During late sixties I trained as a medical doctor and a physician at Medical College Srinagar. I loved all three components of medical profession namely patient care, teaching and research and worked hard to excel in each.  I was asked to set up a gastric physiology lab and I put untiring efforts to build it. Although I wrote a thesis and got my degree on this work, it was depressing to discover that the work I was told to do was a duplication of research done and published by others and held no teeth. Excellence in patient care was measured by the length of the patient-rows you could generate outside private clinics and not acceptable to me. There were no innovative methods introduced to teach, learn and practice.
I became increasingly worried and resigned from the coveted faculty position I held in the Medical College Srinagar and restarted my career as a post-doctoral student at PGI Chandigarh. This struck the right chord of the three tiers of medical practice I wanted to excel. I for the first time discovered what excellence in patient care and teaching meant. Work started at dot 8 AM with dedicated one hour of academic activities and the first man to arrive at the meeting was none other than the Head of the Institution. Friday morning session was dedicated to morbidity and mortality (M&M) meeting, which set standards for clinical practices.  These 2 years I spent proved a turning point in my career as I hardened my clinical skills, learnt medicine as an art to practice and teach, and developed interest in research to explore the unknown. 
During my first week at PGI I looked after 2 brothers from Kurukshetra Haryana.  Both brothers had taken herbal medication from a local Vaid and developed jaundice and progressive liver failure, and died. Nobody knew the exact cause of their illness. As an immediate primary care physician of these brothers I had to release their bodies for the final rituals by the family. However, I advised autopsies to find/explore for what had happened. Chief Minister of Punjab called Prof. P. N. Chuttanni (Director PGI) and forwarded a written complaint from the family against my insistence of ordering autopsies. The great man wrote and spoke to me “Boy, I am proud of you and did exactly what you ordered”. Autopsies revealed that both brothers had died from a rare disease called “Veno-occlusive disease of liver”. I travelled alone in my Ambassador car to Kurukshetra, did the inordinate job of interviewing the angry family, met the Vaid who had prescribed the herbs, went to field used for cultivating this herb to collect samples for studies. The herb “Heliotropium iitchwaldi” the exact botanical name declared by the botanist was called locally as “Hathisund” as the flower of the herb resembled the elephants trunk. Analysis of the herb done in UK showed a highly toxic substance called heliotrine. We had struck the gold. We identified several more instances of occurrence of this disease in this community due to ingestion of this herb given for medicinal purposes. Multiple sessions of grand rounds, health advice to the community, oral presentations at national and international conferences and a series of publications in reputed international papers followed. For the first time I appreciated the reward for a hard work well done. 
Next, my mentors coerced me to watch and think of many young pregnant mothers who developed a rapidly progressive liver disease and autopsies had revealed extensive thrombosis of hepatic veins (Budd Chiari Syndrome). Over the 2 years of my training I collected data of these patients under my care and did extensive hemodynamic studies to define the pathogenesis of the disease. I went ahead to collect all cases of hepatic vein thrombosis recorded for the last 16 years since the Institution had been inaugurated. To do this for a period when no records were computerized was extremely difficult job. I spent days and nights in the basement medical record department searching for the correct records from dusty bundles. After 6 months of this ordeal I had collected 105 case records of patients with hepatic vein thrombosis. Of these 35 patients were those who were under my active follow up. I sat to analyze the clinical features, laboratory and radiological features, hemodynamic data, clinical course, outcome and pathology/autopsy findings of these cases. I divided these 105 patients in to five distinct groups on the basis of the etiology namely congenital webs; thrombotic disorders; pregnancy; tumors and ingestion of herbal toxins. Sixteen patients had developed the disease during their pregnancies.  There were many aspects of this study, which were novel and needed mention. This was the largest series of cases of Budd Chiari Syndrome (hepatic vein thrombosis) ever recorded in literature at that time.  Data collected had strength as all fatal cases had confirmation of the disease at autopsy. The cases under my care had detailed hemodynamic studies. Sixteen pregnant women who had developed hepatic vein thrombosis was a novel group not studied in the literature. This encouraged me to write a paper on this disease and send it to the first ranking “American Journal Medicine” for publication. In this paper I reviewed all the 105 cases of hepatic vein thrombosis and gave a critical analysis of the 16 cases, which had developed the disease during pregnancy. This published work has become one of the important articles referred on this subject in textbooks of Medicine, Hepatology and Gastroenterology and to accomplish this during my training has always made me feel satisfied.

Prof. M. S. Khuroo, is Ex-Chairman, Medicine and Professor Gastroenterology, SKIMS Srinagar. Mail him at Khuroo@yahoo.com.

Lastupdate on : Mon, 30 Apr 2012 21:30:00 Makkah time
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