Dr A Shanthy Fenn - A Reminiscense

Dr A SHANTHY FENN  - A REMINISCENCE!

15, Oct 1928 – 24 Oct 1999

“THE GOOD SURGEON IS ORTHODOX IN HIS TEACHING AND HIS PUBLIC UTTERANCE; HETERODOX IN HIS INNERMOST CONSCIENCE”

 – William Heneage Ogilvie , 1887-1971

1970: THE INTERVIEW

Every  Christian student aspiring to become a doctor wants to train in Christian Medical College, Vellore founded by Dr Ida Scudder. But getting a seat is dicey.

Dr Ida B Scudder

4 decades ago, 10000 students wrote the exams held all over India and Asia in the various subjects like Chemistry, Physics and Biology.  Based on the MCQ results 120 candidates were called for final interviews to Vellore. Out of these 120, 59 would be chosen finally for the MBBS course .This would mean 34 boys and 25 girls. As always, central government would appoint the last candidate to make up the final total of 60.

 

I was one of the chosen for the interviews in the summer of 1970 and my father took me to Vellore. 

Tradition dictates that the senior students accommodate a candidate each in the room during the time of interviews. This is not only to give advice but also to train one for life should one get selected. For the next 3 days this would be my abode and possibly my future. It was a residential course where all the students and teachers were housed in the same campus like some of the traditional western universities.

 Dr Ida Scudder with Mahatma Gandhi.

Entrance to Medical College, Bagayam

We were divided to 12 groups , each of  10 boys or girls. Each ‘group’ had 2 ‘group observers’ one of which would generally be a physician and the other a surgeon ( of different specialities). The job of the group observer was to be with their own designated group of students over the next 3 days from morning till night , assess them for fitness to be a doctor and to give marks for a pass or failure.

I was in group 2 (classified according to the age). My group had only 9 students as  one candidate had failed to show up. 

That is where I met Dr Fenn - A.Shanthy Fenn for the first time. He was my group observer, the other one being Dr Bob Carmen. Dr Fenn was a quiet, well- built man with thick ‘soda bottle ‘ glasses wearing a suggestion of thin smile all the time. Silently looking at us and appearing to measure  us up all the time. I knew he along with Dr Bob Carmen would decide our fate over the next 3 days.

Each group assembled every morning and  went about  with its twin group observers performing various ‘ tasks’. The tasks were chores which were done either individually or as a group. Each task was observed and carefully marked by the twin group observers. To prevent bias, a third observer designated for the task would supervise for the entire 12 batches. Marking was done confidentially between the three of them before the group moved onto the next task.

Dr Bob Carmen ,Dr Fenn, Dr TS Koshy  interviewing  Vinohar Balraj. He was in group 2 with me and stayed on in CMC to retire as Registrar of CMC Vellore.

We had to wear our number in front and back of the shirt like an athlete at all times. We met the other groups for the meals. The groups dined at both the men’s and women’s hostels.  Though it was exciting at that time in womens’ hostel, tensions ran high as we knew were constantly being observed for gentlemanly behaviour and good manners. 

In between the tasks, we took refuge in a very nice house which was situated at the foot end of the college hill, isolated by trees with a beautiful driveway separated by pine trees and a rocky terrain. It was painted blue and was situated well above the road. Though it was only about 100 metres from the road, you could not see it from the road ; it was well hidden  by the tall trees and the rocks. 

The blue house had even blue doors with netting to prevent the mosquitoes out! Potted plants – daisies, sunflower, roses and orchids lined the driveway carefully marked by bricks painted white.

This was where Dr Fenn lived. The nine of us fooled around in the living room most of the time, raiding the fridge, listening to the long playing records in the ‘gramaphone’ or devouring whatever his chef Varghese  made for us. He kept the delicious food coming up for us all the time.

We learnt that Dr Fenn was a bachelor. The garden of roses was well kept, the house very tidy and the menu was planned meticulously by Dr Fenn for his guests so well that one  would have never notice the absence of feminine touch.

One of the dreaded’ tasks’ was the individual interview by the group observer ( each in turn ). The candidate had filled up many months ago as to why he/ she wanted to be a doctor on foolscap ( similar to A4 nowadays!) pages and submitted the same to CMC as part of application. Little did we realize that these would be scrutinized by the group observers who would ask probing questions on these fine details, many months later on.

One would have written truths, partial truths and even imaginary events on these sheets of paper. Casual conversation with the group observers during half or an hour of chatting would reveal to him how much you had actually meant in what was written! Dr Fenn called me up for half hour and did not really say much. He just sat there with a thin smile took quietly letting me do all the talking. Only later on I realized that my interview had already been conducted.

Dr Fenn at his table as the Principal of CMC

His choice of music was superb - Herb Albert & theTijuana brass band, James Last, lots of Jim Reeves, Nat King Cole et al. My Delhi and Mumbai mates – Ajay Hala, Egborte, Gopinath usually did the soul dancing to the music while the rest of us watched with amusement.

There was an aura about Dr Fenn even when he was around with Dr Bob Carmen. No one cracked silly jokes with him or acted familiar with him among the faculty. When he walked, the faculty and the senior student alike parted respectfully to let him pass through. He was a loner who carried himself with dignity and poise, keeping his own company most of the time. I was not surprised to learn that he was the deputy director of the entire institution.

The ‘indoor task’ during interview included  the ‘extempore speech ‘ in the ‘Big Bungalow’. You were given three minutes to prepare a talk based on a lot you picked up.  

When my turn came, my paper slip read  ‘ the evils of smoking or the evils of drinking’. I had known  many smokers but no drunks! So it was easy to choose.But when I went in to speak in front of my group of ten and the 3 observers, I found to my dismay Dr Fenn puffing away at his cigarette, all the time with the smile on his face. Though I bravely carried on with the fiery talk on the evils of smoking, I always knew if I did not get chosen to the hallowed halls of Bagayam, it would be because of this topic.

The other evil omen was my interview number 13. Not only was it considered unlucky, but  also Apollo 13 had crashed at that time killing everyone in it. I was sure to lose out.

On the third day, the results are announced in the ‘sunken gardens’ situated near the college chapel in the medical college, green with plantations. Group one had a few numbers called out (no names). Then the announcement over the speakers 11,12… and the pregnant pause till 13. I had been chosen along with my entire group. It was the first time that all the members in a group had been chosen en block. 

Obviously either we were too good or our group observers Dr Fenn and Dr Carmen were too good!

THE RAGGING

My father was with me during the announcement of the results. He was more happy and I was more relieved! Trevor Adie fourth year student promised my father he would look after me as the course was starting right away. He saw my dad off and accompanied me to the ‘Mansion of the gods, quite appropriately as the gods reside there! Yes this was the men’s hostel where all CMC is the residential college. My future for the next 5 and half years!

Men’s Hostel, CMC, Bagayam

What struck me was the much shouting and swearing everywhere when the drive up to the hostel ended.

It took a while to sink in but clearly ‘ragging’ had started. Ragging or initiation is how the seniors in the university or a college treat the freshers over the next few days . It follows different nomenclature in other countries ‘hazing’ for instance in united states. Now the government in India has officially banned it as the evils are more than the gains in this system.

Initiation in Vellore was very organized. It was held for 3 days. Ragging for the males was confined to men’s hostel and females only to women’s hostel. There was no ragging of the girls by the men and vice versa. The program was drawn up in a general body meeting and the governing board  of the hostels ensured that no one would be physically hurt.

Each ‘fag’ .. fresher was under the two ‘fag masters’. Fag masters were final or prefinal students with presumably much maturity . Fag master  was the ‘Lord and Master’ who  was  above all the power be. He had the right to pull you away from any of the other younger senior and no one… NO ONE could question when he told others to stand down. This had a sobering effect on the ragging and the extremes of situations were avoided.

Yet other mechanisms to avoid mishaps included the fact that most of ragging was conducted as a group and no single person was individually ragged in isolation as well as staff supervision. The three days were divided into several activities like physical training were we had a ‘field marshal’ who had dressed up as a pirate or a bandit to intimidate us. He took us through several rounds of running around, frog leaping etc. The prince and the pauper were brought together in no time and clearly it was an equalizer for most of us.

We were supervised by seniors to ensure that we had the toilets available to us on time and clean baths. Freshers were from all walks of life and clearly we all understood how we should behave during meals, sing grace at the tables, wait patiently in queue for the food , and physically running around a lot which helped us a great deal years later on.

Staff supervision facilitated  the senior faculty of the college like the principal, professors , directors to drop into the hostel during initiation and report to the senate any anomalies. Dr Fenn was present to ensure that the ragging was fair and this was one time I realized how big a person he was. The seniors who were so noisy with us became pussy cats when he was around and his aura of invincibility and power could clearly be understood.

Ragging came to an end after three days with us blind folded at mid night to take a dip in the pond . All was peaceful after the conclusion ceremony. Years later the fag masters still keep in touch- mine are two famous distinguished professors of neurology and GI medicine in USA . 

Sadly the tradition has ceased now; the bonding between seniors and freshmen is , I guess no longer the same. I feel that initiation had more to increase this bonding and less of negatives. But I agree that many may have had unpleasant experiences especially in other institutions. Anyway now officially this is a public jail able offense.

INITIAL YEARS:

 

Christian Medical College Chappel, Bagayam Vellore

The hallowed hall of Christian Medical College , characteristic of its 100 years of legacy is full of traditions. Motto was ‘Not to be ministered unto, but to minister’. The college song highlighted ‘Each for all; all for each. Thus forever!”  During the first year, there were several dinners - college day, the men’s hostel day, women’s hostel day,Pongal day, Onam Day, Deepavali day, Christmas Dinner, Graduation Day, Sports Day, etc.

Each function involved socialization between boys and girls, staff and students. This was the time you came to know ‘who was who’ and learn the real accepted behaviour in a mixed society.  The fresher men traditionally undertake the arrangement of tables and chairs for the seated formal dinners. They are supervised by the fourth year students. Also at the time of the dinners, the first years actually do the serving of the food to all the staff and students.

Dr Fenn with Dr Ida Scudder and Dr KG Koshi

In my first year, I had a call from the ‘ high table’ to come up and report. I ignored it as I was busy serving at my table with a few of my other mates. This time the field marshal of the ragging (fresh in my mind) came and demanded, “Where the hell are you? Dr Fenn wants you!” 

That is the first time I have seen the stature of the man I had come to respect and envy. There he was sitting causally at the high table puffing away on his cigarette. He asked for a chair for me and made me sit down. 

Dr Fenn, Dr LBM Joseph, Dr CK Job, Dr Jacob Abraham at formal meeting

He said, “You had promised to teach me violin. When will you come home to teach me ?” All ears around perked up and I felt really important. 

I had omitted to mention that my dad in his youth had his hernia operated by Dr Somervell  a famous missionary surgeon  in South India(who later on became the famous Prof of surgery in CMC Vellore) . He was a remarkable person who had been awarded the Olympic medal for mountaineering. He worked for 40 years in India as a surgeon – in CSI hospital, Neyyoor and later in Christina medical college 1949 -1961. He was awarded the Order of the Brititish Empirein 1953 (OBE).

Prof Somervell, Surgeon,  1890-1975

CSI Mission Hospital, Neyyoor, Kanyakumari District, Tamilnadu.

Dad had promised to himself that  if ever he had a son, he’d be like Somervell;  that was bad enough for me . Worse was to follow- Somervell played the violin. So on my fifth birthday, my father took me to a famous violin teacher and started me on violin training. I finished my grade 8 violin in Trinity College London in school years. This was mentioned as an extracurricular activity on my biodata while applying for a medical seat in Vellore . I had clearly forgotten, but during the personal interview not only Dr Fenn had noted this but also the fact that I would help him to teach him as he had his own violin. 

I promised him that next Sunday I would teach him and returned to my lowly waiting at my table. Next Sunday came and the field marshal showed up at my door and rudely reminded me, “Hey Bugger, you bloody well go to teach him today!”

So began the series of violin classes at his house every Sunday at 11am. I made him practice daily at least initially. I used to chide him for not practicing him  whenever he failed to do so.  I had to wake up daily at 5 am for a one hour practice all my life from 5 years to 15 years of age. This still did not convince him to practice daily! In the end I told him that it was hopeless trying to teach him if he did not practice regularly! He used to continue to smile despite all my criticisms. Much later in my clinical and internship years did I learn that I should have been kinder on my comments !

He was a perfect host and never made me wait for the music classes though I was the lowest of low in the food chain !If he was held up and was going to be late, there was always a call from his office to the mens’ hostel saying he’d be late.  Varghese used to make a heavy ‘non vegetarian ‘ lunch which would  mark the end of every violin lesson. Varghese was his  man Friday who kept the house clean, did the cooking and generally did all grocery trips for the house. During Lent days, he used to profusely apologize for the providing the vegetarian food. He was a pastor’s son and the religious up brining sometimes showed!

I became friends with ‘Meenakshi’ probably the only significant female of in his life. Meenakshi was a German Shepherd Dog he treated like a child in the house. Now I have GSDs in my house and treat them with love. A man with passion for the dogs is always a kind man at heart.

CMCites  attend Sunday morning English service at St John’s church and the college buses took us to church and back. Once the Tamil church folks wanted me to play a solo; I mentioned this to Dr Fenn and he insisted on taking me in his car to the church for the 6 pm service in his car. He had never been to that church and they had not even invited him. He chose to drive me rather than let me travel in city bus to the venue. One recalls such events with much fondness!

SPECIAL CLASSES:

It is generally believed that good surgeons are poor teachers. Good teachers are poor operators. 

Dr Fenn proved this hypothesis wrong. He was a teacher par excellence. He used to make even the routine classes very interesting with so many stories. His classes were studded with anecdotes. The man was a legend in surgery.

The medical college (CMC) was in Bagayam and housed preclinical year students and their classes.   The hospital (CMCH) was situated about 8 km away. Just before our exams, he traditionally conducted extra night classes for the exam going batch.  

Christian medical College Hospital

I have no doubt that he enjoyed these classes as much as we did. The entire class attended these special occasions – they were essential for a pass in the exam, there were a different teacher at attendance here!

 His attire in the hospital was always half sleeved white untucked shirt . As was the general custom, there was a leather pouch in the left upper pocket for holding the pens and name plate. He was totally against white coats and ties as he said these used to carry infection from one to the other. We know it now and he knew it then!

Dr Fenn, Dr LBM Joseph at the department with a visitor

 The special classes were held in the medical college premises in Bagayam usually at 7 pm. He used to show up for the classes wearing long salwars looking very fresh!  Each lecture would start off with stories of patients; anecdotes which made classification of even ... rupture urethra or rupture bladder clear!

He used to even tell us personal stories! 

When he did MBBS, he was terrified of being ragged, so he abstained from joining the class for a long time. Roll call for Shanty Fenn used to be unanswered for many weeks and the class boys longed to meet this Shanty which traditionally is a girl’s name! Imagine their surprise when he walked in (and he laughed and laughed!)

By now, we had learnt to refer to him behind his back as ‘mama’ (mom’s brother).Meaning ... caring for us well beyond that of a standard teacher! 

Any stupid question by the ‘eager beavers’ used to be answered with clarity without rebuke. Nothing was too small for him to answer.

BEDSIDE TEACHING – ‘THE CLINICS’

His clinical teaching was legendary. His classes for the MBBS graduates used to be attended by post graduate students as well as by many of his assistant surgeons. He was a regular examiner in Madras University as well as other Indian universities. He used to know all the examiners of all the states. He was the pillar of bedside teaching for us. We learnt how to present short and long cases to examiners efficiently.

He emphasised that no surgical examiner in MBBS surgical examination wanted to fail the candidate. He used to say, when the candidate walked in during MBBS examination for case presentation, he would be awarded 100 marks. Every time he made a mistake, he marks would come down by 5 marks. So we learnt during MBBS, only to speak on the positive matters of which we were sure. The focus was on eliciting clinical signs and arrival at bedside diagnosis. This habit came in useful when the students served later in mission hospitals with limited facilities.

C Subramaniam, JCM Shastry,Dr Fenn, Stanley John, VI Mathan

As for post graduate (Master of surgery MS) examinations, the candidate would get 0 marks when in walked in to present the cases. Every time he mentioned the appropriate history and finding, he used to add five marks. So the logic was that you should convince the examiner that you were fit to be trusted to diagnose the patient. For the post graduates, he would then ask for more details on investigations and the surgical aspects.

GRAND ROUNDS:

Another time of teaching not to be missed was his ‘Grand rounds’. This was held twice a week. He had the maximum number of patients in the surgical unit ranging from 45 to around 60 at any given time. Grand rounds were held in the hospital.They started always from the private wards going onto the general male and general female wards, named alphabetically. During grand-rounds we had to visit the beds of all the patients.
 

When the medical students were around, he was kind to everyone and was in a ‘teaching mode.’ Otherwise, the grand rounds were more in 'business mode' with the intern giving brief summary of the patient  (reminded me of the interns in the movie “Coma”). Occasionally he would get into the 'killer mode' when he would take the seniors apart with the line of clinical management . So grand rounds were events to learn from, to answer unprepared questions and sometimes to dread!

C Subramaniam Union Minister visiting patients in surgery department with
Dr JCM Shastry, Dr Stanley John, Dr V I Mathan, Dr Job

EXAM TECHNIQUES REVEALED!

His clinical cases for the exams took place for the final year MSSB students, again strictly for the exam going batch only. These were held in the hospital premises.  Final year post graduates were however allowed to attend. One student would present the case and had to answer all the questions by him the examiner with the rest of the class watching. It was a humbling experience but educative and rewarding from exam point of view. 

Emphasis was on bedside clinical signs, establishment of a differential diagnosis and simple tests at arrive at a clinical diagnosis. He was a very good and kind examiner. He travelled all over the country. Every non CMC trained surgeon would praise Dr Fenn  as he was popular and was well known for passing you if you were in the danger but salvageable zone! 

CONCERN FOR THE STUDENTS

An incidence of his kindness was when the deputy director Dr K V Mathai a neurosurgeon was arrested for political reasons ; the senate ( the highest body of senior professors in the college) decided that the college would only write a strong letter of protest and not anything else. 

As an active student body, we the students went on a procession with placards saying ‘ Release Dr Mathai’, etc. There was a 144 police act in practice banning any such process with police powers to arrest any gathering of more than 4 members. 

Dr Fenn, Dr B Pulimood, Dr Booshanam, Dr Ganesh with students.

When the procession , technically unlawful, went on for a 5 km march into town, it was a sunny and hot day. Dr Fenn slowly drove in his blue herald car so patiently all the way at the end of the procession carrying big containers of water for us to drink and to protect us. There was no air conditioning in Indian cars those days! He was the only staff member around as far as I knew. 

He knew all the top police officials in town! We were not touched by any of them throughout, though the police were all around us.

Dr Fenn at tree planting by medical students

Incidentally, Dr K V Mathai and Dr Fenn shared the same birthday. He used to be constantly invited for to the Mathais for many decades for birthday dinner for this reason!

 EXAM GOES HAYWIRE

In the month of December 1975, our exams were held . Many students failed, mainly in medicine. There was a tough examiner in medicine who asked very probing questions much out of the depth of our knowledge. For instance for a short medical case, I had a PDA – patent ductus arteriosus.  He asked me about embryology, complications and when I told him, he demanded to know the cardiac catheterization findings including the pressures changes and the oxygen levels...  not to mention which end of the duct held a high pressure whether the aortic end or the left pulmonary artery end! I managed to pass, but unfortunately many of my classmates did not make it.

Dr Fenn being the chief examiner pleaded with the external examiner to pass more students, but this did not cut dice with this particular examiner and so the result stayed. The damage had been done.

He arranged a surprise dinner party for the entire exam going batch the night of the last exam in his house. 

He invited our entire batch home and in addition Professor Selvapandian a giant in orthopaedics and Prof S X Charles gynecology chief for the dinner. Both of them talked of their student days, about how they had failed in their examinations. They never let it affect their lives and became well known in the fields as top specialists of the day! 

We came to know later that Dr Fenn had arranged for them to give us a ‘pep talk’ and the free food to elevate our gloomy mood before the exam results came out.  Now when I look back at this episode after nearly 40 years, I cannot remember any  professor doing so much for his students when exam results went south!

M A Sajeev who was born on the same day as me, same year and from the same town of Trichy  was  in group 2 of the interviews number 14- at graduation with Dr Fenn

My proud moment-receiving  MBBS certificate from Dr Fenn 1975

 HOUSE SURGEONCY 1976-77

During 'house surgeoncy’ or internship, the budding doctor has to spend  3 months in surgery, medicine, OG and community medicine. I was fortunate to be post in SII unit headed by Dr Fenn.

Suddenly we became very busy, missed meals, missed sleep to run and answer the ‘bleeps’ made by the pagers. There were no cell phones at that time. Interns were the lowest of low. We were busy all the time either withdrawing blood or taking them to lab after clerking up the cases. During grand-rounds we had to be in the best form to present cases to Dr Fenn.

Now you have to know something about the wards. 

There were private wards housing Dr Fenn’s patients who had come only to see him and to get operated by him. General wards had patients who were looked after by the rest of us. 

House surgeons had to spend half the posting in private wards and the rest half in general wards ; post graduate residents did the same. 

It was generally the accepted principle in all the other surgical units, chief did the operations on the private patients, whereas the residents and the house surgeons were given chances to operate on the general ward patients under supervision.

Surgical Grand Rounds with Dr Paul Brand visiting

 

Dr Fenn always made sure that  the interns were allowed to perform operations for hydrocele, hernia and vagotomy with gastro jejunostomy under supervision – at least once each during the posting. It was immaterial to him whether  one would become later on a surgeon or physician.

Internship was the time when the young doctors dreams were made or broken. One decides whether to become a surgeon or a physician depending one one’s experiences during internship. 

Raghuram and I were the only interns in the busy surgery unit II. Raghuram was always a brainy chap. He had worked hard clerking the emergencies the previous night along with elective cases. One admission had anemia with duodenal ulcer. He had done all the blood counts, blood picture, reticulocyte count, bone marrow, blood for copper levels and what not.   

The next morning during the assistants’ ward rounds, I remember Raghuram rattling off all the results by heart.  He was stopped by the assistant surgeon who asked only one question. What was the blood group of the patient?! Raghu was taken by surprise. The assistant professor whose wife was working in blood bank then went on to say that there was plenty of O positive blood units available in the blood bank. He instructed that we give blood transfusion to correct the anemia and get the patient for surgery, setting aside all the results. 

Raghuram was livid and later on swore to me that he would never have anything to do with surgery! True to his work, he continued with medicine and is now a well known and respected neurophysician in USA!

In unit S II, there were able surgeons to help run the unit efficiently such as Prof KE Mammen, Prof Joe Devadatta, Dr  Keith Gammon et al. We also had Dr Bannerjee Jesudasan, Dr Ranjit Oomen - the post graduates who taught us the basics of surgery. 

Dr Fenn was a person to look up to, if  you were ever in trouble. Prof K E Mammen ‘s wife had to undergo hysterectomy with active DIC. She was pumped with heparin for the DIC and was taken to theatre. Dr Fenn was present in theatre as a 'mere observer' till surgery was over, only to keep Dicky Mammen calm.

Dr Fenn with Dr K E Mammen and Prof Paul Brand ( Ten Fingers for God)

MY POST GRADUATE YEARS – RESIDENCY 1979- 82 :

I just as the rest of CMC graduates spent 2 years in a missionary rural hospital and returned to specialize in general surgery 79-82 and obtain MS ( Master of  Surgery) certification.

During these three  years, 6 months were spent with in each of the three surgical units with the rest of the time in the allied specialties. We rotated through all the three surgical units and in each the same disease like peptic ulcer with complications would be operated in different ways! In surgery unit II, we followed strict protocols even in the early 1980s. 

In Dr Fenn’s unit , the specialties included not only general surgery, but also pediatric, vascular and endocrine surgery. Surgical residents had to do rounds with Dr Fenn everyday in the private wards, on the out patient days as well as surgical days. The rest of the unit would join up for the ‘grand rounds’.

 Dr Fenn giving the degree certificate to Dr GD Sunderraj

TOUGH BOSS:

Dr Fenn had the habit of taking the surgical resident not only in his wards, but also through the general wards sporadically on non grand rounds days. He would expect every surgical resident to know all the patients in all the wards. So some of us including myself would walk through the general wards ( though I was posted in private wards) since 5 am everyday including Sundays, making notes of all names of patients with the diagnosis, surgical post operation day , intake output, antibiotics, et al before starting round in private wards with my own patients.

He spoke less and less as we rose up in seniority. We were expected ‘ to know’ what to do for his patients. He had his own dressings schedules for sloughy wounds, his antibiotic routines and his ways of surgery.In the pre ultra sound scan era, his aged patients with residual urine of more than 60ml , got their prostates injected. He practiced what he preached; when his time came, he had his own prostate injected.

He was a superb and fast surgeon who always knew what to do. He could embark on difficult surgeries without vocalizing much or putting on airs. 

I remember in 1976 once he was called in theater for an unexpected mass in the pancreas at laparotomy for a duodenal ulcer, he scrubbed in, palpated and leaned to tell the anesthetic chief Dr Valerie Major, "I am going to do a Whipple". During the next two hours he kept his vision down on the abdomen and walked out without a word after a successful operation. In the meantime, the anesthetists were busy with central lines and their poisons and the house surgeons were running around for the blood and the frozen section reports.

It was exciting to watch him do pheochromocytomas of the adrenal glands- the tricky organs placed at the back, just above the kidneys. This surgery requires gentleness in the surgeon's touch, speed of surgery and minimal blood loss. There was no one like him to do this so efficiently.He was unbelievably fast and magical with 'pheos' In the end he would say, the anesthetist saved the patient!

But a suction device failing to work, or a theater light not in position, or someone speaking loudly could trigger a wrath of great magnitude in him. He was feared by all for this, but worshiped by all for his skills. He was a surgeon par excellence and did surgery very rapidly, without blood loss and mostly without speaking a word.  

His favorite was pediatric surgery which included neonatal surgery. MCh degrees came into vogue much later. He encouraged us to present papers in conferences by financing our journey and stay in far-away places and also to publish articles in vascular, endocrine and general surgery.

Pediatric ward Q1West was started under his guidance with plastic surgical ward.

THANAKUMAR’S PROCEDURE!

Being a first year intern I was posted on the list as third assistant for this neonate. The first and second assistants were highly decorated teachers with MS, FRCS who had spent many years with him. After the baby was draped, Dr Fenn walked in, he scrubbed up and open the baby with no words in a very silent theatre with many watching via the glass dome from above as this was a rare surgery. He muttered, ”operative cholangiogram” and the machine ( part of the routine those days) was  wheeled in. Someone at this point told him that the frozen section sent during the surgery supported no hepatitis and there was obstructive pattern.

This baby had a gall bladder. He injected the dye into the gall bladder and xrays revealed dye in the Common Bile Duct below the cystic duct draining into the duodenum, but no connection to the liver. He waited patiently for the xray plate to be developed, saw it and said, “Nothing can be done!” . This spelled doom for the baby; I was in charge of his private and pediatric wards at that time. The mother had waited for a long time to have the baby and so I much against my better judgement decided to speak up for the first time in theater.

I muttered , “ Can we stitch the gall bladder to the liver?” . A moment later, I realised I had made a blunder. Dr Valerie Major chief anesthetist gave me a scorching to shoot down dissent in the ranks! The two highly decorated, learned assistants tried sh..sh..ing me .

But unfortunately the big man had heard me. He slightly bent his head down towards me and said, “What did you say?” very softly but clearly. Time stood still, all eyes focused on me for the wrong reason!

 Everyone had wanted the surgery to be over as neonatal can be stormy and eventful especially biliary atresias! And no one speaks to Dr Fenn when he says it is over!  Who was this idiot who had opened his big mouth when everything was but over!

By now, even a dud like me had realized what a big mistake I had done.  Anyway nothing else to do, but to bravely carry on. When I repeated my query, he, without a word, asked for knife and cut the liver near the hilum ; there was bile. Then he stitched the gall bladder to the raw surface oozing bile. He left a drain and before he left, he turned to Dr Valerie Major and said, “I have never done or heard of this operation!”

The assistants, as soon as his back was turned gave me a piece of mind which has made me quiet since! 

But Dr Fenn in the senior doctors’ lounge told Dr LBM Joseph and others that his resident suggested a new operation! Whenever he made rounds of the patient subsequently, he never mentioned a word about this. I was sure he had forgotten about it. 2 years later, after a surgical lecture, my juniors came and told me about how Dr Fenn said that there was something called “Thanakumar’s procedure!!” and laughed in class about how scared I was to suggest it! 

Dr LBM Joseph and Dr Fenn with Dr Jacob Abraham

During the next 3 years he encouraged us to operate on his private international patients. I had done my first cholectomy, my first Gastro jejunostomy with Vagotomy on his international patients! He ensured that we gathered maximum skills in operative surgery to serve as lone surgeon in mission hospitals. We carried out thyroid operations, resections of stomach, and entire gut, hernias, perforations, breast surgery, varicose vein surgery and the such over the next 3 years, always under supervision .

BIG PROBLEMS!

He always found time to sort out students’ problems. During the final year of my residency before my main exam, I was on duty for 3 months nonstop. As senior registrar, I had to lead the rounds every night with the other registrars and house surgeons. Towards the end of rounds,  I saw a new patient late at night. We had to fill up the lab slips and put them out for technicians to collect them the next morning. To make it simpler and quicker, I signed all the request forms. Someone else from my team then applied the ‘bradma’ to all my signed slips. Bradma is a machine with the patient details like number, age, sex address,  etc so that you don’t have to repeat it. This was the era of early 80s before the computers! 

Bradma

Next day, the blood was collected from another patient and the bone scan too!! The wrong bradma had been used on the slips I had signed. Technically it was my erro, I signed them before checking the bradma. I was the most senior registrar in the team that did the late night rounds. The fact that I had done 90 days of continuous duty, the fact that  I had done the interns’ work ( mine was just  to issue the order and walk away, not to be signing the lab forms !!) did not matter anyway you slice it.

The penalties included grounding my pay for one or many months to reimburse the patients’ expenses  or a suspension. One of the unit assistants had discussed these possibilities with me but said that most likely I would be stopped from appearing for the final surgery exam as a punishment. Being barred from the exams was the last thing I wanted.

My Father with me at time of graduation.

I rushed to Dr Fenn for help when I heard that there was going to be an official enquiry into the matter. I was not working in his unit, nor was the patient his. I’d always remember how he stormed off to the medical superintendent’s room immediately on hearing my side. Returned in ten minutes and said, “Just go and answer the committee truthfully. Nothing will happen to you”.

The committee asked the usual questions and finally came with a verdict if something like this could happen at the end of 90 days of continuous duty to a conscientious senior registrar with no black marks in the past, nothing more to do. No action or black marks against me! Dr Fenn just smiled when I went to thank him. But to till this day, I know his words were gold and  a whole lot of students  trusted him with implicitly. He was popular among senior staff too . He gave loyalty to the organization and he got it back in abundance.

With Dr KV Mathai, Dr B Pulimood, Dr Abraham Joseph, Dr Bob Carmen,Dr A D Singh

WHEN IN TROUBLE:

Time rolled on. I had left CMC in 82 and joined the mission hospital, Dharapuram. My first son arrived in 1984. He was born by Caesarian section in CMC Vellore. He had liquor aspiration and was transferred direct from operation theatre to neonatal ICU. I was extra luminal alumni, no longer employed by CMC. I was really worried about his condition and there was no one I knew among the neonatal medical staff.

 But I remember rushing to Dr Fenn’s  room for help. He listened carefully without asking any questions, left for the ICU and spoke to the chief neonatologist. In half hour, the icon of neonatal paediatrics Prof Malathy Jadhav paid a surprise visit to the ICU to see my son. She even asked for me and had a long chat saying all was well and there no need for ventilation. I have been ever so grateful for these acts of kindness.

Dr Malathy Jadhav addressing, Dr Fenn at extreme left,Mr Savrirayan,Dr KG Koshy, Dr V Benjamin

AS TIME ROLLED ON:

I had returned to Coimbatore from UK in 1990 and embarked on laparoscopic GI surgery. 

Our relationship matured to a different level when I grew up to be a consultant surgeon. He paid a curtsy visit to Coimbatore and his unit was not doing laparoscopic work at that time. He asked for advice on how to improve the department in  laparoscopy. It was strange at that time, as he had taught me the very essence of surgery . 

Dr Fenn had retired by then and had taken up the post of chief surgeon and medical superintendent of Bethesda mission hospital, Ambur situated near Vellore. Bethesda hospital was in the verge of closure due to administrative and financial difficulties. Initially my classmate Dr Ninan Chacko joined to help Dr Fenn and  the team .  It was an honour to help start minimally invasive surgery department in 1994 in Ambur. Dr John Francis from Ambur was released for in house training in Coimbatore for many months in laparoscopy . 

Prof Aravindan Nair

Dr Ranjit Mathew Oomen, senior surgeon from Malaysia and  Dr Aravindan Nair carried out a laparoscopic workshop in Ambur attended by many of us in the same year. Dr Fenn’s  zeal to keep up with the recent developments in surgery was amazing ; he wanted to train his juniors in all the newer aspects of surgery.

WHY DR FENN WOULD ALWAYS BE ‘CHIEF’:

We learnt several things from Dr Fenn, some definable and some not. How to really care for patients, how to encourage juniors to present papers in conferences, to write up papers and get publications under your belt , to take nothing for granted, to teach the juniors , to think on your feet, to speak up for the weaker section of the society are some of them.

He was special and stood well above the rest for many reasons. 

Maybe the fact that he was a bachelor with more time to spend with us. Maybe the fact he became unit chief as soon as he passed his MS degree which made him so emphatic, independent and a giant in surgery.  Maybe being the son of a chaplain helped him to be kind to the weak and heavy laden. I am sure working in Vellore also moulded him as environmentally Vellore has a soothing effect on everyone!

He continued being ‘Chief ‘even when we left CMC as surgeons. His letter of recommendation to Prof RCG Russell opened several doors for me in UK during my overseas tenure. He gave a glowing report when I applied for Rhodes scholarship. His friendship, fellowship and association with former students extended throughout life. 

Surgeons too many to innumerate all over the world would bear witness to his teaching, his superlative operating skills, ability to convert his juniors to brilliant surgeons, his overpowering personality, his dedication to God , profession and his students.

He left a legacy of very skilled surgeons in the department. When we were working with him, we were also enriched by Prof KE Mammen, Prof Joe Devdutta, Dr Keith Gammon, Prof Aravindan Nair among many others in S II. Dr LBM Joseph, Dr Prakash Khandhuri, Dr Shead who were unit chiefs at the same time had tremendous respect for Dr Fenn. SII unit included the secretary Mr Krishnamoorthy who used to type out every summary on time and Rajamanickam the peon who kept us alive with coffee and snacks!

First official Pediatric Surgery team with Dr KE Mammen, Dr Fenn – Dr Aleyammal Bakthvizayam also 

OFFICIAL RECORDS FROM CMC ABOUT HIM AT RETIREMENT:

Dr Fenn , picture from 1971

“An outstanding Professor fo surgery. He trained in pediatric surgery and was the first pediatric surgeon in CMC. Under his leadership and guidance, pediatric surgery became a separate department. He developed a third speciality – surgical endocrinology. A surgeon par excellence, he was a gifted teacher and an enthusiastic research worker who had over 60 publications in national and international journals. As Principal of the college he took a great interest in student activities. He understood the students, cared for them, respected them as individuals and was friend, brother and counsellor. Generations of students loved and respected him”

OFFICIAL OBITUARY BY PROF DR ARAVINDAN NAIR AS PUBLISHED IN ASI JOURNAL:

“He continued with his contacts with the surgeons of India, but on a lesser scale. In 1995, he delivered the Pandalai Oration at the National Conference of the Association of Surgeons of India (ASI) in Bangalore. He was a member of the Governing Council of the ASI and on the editorial board of the Indian Journal of Surgery. He was an undergraduate and postgraduate examiner for the National Board of Examinations, Inspector for the Medical Council of India and Advisor to the Union Public Service Commission. Among the many awards conferred on him was the Immanuel Sunder Ran Prize for outstanding services in surgery in mission hospitals”. 

He passed away on 24 Oct, 1999 due to sepsis from diabetic foot. Prof Aravindan Nair continued to look after him in Ambur travelling daily from Vellore.  His funeral was attended by many CMC trained surgeons from all over India.  

Acknowledgements:

Prof Abraham Verghese MD, MACP, FRCP(Edin) Linda R Meier and Joan F Lane Provostial Professor, Vice Chair for Theory and Practice of Medicine, Stanford university .He was kind enough to encourage me to write this essay on Dr Fenn and was gracious enough to read it and suggest measures to improve it.

Also my life long mentor, friend and philosopher Aravindan Nair, Former Prof of Surgical Endocrinology CMC Vellore who has supplied me with details of events, pictures to make this presentation more effective. He has been trained by Dr Fenn and was more of a son than a surgical disciple to him.