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.
