Dr. D.K. Chhabra “If I Meet this Doctor Once, I Shall be Cured…!”
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.293438
Source of Support: None, Conflict of Interest: None
Professor Devendra Kumar Chhabra has been one of the most illustrious names in Neurosurgery in North India. His immense compassion for his patients and the amount of hard work that he did for them; his quiet yet authoritative demeanor that generated veneration and made his orders impossible to disobey; his legendary hospitality that was hard to forget; his innate intelligence and innovative nature that has benefited countless patients; his self-effacing nature that endeared him to even those people meeting him for the first time; and, his immense commitment to neurosurgical training of his students, has been a constant source of inspiration.
Professor Chhabra completed his MBBS, MS (General Surgery) and MS (Neurosurgery) from King George Medical University (KGMU), Lucknow, Uttar Pradesh, India.
His contribution to the establishment of Neurosurgical teaching has been remarkable.
He has been instrumental in starting three major academic departments of Neurosurgery in his home town, Lucknow, the capital of the largest state of India, Uttar Pradesh. Along with his mentor, Prof. VS Dave, he established the Department of Neurosurgery at KGMU. After working there for more than a decade, he was one of the three faculty members who helped to establish the prestigious Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, a deemed university, located on a sprawling 550-acre campus, 15 km from the city of Lucknow, under a generous grant from Japan-India International Cooperation Agency (JICA) [Figure 1]. It is today ranked among the best five government medical postgraduate institutes of the country.
Prof. Chhabra joined the Department of Neurosurgery of SGPGIMS as Chairman in 1986. More than 100 residents have undergone training in Neurosurgery since then. His students now occupy prominent chaired, academic and consultant positions in many medical institutions of India and various parts of the world. After superannuation in 2003, he went on to establish an academic Department of Neurosurgery in a private charitable institution, Vivekanand Institute of Medical Sciences, Lucknow. Under his guidance, a DNB program was established in this hospital that continues till date.
Professor Chhabra always shied away from holding an executive post in any society. In spite of that, in order to promote neurosciences in the states of Uttar Pradesh and Uttarakhand, he became the Founder Member of the Uttar Pradesh Neuroscience Society, helping to organize its first meeting, and later on, serving as its President. He also served as the President of the Indian Society for Pediatric Neurosurgery. The respect that he commanded is exemplified by an interesting episode related to his appointment to this post. He was so reluctant to accept the honor that he was virtually nominated for the position by senior members of the society without any election being held that year. After the announcement of his being the President of this prestigious society of India had been made, everyone realized that he was not even a member of the society. He was, therefore, made a member of the society after he became its President! [Figure 2].
Several academic international conferences were organized during his tenure as Chairman and Professor of Neurosurgery, SGPGIMS, Lucknow. Prominent among them were the Annual Conference of Indian Society for Pediatric Neurosurgery, October 1996; the First National Workshop/Continuing Medical Education (CME) Program on Craniovertebral Junction Anomalies, October 1997; the First Indo-Japanese Microneurosurgical Workshop, April 1998; the Second Indo-Japanese Microneurosurgical Workshop, August 1999; the Second Annual Conference of Skull Base Society of India, October 2000; and, the 14th Annual Conference of the Indian Society for Pediatric Neurosurgery and the Continuing Medical Education Program of the International Society for Pediatric Neurosurgery, October 2003 [Figure 2] and [Figure 3] [Figure 4].
Professor Chhabra is best known for designing the economical “Chhabra” ventriculoperitoneal shunt that has benefitted countless patients suffering from hydrocephalus. This has been possible with the biomechanical innovations made by one of his students, Dr. GD Agarwal, who, being inspired by Professor Chhabra's mentorship role, set up a factory in the small city of Shahjahanpur, Uttar Pradesh, India, to devote himself full-time to the manufacturing of various low-cost medical devices. He also worked hard to bring the manufacturing of the shunt to international standards. The shunt is now used in more than 30 countries of the world and has been endorsed by the International Society for Pediatric Neurosurgery. The shunt system is affordable enough to be used by most patients in developing countries and yet is of adequate technical and sterilization standards to be used in the developed world.,, Professor Chhabra never accepted any royalty acquired from the sale of the shunt system and strived to keep it a low-cost system. He received the “World Medical Inventor of the year” award in Japan for the shunt system. He has also co-authored several important publications related to the subject in prominent journals and books. In Professor Chhabra's own words written in his article “The saga of the 'Chhabra' shunt” published in Neurology India (2019, volume 67, pages 635-68), “… What started as a small idea that was being initially executed in a small corner of a state medical college in 1978, has grown into an unimaginable project in 2019 and has benefited innumerable patients.”… “I consider myself extremely lucky and blessed. It is not often that one enjoys the fruits of one's labours in one's own lifetime.”
To the world, Professor Chhabra is known for his scientific innovation of the ventriculo-peritoneal shunt system that has benefitted countless patients, especially children, with hydrocephalus. In this own state, however, he was revered for his keen clinical sense, his compassion towards his patients and his constant resolve and willingness to devote himself completely to their well-being. To the best of the knowledge of all his close associates, he did not miss out a single outpatient clinic, unless, and that too extremely rarely, he had a pressing engagement in another city that could not be postponed. He would himself walk into the Radiology or Pathology departments with some of his patients, after a taxing outpatient clinic schedule (of nearly 100 patients a day), to enquire about or to expedite their investigations.
In his earlier years as a faculty in KGMU, countless colleagues would recall that he would spend his entire days and nights in the hospital tending to his patients and sleeping in the hospital beds. In the era of diagnostic angiograms to detect brain tumours and other pathologies, he had learnt to maintain and repair the machine himself and would tend it with loving care. He would never turn away a patient who sought his help, even if the latter approached him at odd hours at his home. Another quality that endeared him to all his patients was his absolute disinclination to give preferential treatment to patients arriving with political recommendations. These personal attributes, especially his special ability to treat every patient, rich and poor, with uniform dedication, had made him the most sought-after neuroscience specialist of the state until even a week before he passed away. As a tribute to his complete dedication towards his patients, a statement that was often heard from them was, “If I meet this doctor once, I shall be cured…!”. This statement was not expressed solely by patients with neurological ailments; it was also an 'unspoken hope' of many more patients with disorders related to systems other than the central nervous system.
Absolute belief in team-work and a calming influence
A thorough gentleman, his humility and helping nature won him several close friends. His self-effacing nature and special ability to always project his junior colleagues ahead of him enabled him to establish a successful team wherever he worked and in bringing out the best in his colleagues. In King George Medical College, under the leadership of Professor VS Dave, the training of a formidable group of neurosurgeons, who later on served as leaders in their field and guided the destinies of several prominent future neurosurgeons on India, was carried out. Some of the prominent ones in this list included Prof AK Singh from GB Pant Hospital Delhi, Prof Mazhar Husain from KGMU Lucknow, Prof IN Vajpayee from Medical College Kanpur, Prof Sanjeev Dua from Max Hospital Delhi, Prof VS Madan from Gangaram Hospital Delhi and Prof SC Tandon from Varanasi [Figure 5], [Figure 6], [Figure 7].
In SGPGI, he created a very vibrant Department of Neurosurgery. During the initial phases of the department, this team included Prof. VK Jain, Prof. Piyush Mittal, Prof. Deepu Banerji, Prof. Isha Tyagi, Prof. Kumudini Sharma as consultants. Dr. Apjit Kaur and Dr. Sunil Gupta were the initial pool officers and were later on joined by Dr. Raj Kumar and Dr. Sanjay Behari [Figure 7] and [Figure 8].
All of them, later on, became leaders in their respective areas under his tutelage because of the wonderful working environment that he created that has served as the beacon for succeeding generations to emulate. Among the various departmental teaching and operative protocols that he helped to established, three protocols stand out. The emphasis on proper recording of patient's data right from the time of inception of the department in 1989 has meant that the record of every patient ever admitted and operated in the Department of Neurosurgery, SGPGIMS is available till date. The pilot project on distribution of every medicine from the hospital to the patients at a subsidized cost that was started by the Department of Neurosurgery has now been adopted for the entire SGPGIMS and is being followed by several hospitals of the state and country. The innovative academic and research protocols that were established under his leadership are still being followed by every department that he helped to create.
In the third phase of his professional life, in Vivekanand Institute of Medical Sciences, Lucknow, he formed a cohesive team with two of his students, Dr. Tarun Pandey and Dr. Himanshu Krishna [Figure 8]a and b].
The department not only became popular for its teaching, neurosurgical exposure and training of DNB students but also became a low-cost, private charitable center for patients of Uttar Pradesh. Needless to state, the exacting decorum, cleanliness, adherence to protocols and discipline are the all-pervading tenets of care at this center also.
His quiet yet formidable personality and his focus on quality and on the establishment of protocols were often met with resistance by those in authority. His clarity of thought, single-minded dedication and strong team-work always dissipated any such reluctance to accept his thoughts and was responsible for establishing citadels of learning where discipline has prevailed and the wards and intensive care units are kept spotlessly clean, no patients' relatives are allowed except during visiting hours, and the academic sessions and rounds are held by the entire team together and exactly on time. One cannot help but recount the countless times he had spent in the operation room repairing instruments while sitting on the floor; just being around during the tense phase of surgery while someone else was operating, to maintain the proceedings in a calm and organized manner; or, permitting his junior colleagues and residents to perform the complete surgery without once admonishing the person, and then taking full responsibility for any problems that arose in the postoperative period. Every resident who was trained in Neurosurgery in SGPGIMS in the initial years also recalls the evening parties at Professor Chhabra's home or in the remote roadside-restaurant situated on Rae Bareli road, which all consultants and residents used to attend after a hard day's work [Figure 9].
The all-pervading atmosphere of congeniality, creativity and self-expression in the departments that he created has been responsible for the niche the speciality of Neurosurgery has attained in this part of the country.
As a mark of his contribution to the development of Neurosurgery, an operation room in SGPGIMS has been named the “Professor DK Chhabra operation theatre” [Figure 10].
An annual “Dr. DK Chhabra oration” is also held in the institution, where an international orator is invited [Figure 11].
Respect for his teacher
One amazing aspect of Prof. Chhabra's personality was the immense regard and deep affection he had for his mentor and teacher, Prof. VS Dave [Figure 12]. Prof. Chhabra writes in an article published in Neurology India dedicated to Professor Dave (Neurol India 2018: 66: 1244-53), “I had a very deep and intimate professional understanding with Professor Dave. Professor Dave would say, 'Doctor Chhabra, us patient ka woh karva dijiyega' ('Please get this done for that patient') without specifying any further either the work to be done or the patient on whom the instructions needed to be carried out. I would immediately know what exactly Professor Dave wanted to be carried out for a specific patient. We shared an extreme degree of mutual trust for each other. On every Teacher's Day and on Professor Dave's birthday, till today, I have always had the privilege and honour of greeting him.” A few days prior to Prof Chhabra's demise, Prof. Dave (who is now a nonagenarian settled with his son in Delhi) and Prof. Chhabra (from Lucknow) had a teleconference meeting. Although they could not converse much due to their frail physical condition, their eyes and smile conveyed the mutual affection and respect they had for each other!
Prof. Chhabra has been instrumental in forging deep friendships with several international neurosurgeons. His hospitality has been legendary. The Department of Neurosurgery, SGPGIMS, has had close contact with the Japanese neurosurgeons that persists till date. Six generations of Japanese neurosurgeons have visited SGPGIMS and several of them have become Chairpersons of prominent neurosurgical departments in Japan. Some of the prominent ones among them have been Prof. Yoshio Suzuki, Prof. Jun Yoshida, Prof. T Wakabayashi, Prof. M Takayasu and Prof. K Saito [Figure 8]. He has also been invited as Visiting Professor to Nagoya University, Japan, having forged a close friendship with Prof. Kenichiro Sugita [Figure 13] a and [Figure 13]b.
Several neurosurgeons in UK, Europe and USA were his close friends [Figure 14] and [Figure 15]. A testimony of his international stature has been the number of international condolence messages that have poured in from all corners of the world at his demise.
Three incidences from his life
Three incidences that occurred in different periods of his life highlight different aspects of his personality. During his neurosurgical training, despite working very hard and managing the entire services to the complete satisfaction of his mentor and Chief, Prof. Dave, he was not successful during his first attempt in the MS (Neurosurgery) practical examination, where Prof. RG Ginde from Bombay was the external examiner. Rather than feeling even a tinge of bitterness, he enthusiastically requested Prof. Ginde to take him under his guidance in Bombay for 6 months. He roughed it out in a shared single-room accommodation with four other students, reading Prof. Ginde's collection of books and observing him operate. He recalled that the stint had been one of the most productive and learning experiences for him. This ability to derive gains from adversity with grace stood him in good stead throughout his life.
When he was Head of the Department of Neurosurgery at SGPGIMS, Lucknow, he continued to conduct neurosurgical services in the small peripheral building known as the 'General Hospital' within the campus. He was adamant not to shift to the main building and the operation theatre complex of SGPGIMS unless the complex was made exactly according to his specifications and needs. Even pressure from the highest functionaries in the state, including the Governor and Chief Secretary, did not deter him and his team. He had the astonishing experience of having the entire furniture and equipment of his functioning department being placed on the street outside the 'General Hospital'. This was done in an attempt to deter him from his resolve and to force him to compromise his standards. He bore this setback with complete equanimity, fearlessness and without any heed for personal security or gains. Finally, the administrative authorities were forced to relent and agree to his demands and he was successful in establishing a department that confirmed to his own standards.
During the last one-and-a-half years of his life, where he underwent surgery and further treatment for primary central nervous system lymphoma in the department that he had established, not once was there an expression of discomfort or complaint from his side. He had placed himself unquestioningly in the hands of the students whom he had trained and had full faith in their ability to do the best for him. Following surgery, in the intervals between the cycles of radiotherapy and immunotherapy that lasted for nearly eight months, he would attend to his hospital duties and continue his outpatient care services for his patients. He also enthusiastically attended the oration being held annually in SGPGIMS, delivering the inaugural address. This ability to always disregard his personal discomfort in order to care for others set him apart from ordinary men.
Very few of Prof Chhabra's personal achievements in life would have been possible without the loving, whole-hearted and unflinching support of his family. His wife, Prof. Apjit Chhabra is currently the Head of the Department of Ophthalmology at KGMU, Lucknow. Prof. Chhabra and Prof Apjit have had the great satisfaction of seeing their son, Sarab, become a doctor, after having passed his MBBS with flying colors and completing his internship this year [Figure 16].
Professor Chhabra's inspiring legacy will continue to last forever in the ethos of the prestigious institutions that he helped to create, as well as in the minds of countless patients and students who have been touched by his selfless zeal and dedication.
“Attitude is a choice. Happiness is a choice. Optimism is a choice. Giving is a choice. Respect is a choice. Whatever choice you make, makes you. Choose wisely.”
Roy T Bennett. The Light in the Heart
Prof. Chhabra made his choices wisely!
I acknowledge with deep gratitude the help rendered by Prof. Apjit Chhabra, Prof. BK Ojha, Mr. Rajiv Suri, Dr. Bernard Lyngdoh, Dr. KK Bansal and Dr. Soumen Kanjilal in collating the photographs for the article.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16]