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Into India

any formal training in general surgery, so none of them were qualified to be trained in thoracic surgery. Aside from the simple rib-removal procedure, they knew nothing about surgery. The principles of surgical physiology and surgical anatomy were a mystery to them. This "minor" problem had never occurred to the Mission Board. For me, it was an unwelcome discovery.

During my first year at the sanatorium, I tried to recruit young Indian general surgeons who wanted to study thoracic surgery—but found no one qualified. When I operated myself, I had to call on my American colleagues in Miraj for assistance. Finally, I identified two promising trainees. Unfortunately, both were Hindus and thus non-Christian. But they had completed good surgical training programs in Poona and were eager to learn thoracic surgery, so the Mission Board allowed me to take them on.

Dr. Paul, however, was not convinced that he lacked the background to learn thoracic surgery After all, he was the medical superintendent. It galled him to be shut out of a major part of the sanatorium's activities. In retrospect, had I been more mature and perceptive, I would have recognized the seriousness of the loss of dignity he must have felt. Here I was, a much younger man from another country, taking over the surgical program and excluding him from a significant portion of it.

We fell into an uneasy working relationship. My path crossed his mostly at x-ray conferences, where we studied the chest films of our TB patients to identify which ones to consider for which surgical procedure. Over time, the simpler rib-removal operation was being used less and less, because of its shortcomings. As a result, Dr. Paul was doing fewer and fewer operations himself. His habitual scowl deepened with each succeeding week. He could hardly abide the two young, eager Hindu trainees, who were learning quickly.

Enter the vice president of India. As it happened, the 25th anniversary of the founding of the Wanless San fell during my stay there. The facility had been established as the final act of Dr. William Wanless, a Canadian physician who was knighted for spending his career starting up medical institutions in western India, including Wanless General Hospital in Miraj.

For the 25th, the sanatorium got all spruced up—after its own fashion. The walks were raked and the wards were cleaned. The ward buildings were not much more than simple open-sided sheds, however, so there wasn't much more that could be done, since they had no paintable surfaces. But the sign out

The medical staff at Wanless; author Tim Takaro is on the far left and Dr. Paul is second from the right.

The day after the vice president's visit, at our regular x-ray conference, Dr. Paul made a sudden pronouncement. There would be no further training of residents in thoracic surgery until all of his own staff physicians had been trained. A stunned silence fell over the conference.

by the road, proclaiming "Wanless TB Sanatorium," did get a fresh coat of red and white paint. This was the road that led to Miraj, the site of the region's large, busy general hospital and of a small medical school. Our sanatorium was merely a tiny satellite of that busy hub. So it was a surprise to have as prominent a personage as the vice president of India, Sarvapalli Radhakrishnan himself, come to our backwater village. I suspected the honor was due to the emphasis India was placing during those years on the control of tuberculosis.

Sarvapalli Radhakrishnan cut a graceful, dapper figure. It was impossible to tell how old he was. He looked ageless in his long, white Nehru jacket, with a red rose pinned on his chest in the manner affected by Jawaharlal Nehru himself. He was fluent in English and warmly regal in his manner. He clearly enjoyed his role. Somehow I found myself at his side as his guide. He seemed genuinely interested in the newer ways of managing tuberculosis and allowed me to babble on enthusiastically as we toured the sanatorium grounds. "I must tell Amrit Kaur—she's the health minister, you know—about this," he said. At the end of the visit we were photographed together. Dr. Paul, scowling blackly, lurked in the background of the image.

The day after the visit, at our regular x-ray conference, Dr. Paul made a sudden

pronouncement. There would be no further training of residents in thoracic surgery until all of his own staff physicians had been trained. A stunned silence fell over the conference. There was no further discussion. There was nothing to discuss. He knew no one on the staff was qualified for the training, since they all lacked the requisite background, so he had placed an insurmountable obstacle in my path. He had, in effect, given me an invitation to resign. He knew there was no way I could meet his demand.

"Well, we might as well start packing," I told Marilyn later. "There's nothing more I can do here. Dr. Paul just killed the training program."

My colleagues from Miraj, Archie and Jim, who had been helping get the program off the ground, brooded with me. They agreed with Dr. Paul on one point—that we should train Christian surgeons in preference to non-Christians. But since there were no qualified surgeons of the requisite religious persuasion, the point was moot and they recognized my dilemma. "Too bad," they said. "Nice try. Maybe we should move the program to Miraj."

Dr. Banerjee, the most promising of the two young trainees who now found themselves out of a job, came to offer condolences and to ask my advice. We talked about the Medical College in Vellore, near Madras—a first-class place, where thoracic surgery had gotten its start in India. I was touched when he gave me a volume of the poems of Rabindranath Tagore as a farewell gift.

Marilyn and I began, reluctantly, to make plans to resign from the Mission Board a year before the end of our three-year contract. That meant we'd have to pay our own way home, which would be a serious financial setback. But we didn't see any other alternative.

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