Prof K Rajasekharan Nair was the former Director, Professor & Head, Department of Neurology, Medical College, Trivandrum. One of the pioneering leaders in neurosciences in India, he served as president of Neurology Society of India (NSI), Indian Academy of Neurology (IAN) and Indian Epilepsy Association (IEA). An eminent neurologist and a well-known writer, Dr Nair is the recipient of many awards and honours from different universities and scientific bodies from India, UK and USA, including Lifetime Achievement Award in Neurology by IAN, Chennai (2017), and Kerala Sahitya Academy Award for the Best Scholarly/Scientific Literature (2014). He has published over 138 papers in different peer-reviewed neurology and general medicine journals. He is also the author of nearly two dozen books, both in English as well as Malayalam. Currently Emeritus Professor of Neurology, Medical College, Trivandrum, he teaches movement disorders and cognitive neurology.
Dr Nair discusses the profession, practice and teaching of neurology.
You have been practicing as a clinician and a teacher in neurology for over five decades now. How do you see the specialty evolved over the years?
When I started the first neurology department at Medical College, Trivandrum in 1973 soon after completing my training in Glasgow, I had an extremely tough time convincing the authorities about the need for such a specialty. I was the lone neurology teacher in this part of the world. I used to do everything myself. I needed to conduct exams. I needed to give training.. all by myself… In a short time, I formed an association of teachers in neurology, involving my students, to promote academic activities. TAN organised around forty CMEs over the years. As usual, securing funding for the programme was the biggest challenge at that point of time. We also came out with ten books for teaching neurology. In these years, I could also become the president of prestigious organisations like Neurology Society of India (NSI), Indian Academy of Neurology (IAN) and Indian Epilepsy Association (IEA). It was not easy for a southerner like me to get into the top echelons of these medical bodies.
The practice of neurology has changed dramatically over the years. I studied neurology in a conventional way. But I used to teach neurology in a manner which seemed unconventional at that time. Today, I am studying neurology as the cutting-edge of medicine. The exponential growth of the subject is so beautiful, so good. Seeing the way it has emerged..is absolutely pleasant. The difference is so remarkably huge that no one can deny it. However, the new doctors, who go by a technology-oriented methodology, have a problem. Quite often, they tend to forget the fact that the person sitting at the other side of the table is a human being, with his own fear. The man is least interested in the MRI finding of a tiny growth in the pineal body. He’s bothered only about his headache. He is worried about what will happen to his wife and his child if anything goes wrong. The man sitting at this side of the table does not recognise the you in you. The you in you or the I in I is different from what the machine shows. No machine, till date, what should I say, can truly reflect all emotions of human being or any living thing…
Medical profession has become much more demanding and complex in today’s world. What is your view?
I believe that a clinician has a much bigger role in today’s world. He can be instrumental in changing society. Like treating the sick, the clinician can treat the society as a whole. But there are times the medical professionals do not receive what they legitimately deserve. Today, we talk a lot about the Kerala model of health care. It is often touted as a runaway success story and a great model which others can look to emulate. When you look at the success of Kerala’s well-touted healthcare model, you will find that it is no one else, but the doctors who are the real architects and who made the model a resounding success. It was the doctors who dared to go to the far-off hinterlands, the remotest villages; they were the ones who crossed rivers, traversed forests and climbed hills to reach out to communities living in the far-off locales to make it happen and came back afflicted with endemic diseases like malaria and filariasis…
But the credit for the success went to the so-called planners of the programme.
Again, very few people know that it was Dr Rustom Jal Vakil, a cardiologist from Mumbai, who pioneered the use of reserpine for hypertension. It was the first-ever medicine to be used against hypertension. Extracted from the roots of Rouwolfia serpentina (Sarapagandha), use of reserpine was popular in India as a routine anti-hypertensive agent. At that time, the West did not have any drug treatment to lower blood pressure. They regarded the condition as benign.
Vakil, in 1949, published the 1st clinical report on R. serpentina therapy in the British Heart Journal. The article really fired the imagination of the international research community. In his paper, Vakil summarized 10 years of his experience with Rauwolfia. After an extensive trial of various hypotensive remedies in thousands of cases of hypertension, Vakil found Rauwolfia to be the most consistently successful agent. In addition, Vakil sent a questionnaire to 50 physicians from all over India, and 46 of those voted for Rauwolfia as the best hypotensive agent in their experience.
A well-known neurologist and academician, you are also renowned for your writings. Your first published fiction was a novel. How do you eminently combine these two diverse streams?
My first published novel ‘Oru Puzhayude Katha’ (The Story of a River) was not pure fiction. It is also a scientific novel. The novel discusses the story of the decay of a river called Chaliyar river, which was the bloodstream serving a large number of villagers in a northern part of Kerala. An industrial unit in the locale was polluting the river and its environment with its effluents. It was affecting the lives of so many poor people living on the banks of the river. For me, the issue was so compelling. I wanted to write about it but I was not finding time because of my extremely busy schedule. In those days, as the head of the department of neurology at Medical College Hospital, Trivandrum my routine started in the early morning hours and ended late in the night.
Fortunately, I chanced to get the time to write the book while in Libya where I was assigned with the responsibility of setting up a department of neurology at Garyounis University, Benghazi… The Libyan authorities took nearly three weeks to arrange the necessary facilities for me. I managed to complete the novel within this time gap. Oru Puzhayude Katha, which was published in 1979, was the first environmental novel in the Malayalam language. I am not sure how many people are aware of this fact.
Are you working on any new books presently?
Yes. My latest book is currently in print. It is written in Malayalam and is expected to be published in the next two months’ time. The title of the book is ‘Munpe Nadannavar’ (Those Who Walked Ahead). For a change, it is a homage to my contemporaries, but is also the story of disregard and neglect. You know, the person who brought neuroscience to India is a Keralite. His name is Dr Jacob Chandy. He was living for fifteen years in Kottayam totally unheard of. And he died there, unknown, forlorn. Nobody, not even anyone from the medical community, bothered to take care of him, the great man. The only mistake he did was that he decided to come back and settle in his homeland. I discussed his case among our circle. Many of them didn’t even know him. Since I am the only person who is alive today in the clan and the only one who can write, I thought it is my duty to pay homage to that great man.
And the second book that I am working currently on is about how we understand our perception or experience and how they can turn, what should I say, faulty? The book has these ‘faulty’ perceptions and sensations people experience as its theme. For instance, if you drop a pen before some of my patients, they will get absolutely frightened. They will think that it is a snake or something, and will try to wriggle out of the situation and run away… I thought of the idea of putting together the cases of these ‘faulty’ sensations. To achieve this, one needs deep knowledge in the subject. And secondly, the person should know how to write. Among the doctors’ fraternity, I don’t see anybody else who can write. So, again I thought I should do it.
What would you prefer to be known as — a neurologist or as a writer?
A neurologist. Till the end of my life.
I started teaching neurology even before I joined for my DM. In hindsight, when I look back sometimes, I feel some of my decisions were not proper. For one, I used to teach post post-graduate students. A few batches passed through my hands. In between, I happened to teach two batches of undergraduate students. That was purely out of compulsion by someone whom I cannot say no to. Then I stopped it as I was not able to find enough time. But when I look back at those jam-packed classrooms which seemed to swell each day, I feel that I should have done more. I realize there is an advantage of teaching MBBS students. There is a large number of students with fresh minds. They also imbibe and absorb things much faster…
And the second thing is about not participating in public functions. As a rule, I never attended any public meetings. Now, I see there are so many people around who would like to listen to speeches. There are very many who would love to read books. When I published a book that comes around 1000 pages and cost nearly 900 rupees, it got sold out like anything in a short time. Now the second edition is being printed…But I am exceedingly happy with what I am doing.
So, your practice, teaching and writing will all go hand in hand…
I have been writing since my childhood. Everything can be made a story. Probably, that is what a raconteur does… I am teaching my favourite subjects — movement disorders and cognitive neurology. And I am practising neurology even today, even though [it is] for select patients who come seeking me. Touch wood, I can say I am very old. It is because of nothing but God’s grace. A lot many in my generation have passed away. Many others are sick. Most of them stopped working. I have my own problems too, but still, I keep going. I keep myself awake till late in the night… studying neurology…
All I wanted to say is that there exists a power beyond the limits of our comprehension. To deny it is fashion. Deny it or not, without the power, we are but a big zero.