Thank you, Sir!

Prof. N K Hase, a nephrologist, and a teacher par excellence retired recently from the services of the Seth GS Medical College and KEM Hospital, Mumbai. He was very reluctant to have a grand send-off and after lots of requests, he agreed to have a roundtable meeting with the members of his department. This three-hour meeting was the most memorable send-off I have ever been to; everyone including Dr. Hase, was tearful while expressing themselves. Dr. Amar Sultan, one of his students, gave a very apt tribute by presenting Dr. Hase’s own life in a case presentation format. Here it is for you all:

 

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MR. NKH, a 65 years old gentleman, married, father of two, right-handed, residing at Thane, hailing from Sangamner, a physician and a teacher by profession, presented with symptoms of awesomeness and brilliance for last several decades.

These symptoms appeared to be progressive and to an extent, contagious.

Sir, I would like to start my history from the year 2004, when I first met this gentleman for the first time in ward number 5 of L.T.M.Medical College and Sion Hospital during ward rounds when he complimented me by saying, “very good” for correctly telling the antidote of heparin in my second year MBBS posting; however this phenomenon of complimenting occurred only once and has not recurred till date.

During the same round, at the bedside of the next patient, he asked us about symptoms of yellow phosphorus poisoning. Now, having recently studied yellow phosphorus in my twelfth standard chemistry, I knew that as a highly inflammable element. I spontaneously answered that it tears our the GI tract. (I wasn’t aware of medical terminologies like ‘erodes’, ‘corrodes’ or ‘perforates’ by then; I had to use the word ‘tears’). Stunned with my answer, he turned to me, took out his magic wand (i.e. his right index finger) waved at me and said, “If you don’t know, say ‘I don’t know’. Don’t bluff.” (Unlike symptom of complimenting me, this phenomenon of waiving his magic wand at the fellows was strikingly recurrent, particularly in 2015 during my transplant rotation in nephrology training under him).

In the same year (2003-04) while teaching a CNS case to PG students in Friday clinics at the Sion hospital, this person had surprised all exam-going students by quoting the then-recent classification of ataxic disorders which probably was not even published. By this time, he was famous as an outstanding teacher among undergraduate and postgraduate students.

From 2004, he was lost to follow up and had opted to explore alternative horizons of medicine. Details of the events during this period are not available to me. However according to his close associates, symptoms of excellent teaching, extraordinary clinical judgment were relentlessly progressive during this time.

Thanks to my good fortune, I encountered him again in August 2014 when I noticed that the above-mentioned symptoms had significantly progressed. At this time, his awesomeness was associated with an increased responsibility, increased enthusiasm along with increased teaching activity and hard work. His punctuality and clinical acumen had no comparison. These symptoms were present throughout the year without any diurnal or seasonal variations and were present even during sleep (evident by the immediate response to the midnight phone calls from the clueless residents). There were no relieving factors.

On inquiry, he also gave the history of immunity to the fatigue and stress from his hectic daily routine.

There was a recurrent history of attending patients outside clinic hours in his cabin, corridor, lift and even at the entrance of the hospital. There was a history of postponing lunch while attending to the patients in his chamber. History of playing a role of a father when he took all the responsibility for the mistakes made by his children particularly the younger two (read- the 1st year residents).

He never lost his patience. There was no history of refusal to see patients, to solve a query or to teach undergraduate or postgraduate students. There was no history of shortcuts while examining a patient, writing medical notes, filling up the lab request forms (which is not so easy in a municipal hospital with paper-based records) or while arriving at a diagnosis.
There was no history of craving for fame, appreciation, spotlight or money.

Past history
Similar complaints in past ever since he has joined medicine.

Personal history
Mixed diet; the voracious appetite for reading. Addicted to Halls and Mentos 🙂
Unable to sleep unless he reads for a couple of hours
Sleep is disturbed due to frequent calls by on-call Nephrology Residents.
Very neat handwriting just as his character is.

Family history
Similar symptoms, albeit in early stages are found in his son as well as his daughter.

On examination
He is calm and quiet and appears radiant. Pulse rate( I swear, I have measured it for one complete minute) is normal.
Blood pressure checked in an ideal calm environment of Tuesday Nephrology OPD (read- chaos) is normal.

Systemic examination: massive cardiomegaly enough to accommodate mistakes of his residents. Rest of the examination is normal.

To summarise-
I am dealing with a 65-year-old gentleman with progressive symptoms of excellence, brilliance, and hard work, for whom age is just a number.
He also is a good doctor, teacher, and a mentor and has limitless empathy for his patients.
He also is one of the best human beings on this planet and has a big heart.

Diagnosis
There are no differential diagnoses here. A thorough literature review revealed that presence of and more importantly, the persistence of these symptoms till the age of 65 is rare and only one case has been reported till date which is from western India. This symptom complex is characteristic and diagnostic of the persona called PROF. NIWRUTTI K HASE.

Amar Sultan (@sultan_amar8)

Author: lastmonthinnephrology

Clinicians, interested in 'what matters at bedside', readers, researchers. Tukaram Jamale and Vaibhav Keskar

12 thoughts on “Thank you, Sir!”

  1. God has stopped making teachers like him….
    Worked as a lecturer in Sion hospital under him …teacher par excellence
    1990 to 1996

    Like

  2. I don’t remember Sir as extraordinary Nephrologist or brilliant internist or respectable HOD Medicine or examiner. There is only one word that comes in my mind when I think of him …….. a Teacher,
    A kind of a teacher I have never met before and unlikely to meet one in future.

    Like

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