The Weekly Dose: An uncommon doctor who six strangers have in common
Part two of a two-part series about the late Dr Athavale.
This is part two of a two-part series on The Weekly Dose. To read the first part, please click here.
One day, about forty years ago, Aparna Gothoskar took her four-year-old son Bharat to their family physician Dr Sone, who tended to his now-forgotten bruises. When she brought him home, he - quite suddenly - vomited. Panicking, she called Dr Sone, who rushed over, examined him and insisted that they consult the paediatrician Dr VB Athavale.
She had been instructed to prevent her son from standing up; a hyperactive, bored Bharat scrambled around in her arms while they waited interminably at Dr Athavale’s clinic for their turn. Four decades later, both mother and son still remember that Bharat’s only distraction was observing rats outside the building, scurrying this way and that. They also remember the compulsory ‘janta-janardhan’ educational lecture they had to sit through, before being seen.
When their turn with Dr Athavale finally came, he looked at a perfectly healthy-looking Bharat and said, “Gothoskarbai (Mrs Gothoskar), why are you worried for no reason?” Then, he furrowed his brow and said, “I cannot doubt Dr Sone. If she has sent you, there must be something wrong. Let us do a complete check-up.”
A battery of tests revealed a pancreatic ailment. Dr Athavale said, “Dr Sone has won!”
His light-hearted manner of speaking marked every future interaction. When Aparna accompanied her cousin and her child for a visit, Dr Athavale took one look at the mother and asked, “Isn’t she a bit too old to be seen by me?” Bharat, of course, has a different perspective; Dr Athavale’s strict orders about his diet meant he wasn’t allowed cakes and wafers at birthday parties and could eat his first vada-pav only in college!
When Aparna became a grandmother, she took her granddaughter to Dr Athavale with a puzzling symptom. She says, "Dr Athavale told me, ‘I can't find the reason why it’s happening. Go to Dr Kumud Mehta. She is newer than me, and her knowledge is more up-to-date than mine.’”
“That a senior doctor would say this about another is praiseworthy”, avers Aparna.
Dr Athavale’s respect for his juniors extended to his own practice. Not long after Bharat’s first visit, Dr Dilip Nadkarni was a fresh-faced intern when he joined the paediatrician’s clinic. The OPD began at three in the afternoon and continued until the last patient was seen, which in the monsoons, could extend up to three in the morning.
Dr Nadkarni (who was always addressed thus by his very senior boss) remembers that Dr Athavale would advise his patients to first go to their General Practitioners. “He would never find fault with their diagnosis”, says Dr Nadkarni. “Even when a GP had made a mistake, he would say, ‘your doctor has given you good treatment; I’m just going to change it a little bit.’”
When a paediatrician brought her child for treatment and it fell upon the young Dr Nadkarni to conduct the group lecture for patients’ parents, he demurred; “She’s a paediatrician, how can I educate her?” Dr Athavale told him, “You have to tell her what I want to tell her”, and told the paediatrician: “Listen to him as a mother and ask questions like a doctor.”
An allopath who became a multi-path
While acquiring his MD, Dr Athavale realised that some allopathic medicines have terrible side effects, and slowly came to the conclusion that while they were essential for acute care, other streams of medicine were better suited for chronic conditions. In his pursuit of providing holistic care, he went on to acquire a degree in Ayurveda, studied homoeopathy, and also trained in acupressure and acupuncture. In an age with fewer legislations, he prescribed remedies across streams, as he saw fit, to the benefit of patients.
Dr Ashish Kelkar - who joined, and later took over his practise after he retired - says, “People still come asking me to prescribe Ayurvedic medicines. But I have to say that I’m not allowed to”.
The question of fees
In the initial years of his practice, Dr Athavale would keep a box in the clinic and tell his patients: “I don’t know your financial condition. Leave whatever you can afford”. By the time Dr Nadkarni joined him, he charged a fee of fifty rupees, which included a blood test, radio-imaging to screen for TB, the patient education lecture as well as a consultation. But this amount was not uniformly levied.
He had instructed Dr Nadkarni and his fellow assistants to keep an eye out for genuinely poor patients, and empowered them to waive off his fees; a zero scrawled in the top-right corner of the OPD paper meant no money would be collected. They were primed to sniff out poverty; Dr Athavale knew that a prosperous-looking man may just be a penurious one who had worn his best shirt before he took his child to the doctor.
Towards the close of his career at the beginning of this millennium, when he was at the pinnacle of his field, the fee still stood at a 100 rupees. When his daughter and his son-in-law began practising (other specialities) in the same clinic, they had to request him to increase it; they couldn’t survive by charging the same old fee, and couldn’t possibly charge more than he did!
The man underneath the stethoscope
Vasant Balaji Athavale grew up in a two-room chawl in Bombay, the eldest of five children. Always a punctilious and meritorious student, his choice of paediatrics may have been guided by something he once told his daughter Dr Kavita Deosthali: “Geriatrics have already led their lives. You can't reverse their illnesses, you are just prolonging life. But if you help treat children, you can help them lead a better life.”
Not long after graduating, he was given the option of joining an established public hospital; he chose instead to found the department of paediatrics at Sion Hospital in the ’60s. He would insist that all cases of a certain subgroup of illnesses - say, of newborn babies - be examined by the same member of his staff, thus pushing each person into becoming an expert in a particular subspecialty, before paediatricians had even heard of the concept.
I first heard of Dr Athavale when I interviewed one of his juniors, whom he persuaded to take up neonatology as her calling; she went on to found a full-fledged department in Sion Hospital, as well as Asia’s first human milk bank. But he and I - and everyone mentioned in this column - are connected many times over.
Dr Nadkarni became Bharat’s father-in-law. Bharat founded a heritage tours company for which I conduct walks; Dr Kelkar is a history buff who attends them. He earned his degree in paediatrics at Sion Hospital, which is across the road from Dr Athavale’s clinic. Dr Deosthali’s husband was the go-to ophthalmologist for students of the medical college attached to Sion Hospital, which is also my alma mater.
Dr Athavale is no more, but his knowledge, words, practices and kindness live on.