by Dr M C Gupta
An autobiographical account of managing between two careers--Medicine and Law.
|BETWEEN TWO STOOLS
Have you ever tried to stand between two stools? Hope you haven’t. Because, if you did, the trial would have been a failure. Between two stools, one can neither stand nor sit. One has got to come crashing down on the floor.
Fortunately, I did not crash. I had two stools, but I did not try to stand between them. I made a choice between the two and stood on the one chosen. With a bit of luck and effort, I was able to stand tall and erect, without hurting myself.
This is getting too much like a riddle. Hence, I must explain.
I recollect that since I was a mere boy of about eight years, the third among a total of four brothers, my mother used to say that she wanted one of her sons to be a lawyer, one to be a doctor and a third one to be an engineer while the fourth one was probably to be allowed the liberty to follow the vocation of my father, who was a teacher. The first two brothers having failed to honour the maternal wishes, it fell upon me to be a dutiful son. I decided to become a doctor.
Now, it is a fact that such a decision was, in retrospect, a lifelong bondage to a hard life at each of the three stages involved. The first stage consisted of studying damn hard in the school and degree college to make it in the tough competition for selection to the medical course. The second stage was the arduous medical course itself, starting from the long anatomy classes in the first year, involving dissection on dead humans, to the long night duties in the hospital wards in the final years. The third stage started with the grant of the medical degree and the registration with the medical council and involved various obstacles like getting admission to a specialty course, working successfully as a resident to get the certification, finding a job and, yes, coping with the job. A doctor’s job is no bed of roses. Very often it is a thankless job. True, there are thanks galore when the patient gets cured and walks back home. However, if the disease is serious and the patient does not recover, the relatives often blame the doctor, alleging incompetence and carelessness. Gone are the days when a doctor was viewed as a demi-god. Nowadays, if the result of treatment fails to satisfy the patient or the relatives, the doctor is more likely to be viewed as a demi-devil. Of late, Even the incidents of physical assault on doctors for their perceived failure to treat have occurred and are increasing.
So, to get back to the story, I decided to become a doctor and, with that decision, to consign myself to a life of work, work and more work. I passed all the three stages, suffering the rigours at each stage, especially the third one. I had chosen to specialise in internal medicine and moved on to clinical nutrition and public health, ending with being a training specialist. Through the thirty seven long professional years, I served in several capacities in army and in the civil, the latter in both private and government service. The last was the longest, seeing me retire as a professor in an internationally reputed institution in India.
The one thing that I found disconcerting about the medical profession was that doctors are often neck deep in work; sacrifice personal comforts for the sake of others; get a salary that is much less than they deserve; have few perks; are overly conscious of their sense of duty; but, are yet reviled by others. Even though they are poorly paid and work long hours, often with primitive facilities, the public has unrealistically high expectations from them and the government, rather than provide facilities necessary for proper professional work, sides with the public perception for political reasons.
It was in this background that I decided to look for another stool. After retirement, which I sought prematurely, I decided to practice not medicine but law. I studied law and earned my bachelor’s and master’s degrees. Ultimately, I enrolled as a lawyer with the Bar Council of India and started legal practice as an advocate.
To walk the ropes after getting the license to practice law was not easy. There were no ropes. One has to weave one’s own ropes. The situation is different on the medical side. The day one qualifies as a doctor, the same hospital where he studied as a medical student is, almost as a routine, willing to employ him as a resident. It is an imperceptibly smooth transition. The yesterday’s medical student or intern is the resident the next day, in exactly the same environment, though with a salary and responsibility. There is nothing of the sort in law, at least in India. There are no immediate openings for a fresh lawyer. While there are many hospitals where doctors with a fresh medical degree are welcome to join as junior residents, nothing comparable obtains in the legal profession. There are not many legal firms where jobs for a fresher might be available. When they offer the jobs, the salary offered is very low. The other option is to join an established advocate as a junior. While such experience is necessary and invaluable, it is gained while getting a pittance by way of salary. The time spent with many senior advocates is often an exercise in exploitation.
I was spared the stress of groping my way in the dark alleys of law because, having retired as a medical professor, I had no spectre of unemployment and hunger staring me in the face. I took my own time choosing and creating options for myself. Ultimately I settled for a law firm of my own, in which I was a partner along with three other advocates. The senior-most partner had been an advocate in the Supreme Court for 18 years. I thus started my law practice mainly with the Supreme Court of India and the Delhi High Court, with some cases coming from lower courts as well. The firm lasted a year. It was broken up because of conflicting interests actuated by greed and unfairness on the part of the senior partner. Giving details here is not appropriate, but this one year experience convinced me that association with lawyers in business transactions is best avoided. As a lawyer, I have no hesitation in saying that lawyers are tough, even rough, people to deal with. Their crooked mind always thinks of possible loop holes and the ways to cover the same. A lawyer cannot indulge in straight dealings. It is not his fault. By virtue of his training and professional needs, he learns to build up a case for his client by finding holes in the opponent’s case and identifying weak spots where to shoot arrows. A butcher who kills hundreds every day cannot be expected to be a paragon of kindness and courtesy in his personal or family life!
After breaking up with the law firm, I decided to venture on my own. Even otherwise, I had realized that my own special back-ground was not suitable for practice at Supreme Court or High Court. As a doctor converted to law, the cases I was most competent to deal with were those of alleged medical malpractice or negligence. Such cases are dealt with by the consumer courts which are, in fact, tribunals having their own distinct hierarchy outside the regular system of Supreme Court, High Courts and lower courts. My plans to work in the medico-legal field got a unique boost when a firm providing legal cover to doctors spotted me on their own and requested me to provide my services. That was the beginning, six years ago, of a legal career that saw a gradually more and more satisfying and fulfilling growth.
People often ask me how I compare and like the two professions that I have been engaged in. Earlier, I used to hesitate a bit while answering this question. After having completed eight years in my new shoes, which have now become old enough and quite comfortable, I have no such hesitation. I can assert with full confidence that as far as I am concerned, I am quite happy with my new vocation and, given a chance in another life, I would prefer to be a lawyer rather than a doctor. However, that is not to say that I would opt to be a lawyer if God asks me in the next life what I would like to choose as my vocation. I would opt for neither of the two, medicine or law. But, about that, some other time.
There are many reasons why I would prefer to be a lawyer rather than a doctor. The most important is that law is of immediate use and concern to everybody. There is a basic dictum that everybody is expected to know law and ignorance of law is no excuse. As a matter of fact, law is distinct from all other disciplines of knowledge. No person is expected to know medicine or mathematics or music etc. Ignorance in these fields can be a valid excuse in relevant situations. This single factor is, in a way, reason enough in favour of law. However, there are other more mundane reasons. Law makes one aware of one’s legal rights and duties, the knowledge of which is the backbone of citizenship in a democracy ruled by law. Law is what empowers. Doctors are highly knowledgeable in their own profession. They are eminent brain specialists and heart surgeons. But, as a class, doctors are ignorant of law, their own legal rights and the legal remedies available for their grievances. It deeply pains me to see resident doctors in different states of India frequently going on strike for their just demands, constantly ignored by the government, only to withdraw the strike when threatened by the government of punitive action. It is a pity to see them meekly retract their protests without having the wisdom and courage to take the legal route for getting their just grievances redressed.
Before I end, I must recount some of my views as regards medical malpractice. I am happy to practice as a lawyer in the specialty of medical negligence because I am able to render a unique service to both the doctors and the patients. I am able to defend doctors against an allegation of medical negligence like nobody else can. Ordinary advocates, lacking in knowledge of medicine, are often unable to marshal facts fully, appropriately and strongly in the defence of doctors. Even when such facts are given to them by their client, the doctor, they are unable to appreciate these and, what is of crucial importance, to make the court appreciate these properly during the course of arguments. On the other hand, I am able to make a cast iron case against a doctor when I am engaged by a patient who has suffered negligence. It is important to keep in mind that it is often not possible for patients to find evidence against doctors because neither they nor their lawyers know medicine, while other doctors are unwilling to testify against their own colleagues.
Finally, I would like to end by telling about an instance of medical negligence that is so gross that it is inexcusable. The astonishing part is that though hundreds of doctors to whom I have recounted this have agreed that it is just unimaginable how a doctor could ever do it, the doctor concerned, an MD in anaesthesia, insisted that he had done no wrong. A seventy year old man was undergoing an arthroscopic examination of his knee by an orthopedic surgeon. The procedure was being conducted under anaesthesia. The anaesthetist noted that the heart beat had developed some irregularity and thought that this was due to a condition called pulmonary hypertension. As a remedial measure, he injected into his veins five grammes of a drug called furosemide or Lasix, giving one gramme every two minutes over a span of ten minutes. The patient’s condition worsened, he was taken to a heart hospital nearby and there he expired within 45 minutes of giving the injection. The lamentable part was that he was given 5000 mg. of the drug while the proper dose should have been 20 to 40 mg. The patient was destined to die with a dose 125 times the permissible dose. Yet, when I talked to the anaesthetist later, he refused to accept his mistake and insisted that he had done no wrong and had, in fact, given even higher doses to patients. When I asked him when and where, his proud answer was that he had given such dose to soldiers in Leh (height about 17000 ft.) for treatment of high altitude pulmonary edema. It was no use telling him that I had also served in the army as a doctor and that this patient was not a 20 year old soldier and Delhi had an altitude of 672 ft. He was determined to give the same treatment to his next patient!
The above example, from a different angle, illustrates the peculiarities of practicing as a medico-legal advocate. In this case, I was appearing for the doctor and my job was to defend him. My conversation with him was unofficial, on the phone. Officially, it was the job of the complaining party to prove negligence. Had the complainant alleged negligence due to wrong dosage of the drug, I would have probably been unable to defend the doctor. But the medical aspects like dosage and ill effects of wrong dosage were not known to the complainant and my job was to help my client, who happened to be the doctor.
In the end, I would say that at 68, I am fully satisfied with my current profession as a lawyer and medico-legal consultant. Let not the above example convey an impression that I am anti-patient or pro-doctors. I have won cases for patients, against doctors, that no other lawyer could possibly have won. As a lawyer, I am duty bound, under the Advocates Act, to defend my client, whether a doctor or a patient. And, therein lies the challenge and the beauty of my job. I have been steered by god’s will in whatever paths I have taken in life and I am grateful to Him.
M C Gupta
24 September 2009