The Last Case

Scanning his mail briskly, Dr Karunakara Rao picked up an envelope from the pile, tore it open and went though the letter and reached for the telephone on his desk. Right from his college days, Vissu had been choosy about his stationery and even in a big pile Karun can easily spot his friend’s letter.

“Is it King George Hospital? I am Doctor Karunakara Rao here. Get me the surgical Ward! All right then, ask the Staff Nurse to call me. I am in my office.”

He read the letter once again.

Viswanatha Rao had been his friend right from boyhood. They went to school and college and still later the medical college. They shared a room in the hostel while studying medicine. While both were interns, Vissu’s father suffered a stroke but recovered quickly. Now, he has been looking forward to his son taking over his practice. Hardly three months after Vissu got registered, his father breathed his last. Vissu had to stay back in his small town and fill the gap. He visited his alma mater now and then and every time he visited Visakhapatnam invariably he spent at least a few hours with Karun. But such visits were few and far between for he had a roaring practice and there was practically no breathing time with the moffosil practice. He had come to make such a name for himself that his clients looked upon him as one having the healing touch of the divine.

Karun pursued his studies further and obtained a gold medal in his M.S. It was easy for him to get an assistantship in the Surgery Dept in the very hospital where he studied. He made his way up very quickly. Karun was as busy as Vissu for he had both the job and private practice outside office hours. Besides this he was on the panel of the American Hospital where patients who wanted exclusive and special attention sought his service. But the friends kept their friendship always trim: making calls, seeking advice or referring cases. Vissu from his place referred his surgical cases to either Kiran’s private attention or hospital admission.

The telephone rang.

“Karun here! … Thursday? I’m sorry. Fix it on some other day. No. No. Out of the question. Sorry!”

Perhaps the fellow thinks he can have his way. It’s not just a question of his payment alone! He muttered to himself. Aren’t doctors human beings? Don’t they have their inconveniences? After all a mere hernia and it can wait for a day or two. He sighed.

Venkat, his pharmacist cum assistant came in opening the creaking swing door saying: “I gave the tokens, Doctor! Seventeen in all. Shall I call the first one?

“Give me five minutes.”

Even as the man was going out leaving the Doctor to himself, the telephone rang and Karun leaned to reach it.

“Yes, speaking. Look up my schedule for Thursday. I know it is my theatre day. What, four? I wouldn’t be available on that day and hence I thought I should let you know beforehand. If there is anything urgent ask Doctor Ranganath to do it. If he is there, please …. Hello! Ranganath, please help me. I wouldn’t be able to do any surgery on that day. Nothing very wrong. Only some urgent personal work. Thank you!” Ringing off he dialed again and spoke very politely into the phone: “Can I speak to Doctor Suryanarayana garu? I’ll hold the line.”

He must be taking his bath too methodically. Karun smiled to himself. There used be many jokes about him I the college while they were students. He was punctilious and insisted that one should not swallow till masticating a morsel for thirty-two times. Perhaps he had a way of washing his axilla too in a systematic manner. He was wondering whether the patients outside were joking about him. He pressed the buzzer to let the first caller in.

An elderly gentleman entered walking in a young girl saying “Namaskar.”

“Please sit down, baby! Is it very painful? Oh! You brought a letter too…”

Karun was startled when the grand old man’s voice came on the line.

“So you are holding a consultation while holding the receiver. What is happening to our professional ethics? Absurd! They should serve you a notice …” His voice was hoarse.

“I am sorry, Professor! This person came in …”

“That’s all right! What’s the news?

“My friend, Vissu …”

“I remember, your class fellow 1952 batch. I remember his bungling the short case. He called it appendicitis when it was colitis. Funny! What about him?

“He wants to see you: he is coming on Thursday. It was my theatre day, but I cancelled all my appointments.”

“In my days this wouldn’t be highly professional, all right, Thursday is fine but don’t let him miss Thursday.” The voice went hoarse again and the line was cut off.

Karun was amused. These twenty-five years did not make the good old man any different: the same curtness, the same affection, and the same unconcern for anything else except professionalism.

“Sorry, sir, what were you saying?”


“Arre! How are you? How’s Ratnam?” Karun greeted him warmly but looking into his face, he did not wait for a reply.

“Well! What happened?”

“Let’s go upstairs.”

“Oh! Dear! The fellow has come. We are going upstairs. Please send the coffee up,” said Karun and followed his friend.

“Did you come by car?”

“I gave up driving some six months ago. A driver is never reliable in that place.”

They sat down and an unnatural silence descended on them.

Neeraja, Karun’s daughter, brought the coffee.

“Oh, my dear! How tall have you become!” Vissu greeted her, as was his wont.

“You could have brought along your wife Ratnam and children too.”

Vissu heaved out a sigh for a reply. He took in a long breath and began after a while: “My health is not all that good. I have been keeping it a secret. My BP is well above admissible limits in spite of medication. You know I have been a diabetic for quite some years now. My sons are studying well: one doing his CA and the other is in the second year of the Intermediate. God only knows whether he would make it to the medical college. I have been toying with the idea of getting myself examined by our GOM. By the way, did you tell him we are coming? Otherwise he’d be cross for barging in without intimation for a consultation.”

“I did tell him but think about it again. One of my friends has just returned from Cardiff having gone there for an advanced study of cardiology. We can get an ECG, blood picture, lipid profile and if necessary an angiogram too. In Pathology there is that Kondi. The serologist is a friend too.”

“All that is fine: but I must see him. He is not just a doctor and you know it as well as I do.”

“Then you should be prepared to get a good thrashing. You know how he would start a lecture on a physician’s personal health.” Seeing this to be a good opportunity, Karun told his friend what he was told over the telephone the other day.

“Say what you will but his style is inimitable. Most importantly, he has a moral right to chide us, for we richly deserve it.”

“Any way, at last you could come. Perhaps you are unnecessarily rattled. All right, let’s go. Do you remember Ramanatham’s joke?”

“What is it?”

“He is orthodox and punctilious: that’s why his daughter looks like a puppy!”

“Shut up! That scoundrel is always obscene, no matter who he is talking about. Where is she now?”

“In New York, with her husband, an ophthalmologist.”

“Lucky man!”

“Shall we make a move? I’m sorry, I should tell you this. The moment I mentioned your name he remembered you with details of your blunder with the short case. His memory is impeccable!”

“Very like him. Anyone else in his place would have ploughed me but then he has a heart of gold. No doubt about it at all!”

“Every one of us gave you up for lost. Do you remember how he shouted at the one who walked in the ward with noisy shoes right in the presence of the externals? I thought he’d be finished.”

“That apart, when he comes to like a person, he’d do anything to help. Do you remember that fellow, Avadhani? He was snoring in one of the benches at the back in the Medicine class. Someone came to tell the class that the professor would not be taking the class. A tutor was supposed to come to take the attendance. That bloke was snoring in the class room in stead of going back to his hostel room.

“For the last three days he had been at his revels.”

“The tutor didn’t make his appearance, but the professor walked into the class and began his lecture. You left reminding me of our covenant to answer your number too. The professor was freewheeling in a leisurely way.

“The snoring was clearly audible. It was just above the level of the professor’s stentorian voice. Luckily his head was not visible. He bent his head on to the desk and snoring.

“‘Who’s that? Look out, he has a congestion in the lung!’”

“He went up the gallery and lifted the head to bring the snoring one into an upright posture. Our fellow was flabbergasted. The professor pulled out the stethoscope from his overall pocket and auscultated his chest then and there, pronounced there was a cavity in the lung and suggested immediate admission in the hospital.

“’I pity the young fellow,’” he said washing his hands at the wash basin before he continued his freewheeling.

“The talk now took a turn to personal habits. Sambu, our Snub Face, was taking down some notes furiously. He was looking up at the professor now and then very dutifully. Suddenly the professor came up and snatched the book in which he was writing and read out for himself the words that I could read much later: ‘I never believed your words. I thought you would take proper precautions. But don’t worry I will consult my senior …’ He folded the piece of paper put it in the book and returned it to him. Everyone tried to guess to whom the note was intended by looking into the faces of the ladies in the side benches. Only Padma went red in the face as reported by Meenakshi. But later it was discovered that the letter was meant for Margaret, the Sister in the gyaenic ward. As if nothing had happened he went ahead with the talk on professionalism. Sambu never forgot his thoughtfulness.”

Karun looked into his friend’s face. He looked his old self, which made Karuna happy: after all his banter had a purpose.


“Welcome, young men, welcome!” The Professor Emeritus, Suryanarayana garu greeted the friends.

It took some time for Vissu to remind himself of the tiger-like professor. Now, he was reduced to skin and bone. But his dignity, his mien and the twinkle in his eyes remained.

After the usual exchanges, Karun brought up the subject of Vissu’s health.

“Come into my office,” he said and opened a door. The friends brought up the rear.

“Sit down!” he said to Vissu and turning to Karun said “Tie the cuff,” just as he would tell a sister.

He read the blood pressure patiently and pulling out the cuff said: “Nothing very abnormal. This is quite normal for a practitioner of your popularity.”

“But I measured at home …”

“All right, lie down…. The vest too.” He took a full five minutes auscultating and tapping. Folding his steth he said: “No murmurs at all. Nothing peculiar. I am sure. Karun, you examine.” He handed him another steth hanging from a nail on the wall.

-Karun took his time for the examination and looked at the professor, not knowing what to say.

“He is getting worried, becoming cardiac conscious. Surprising, after so many years of active practice! Did ever any patient achieve any cure by worrying?” The GOM cleared his throat again. His voice was getting hoarse suddenly.

“Did I ever tell you the case history of one Professor Dayanidhi? Perhaps I didn’t. That was after you had left. Remove it there!”

Karun was absentmindedly going to hang the steth on his neck. Then he remembered the GOM hated the habit.

“Sorry, sir!”

“Forget it.”

He paused for a while as if trying to recollect. But Karun knew he was waiting for his breath.

“What was I saying? Yes, Professor Dayanidhi. Very interesting. An authority on Plasma Physics. He came to me when he was fifty-five. First went to the cardiology unit in that great college. They had all the investigations and all the cardiologists there took a good look. The chief, he told me, gave him three months. He came to me. Of course, life is sweet. I can understand.” He was short of breath and the voice went hoarse too.

“… He came in breathing with difficulty into my room in Bhavanagar ward. Someone gave him my name. The DMO brought him to me. I asked the House Surgeon to read the BP. Silently he handed me the stethoscope keeping on the inflation in the cuff. Do you know what it showed? 280/160”

Vissu was holding his breath, all attention.

“The DMO was sitting in the chair smoking, violating his own rule against smoking in the offices. The Physicist was looking hungrily at the cigarette. He was given permission to smoke once in two days as a great concession. He was sad that he had smoked one the previous day. I permitted him to have one just then. He choked, perhaps with joy. I called my assistant and asked him to get me the Journal of Cardiology and gave him the volume and the number of the issue. And then I turned to the scientist. “Well, Professor! To tell you the truth, your heart is of steel, I should say. We pride ourselves that we are objective, impersonal and always rational. You know the investigations and the results and you are not a lay man. Judging by your life style, it is surprising you are at least this well. I suddenly remembered a case and if you would like to …”

“Please go ahead, Doctor!”

“‘Let my assistant record the readings taken afresh.’”

The assistant took the reading and recorded it in a volume.

“‘Now I would give you some tablets for a fortnight. Take one once a day after breakfast, the diet prescribed for eight weeks: three glasses of fruit juice every day and two large spoonfuls of rice with buttermilk sans cream for lunch and dinner. Most important, take your wife to a place like Bhimunipatnam, go out of circulation and take complete rest. You can come to see me after four weeks. Don’t forget to take the tablets.’ I gave him the tablets in a bottle and he put it in his pocket and walked out.”

“I used to look at the obituary columns every day.

“Four weeks later, he came with a cheque for a thousand rupees, which was quite a lot of money in those days. Here it is. (It was under the glass on the table.) … Later I don’t know what happened to him till I read of a plane crash where he died along with several.”

“So, the tablets worked!” Karun asked anxiously.

“You can safely infer so. The secret would die … with me.”

With difficulty he could complete the sentence. The voice wouldn’t come out. With a painfully (for us too) hoarse voice, he said: “Young man! Stop worrying. In about three months you’d be normal. Forget about your heart or any ailment whatever. Another thing: you are staying for lunch. My wife is waiting for you. Let’s go in.” After seating them at the table he clambered upstairs, possibly to change.

“How fast have both of you grown!” She was all admiration. She made kind enquiry about our families and asked about the children, their studies and so on. “Sorry, Mallika, serve the food now. My dear young men, I’m afraid I’ve to be content with some gruel…for some more time… You go ahead.”

While serving curds towards the end of the meal she brought up the subject of the professor’s health. “Look, my dear children, your teacher’s health is not at all satisfactory. For months he has a bad throat and now he has some breathing difficulty also. He laughs away my concern.”

The friends kept staring at each other. Karun wanted to stop him and examine his throat. Vissu felt like auscultating his chest. Was it only senility and seasonal ailments? “Can we really make bold to … No.” Each told his conscience. The professor pretended not to have heard his wife’s plaint. None of his students could brave discussing his health in his presence. After a short while they took leave of the old couple.

On the third day Vissu got a letter from his friend Karuna.

“My dear Vissu:

I hated to give this news over the telephone. The GOM expired. Mallikammagaru is inconsolable. You are the last case to be examined by him. Now I remember his words: “Don’t miss Thursday.” He wrote casually to his son in Delhi a week ago to come on Friday by the first flight. It is a wonder he could brave it cheerfully, having known the end coming. We lost a unique personality.

May his soul rest in peace.


(GOM - Good Old Man)

(This story originally in Telugu was published in Andhra Prabha Weekly on 12- 2-1975)


More by :  Dr. Rama Rao Vadapalli V.B.

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