Prem K.G. Chandran, MD, FRCP(E), FRCP
University of Iowa, Des Moines, United States
|Govinda Krishna Warrier|
On the morning of an auspicious wedding day in a very conservative and ritualistic Warrier community in Southern Kerala, India, a seven-year old boy with curious eyes and bushy hair, youngest sibling of the groom, insistently knocked on the door of the bride’s dressing room, saying, “I want to come in.” Reluctantly the women of the house let him in. Affectionately he uttered to his to-be sister-in law, “I do not want to wait until the ceremonies are over to meet you; I will call you my sister from now on.”1 Later in life, he gave her all his gold and silver medals won for scholastic achievements, instructing her to make jewelry out of them. Instead, she preserved them for posterity. This boy became one of the most famous physicians and medical educators the small state of Kerala had ever seen. He was Govinda Krishna Warrier, or simply “GKW.” Born in 1928, he died in 1982 aged 54.
His mother died when he was a child. Later, as a professor of medicine, he would remark to his students, “The only person really interested in your wellbeing is your mother.”1
GKW completed his basic medical training at the Christian Medical College, Vellore, South India, on a scholarship and went on to become a member of the Royal College of Physicians of London. While being trained as a neurologist in University College Hospital, London, his contemporaries remembered him for his incisive mind and his exceptional skill in completing the crossword puzzles published daily in Manchester Guardian.
GKW’s interests spread over a myriad of areas: literature (contextually he could recite impromptu from Shakespeare’s works), Karnatic and Western classical music, Kathakali (a colorful and operatic form of dramatic art), and chess. As a medical student, he is said to have spent more time in the library than in didactic classes. All his life, his dearest companions were books. Well into his professional career as a busy physician, he would study the latest medical journals and textbooks in the back seat of his chauffer-driven car. GKW had a remarkable ability to orderly store information and retrieve it in a moment, bypassing methodical but less than necessary steps. A house burglary that depleted his library of books evoked the response, “Whoever stole them could not have afforded them; therefore I won’t press charges since I have read them all!” After reading CP Snow’s famous book Two Cultures, which dwelt on the chasm between the schools of science and liberal arts, he believed that both the fanatic faith of the religious right and the frequently fallacious logic of the scientifically erudite were on shaky grounds.
As a physician working for the state government, GKW would treat both a minister and a janitor in the same way. He was choosy in laboratory investigations and avoided shotgun therapeutics. Many patients remember him for his accurate diagnoses and therapy, as well as reassurances of no illness. He would decline to prescribe nutritional “tonics” to healthy individuals for fear of fostering the impression of failing health. A police officer once consulted him for insomnia. On learning that the cause was nightly raids in the city against prostitution, GKW asked him whether he seriously thought he could impact the trade by his raids and whether the resources should be directed elsewhere.
As an educator, GKW was a phenomenon. He advocated an investigation only if 1) it could provide additional and consequential information, 2) it did not pose additional risk to the patient, or 3) the outcome could change the course of therapy. He insisted on giving a preferential ear to the patients’ words while history-taking, patient-described sequence of events, often asking students to repeat the history in his presence. Forming the diagnosis after listening to the patient’s history, he would caution students regarding the error of Procrustes, i.e., altering facts to conveniently suit their diagnosis. Giving precedence to relationship among facts over facts themselves, he intentionally promoted clarity of definition of disease states and precise expression of biologic phenomena. A master of bedside rounds, he could spot fleeting disease entities and trends using simple and ‘inexpensive’ clinical skills. For instance, he would ask his post-graduate students to discuss the difference between a patient who seized and then became unconscious and a patient who became unconscious first and then seized. Or how to differentiate between seizures and pseudo-seizures. Or how to view urinary bladder dysfunction as either a spastic state with low intravesical volume caused by an upper motor neuron-type lesion, or a flaccid state with urinary retention induced by a lower motor neuron lesion.
Chronic headaches, loneliness from being an intellectual, idiosyncracies, and perhaps the winter of discontent, led GKW to chain-smoking and meperidine addiction. For the latter he took intensive therapy and was cured. The agony of addiction and therapy, later the ecstasy of liberation, were both punctuated by a brain-stem arteriovenous malformation eventually claiming his life – like the inevitability of a Greek tragedy.
Mercurial in character, he stood fearlessly by whatever was true and remained an intellectual until the end of his life.
Professor G.K. Warrier Memorial Society for the Advancement of Medical Education. pp. 7-163, Calicut, Kerala, 1991.
PREM K.G. CHANDRAN, MD, FRCP(E), FRCP, is a medical graduate of University of Kerala, South India. He studied internal medicine and nephrology at Christian Medical College Hospital, Vellore, South India and later continued his studies in United Kingdom, Canada, and finally at the University of Cincinnati Medical Center in Ohio. He currently practices clinical nephrology in Des Moines, Iowa and is also an Adjunct Clinical Associate Professor in the Department of Internal Medicine at the University of Iowa, Iowa City.