Tete-a-tete with Dr. NKJ

He belongs to a field of surgery whose birth name of Greek origins is now considered outdated. Once referred to as Proctologists –?treating disorders of the rectum, anus, and the gastrointestinal tract – his ilk is now popularly known as Colorectal surgeons. Call him by either name, his zest and zeal for life, his approach and attitude to work, and his talent and temperament stay the same - oven-fresh at all times, and gloriously updated to lock horns with a rapidly changing world around him.?????

?One look at him and you begin to comprehend why his specialty has a deep connect with the gut, an apt name for the gastrointestinal (GI) system, which is also a magnificently metaphorical term with special significance in our lives, which takes on a variety of meanings and connotations including intuitive feelings, courage, conviction, resolve,??bravado, essence, fundamental tenets, and inner workings. He has all of these traits and qualities bundled together in his slight frame of colossal impact, a potent ammunition that has seen him grow in relevance and reputation over the years – managing different roles and responsibilities with acumen and aplomb – whether as a colorectal and minimally invasive surgery specialist, medical director, advisor, lecturer, professor, examiner, inspector, author, healthcare activist, public crusader, industry proponent, entrepreneur, founder, or philanthropist.??

Meet Dr. Nandkumar Jairam, fondly known as NKJ among friends, peers, and close acquaintances.?Dr. Jairam’s surgical accomplishments, industry representations, activism, and his stellar role in shaping the sterling strides of Columbia Asia Hospitals are well known.?

?The purpose of this offbeat Q & A interaction is to throw light on the?little-known aspects of his life and work, an endeavour that?was on my mind since long, but thanks to the good doctor’s maddening schedule, the journey from ideation to fruition was a long winding route of umpteen lulls and unforeseen pauses.??Thankfully, it happened in due course and here it is, dear reader, for your consumption, contemplation and reflection:

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Your enthusiasm is unmistakably contagious. Was this oozing confidence a defining trait even in your childhood years???

Not really! But before I answer your question, let me give a preface. I am the third of four siblings. I am told that I was born in the Victoria Hospital?quarters, when I was two. My father was a very busy surgeon, and my mother a homemaker. Coming back to your question, I grew up as a very shy, sicky child. At the age of four or thereabouts, I stopped digesting food. My mother tried in vain to cure me through a regimen of various?treatments, but to no avail. I was all skin and bones, and almost a lost cause. As if through divine intervention, I was given the native seeds??of Jathikai and Masikai, which along with the heartfelt prayers of my mother got me on the path to recovery over a span of few years. Yet, I remained thin, short, and very inhibited as a person.?I still recall my persisting??discomfort at birthday parties. I hated any social connection. I loved to be on my own in some secluded corner, and the only company I relished was that of my pet cats, and of course my mother, who was my reservoir of hope, enthusiasm and strength. I hated school and its activities, and instead preferred to work in the garden or help our servants in their chores. My cook honed me culinary skills and we became very good friends. I was a very average student till standard 5.

What transpired standard 5 onwards?

?I changed?for the better when I moved to the 6th standard. This change?was entirely influenced by my class teacher?Ms Menace, a lovely lady. Her influence on me was profound. The very first?term I topped the class and never looked back. thereafter, I started doing well in class. Much later, I was also strongly influenced by my brothers in law. They were?well accomplished and I hero worshipped them.?Although I remained suppressed as a human being, very quiet and subdued, my scholastic achievements?began to unleash themselves.

How did you gravitate towards the medical profession? Surgery in particular…

?My career decision was based on only one fact. I came from a family of surgeons and I had?to be one. My father was a well-known surgeon, and so was his uncle before that. So when it came to deciding what my career path should be, there was little to discuss. Not that my father or anyone else put pressure on me. I on my own accord was keen to don the surgeon’s mantle. Therefore, to get better marks, I shifted out of the ISC class and did my PUC. I got the 11th rank in PUC.?

?With the good marks in PUC and a great performance in the entrance test of St Johns, I got a seat in both places – Bangalore Medical College and St. John’s. I chose BMC because two of my best pals from school days (we were called the Trimurti) went there. To date, I wonder what my life would have been if I had enrolled at St. John’s. An unanswered question, and perhaps an irrelevant thought now.?

?The medical seat was confirmed, which meant a shift of the academic year. Those were the days of the AISSC,?or the Anglo Indian Secondary School certificate examination, which was, thanks to the influence of the British, held in December. This meant I got six months before I joined college. A divine six months. As an adolescent, I enjoyed this time with music, dreaming, travel, and like all others of that time, I learnt the art of shorthand and typing. I also toyed with the guitar but with little success.?

?Could I have taken a different career path? What would I have been good at? Again an unanswered question. What I know for sure is that I did not have the personality to be a surgeon, I consciously moulded myself to fit into that role. You may also wonder what I could have become, if not a surgeon. Hold your breath! An actor! Stage acting was a very likeable profession for me. However on a lighter note, given my physique, I could have tasted success in that field as a comedian, certainly not as a hero.

Any stalwarts who left a lasting impression on your mind?

?I have already talked about my class teacher Ms Menace. There have been others who influenced me substantially. My father ranks high on the list. He was an icon of his days, revered?as a teacher, as a??surgeon, and as a human being.?

Around the time I was in high school, another influencer entered my life. He was the first pediatrician of Bangalore, Dr Sampath Loganadan. He was sharp, intelligent, a champion tennis player, fearless, and very disruptive?in his thoughts and behaviour. He came into my life at the most opportune time. I was always at his clinic in my free time, helping him, and learning?from him, throughout my?medical training years.?

He regularly organised camps for children in various outstation locations and pushed me into taking the lead in this endeavour. There were others role models, some collectively, like the two pals of the Trimurthis I spoke earlier about. They had the right mix of fun and study, of games and teenage stuff which is so necessary in life.?

There was a Dean in St Johns who influenced me with a single interaction. This was an appraisal. He told me: "No one speaks about you. You are not known as a teacher, nor as a surgeon, remember you cannot ride on the wave of your father's success for ever"? That evening, while swimming, which I did?for exercise, I made?a resolve, so strong that it changed me overnight, aided by the strange influence that the students of St John's collectively had?on me. When I started as a lecturer, I realized that my classes were boring, and most in the class would do exactly what anyone would in the circumstances: sleep, laugh, and yawn away the hour. This spurred me to think differently. I thought about how to make my lecture interesting?and bingo, my introspection helped. I began to speak my mind based on knowledge and practicality. This changed everything and my popularity?went sky-high. Now the same set of students were furiously circulating my notes. They fondly called it ‘Nandu's Notes’.?

Surgical training is arduous, to say the least. Further, it also depends on how adept and good you are with your hand eye and brain coordination. I watched many of my professors, my father and peers use their hands with dexterity, and wondered why my own were not that nimble. That was a fact but having embarked on a surgical career, one cannot rue the fact and suffer. Thus began the painstaking ordeal of practicing this coordination to near perfection. I thoroughly relished the penance of moving up the value chain of surgery. I am not saying I became the best but I definitely got as good as is necessary to be recognised as a good surgeon.?

There is another colleague who influenced me significantly. His tale merits narration. He was a village shepherd who did his early education in a Kannada medium school. However his grit and hard work won him a seat in medical college. We were classmates and we trained together and worked together for many years. What I have admired in him is how far he reached in his career both in terms of surgical competence and social commitment. He is a committed surgeon, his hands move superbly and he’s spent a good part of his earnings in incepting and running a school of poor students. I respect and value him as a friend, classmate, and someone who has walked with me for a good part of life. Hats off to you, Muni Reddy!

There was also the influence of another colleague who also had a huge impact on me - Dr Patrick S Kamath. A gastroenterologist, he was a good friend and colleague in St John's. He helped me immensely as a surgeon, administrator, and person. Extremely intelligent, he moved to the Mayo clinic in the US, but stayed a friend all along. He was instrumental in helping me get the observership?and also exposed me to the way medicine is practised in the US. We are in touch to this day!

St. John’s has a special place in your heart, having spent 15 years in academic surgery at the legendary institution…

?Undoubtedly. My tenure in St Johns was immensely satisfying? by many accounts. I credit this organization for grooming?and shaping my ability as a surgeon and myself as a person. As indicated earlier, I took longer to mature as a surgeon compared to others. St John's ignited in me the desire to lead change for the better, to address issues in healthcare that were a dire need at that time. I refer to the early 80s when there was no defined private healthcare. Also sorely lacking were accountability, quality, and process-oriented care. The glaring gaps became more prominent when we did fellowships and observerships overseas.?

After more than a decade in St John's, I sensed a misfit in one area - between my desire to create a change and the traditional way with which St Johns functioned. Also, St John's paid its staff meagrely. Hence, I decided to move away from this great Institution. To date, I salute St Johns for shaping me and making me what I am.?While I realised that my time to leave St? John’s had come, the difficulty in precipitating that decision was substantial. St John’s is a great institution. It provides a fertile opportunity to learn, grow, and interact with young minds that stimulates you to deliver your best.?

For me personally, the attachment and emotions were substantial. However, I had to take the plunge. I have already outlined the reasons. They were mainly financial, apart from the monotony of doing the same thing over and over again.?

When I finally wrote my resignation, I was more relieved than I thought I would be. When I cleared my desk, I left with no tears, with not a tinge of sadness! I realised that this phase of life was over. I had to move on. This lack of emotion on the very last day to date surprises me. I am a very sensitive person. How could I have been so matter of fact? I don’t have an answer.

What are your other passion pursuits besides your vocation?

?In my younger days, when I was in class 1 to 3, I hardly played any sport. I was skinny and had serious issues of poor health that made me physically weak. While I was still very poor in games and sport, Dr Sampath, introduced me to three divergent sport: gymnastics, Tennis and swimming. Under his influence, I excelled in one of them. Gymnastics. I could jump the Roman horse, effectively handle the parallel bar, the Roman rings, and floor exercise. I even secured the 4th?place amongst juniors at state level.?However, I never excelled in any other game.?Decades later, I started playing golf. Again no champ, but a keen and committed golfer for sure.

You must have locked horns with umpteen challenges en route your tryst with surgery…

?There have been several moments of truth, some humorous, others scary. Fortunately none of them have had a disastrous result. One particular incident comes to mind ahead of others. This happened many decades ago when facilities in the operating room and hospitals were not what they are today.?

I was operating on a patient in a reputed hospital when the electricity went off. Those days we did not have the luxury of a generator. Torches were used to illuminate the area, but as you will realise, that was not the best deal on offer. In this instance, the batteries died after a while and we were at a crucial juncture of the operation in pitch darkness. Before I narrate further, I need to mention that the operating room in those days had inflammable gas in the environment. There was a well meaning OT attendant who, in his his zeal to help out, decided to light a matchstick! When he struck the match, we froze, expecting a blast of fire! Thanks be to God, nothing happened. The lights came on and we did the needful safely and successfully. Many of us from the 70s have had to manage with minimal infrastructure, squarely depending??on our brains and hands to deliver care. We did our best.

Could you elaborate on your pioneering work of developing a self-help group for ostomy patients?

?Stoma is an artificial opening on the abdomen (stomach) to allow persons with a problem with their anal or urinary outlets, to empty. It creates a variety of formidable challenges for them, both biological and psychological. Biologically, they have to manage the effluents, whether urine or stool, and psychologically, they need to take care of social and interpersonal issues.

In the 80s, no professional body or group of persons was available to help these patients. Some of us who were to keen to do out bit in this area set up Stoma care centres. One of the most prominent among them was Ostomates India, which trains, counsels, and provides support and appliances to people who have had a Ostomy procedure. This organisation is now well equipped, well run, and supports a large number of people.?I was involved in this initiative in the earlier part of my career. It has been a very humbling experience.?

You have always stressed upon the need for transforming and fast-tracking?Learning & Development (L&D) initiatives for the Healthcare industry…

?Although L&D always features in most mainstream discussions, it yet remains an inadequately addressed area, more so in the specific context of healthcare.??What we need is Fit for purpose L&D ensures a holistic strategy and system aimed at building a strong executive team, carefully aligning employees’ needs and aspirations with organizational goals and objectives. It can then yield measurable and sustainable value – whether in terms of cost-effective operations, maximising revenues, enhancing patient outcomes and quality of life, enabling cross-talk between different departments, promoting a culture of camaraderie and collaboration, repurposing employee recruitment and retention strategies, and boosting employee morale and motivation. Done right, L&D can become the defining value proposition of a healthcare provider, thereby contributing to its competitive edge.??

So, communication is key to both learning and development…

?Beyond a doubt! It is the lifeblood of care and cure. My training and practice has happened largely in India, where communication is not given the place of pride it deserves. During my overseas visits, I had the opportunity to examine and appreciate the exemplary value of end-to-end patient communication. I witnessed several interactions between doctors and patients which highlighted a stark difference that divides the West from the East.?

?In the West, significant time and effort is spent on discussing the root cause, solutions, and options. A very candid discussion ensues between the doctor and the patients on all aspects of the ailment and the treatment, including delicate issues like potential complications and the probability of mortality based on past cases and studies of disease progression. This honest interaction allows the patient to know exactly what he or she is likely to undergo and enables him or her to get into the right frame of mind, which is critical to the success of the treatment outcome.?

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High time our doctors become unconditionally open and comprehensive in their communication with patients. The lurking fear that one may lose the patient to competition if one is bluntly honest is simply not tenable. It is absolutely vital to ease the patient of the “fear of the unknown” in clear and precise terms. Adequate time needs to be devoted to explain the disease progression trajectory, treatment procedure, complications, and alternative options. Short-changing the time spent with the patient can turn counterproductive, and at times, even fatal.??It is absolutely essential to probe the patient’s heart and mind. It is important to understand his or her innermost feelings, inhibitions, fears, doubts, needs and inherent expectations, which may obviously differ from case to case depending on the individual’s nature of ailment, prognosis, age, sex, persona, psyche, familial situation, economic condition and the like. Communication can’t be reduced to a formula or a automated process. It needs to be tailored in line with the needs and sensibilities of each patient.????

From time to time, You have also expressed concern on the growing cases of doctor burnout…

Stress, strain, and exhaustion are integral to a doctor’s life. It is an indisputable fact that doctors experience overwhelming emotional strain throughout the tenure of training and practice. In recent years, we have witnessed an alarming rise in the number of physical attacks on doctors and medical establishments following patient deaths or complications. Given the varied complexities involved in treatments and procedures, the sword of litigation perpetually hangs on a doctor. This adds another source of constant anxiety in the course of duty. Given that legislations do not, and cannot, adequately address the multiple factors governing (both actual and alleged) medical negligence, it is imperative to avoid or at least minimize the possibility of lawsuits through preventive measures like scrupulous compliance to policies and procedures, and developing value-based and patient-centric care. This in turn necessitates that we prevent doctor burnout and create a conducive environment for the healthcare providers to do their best in treating patients and improving their quality of life.?

Then, there is this perennial problem of being deprived of a much needed work life balance, which ends up severely disrupting the doctors’ personal lives leading to a host of familial and work issues. Add to that the constant pressure to get ahead in the corporate race, made more lethal given the peer pressure of a highly competitive workplace.????What holds true for doctors in fact applies to all healthcare providers and caregivers including nurses, attendants, and other medical support teams. Needless to say, the laundry list of problems is endless, and we need to focus on solutions rather than look for problems.?

The need of the hour is to find credible and sustainable solutions aimed at reducing the rapidly intensifying doctor burnout which has a cascading negative effect on the quality of care and cure, as also patient outcomes. The industry can urge senior physicians to share their actionable insights and the wealth of diverse clinical and non-clinical experiences. Wisdom is timeless and the experiential learnings may be more relevant for today’s world than what we imagine.?

Relaxation and recreation are magic potions for a doctor. What these words imply, however, may mean different things to different people - Travel, Exercise, Music, Sport, Spirituality, Religion or something else. Each professional must dive deep within to find the oasis which soothes the mind and the body, and helps cope with the pressures of work and home without losing one’s cool or blowing one’s top.

We also need to probe deep into the possibility of addressing this thorny challenge???from a statutory point of view, maybe through mandating of restricted working hours, or compulsory time off.??Rescuing doctors and other care providers from the vortex of burnout calls for an all-out search for a lasting solution.??

Looking back, what feels most satisfying about your career?

?I have to say that every part of what I have done has been satisfying in its own way as along as the end goal was achieved. It is only when the planned end point is not delivered that frustration creeps in. However, even in the event of a setback, I have strived to see how I could reach the goal post : by changing strategy, taking a different course, or by seeking help.?Having said that, the crowning glory of satisfaction comes from the satisfaction of the people my intervention is aimed at. So, if I have made a patient, customer, friend, or colleague happy by my actions, I get immense comfort and happiness. I am a people person.?

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The profound words of Dr. Joseph Lister, surgeon, scientist, experimental pathologist, and a pioneer of antiseptic surgery and preventive medicine, while addressing a class of graduating students, beautifully sum up the ethos of the medical profession:?

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“It is our proud office to tend the fleshly tabernacle of the immortal spirit, and our path, if rightly followed, will be guided by unfettered truth and love unfeigned. In pursuit of this noble and holy calling, I wish you all God-speed.”

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Dr. NKJ is wedded to the same ethos en route the same path, and we wish him God-speed!