BOOK REVIEW: A Doctor's Story of Life & Death

A Doctor's Story of Life & Death 
Written by Dr Kakarla Subbarao with Arun K. Tiwari
Publisher: Ocean Paperbacks, New Delhi
Re-release: 2013 

ISBN Registration: 978 - 81- 8430 - 180 - 9
For copies: Amazon.com

Reviewed by Sanjay Nannaparaju

BOOK REVIEW (Part 1)

For some, doctors are life givers, for few others doctors are life takers. Those who have been benefited idolize doctors as living gods on Earth, and those who remain as aggrieved shower their full wrath to condemn doctors as cold-blood murderers. Whatever may be the common man's perception of doctors and physician's practice, the commitment to exceed patient's expectations continues in this niche social group, that have served humanity all through the ages.

It is understood that, there are many contradicting forces which are greatly unexplainable that are at work to determine the success of a doctor. If fair diagnosis and treatment is a major consideration for each physician's success, it is the strong belief of the patient in doctor's practice to relay cure and people's opinions of the doctor's capabilities in treating diseases are equally prominent. Somewhere in-between the diversity of views emerges an objective and realistic perspective of Dr Kakarla Subbarao, who shares with us his experience, expertise and profound views on his personal life, medical science and surgical practice. He does this at a juncture of time when the global healthcare industry moves from the predominance of 'human touch' based treatment to advanced and high-end technology driven procedures.

Dr Kakarla Subbarao with Arun K. Tiwari's "A Doctor's Story of Life & Death" is a well written autobiography. This work loudly echoes the observations of a renowned doctor from India who made his mark in Radiology medicine. He established benchmarks in medical practice, which are sure to guide the global doctors community to practice medicine with the basic human touch. No doubt, we stand today at a juncture of time when healthcare domain reflects the dominance of hi-tech equipment and the robots gradually ushering precision based practice to each clinical, surgical and emergency engagement.

In the Preface to the second decade reprint, he sums up "The privatization and industrialization of healthcare started in early 80's in India is complete. The healthcare industry is growing gloriously but as a commercial enterprise. Everything is available within the country and patients are coming from other countries to receive treatment in Indian hospitals. The healthcare is increasingly delivered in packages and through smart insurance deals. Doctors hop across hospitals for better engagement fee and diagnostics have become a highly networked enterprise. “

Dr Kakarla Subbarao's autobiography elaborates on the author's observations of life, patients, diseases, whims and fancies, beliefs and disbeliefs, treatments and outcomes. In the opening part of the book itself, Dr Kakarla summarizes to the reader of what is to come..."There is a fatal fascination for the status quo. An inherent inertia can be seen in every walk of life. A lack of drive to come out of the rut is the most common trait among Indians. God has been idolized in hundreds and thousands of forms and is seen as an ombudsman out to bail out of one's life problems including those related to health. Everything, everyone, has been segregated into the two compartments of good and bad, black and white, zeros and heroes. Everything is either sacred or sinful."

Dr Kakarla Subbarao has nearly fifty years of professional medical experience in India and US. He draws a powerful contrast between medical practice in India and US..."More than five decades of working in hospitals has brought me very close to pain, suffering and death. Looking around in my domain of healthcare I see more of pain than care. Problems outnumber solutions. There are crises related not only to individual and community health but also in the deliverance of healthcare. Unlike in Western countries, where medicine is practiced as a law monitored, insurance driven service profession, in India it is very complex proposition involving handling of human emotions."

For every human living on Earth, two things are of great importance - survival and faith in god. The component of these two may vary from individual to individual, society to society and nation to nation. Dr Kakarla's observation of people in India and his experience with different patients of India has taught him great many things. He considers healthcare in India as a "complex proposition involving handling of human emotions. Disease and pain are seen here as a punishment from God. Patients look at treatment as an exercise in atonement and salvation and approach doctors as they would, a priest in a temple - carrying all they have with folded hands and leaving egos outside as shoes." Prominently, Dr Kakarla finds an inherent irony in this rather enigmatic situation, as he says "Doctors find themselves tangled in the web of these emotional loose ends and their own personal priorities for affluent life. This is a very peculiar situation that needs closer observation and careful analysis.

A human being's health condition is programmed in the genes, which is proven by the factor that "the response of the body to the disease is what makes each patient unique." Dr Kakarla highlights the predominant role of genes and genetic information that determine our health and happiness in life. "Each one of us is created from genes of our two parents. Each one of us is a product of generations of evolution, countless bits of information collected over millions of years, focused, narrowed and refined until one is pushed out of the birth canal into the world."

Dr Kakarla sensibly plays with figurative language. He tactfully draws a comparison between the "laddu" of Tirupathi Balaji Temple with each individual persona. "Just as "laddu" has little to say about its shape, we are born with limits on the shape of our bodies, the color of our skins and type of hair....There is an obese gene we all inherit that determine our body weight rather than that quantum of food we eat. Genes also control how quickly the body breaks down with age."

From the start to the finish of his autobiography, Dr Kakarla is clear about his objectives, priorities and goals that he aims to achieve. He provides clarity to the readers of how the information is organized in the book. "The text is organized into ten chapters and arranged in three parts - Cognition, Creation and Contemplation. The first part covers my childhood, medical education and initial years in the United States. The second part covers my comeback, retreat, growth and final return. The third part overviews the new emerging medical science based on molecular biology and genetics and records my views on going back to the basics of good living."

For Dr Kakarla healthy and good living is a step to realize the divine. However, for one to achieve this there is need for physical discipline, high spirituality, and dis-attachment. "The entrance to divinity is through a pretty narrow door. If we want to pass through it, we must discard everything that sustains us in ordinary lives - everything that props us up and makes us feel safe, everything we know, trust and rely on."

It appears that, in the art of deploying metaphors, Dr Kakarla has no match so far. He draws a glorious comparison between scriptures and genes. One written in the age-old times and handed over to generations of readers. Other, embedded within each one of us which inordinately influence our lives and our healthy living. “Let's evoke the Life's force by understanding the scriptures transcribed in our genes. If there are imperfections coded so are compensatory powers. The art and science of modern medicine can intervene to deal with the nature's imperfections, and to make use of nature's compensatory powers. The story I am going to narrate is that of the triumph of the human body, and the human spirit. While pain is inevitable, suffering is optional."

Dr Kakarla had great love for his family. Coming from a family of landlords, he had great knowledge of tradition and norms of values bound Indian family. He is thankful to his father Venkata Ratnam and mother Manikamma, and also his Pedamuttevi village in Krishna District for the life and rich experiences of childhood. He turns reminiscent when he says “It was the third day after the Sankranti in 1925, I was given a modern version of my grandfather’s name, Subbanna – Subbarao.”

Every stage of human life teaches something and prepares one for the next stage of life. Dr Kakarla establishes an intimate connection between his childhood and later part of life. Like a new lily, his childhood memories are fresh and highly appealing for the reader. “There was no school in the village. My father had organized a school in a big veranda of our house. When the time came for me to be initiated into education, all I was asked was to sit there that was indeed the school. Even this constraint appeared to me as a rude shock and unbearable punishment.”

In his childhood, Dr Kakarla found shame as a powerful emotion. He illustrates graphically of how shame subdues people into obedience and makes masters as aggressive and unjust leaders. He pities the plight of poverty-ridden laborers “squat outside our big house for hours waiting for my father to come out and pay their wages. I used to feel very disturbed by their presence and many times dared to plead their case for payment.”

The attraction to opposite sex often finds expression from one’s childhood. Here it is Sarojini, a childhood friend that pulsated the little boy's heart at a mere glance. “Many such times Sarojini and I exchanged glances and experienced the thrill of stealing something precious away from the crowd.” This stands in contrast to what he finds in Challapalli School. “If anything what Visalakshi returned to me was a glance full of vanity and an invitation to compete.”

Sarojini continues to be an obsession even after completion of school and planning to go for higher studies. The intensity of love can be subdued only by marriage, an inseparable bond that lasts for a life-time. “The only hitch was between me and Sarojini. She was of marriageable age by the standards of those times and if I went for further education, either I had to marry and leave her alone or she would be married to someone else and I would be left alone.”

Dr Kakarla’s nature and beliefs were hurt when he saw the exploitation of the poor by the rich. This brought him closer to communist ideology during his school days, where he says, “I started knowing more of politics of poverty and property.”  His reverence for the Gandhian path was equally strong. “To me Gandhi and Marx were equally appealing. The dignity of labour, equal right to existence, simplicity, sacrificial quality to help others and social justice were sacred to me.”

Each one of us has the freedom to choose our life, our friends, our beliefs, our professions and the like. However, bad company truly puts us in a wrong perspective, in-spite of our hard work and genuineness in life. “Your surroundings, the people who live with, can really make you sick. You have a good chance of ending up as a loser if you live in company of failures.”

In life things happen the way they shouldn’t. We think to become something and we dream to possess something, but something else happens. The obsession for Sarojini and ideas to marry her go crashing as she is married to someone else. The good performance in mathematics couldn’t land Dr Kakarla in Engineering studies, but fetched him a medical seat, the next year. In the former, his own inaction at the moment made him lose Sarojini, in the latter a determined action made him something superior. Joining the medical college at Visakhapatnam and later standing in front of family members for explanation greatly one-sided meant “The superior man when he stands alone is uncovered and if he has to renounce the world, he is undaunted, I was indeed alone and in fact renounced my village.”

Dr Kakarla questions human greed, jealousies and cravings. “The clever manipulations, pretensions, plots, pride, prejudices, greed so familiar and almost omnipresent would appear so strange and remote in the presence of the human corpse.” Dr Kakarla turns into a great medical teacher whenever the moment provides for it. “The feature of human body visible to the naked eye make morphological anatomy…” The vessels that carry blood from the heart and keeps pumping it to maintain circulation to various tissues are arteries, and the ones that return this blood to the heart are veins.” This detailed description of human organs and their functions reflects as though Dr Kakarla is preparing the reader for an advanced surgical procedure to follow. Sans an understanding of medical basics, the cases of different patients may appear incomprehensible.

For generations born in India after freedom struggle, the old times of sacrifice by our leaders may not mean anything. Dr Kakarla offers a glimpse into how as a common person he felt when India got its independence. This prominently may aim to educate the new India’s generations of our freedom struggle and its aftermath. “On the night of 14^th August, 1947 we were all awake and excited to receive Independence. Nobody slept in the hostel. However there being nothing specific to do everybody was talking to everybody else. All India Radio broadcast the midnight session of Parliament live. Our local Congress leader Tennati Vishwanatham hoisted the Indian Tricolour flag at the stroke of midnight – a historic moment…”

Dr Kakarla offers easy ways to diagnose each disease when diagnostic equipment wasn’t available. The doctor’s touch is considered to reveal many of the hidden diseases. There are realistic lessons for the new generation of doctors who consider diagnostics and diagnostic equipment as primary to tender treatment. “If the patient is short of breath even when resting and coughing brownish sputum chest infection such as pneumonia would be a possibility…” Dr Kakarla advises doctors to enhance their touch and observation skills in this he guides doctors in right diagnosis of meningitis, influenza, TB, pharangitis or tonsillitis, CKD, malaria and typhoid.