident after. It was immensely satisfying for me to treat, find the cause, publish and see the effective solution which abolished this complication forever.

  CHANGES FOR THE DEPARTMENT OF CTVS

1.Building

Until 1984, we were operating in the main hospital with just 4 beds for an ICU. Prof Gopinath worked hard to propose, follow and obtain sanction of funds and planned the Cardiothoracic Centre. I joined him in 1978 to dig the ground for the building. It took 6 years to complete the building. The architect had built it like an office. The operation theatres had very high (10ft) ceiling and the air conditioning units were placed behind. The windows had shutters which could open to the corridor surrounding the 4 operation theatres(OT). When we planned to move we had to first break down and fix sealed, glazed windows with double glass. It let in the light but not the air. Then the air conditioners were not specifically meant for OT. They were like normal air conditioners that circulated cooled air. The ducts were high on the sealing and there was no exhaust. So the pressure inside the OTs was high and the doors had to be kept partially open. It was the same in the Intensive care unit(ICU). I joined my senior colleague to redo the OTs and ICU. It took nearly a year before we could begin surgery. The ICU had 16 beds and was not fully furnished. We opened with 9 beds and used oxygen cylinders and a pump for compressed air  for the ventilators. It took another year to completely utilise all 16 beds. It was still not modern. We asked the only company with know-how, Indian Oxygen who proposed modernisation with piped gas outlets, and Oxygen tank of large capacity. They fixed the outlets on the wall. We seemed to be the first to have a modern ICU. More changes were to come.

 2. The service panels

    When the new ICU was begun, we ordered wall panels for each bed. The bid was given to the company that also supplied the monitors. The representative measured the height of the ceiling and accordingly ordered the panels in bulk,16 for us and 12 for the neuro surgeons. When the panels arrived we saw that if they were mounted as suggested the utilities 2 oxygen points, one compressed air point and two suction outlets were way above the reach of nurses and would be just below the false ceiling. Also the bracket for mounting the Monitor would be above the false ceiling. The rep realised that it was the wrong size and design. Ordering new panels and sending these back was frightfully expensive. The CT Centre engineers  backed off and put the entire responsibility on the company representative. He was completely at a loss as how to fix it. He tried turning the panels upside down and fix it at floor level which was not feasible. This is when I was asked to see what could be done.

   The panels were 8 feet in height.  The top four feet were just a wooden board on an aluminium box mount. There was the bracket for the monitor and just 4 ins below were the gas outlets These were four feet from the top.  The gas outlets formed the bottom row on the panel. I called the company rep and discussed with him my plan for remodelling. The panel would be cut across at the middle just above the  monitor bracket and the aluminium frame would be left open for the Gas pipes to enter the panel. This would now be just below the false ceiling and hidden. The cut upper four feet of the panel was turned upside down and fixed by the aluminium frame below the gas outlets. This portion was extended forwards by 6 inches with additional aluminium frame like making a box. The wood sheet was cut vertically in half and made as shutters. Two shelves were fixed inside the box for the patients’ personal effects and for IV fluids. He reluctantly agreed to remodel one panel and see how it would be. After some urgent work by a carpenter the panel was brought and mounted on the wall. It turned out to be perfect. The ICU false ceiling was being erected. I asked the engineers to fix vertical pieces of aluminium brackets  fixed to the ceiling to support the false roof. The utility pipes were just below the false ceiling and windows provided access to the inside for repairs. We also got Audio speakers and fixed them in the false roof and connected to the audio system near the Nurse’s station. Horizontal strips at 8 feet intervals on the bottom of the false roof provided for curtains to partition and enclose each patient for privacy. Vertically mounted movable hangars for IV bottles eliminated IV stands on the floor. The flooring was covered with sound proof synthetic PVC  floor sheets. When completed the ICU looked very modern and appealing. The company rep was very grateful for redesigning the panels. He did this in the neuro ICU as well and saved a lot of expense.

3. Air conditioning

  A few years after we began operating in the new Centre we found a higher incidence of fungal endocarditis, when there was a water leak from the roof. The OT’s were shut and the engineers took time to fix it. At this time we asked the engineers to inspect the ducts. They were high and at 10 feet.  They brought a mobile robot car with a camera that went into the ducts and took videos. We found some hairy black masses which were pulled out and examined. They were fungal masses. It took a herculean effort to clean the ducts thoroughly and disinfect before restarting surgery. A decision was made to change the Airconditioning(AC) with a false ceiling to reduce the cost. The AC machines did not have the kind of filters required for heart surgery. The Blue star company were contracted to do the false ceiling, new ducting and bring in modern AC units. When they came and inspected they clearly did not know the standards. I asked them about Laminar flow, number of exchanges per hour and the filters. I had studied this thoroughly and educated them. They had to Bring in powerful AC units with High Energy Particulate Air (HEPA) filters of 0.3 microns. This required more power to push air through the filters after cooling. The ducting had to be done to blow clean air at the surgical site and suck out at the corners of the OT. Only fresh air with 13-15 exchanges per hour  was acceptable. After much discussion the engineers designed for one OT as a demo. We made some alterations  and then it was completed in all OTs. The air conditioning in the ICU also had to be changed with making a false ceiling to reduce the space and cost. However, the ICU air was recirculated, unlike in the OTs.

It took nearly 2 months of intense effort and pushing to get the renovation completed. After these changes the infection rate dropped to acceptable levels. The Blue star engineers are now  using the same technology in Air conditioning for other hospitals, taking the AIIMS as an Example. It has remained so till I retired.

4. The CTVS store

    To perform Open Heart Surgery(OHS) we needed a lot of disposable items. These were not stocked in the hospital. So the senior resident had to give a 2 page 40 item prescription to the relatives who ran around the city and brought the items. The prescription form had the address of dealers and they charged more for extra profit. The whole thing was so cumbersome and disorganised. When we were to move to the new building we realised that daily the residents will have to make and give prescriptions to patients who ran around and spent a lot more than expected. We also found that sometimes not all items were available and not all were the best. At a  meeting of the faculty to solve the problem a decision was made to change the system. There were many suggestions but no solution. I had thought about it and realised that our requirements need to be stocked in the theatre and be available immediately. So I proposed some changes. 1.To appoint a stores clerk who would manage the store. 2.A fairly large room within the OT complex  to stock the items. 3.An accounting system that would be acceptable for stores purchase procedure  in the hospital. Finally, we agreed and the Stores officer was asked to call for bids as per procedure, for all the items we had listed. A store clerk was appointed and space found in the OT area for this. The bids were scrutinised and the vendors were selected as per rules. We asked them to supply in bulk for one week, every week and collect the payment. The price was negotiated and fixed for a period of 2 years. The store clerk was given the responsibility of ordering, procuring, storing and accounting all items. A utilisation form was prepared with all items listed, along with patient details. Unused items would be returned to the store and deleted from the utilisation form. This form was used to generate a bill and patients were asked to deposit the calculated sum in advance. The relatives would then receive a proper bill and refund of excess deposit.

  This system did a lot of good. There was no shortage of items, the residents did not have to prepare a prescription, The patients relatives did not have to run around town, the cost was considerably reduced, with much relief for surgeons, nurses, technicians and perfusionists. We could do any surgery at any time of day or night without hassle. The accounts were audited a per rules. This remained until I retired.

5. Cautery Burns

  This was a most disastrous complication that defied all our efforts. Every third patient suffered superficial skin burns on their buttocks and stayed in the hospital longer. Almost daily we had to make rounds and inspect the patient’s behind! We called the cautery machine vendors to explain the burns. They suggested that we use copper strips for grounding in all OTs. The burns seemed  reduced, but after a couple of months  we began to see them more often. There was one modern cautery machine that did not produce burns as frequently as the others. The professor transferred the machine to his OT and left us to fend for ourselves. That did not solve the problem for him either. I called the Electrical engineer in charge and asked to find the cause? He came back with a blank face. I consulted my colleague, a prof of Biotechnology to help. Even he could not fathom the problem. We had asked one nurse to check, on a daily basis the number of patients, the type and duration of surgery and many other details in all patients who suffered. I was disgusted and very disappointed. In this situation our electrician came to me and asked me if he could try to solve the problem. I admonished him for not trying and waiting to ask. I told him go immediately and find the solution. I was sure he would not be able to find a solution.  A few days later the nurse came and told me that the burns problem had almost disappeared. I was overjoyed and called the electrician to come and explain how he had done it. He told me that he would wait for another week to be sure before telling me that it was effective solution.  When a week had passed  and burns disappeared, he asked me if I could go with him and he would show me his solution. I went  and saw the connections, and  he explained. He said the electrical  mains had a solid copper rod for earthing. The standby generator  also was connected to the same copper strip. He said he separated the two because there was a current leak between the two supplies. This solved the problem that qualified electrical engineers could not solve. I thanked him profusely and made sure that he was appreciated with a certificate as Employee of the month and a gift. I realised that in any organisation even the lowest employee in the hierarchy may contribute significantly to the outcomes.

6. Tissue  valve bank

   In 1974 my senior colleague and another Asst. prof. performed homograft heart valve replacement. I was a resident and it impressed me that we could give patients a better life without anticoagulants with human cadaver valves, compared to expensive metallic valves. The homograft availability was sparse and the few operations caused a natural death for this technique. Both of them had been trained by pioneers in homograft valve replacement. Fast forward to 1993(21 yrs.)

I was offered an opportunity to develop a valve bank. Another younger colleague had just joined the department and he brought me the American Association of Tissue banks(AATB) guidelines for the technique of sterilising and storing homograft valves. At about the same time my senior colleague gave me an illustrated brochure for the Ross Procedure. Both events gave me an opportunity to begin the program. I met my colleague and close friend in Forensic medicine and discussed with him the possibility of obtaining cadaver hearts for valve replacement. It was legally allowed. He agreed and slowly we began to get cadaver hearts for Dissection. There were clear criteria for donor hearts that could be used for homograft harvesting. We followed the guidelines and in the meanwhile obtained the basic equipment and identified a technician and a room within the operation theatre area. We prepared the antibiotic solution and the plastic Jam jars for storing. We obtained an  ordinary refrigerator. I had to ask the nurses to prepare a large Stainless steel  Basin with the instruments and empty penicillin vials and jars. These were packed in cloth sheets and sterilised by autoclaving.  The  homograft valve bank was born. The first few valves that we harvested had to be discarded because of contamination. After streamlining the procedure including harvesting the heart at autopsy,  we were able to get a few heart valves for implantation. I studied the technique thoroughly, saw the illustrations and did the first Ross procedure at the AIIMS in October 1993. It was a momentous achievement, since no other Indian  surgeon or Hospital had done this procedure in India. This encouraged me to push ahead and get more funds sanctioned for developing the Cryopreservation technique which would give us the ability to store these valves and other tissues for up to 5 years. As the equipment arrived and the set up was established we had more homografts in the bank. This was the first state of the art homograft valve bank in the country. I began using these valves for those who could not afford the commercially available valves. I did a large number of aortic valve replacements and Ross procedures. I also used the  homograft mitral valve and replaced the mitral valve in some patients. The procedure was technically difficult and did not give good results and was abandoned after we reported the 5 year follow up. When I presented the results of the Ross procedures for the Aortic and Mitral valves, Dr. Ross was very complimentary for my efforts. We published the technical aspects of developing a heart valve bank, and also our results with homograft aortic valve replacement,  Ross procedure for Aortic valve, Ross procedure for the mitral valve (another first in India) and the use of pulmonary homografts for children with heart defects. By the time I retired in 2009, more than 3000 patients had benefitted with the homograft valve replacements. The valve bank is still functional at the AIIMS in 2024.

7. Academic progress

  As a resident in surgery my mentor encouraged me to publish articles in journals. Before I completed the Master of Surgery(MS) Examination in 1973, I was the only resident with three publications. This got me hooked on publishing  and I have not stopped, even now in 2024. I have encouraged, assisted and mentored all my students to publish and learn to write articles for publication. I taught them the importance of academic progress.  As a faculty I published at least 3 to 5 articles in peer reviewed journals every year. These got me a position as Editor of the Indian Journal of Thoracic and Cardiovascular Surgery(IJTCVS). After serving for 11 years, I continued as Editor of the Asian annals for another 10 years. I also got a position as Editorial board member of the Annals of Thoracic Surgery, the only Indian surgeon to get this honour till now. In most  of my publications my students have been first authors. Cardiologists, Nurses, Physiotherapists, perfusionists and anaesthetists have been my co-authors. 

    I was the first faculty to join the Society of Thoracic surgeons as an international member. I went on to acquire membership of all prestigious professional associations in Cardiothoracic surgery. The institute provided  a substantial allowance for membership fees. Yet my colleagues never applied. I got many of my students to elevate themselves to these memberships. This was an academic progress that counted towards promotions. 

8. Editorship

   Mr. James Bagg, Editor of the Texas heart institute journal was primarily my educator in editing. As I progressed in Academics I became a reviewer for many journals and learnt to review and edit articles. This helped me to become the Editor of the IJTCVS. I resurrected this journal from oblivion and today it holds a position of recognition in peer reviewed journals in the profession. I then went on to become the Editor of the Asian annals. I acquired editorial skills for 21 years and  taught my students the art and science of publications. In AIIMS I was the first cardiothoracic surgeon holding an editor position. No one else  in AIIMS has held this position since I retired. I am now the Emeritus editor of the Asian annals.

9. Patient Safety

   After a number of years of experience I noticed that most surgeons are unaware of the rights of patients. I researched the subject and compiled the data from all countries that had a charter of patient’s rights. There was none in India. It led me to write a book on Patients’ rights, which was released at a function by the then Chief Justice of the Supreme court in India. This book has been upgraded with new information in the second edition in 2022.

  As chief of cardiothoracic Centre, the world health organisation invited me to a conference on patient safety in Washington in 2009. I attended this meeting and learnt that in the world 300,000 deaths annually were attributed to errors of treatment. The meeting was well attended by more than 130 representative countries. The Surgical safety Checklist was released. This was an off shoot of the checklist used by airline pilots who had to verbally announce and confirm each step. I brought back this checklist and made it mandatory for all my surgeries and introduced it in the CT Centre. It was later made mandatory for all surgical departments in AIIMS and through the ministry of Health in all hospitals throughout the country. 

10. Video recording

  A picture is worth a thousand words is an old adage that is true even now. I began adding surgical pictures as background in my slide presentations at conferences. It became popular among doctors. I found that recording a surgical operation for teaching was an excellent tool for education. The equipment purchased in our department was not satisfactory and no one used it for recording a video. I attempted a few times and gave it up because it was unsatisfactory. I then proceeded to design (made by architect son) and fabricate a camera arm in our workshop.  I bought a light weight Handy Cam made by Sony corp. which had all the features I needed, the camera arm was fixed on an IV pole in the OT and the camera was positioned just over my left shoulder. With the remote in a sterile plastic bag I recorded just the steps required and edited the video at surgery. My secretary learned to dub voice and music.  The videos were superb. As a teaching tool, I made 33 videos of various surgeries and sold them at production cost  Rs.100

( $1.5/-) at the annual conference at the IJTCVS  booth. About 80,000 CD’s were sold and students and surgeons from all over the world saw these videos. It was published in the CTSnet and received excellent reviews. I used clips of the videos in my presentations to illustrate the steps of operation. This activity was a phenomenal success for inexpensive, high quality surgical video production, started at the AIIMS. The method was published in the Journal and received a very good commentary. Many of these are now accepted in The STS(Society of Thoracic Surgeons) E Book. It is one of the most popular  teaching aids.

11. Fire Safety

    A fire in a housing complex causes many deaths. Yet a  large number are rescued by firefighters. Most often these are due to poor fire safety installations.  A fire in a hospital is more disastrous as patients in the hospital cannot be evacuated easily resulting in more deaths. Also there is serious damage to electronic equipment, leading to a lot of expense and shut down of facilities for months. There were two fires in CT centre before I became the chief. Fire safety certificate was not given to the Centre by the fire department. I could not take this responsibility as it would lead to serious punishment. The Onus was on the chief of the Centre. I worked hard along with my colleague in the Neuro Sciences Centre, sanctioned the necessary funds and got the Delhi Chief Fire officer’s help to install all fire safety equipment. We obtained the fire safety certificate in 3 months. The CT and Neuro Centres  Building was the only building certified fire safe in the entire AIIMS.

12. Payments and Refunds

  For a number of years, to deposit money for surgery patients had to visit the bank, make drafts(bankers cheque),pay additional charges for the same. Sometimes if the deposit exceeded Rs.50000,  they had to make 2 or 3 drafts and submit them at another counter. Touts and agents posing as helpers stole the money, charged a fee for the services to patients who could not make the bank payment.  Their misery was compounded. I, with the help of the bank manager and a reluctant accounts officer, changed the system. The patients could deposit the money in their hometown bank by cash, debit from their account to the surgical charges accounts. They saved a lot of money charged for making drafts. The bank provided a daily deposit statement of accounts to the CT centre accounts officer. They carried a receipt when they came and deposited the same at the counter. They kept one copy of the deposit slip for their records. The procedure was circulated to all doctors and staff and when a patient was booked for surgery he was given a deposit slip in triplicate. He just had to write his name, hospital registration number and the amount and deposit in any branch of the state bank anywhere in India. It mitigated a lot of problems till the AIIMS introduced digital transfer.

     Refunds were  sent to patients registered address by crossed cheques. Clerks used to hand over the cheques and send a fake paper by post. They charged the patients a hefty sum as commission(10%). When I detected this fraudulent transaction I removed the clerks and made the accounts officer and administrative officers sign the envelope containing the cheque to prevent tampering. This stopped the fraud until the refunds were digitally transferred to patients accounts directly.

13. Hindi communications

In the three years of my presence as chief of Centre, we received the first prize for Hindi communication consecutively for three years. The CT Centre was recognised for this contribution. 

14. Early surgery

   The AIIMS was started in 1956 as a brainchild of the then Health minister, Rajkumari Amrit Kaur. It received a huge grant from the government of New Zealand. The buildings were majestic and in a  central location.  It was opposite the American Hospital, which later became the Safdarjung Hospital. From the beginning the hospital started with all super speciality departments and was a deemed university. It was an autonomous institution governed by the health ministry.

   All surgeries began at 830 am till 5pm. There were 8 operation theatres with galleries for students to watch. All surgeons had been trained abroad either in United states, Europe or United Kingdom. To my knowledge in all these countries  always surgery started at6 am.  No surgeon in the AIIMS attempted to begin surgery at 6,or 7 am.  My colleagues were trained in USA, New Zealand and Australia. 

I spent a year in USA as a fellow, Where surgery always started at 6am,even if there was a snow storm. The temperatures in Milwaukee was well below Zero and you had to be in the hospital before time. When I returned to India, we still started surgery at 830 am. We were the first in hospital for a journal club at 730 am and after the class went to the OT. This continued until 2007(51 Yrs.) until I took over as the head of department. I wanted to begin surgery at 7 am. There were many objections and one anaesthetist agreed to come and start at 7 am. I had to organise the nurses, technicians, perfusionists and the stores clerk, to make sure all supplies were made available at 7 am. They were all co operative and one fine Monday morning I began surgery at 7am. The anaesthetist and I had arrived in the OT at 630 am. When my first patient was wheeled into the ICU my astonished colleagues were just walking in.. By noon My list of 2 surgeries for the day were completed and I had enough time for  office work, a quick snack and OPD from 2pm. The patients were stable by 6 pm when I made rounds and I had the freedom to spend time with the family, play Badminton, or attend a concert. Life became easy and peaceful It lasted until I retired in 2009. I was the only surgeon to begin surgery at 7 am in AIIMS history.

15.OPD registration

        From 1984, when we moved into the new heart Centre  I had noticed a long line of patients waiting for registration in the Out Patient clinics in the morning. They were children, women and elderly patients. Many with heart failure and children with cyanosis. In the winter months and monsoons the patients kept their cards covered in plastic sheet, weighted with a stone and stood in the building. Only a fixed number of first and follow up patients were registered each Monday, Wednesday and Friday from 9 am to 1130 am. It was the most pathetic sight and the misery of the patients were ignored by successive heads of department and chiefs of Centre. The excuse was always the same; this is the procedure followed for many years and cannot be changed.

    In 2007 I decided to change the procedure and ensure that patients did not suffer. With help solicited from the head of records section who was sympathetic and willing to change we changed the procedure. The Administrative officer(AO) and Medical superintendent(MS) were reluctant participants and explained that no overtime could be claimed by any staff. I moved a couple of staff to the record section, who were redundant in the MS and AO offices overruling their objections. The Registration counters were increased to three windows, started at 7 am every day of the week and closed at 11 am. There was enough time to find and place the records in the consultants rooms as per list. The patients were given a room number and time for  examination. The clerks were allowed to go home for lunch and return  in the afternoon to restore the files. In three days’ time  misery  of the patients were abolished. There was no line in the morning  to the delight of the patients. I appreciated the Records officer’s efforts with a certificate and Employee of the month recognition. A procedure that could not be changed was changed like magic in Three days. I felt good that I did not have to see the misery of heart patients coming to our Centre.

16. Educational books/videos

Teaching and mentoring is an Art. It requires preparation, patience and perception of goals. It is also the best learning tool for the teacher. You have to get down to the student level to educate and elevate him to the expertise he is seeking. In this arduous task we need many tools . There are books for the students, brochures to educate the patient, videos to demonstrate the techniques. As a teacher I began considering Making illustrative slides, not just text but surgical pictures as a background. It was a great success and others began to follow.  Then I wrote a booklet with illustrations to answer patient’s questions when they were advised surgery. I had one for valve surgery and one for Coronary bypass. Both were translated to Hindi. I got one of the industrial partners to print several copies and gave them free of cost to the patients for their education. The next step was to publish all my techniques and results in journals.  The students were involved in the writing and learnt both the art of publishing and the nuances of the techniques described. It was good to see their progress and curiosity. The next step was to compile all the techniques I had developed into an illustrated textbook. Here I must appreciate the efforts of My friend in CBS publishers who helped me to publish the book in 2006. The book also came with a Video collection of the procedures described in the book, which had colour and artist drawn illustrations. It received a very good response and went into the second edition in 2009. It is the only book illustrating all the techniques for heart valve surgery.

   I was invited to contribute to textbooks to write a chapter. I have written for two textbooks on Surgery published by B.I.Churchill and  CBS publishers. I did that for a book on Masters Series, for the cardiac surgery, published by Wolters Kluwer. Another book on paediatric surgery had a chapter written by me on valvular heart surgery in Children. Another textbook on cardiology had a chapter on Mitral valve repair written by me Published by the heart Centre.  A textbook on acute Rheumatic fever and Rheumatic heart disease with a chapter on Surgery for Rheumatic heart disease, published by Elsevier.

  I felt there was a need to educate patients for their rights and my first book on Patient’s Rights was released by the then Chief Justice of India. It went into the second edition in 2022 with new and more recent rights added. 

  During the speciality examinations I realised the students were completely ignorant of the history of cardiac/thoracic surgery. They did not know their pioneers and contributors. With help from the historian of the society of Thoracic Surgery, Dr.Gerald Rainer as a co-author, I compiled an easy to read illustrated history book with photographs and one page contributions of all pioneers. It became a very popular book among students and received well by the examiners as well. 

      My interest did not confine to Cardiac surgery alone. I researched publications on patients’ rights and published the first edition. This was released by the retd. Former chief Justice of India. It was published as a second edition in 2022 with additional information. I was the only surgeon to write on the subject of patient’s Rights. I also researched the law libraries to learn definition  of death and how one could introduce a humane and painless execution and use organs for transplantation. Ironically, I could not find a definition of LIFE, for which I provided a provisional definition and published an article on the subject in the Journal of Indian Law institute. These and other publications of short stories on the human side of medical practice(Thoracic park, Once upon a heartbeat and heling touch of a heart surgeon) seemed to me of value in educating young surgeons and the general public.

    At international conferences I saw surgeons use video clips to illustrate their techniques. It pushed me to develop a simple and inexpensive method of recording the surgical operation, add commentary and edit. These were made as compact discs and the Indian association benefitted most when nearly 80,000 CDs were sold at the annual meetings. I published the technique and it received a very good compliments. I had made 33 surgical videos to illustrate all techniques.

 I used the surgical videos to teach the students to perform the operation on a computer based E learning module. These were expensive to produce but were excellent tools for students to hone their skills before attempting on a live patients. They were also good for young beginners to see and do the surgery for valve replacement or Coronary bypass surgery.

17. Foreign training

  This is a legacy of Prof Gopinath, who was trained by the father of Direct vision Cardiac Surgery, Dr.Walton Lillehei. He was keen on sending everyone of his students abroad for training. I was one of them and  I realised that it was my duty to  continue this legacy. I  got the prestigious Evarts Graham Travelling Fellowship by the AATS for one of my students. Another student went to Train in the Carpentier Institute in Vietnam, on my recommendation. Two other students got trained in USA and Canada in Cardiac surgery on my recommendation. I continue to recommend students for foreign training even now after retirement.

18. Power Breakdowns

     During open heart surgery power shut down is disastrous for the patient. In New Delhi it was  frequent. All our electronic Equipment in the OT and ICU were protected against Voltage surge and power shut downs with Uninterrupted Power supply(UPS) units that worked on Batteries. The Airconditioning was a big Problem, With the patient’s heart open lack of air circulation caused dust and dirt to settle down on the operating site. We had to take emergency measures to cover the site and wait for the power to be restored. Many patients suffered serious infection in the heart and circulation and died as a result of this. I kept a close record of such events and realised that many deaths and infections were attributed to this. Our Electrical Engineers were helpless to restore Air conditioning without power. 

In 2007, when I took over as chief I wanted to end this problem. My executive Engineer told me that Airports, Prime minister’s office, Parliament, President’s estate, National Security, and other sensitive areas had dual supply with automatic switch over, with no interruption of activity. I asked him how we could get  dual supply. First we had to approach the chairman of the New Delhi Municipal Corporation (NDMC) which was the nodal Centre for the power supply. We had to build a substation inside the AIIMS  near the Air Conditioning units. A separate connection from the northern Grid could then be connected with automatic Electronic Switch over. I went to work. I got an appointment with the NDMC chairman. I took my electrical executive Engineer and met him in his office. I explained to him that VIP’s including Prime ministers ,presidents and visiting dignitaries of foreign countries were cared for in the CT Centre and we required the Dual Supply. He was surprised that we had not got it. He sent his Exec Engineer to AIIMS to assess and report. It was feasible, The NDMC would do the work and procure both the cable connection and Swich board equipment and they would build and handover to our engineers. They wanted us to pay and advance of Rs.5 lacs to begin the work and 25 lacs overall costs. I did not hesitate even  for a moment and together with my Neuro Centre chief we shared the cost and sanctioned the money. It took another month for the civil, electrical and electronic equipment to be Procured and commissioned. The facility was also extended to the Directors office. When it was finally commissioned we tried it. It was effective and there was no interruption of Air Conditioning. We celebrated the event with a get together with our staff and NDMC staff in the Centre with Thanks over a cup of Tea and Sweets. I thanked the Chairman of NDMC personally for completing this at emergency speed. I was thrilled that we could now ensure safety of equipment and patients lives. I communicated this in a letter to the Director and The Health minister. The CT Centre and Director’s office were the only two facilities that enjoyed uninterrupted power supply in AIIMS.

19. Discipline

    The CT Centre Catered to a large number of VIP’s and VVIP’s. However there was lax security and anyone could enter most of the areas except the OTs and ICUs. All staff members were issued Photo identity cards and were asked to wear the same at all times. There were few including Faculty members who did not care to follow the instructions and fought with the lift operator, the security guard etc. who asked for their identity. I circulated this need for wearing the ID cards to all staff members and security guards who were asked to spare no one. It led to frequent arguments. Finally the Prime minister was to visit the CT Centre for some investigation. The Special Protection Group (SPG) responsible for the PM’s security took over  and ensured that every one displayed their Photo ID Cards and checked their bags. One of my colleagues tried to defy this and was simply not allowed to enter. He complained to the Director who advised him to wear the ID card as ordered and not to meddle with the PM’ security. The SPG chief Asked me as chief of Centre and in charge of PM’s care. I told him that he should not spare anyone. It was strictly enforced and the SPG staff took the derelict Faculty member outside and warned him to wear his ID card or face arrest. When Indians Travel abroad for conferences they wear their ID cards or face denial of entry. However in India they try to use their muscle instead of their brains and face the consequences. Finally this discipline was enforced.

20. Computerisation

   As an academic institute of excellence we were behind times in modernisation. Together with my Neuro sciences chief We undertook computerisation all activities in the two centres. We started with registration of patients, Accounting, Bills payments, Stores management and Patient records. We could now issue printed discharge summaries to all patients. This also helped us to retrieve the records for research and statistical analysis. This activity began in the CT and Neuro Centres and then spread to the laboratories, departments, administration and finally the entire AIIMS activities were computerised and is still active now in 2024.

21. Free surgery

    When the AIIMS began it was mandated to provide free treatment in all departments. By the late 60’s the budgetary allocation fell short for providing the enormous load of patients with free treatments. All physicians and surgeons began to issue prescriptions to patients to buy  disposable items, medicines, antibiotics and sutures etc. In cardiac surgery it became a huge tsk to procure store and use these items. The hospital administration was asked to procure these items and fix a  calculated sum for each surgical procedure. With this the true free surgery disappeared. When we moved to the new CT Centre and increased the number of surgeries, A lot of store items were surplus and we could use them for poor patients. We also asked well to do patients to donate the refund from their deposits for poor patients. Thus a Poor fund had begun. Many others donated to this fund and we could manage to do  a fair number of free surgeries. The health ministry introduced a scheme to provide free surgery for patients, for which the patients had to get a sanction. The kitty in the poor fund increased substantially. Free surgery had to be sanctioned by the chief of Centre and they were reluctant to do so fearing objections. We set up a method to identify the scale of poverty of applicants to sanction free surgery. The number of free surgeries increased. In this scenario I pitched in to push the industry and suppliers to provide for poor patients. We received a good response and got at least 20 free valves ( 10 each of Mechanical and Tissue), Oxygenators, tubing sets cannulae etc. The  free surgery increased and in my time as chief of Centre we had done the highest number of free heart surgeries per year, for poor patients.

D. CHANGES FOR AIIMS

1. Modernising the Gymnasium

       The AIIMS Gym was a big hall with Indoor Badminton and Table tennis. I used to go regularly to play badminton and keep up my health. The Swimming pool was also part of the Gym. Two students had died in the pool and there was a criminal case against the AIIMS. In 2006,  The Director asked me to take over the Gym as Chairman. I agreed. The Gymnasium secretary was an undergraduate student, with enthusiasm and no powers. The allocation of funds for the Gym and Pool was a meagre Rs.75000/annually. I met the Gym staff and identified their roles. Since I was a regular visitor to the Gym, I insisted they be present at the Gym from 6am to 8am and again from 4pm to 9pm when the Gym closed. The pool was open only during the summer months from March to September. The staff posted there were also asked to work in the Gym when the pool closed. I gave them clear instructions about work and security.

   With the help of the engineering department I got the Gym ventilators closed with a mesh to prevent Pigeons from entering. The  Exhaust Fans were  cleaned and serviced. The Gym secretary and the students were willing to discuss their problems with me. They wanted the Table tennis courts to be partitioned to prevent intrusion of the Badminton court. They wanted a Multi gym to be installed and the wooden flooring to be changed. The money was insufficient. I talked to the financial advisor and made them demand a more reasonable allocation. By December the annual allocation had been enhanced to 250,000 from 75,000 per year. Now it was sufficient to provide table tennis balls, shuttle cocks and basket balls. The daily practicing young boys were keen on taking part in inter university competition. So we selected the team and provided them the necessary kits and sponsorship. They won several trophies in the next year.  Discipline was enforced and all had to come wearing sportswear and shoes. The Badminton and Table Tennis courts had poor lighting. With the help of sports ministry officials we had roof lighting fixed as per national standards. They also wanted a PVC flooring. All this was slowly added and many tournaments were held in the AIIMS sports facility. When our team won the tournament, I proudly photographed and sent the trophy and the photo to be displayed in the Foyer.

     The lady students, Faculty and post graduates  wanted to have some activities for them, like an aerobics club. The first floor room was readied with rubber flooring. We installed an accurate weighing scale and got a music system for the Aerobics class. We appointed a coach who agreed to come for one hour in the evening. The medical students were exempted because their contribution to sports was received in their fees. Others were asked to pay a reasonable sum for the one hour class. It took off very well and boys also joined. It was a delight to watch a health conscious bunch working out a sweat.

    The swimming pool was to be opened in march. I had to discuss with the students and the engineering dept. The pool had a diving platform and since it was hardly used it was dismantled.  I had two coaches/life guards appointed to ensure the safety of children. The pool had separate times for ladies and children who were restricted to the shallow end. We had the entire water purifying system refurbished and upgraded. The pool fees was fixed for all and everyone had to wear standard swimwear and deposit their cards before getting in. Diving was banned, because it was only a recreational pool.

    The next problem was the Tennis courts. The institute was building a dental Centre and wanted the tennis court to be closed. Along with the students we worked hard to convince the administration to move the tennis court and not abolish it. So it had to be relocated to the site adjacent to the Gym. It took a couple of months to get two swanky tennis courts.  A coach was found and appointed to teach children of faculty. They had to enrol and come in proper attire and shoes.

     The annual budget and collections from the pool and aerobics added to the kitty. Also the room upstairs was rented out for students / departmental functions like a party with strict control and supervision. No alcohol was to be served. There was a hefty deposit to be paid and it would be refunded after the room was returned clean.

     Now the students union came to discuss more facilities. They wanted a health club, Squash courts and a lounge with music, magazines and Television to watch sports events on a big screen. The room on the first floor had all these and was opened with an attendant for major sports events. There was space in the front adjacent to the Gym hall that simply collected junk of many years. We chose that for the Health club. With the engineering section’s help and active participation the fairly large hall was cleaned, airconditioned and flooring changed. We ordered two treadmills, two cross trainers, Two stationary cycles and  a multigym.  We got a large TV screen on the wall opposite and moved the weighing scale to this room. I insisted that the health club be a contributory facility for all with a reasonable fee. All applicants had to be certified medically fit as I did not want a mishap in the health Club. The Gym sports secretary was entrusted with the upkeep and maintenance. There were two attendants at all times and adherence to discipline and rules were enforced. There was overall cooperation and happiness at the speed of developing these facilities inside the campus. All facilities were strictly for the institute staff and outsiders and guests were prohibited.  The Swimming pool License had to renewed for the next year before March. The sports authority sent their inspectors to see the pool and advice necessary lifesaving equipment. They suggested to reduce the deep end to 12 feet from 20 feet  especially since the diving board had been removed. All this was undertaken in time and we got the police clearance and the license was issued. The license specifically prohibited parties and Alcohol. The pool was opened and all were happy to use the new facility with safety and life guards in place. The pool closed in September and I moved the staff to the various areas of the Gym.

  The AIIMSONIANS (an Alumnus association ) held annual meeting and an evening get together with fellowship and Dinner. Traditionally this was always held on the lawns of the pool. I had been enrolled as a member since I was faculty. The Secretary approached me one evening in the Gym and wanted to book the Swimming pool for the evening Function for Fellowship and dinner. I informed him that the license prohibited such activity at the pool. He argued with me and I was clear that permission would be refused. Disgruntled he approached the Director. IT WAS ARGUED THAT I, AS NON AIIMSONIAN, (since I was not an alumnus in the strict sense), HAD NO RIGHT AS GYM CHAIRMAN TO REFUSE PERMISSION TO TRUE AIIMSONIANS. I was asked to allow the party to be held as the date was nearing. I stood firm and sent a copy of the license for information and copy to the Deputy Director as well. The next day I received a copy of the order by the Director, permitting the party in the pool lawns. They had also not applied for a liquor license for the party. I QUIT AND SUBMITTED MY RESIGNATION IMMEDIATELY, RELIEVING MYSELF OF ANY RESPONSIBILITY. I sent a copy to the Deputy director to take necessary steps, so that the swimming pool licences could be retained and not cancelled. I also quit the AIIMSONIANS association and returned my ID cards.

    It was 11 months of my chairmanship of the GYM . The students asked me to reconsider. I refused and left in peace having accomplished in 11 months what was pending for 11 years. Also I did not attend the party despite many requests.

2. Undergraduate writing

   The Texas Heart institute journal announced A prize for undergraduates to write on history of cardiac surgery and cardiology. I copied this notice and circulated among the students. Two of them came to me and wanted to know the topic more clearly and how to go about it. I gave them all the information and assistance. They chose the topic. The prize was a certificate and trophy, with assistance for travel to Texas. The first article was researched by two students and they wrote  up about an Indian cardiologist who had discovered and introduced a drug to control hypertension. I helped them to correct the factual information and the text. They were very happy when their submission was selected for the prize. They travelled to Texas and received the prize. The Dean and Director of the AIIMS were informed of this honour. 

   The next year another student came forward to write another historical article. He also researched and wrote an article on an Indian Cardiac surgeon who had done the first heart transplant in India. This was also selected for the prize. He went and received the prize and certificate. Both these articles were published in the Texas Heart Institute Journal. They  acknowledged my contribution.

   This was a significant contribution to the AIIMS undergraduate program. I was happy to have promoted scholarship among medical students. No one has written any more articles for this prize.

3. International recognition

     In the year 1992,after I had been promoted as Professor, I applied and got an international membership of the Society of Thoracic Surgeons (STS,USA). I was the first one in the department to get this recognition. I had already enrolled as a member of the Association of Surgeons of India(ASI) and the Indian Association of Thoracic and Cardiovascular surgeons(IACTVS). The fallout was that the CTVS department and the ALL INDIA INSTITUTE OF MEDICAL SCIENCES(AIIMS), went on the international map. In the year 2005, the president of the Asian Society of Cardiovascular and Thoracic surgeons (ASCVTS), asked me if I would join the association as an executive member. I was delighted and the next meeting in  Tokyo I was introduced to other executive members and welcomed. They asked me to take the responsibility to host the 2010 meeting of the association in New Delhi. I agreed and began the preparations. In 2006, I joined the Society for Heart Valve Disease(SHVD) as a member. In the same year, I applied and joined the European Association of Cardiothoracic surgeons(EACTS). I received an invitation to join the Ross Society as I had done and published our results of the Ross Procedure. I attended one of the meetings in Boston and was introduced to several famous Cardiac surgeons by Dr. Donald Ross himself. I attended the Asian society meetings annually as I was invited and offered travel, registration and hospitality. My wife accompanied me for all these meetings and made friends with the spouses of famous surgeons. At the Asian meeting at Beijing, the president of the American Association Of Thoracic Surgery(AATS) Suggested that I should apply for membership of the AATS. We had been meeting each other at conferences and had become good friends. It was a very prestigious membership. There was a fixed number of members and one would be selected on credentials and Six sponsors of the AATS. My application in 2008 was supported by three presidents of the association and three other members who knew me and my work at the AIIMS. I was delighted when I was accepted and I received the certificate in Toronto in 2009. I was the first Cardiac surgeon From AIIMS to become a member and the second Indian surgeon to receive this honour. So now I had memberships of  8 of the most prestigious professional associations. This brought The AIIMS into the international arena as a recognised Centre for training and most students who completed training in CTVS  and went abroad were offered  fellowships and faculty positions on the basis of their training in AIIMS. I was also inducted as a member of the membership committee of the AATS and helped a number of surgeons from around the world to the AATS membership. Through my sponsorship four Indian surgeons have been admitted as members. The AIIMS and the CTVS department was now well recognised in the international scene.

4. Surgical techniques abroad

   The AIIMS mandate was to be self sufficient in all medical education, prevent intellectual migration of doctors, establish and train teachers for the entire country’s needs. In this area I am very happy to express my gratitude to AIIMS for the two specialist post graduate degrees including one superspecialisation. After completing my formal education I took up teaching as a faculty. In the 4 decades of service at the AIIMS,I have taught  medical students, encouraged their participation in international competition, taught general surgeons and cardiovascular surgeons. In all more than a hundred students have gone through cardiothoracic training in my tenure. As a part of the function I have contributed to spreading the new surgical techniques developed at the AIIMS to several other centres of the country  and  the world. I have travelled extensively and performed surgical procedures in several foreign countries. It began with my training in USA and subsequent visits to other institutions in USA. Then I went on to showcase the surgical techniques at  Bangla desh, Indonesia, Thailand, Malaysia, Singapore, Taiwan, China, South Korea, Netherlands, Spain, Sweden, Denmark, Turkey, Italy, Saudi Arabia, Japan, Russia, Australia, Nepal, Algeria and South Africa. These opportunities elevated the AIIMS as an international centre for training and developing new techniques in Cardiac surgery.

5. Patents

     With the experience gained in valve surgery I sought to design  and produce  valve substitutes for better outcomes. They  would be less expensive and avoid anticoagulation and other problems associated with the then current substitutes. I researched and designed these valves. I then sought financial help from the Department of Science and Technology(DST) for patenting.  This was obtained and after 2 years in 2002 I received patents for the designs in India. It was granted to the AIIMS with me as the inventor. I attempted to make the valve and was partially successful. When I retired I sought transfer of patents to me from the AIIMS ,which was refused. I did some modifications and have now patented these designs in my name. I am still working to turn these patents to implantable devices.

6. Heart Valve Bank

    In the year 1993, I set up the first state of the Art homograft and tissue valve bank, with cryopreservation in the CTVS department of AIIMS. The AIIMS was the first institution in the country with this facility. This has been explained in the previous section.

7. Patient safety

    I was the only surgeon to insist that all patients coming for surgery be cleared of Oro dental sepsis. This was mandatory and was one of international guidelines for heart surgery patients. I was primarily responsible for introducing the World Health Organisation(WHO) Surgical safety Checklist in the AIIMS. It was then made compulsory in the whole country through the ministry of health.( see previous chapter) I was and still am the only surgeon from AIIMS and In INDIA to begin routine surgery at 7 am (See previous chapter).

8. Plagiarism

     “The act of taking one’s work and claiming it as yours”   This unfortunate incident happened when the Prof and head of cardiology and his newly recruited assistant professor Casually published two articles on the work that I had done for 10 years. I came to know by chance and asked the professor how I was not an author. At first He said it was an oversight and that I should have been an author. A week later I found another publication on the same subject without my authorship. This time I wrote a letter and asked for reasons to exclude me. The prof simply acknowledged my latter. I then filed a complaint with the Dean of AIIMS against the authors stating that I had proof to show plagiarism and would request an Enquiry. This got the prof in Jitters. Since I was an assistant professor he felt  below his dignity to talk to me and sent his junior. I told the junior faculty to ask the prof.to talk to my directly. The dean called all of us for a  meeting. The Prof then approached my head of department, requesting that I withdraw the complaint. My Head of dept pleaded with me to spare the senior. I told him that I would consider if I received a written apology and assurance that such acts would not be repeated. I received a polite letter with an apology. The dean then asked if I would withdraw and save the AIIMS of Disgrace. I relented. The news spread by word of mouth all over and put an end to plagiarism in AIIMS.

9. Illegal deduction

   The AIIMS faculty got together as an association, named FAIIMS., including all faculty as members. At one of the meetings of the FAIIMS, the prof of Neurology was elected president. The Director and Dean were members of the FAIIMS. The president proposed that a sum pf Rs. 25 be deducted  “compulsorily”  from the salary of all faculty as a faculty fund with no Specific purpose. I  found  this deduction from my salary and asked the accounts officer for an explanation. He sent me a memo that had been passed in the FAIIMS meeting authorising this deduction and approved by the Director. I consulted a senior administrative officer who was clear that it was illegal to withdraw any sum from my salary without my consent. Now I sent a  letter to the president of FAIIMS asking how this is being deducted. My wife advised me that I would be looked  down upon over a petty contribution. If I did not correct this, then there would be opportunity for other groups to do the same and pick my pocket. I consulted my lawyer friend and he drafted a letter along with a reference to labour laws prohibiting withdrawal without consent. At the next FAIIMS meeting the president attempted to denigrate me as petty. I stood up and clearly told him to refrain further comments and to refund the deductions. A fortnight later I received a memo stating that the deductions done in the last 5 months were refunded and this deduction would not apply to me. I circulated this to my friends and finally the order was withdrawn. The Director, President of FAIIMS and the Accounts officer were now EDUCATED on labour laws regarding  such unlawful deductions. 

Epilogue

   The AIIMS, New Delhi, is one of the  most prestigious medical institution of INDIA. It was conceived by the then Central health minister Smt. Rajkumari Amrit Kaur. A huge grant from the Govt. of New Zealand provided the necessary funds for the building and was inaugurated by the Queen of England. The primary purpose was to establish a Medical Institution capable of training teachers for Medical schools in India in all subjects and specialities.   It is an autonomous body.

       It is prestigious to train and serve the institute as a faculty. It has more than 20,000 employees, 25 departments and a Nursing school. It is now recognised as India’s prime institute for graduate and post graduate medical education. After the success of the first such facility in New Delhi, the government has developed 21  other Institutions of the same name in various states. To be part of this endeavour puts a lot of responsibilities on the employees, especially the teachers to contribute to the growth and prestige of the institution. Everyone who has served will pass but the institution will prevail. I am extremely fortunate to have learned and worked for four Decades at this Institute. In my own small way I have contributed my best to enhance the prestigious position that  AIIMS Enjoys. I am sure several others have equal or more contributions. I pay my tribute in this article on my personal involvement.