I am the granddaughter of two Obstetrician-Gynecologists and the daughter of one. The Obstetrician’s basic tenet of watchful expectancy and masterly inactivity did not suit my impulsive personality. The prospect of spending my professional life staring at diseased female genitalia with their odoriferous discharges also did not charm. This is not the case with my mother, Dr. K. Radhakumari. At 82, she is still enthusiastic about her chosen field, Obstetrics and Gynecology.
When she started her career, Kerala was just emerging from the ‘dark ages’ as far as modern medical expertise and treatment was concerned. She talks of her post-graduation days when women with uteruses burst open and babies jammed inside were brought to Calicut Medical College. They were tied to make shift stretchers — usually bamboo ladders, and carried on the shoulders of men who walked many miles with their half dead burdens. The machete that rested permanently on the admission register in their Casualty (ER) was meant to cut the patients free of the ropes that kept them in place during their harrowing journey. If they made it that far, then remarkably many of them survived. Amma says that surviving the surgery was easier than what it took for them to make that trip alive.
Amma has forgotten the role that doctors like her played in midwife-ing the birth of their specialty in our state where it now stands on par with what obtains in the developed world. This fact was brought to her notice recently when a surgical oncologist, Dr. Chandramohan from the Regional Cancer Center, Trivandrum made a video. This video showcased the achievements of the pioneers from Kerala in Gynecological Cancer Surgery. Dr. Thankam, Dr. Susan George, Dr. Kalyanikutty and Dr. Radhakumari began this work in the 1960s. Dr. Sreedevi, Dr. Clara, Dr. Chandrika Devi, Dr. Shyamala Devi, Dr. Usha Sadasivan, and Dr. Chitradhara head the list of those who have carried that baton forward.
My mother tells a story in that video…
The place: Alleppey Medical College, Kerala, India.
Time: The late 1970s.
A young fisher woman was given her death sentence – Invasive Cancer Cervix. The only treatment option was the complicated Wertheim’s hysterectomy. This was a radical procedure in which the entire uterus, tubes, ovaries and upper part of the vagina along with all the pelvic lymph nodes, fat and soft tissue were removed. The urinary tubes and the rectum had to be carefully moved away during this procedure, to prevent them from being damaged. At least three surgical specialists had to work in tandem to ensure its success, a Urologist, a Surgeon and a Gynecologist. Even then, one fifth of the women who underwent this surgery did not make it out alive. Dr. Susan George in Trivandrum and Dr. Thankam in Calicut were the only ones who had had the necessary training to undertake this procedure.
This young woman was poor, barely surviving from day to day. Going to Trivandrum or Calicut was out of the question, you might as well have asked her to go the moon. “Can’t you do something, Doctor Amma? If you forsake me, I will die.” That was indeed true and those words went in deep. Amma talked this over with her colleague, Dr. M.K. Joseph, a Urologist. Neither of them had done this before or had received any training in this procedure. For a week, they pored over an old tattered Bonney’s Textbook of Gynecological Surgery, planning out their surgical moves. Next they needed an anesthetist and Dr. Unnikrishnan, an anesthetist, was willing to join them. The head nurse too nodded her agreement. The team was set to go.
That Monday morning, Amma reached the Operation Theater to find her nurse in tears. Internal politics. The Powers that be had pulled out every nurse from the Theater and reassigned them.
Amma looked around, saw her now dejected team, and took stock of the situation:
1. The Patient is ready.
2. The Surgeons are ready.
3. The Anesthetist is ready
4. Blood is ready.
“That’s it. We are doing this”, she declared. She had no nurses, so she called her other colleagues to help. My mother-in-law-to-be, Dr. Navaneetham agreed to be the surgical nurse. They set up a black board, the Head nurse was not permitted to assist but she knew what was needed. She wrote down the list and count of instruments and swabs. Then finally they started the procedure which took hours to complete.
Afterwards, when they smiled at one other over their masks, they could not have known that the chance they took, and the effort they made would give that young girl ten more years of life. They did know however that their success in that endeavor would give them the confidence to undertake many more such procedures and also to train the next generation of younger surgeons.
That video by the Regional Cancer Center informed me that Dr. Radhakumari aka Amma has many other firsts to her name. She is the first Gynecologist in Kerala to do Radical Oophorectomies, for ovarian cancer and the first to perform para aortic lymph node dissection to remove the lymph nodes around the major artery high up in the abdomen during Radical Hysterectomy. She is the first to do Hysterectomies using a Laparoscope and the first to do Colposcopies in the Medical Colleges in Kerala. Those firsts would have meant little if she had not been able to teach others these new skills. Working in the Medical Colleges ensured that she had the opportunity to pass on the knowledge she gained to hundreds of young gynecologists.
I know that in our country the pioneers in the medical field, those who take that first step behind which many thousands will later follow, are not always recognized or celebrated. Many of those pioneers have been women, who have not lagged behind the men in their thirst for new knowledge and their pursuit of excellence. They did this after overcoming challenges that their male colleagues have not had to face. Their names and achievements should not fade away and disappear with time.
We have to continue those efforts, to remember them and to remember our past.
[Meera Sukumaran is from Kerala, and is a pediatrician who practices in the US]