Indian Journal of Medical Ethics


Reminiscences, reflections and reasoning

Sanjay A Pai

Published online on September 26, 2017


(The following is a set of reviews of two books authored by Dr MK Mani)

MK Mani, Yamaraja’s brother: The autobiography of Dr MK Mani, 2nd edition, ISBN 8185984824

Sometime in 1991, my uncle lent me a book with an intriguing title, Yamaraja’s brother. This was the autobiography of Dr MK Mani; to say that I enjoyed reading his reminiscences would be an understatement. A couple of years later, I tried to buy the book for myself but learnt that it was out of stock. All my attempts to get the book over the next quarter-century failed. Fortunately, we now have a reprint of Dr Mani’s autobiography.

Dr Mani is a pioneering nephrologist in India. He tells us about his mentors – right from the age of 7 or 8 years – when he decided to become a doctor – and how he stuck to the straight and narrow path, the razor’s edge of medical practice in India. Dr Mani practised medicine in Government Medical College, Madras (now Chennai), before going to Australia for training in nephrology, then returning to India to work in Madras; and then at the Jaslok Hospital in Bombay (now Mumbai). Subsequently, he returned to his roots and has been at the Apollo Hospital, Chennai. Because this book was first published in 1989, the story ends in the 1980s. I had expected to see an update to this and would have liked to read about his life and work in Chennai. However, he has chosen not to make any changes from the first edition.

Having been an undergraduate medical student myself, I particularly enjoyed his stories from his college days as I – and I am certain I speak for many others – was able to see similarities in our own experiences many years later and in a different city. We too have had inspiring teachers who are role models as well as the opposite – insecure and boring teachers; we have wondered about the dichotomy between what is taught and what actually needs to be taught in medical college, and fully understood phrases such as “Medical college life revolved around the canteen” and “I am sorry to say there was general rejoicing when one of the toughest…examiners…died…” (pages 15 and 19, respectively). The younger (and older) generation would do well to learn from the author on how grateful he is to his mentors and to his residents and many colleagues.

The autobiography is peppered with his thoughts and opinions and thus, is quite relevant to the readers of this journal. One might even see an apparent contradiction in some of his views – but isn’t that true for all of us? For instance, he is not enamoured about the idea of students getting admission into medical college based on their sports marks – but later, he makes a point about education being “not just…instruction”…but a “strengthening of the powers of body or mind: culture” (page 21). A considerable part of the book deals with his most famous patient, Jayaprakash Narayan; his views on the multiple tumultous medical events that took place in those years and their implications for medicine in India make for interesting reading. The JP story illustrates many aspects of life, medical or otherwise, in India in the 1970s – and much of this may well be true even today. Conflict of interest, fear of failure, problems of treating the rich and the famous, publicity-hungry politicians doing photo-ops and overruling sound medical advice not to visit ICUs for fear of infecting patients are discussed. You will experience black humour (read about the overload of idlis sent to JP for his recovery after surgery in the USA on page 139 and an abundance of medical advice from all and sundry, on various alternative medicines on page 151).

Let me end with the answer to the question that must be bothering some of you – the reference to the unusual title of his autobiography. It is an incantation to Yamaraja, the Hindu God of death, who, we learn is not as powerful as the doctor – because while Yamaraja takes away life, the doctor takes away life as well as the patient’s money. Dr Mani would be an exception to this statement – as a leader in nephrology, he has been responsible for saving many lives, while always following the righteous path in medicine and in life.

MK Mani. Letters from Chennai: Random thoughts on medicine and society, ISBN 8185984832

Along with the autobiography reviewed above, for good measure, Dr Mani has published the collected Letters from Chennai, as well. This series of letters which Dr Mani started publishing since the early 1990s, were originally called Letter from Madras, and later, Letter from Chennai. The letters were published in the National Medical Journal of India. This book contains, in addition to the Letters from the Natl Med J India, some articles from the Indian Journal of Medical Ethics, The Hindu and Lokayan Bulletin.

The Letters obviously consists only of his views on events that have taken place in his city and state in the past 22 years or so. The letters have been grouped together in chapters which are entitled, for instance, The Tamil Nadu Medical Services, A hazardous occupation, Renal transplantation from living donors, Public health and so on. I had initially thought that I would have preferred to read the Letters in the sequence that they appeared in the Natl J Med India, as they would have reflected the recent social history of medicine in Tamil Nadu. However, the approach adopted in the book probably makes more sense as it shows how, far too often, the more things change, the more they remain the same! There is some amount of repetition because some essays are written years apart, but need the same background bumpf. But this is inevitable. However, why the essays are sometimes arranged arbitrarily in the chapter, rather than chronologically, is a mystery to me.

Because this is a journal devoted to medical ethics, let me comment on Dr Mani’s views on the topic. He not surprisingly berates the shameful cut practice, which we learn was in vogue even when was a student. His experiences as well as that of a friend with the medical councils regarding cut practice (pages 143, 161) are worth reading and explain, in considerable part, why the medical profession has lost the respect that it once had. The letters fill you – sometimes – with hope, as you read about positive and uplifting anecdotes (pp 25, 34), but a large part are critical of society, government and especially of doctors. Clearly, he believes in JBS Haldane’s statement “I believe with Thomas Jefferson that one of the chief duties of a citizen is to be a nuisance to the government of his state “.

The random thoughts on society are of course, also linked to medicine, as would be befitting for a medical journal. The see-saw approach of the state government/s in Tamil Nadu on the compulsory use of crash helmets by riders of two wheelers finds place in many columns. Political promises, drinking water, pollution, government-aided subsidised food schemes and of course, organ donations and the misuse, abuse and misunderstanding of the laws that govern it, are other subjects that Dr Mani comments on. I am glad to read his views on eye camps “the accent is on the numbers and the festive atmosphere is like a one day cricket match” – he denounces them because of the high infection rates and is in agreement with the other manner of utilising the funds and achieving the targets – using the camps for testing vision and providing spectacles and for the diagnosis of cataracts (but not the surgery, which is subsequently performed in a hospital). A 2009 column (p 270) refers to the then-new practice of doctors discarding neckties and full-sleeved shirts as these were likely to spread infections between patients. (I wonder if this practice is still being followed). Humour, often self-deprecating, is pervasive in the book as is his love for cricket (clearly, the older version, test cricket) which makes multiple appearances in the books. Like Hardy (of Ramanujan fame), I like to use cricketing analogies to explain many ideas. I suspect so does Dr Mani.

Homer (or the printer) nods, on occasion. I was surprised to see the word “cutbacks” on page 163, in a Letter from 2003. “Kickbacks”, I knew of, as also “cuts”. But “cutbacks”? I looked up the original Letter on the web and sure enough, the word should have read “kickbacks”. I also noted that the last line of the extract in this book was not present in the original Letter, suggesting that some editing and revising of the initial Letters has been done.

I suggest that some further editing be done in the next edition of this thought provoking compendium. Dr Mani’s statement “Speaking of the press during the emergency, Sanjay Gandhi is reported to have said, we asked them to bend and instead they crawled”, on page 96 is incorrect because a later issue of the NMJI (March-April 1997) carried a letter from a reader who pointed out that it was actually George Fernandes who had made the statement. Similarly, Dr Mani’s article on deemed universities (p 40) contains some errors, as pointed out subsequently in the journal (May-June 2000).

These minor glitches aside, the collected Letters from Chennai is a worthwhile read for – if they are willing to learn from it – physicians, administrators, the general public, the medical associations and the politicians.