This is not an elegy lamenting the collective loss of Dr Chaubey’s students and colleagues. We lost him on 20 November 2011, and we will be missing him immensely. I wish to highlight the superb qualities embodied in this extraordinary teacher- physician- the like of whom we might never see again.
Born on 2 June 1934, Dr Chaubey graduated and subsequently obtained MD (Medicine) from Government Medical College (GMC), Nagpur. He pursued his entire career at GMC, Nagpur where he served as a lecturer in Medicine and rose to head the department from 1972 to 1976 and 1978 to 1983. He was also a former Dean, GMC, Nagpur.
Dr Chaubey was a quintessential physician nonpareil, following on from Dr Ramesh Nigam, Dr PK Devi, Dr C Balkrishnan and Dr JN Berry and preceding several distinguished physicians who occupied the chair he left- that of professor of medicine. He built a very strong department of Medicine against all odds, using his own ideas, talents and willpower. He was unique in his ability to ride a wave that accorded highest respect to the art and science of bedside medicine and shaped it in ways that few physicians could emulate.
He was the ultimate arbiter of the department of medicine and his standards were exacting. Impeccably dressed in a long white apron, a blue tie, sharply pressed trousers and shining shoes, he would park his car, a blue fiat in the GMCH a minute before the clock would strike 8. Quick, focused and sharp, his brilliance and passion would fill the wards as he would start rounding precisely at 8:00 am, every day. We, the terrified registrars, would watch him examine the patients and make diagnoses with an efficiency and accuracy few can surpass even today. He taught Medicine in an era when technology had not invaded the patient’s bedside and skillfully showed how to inject art in the science of bedside diagnosis.
He indeed was a clinician in the mould of Osler. He felt that most diagnoses could be made at the bedside by good history taking and the use of a stethoscope and physical exam. His ward rounds were great teaching sessions: we used to be all eye and ears to the words he spoke and to his facial expressions and his emotional temperature and often we were left perplexed about what was really going on in his head. We wondered why he asked certain questions, or detoured into unexpected areas at the patient’s bedside. He would quickly go through clinical data, generate his hypotheses, and would show us how he detected the elusive disorder. He would take just a few seconds to figure out what was wrong and what to do with the patient. He was not the one who would assemble a large body of data, nor did he believe in leisurely thinking over the problem. Fast and frugal, he would combine his thoughts and action to come up with quick differential diagnoses. “Technology alone is not enough, “he once famously said, “its technology married with the art of medicine, married with humanities that the medicine should be all about.”
A master physician, he would use the magical tools of looking, touching, and listening to show us how to detect Parkinson disease from a peculiar walk, diagnose sluggish thyroid by a deep tendon jerk or a leaky heart valve by laying hands on the carotids. We learnt that a quick history and exam can help us figure out which tests to order and which to skip. Indeed he showed us that history and physical exams are very powerful diagnostic tests. A master at the nuances of heaves, shocks, knocks, clicks and crackles, he would quickly figure out a hole in the lungs or fluid in the pleural cavity – much before the imaging results were known. This possibly was the art of medicine at its finest.
In the late 90s, the pendulum of medicine began swinging from the art to the science side. The dazzling array of technologies like echocardiography, high resolution MRI scans and ultrasonography had not arrived when he taught in the medical schools but when they did, he knew perfectly how to blend his excellent clinical judgement with the machines. He felt that students and residents were becoming much too dependent on the various equipment and technologies available and as a result were losing the art of being able to diagnose and treat at the bedside.
His abrasive style and sharp tongue meant that he was difficult to work with– his criticism could be caustic and even humiliating but he grew to elicit extraordinary loyalty and awe-filled respect from his residents and faculty. An autocratic physician with a fierce temper, he could barely stand mediocre, loathed those who were sloppy or unkempt and intensely disliked those who could not match his exacting standards. During the maddening days of my residency, in ward 23 at GMCH, Nagpur, I mistook Guillain Barre Syndrome for acute transverse myelitis. Dr Chaubey, my mentor and guide, could barely contain his anger at my faux pas. “Poverty of thoughts and bankruptcy of ideas”, he vented his wrath and had almost driven me out of the wards for what he thought was an unpardonable mistake. The Ward 23 and 25 residents admired and respected their master physician but found it difficult to cope with feelings of inferiority, intimidation, envy, and even umbrage. The negative feelings would die a natural death, very quickly, though. Every resident thought that it was a great chance and privilege to work under Dr Chaubey.
Nobody else in the Medicine department, back in the 1970s through 1990s could conduct a clinical meeting like Dr Chaubey. The Friday 4 PM meetings those days would attract physicians from within and outside the medical school. The hall would get filled very quickly and doctors seldom minded standing for an hour listening to the passionate and intense discussions on difficult and unusual cases. An awed- and almost spellbound-audience would listen to Dr Chaubey as he would explain that there was a method in his madness and how he used his knowledge in basic sciences- Anatomy, Physiology and Pathology- to make a diagnosis. Indeed the Medicine department was synonymous with Dr Chaubey those days.
Dr Chaubey also designed and supervised a dialysis unit at GMC, Nagpur. He introduced peritoneal dialysis for patients of chronic kidney disease and took exceptional interest in understanding the kinetics of solutes across the peritoneal membrane. He was at his best explaining acid base disorders, lung function tests and renal tubular disorders and developed special interest in histopathology of kidney disorders.
Dr Chaubey also strongly encouraged research and helped several students go abroad and acquire knowledge in epidemiology, biostatistics and research methodology.
A passionate leader and a motivating force without parallel, he successfully conducted the Annual Conference of Association of Physicians of India (API) at the Government Medical College in Nagpur in 1980. “To conduct a conference in a small city like Nagpur, you need a lot more than vision, courage, money and even luck”, he explained to us, “you need stubbornness, tenacity, belief and patience to stay on course.” The department of Medicine, indeed the entire medical college, worked hard for the conference and even today, his former students fondly cherish the wonderful memories that the conference had generated.
Martin Tober once wrote, “Fellows do not learn values from having them preached to them, but from seeing values enacted in the routine of daily life. Values are best transmitted through deeds, not words—a how, not a what. And that is why role models are so important in medicine.
Dr Chaubey was one such teacher. We, his former students, were sad that his teaching skills were recognized so late – almost in the evening of his life. The most charismatic medical teacher received Padma Shri award in 2009. When asked to speak at the felicitation function he focused on the younger generation of doctors: “Sharpen your skills. Do not rest on your laurels. Be hungry and be thirsty- learn new methods, hone your skills, acquire new knowledge and bring them back where it matters most- at the bedside.”
Henry Adams encapsulated the legacy of teaching: “A teacher affects eternity; he can never tell where his influence stops.” Goodbye, Sir. We will miss you immensely.