Remembering an Icon Professor P. Venugopal (1942-2024)

Prof. P Venugopal Baby Venugopal was born in 1942 in the village Panangipalli, district Rajahmundry of the state of Andhra Pradesh of India in a middle-class family. He was one of 10 siblings. From early childhood, he showed shades of precocious scholastic brilliance. Since one of the brothers became an engineer, medicine was chosen as the profession for him, by his father. Qualifying for the All India Institute of Medical Sciences MBBS entrance test, he travelled to Delhi and joined the 4th batch of the MBBS course. Young Venugopal’s academic excellence saw him secure the AIIMS gold medal in 1963, which he was awarded in the convocation ceremony in the AIIMS auditorium by the then PM of India, Sri Jawaharlal Nehru. Intrigued by diseases afflicting the heart by an early exposure to a child of neighbours in native Rajahmundry who suffered from mitral stenosis, he did his MS general surgery from Postgraduate Institute, Chandigarh, and then, his MCh in cardiothoracic surgery from the AIIMS in 1970. Prof Gopinath from Vellore was the head of the department of CTVS at AIIMS when he completed and he was selected as lecturer in the department. The strict discipline and work schedule of Dr Gopinath rubbed off on the young doctor. Dr Gopinath secured a fellowship for his new faculty member with Dr Subramanian, a pioneer in the field of open heart surgery under deep hypothermia with total circulatory arrest, and who had described several new pediatric cardiac surgical procedures, heading the unit in Buffalo, USA. Under the leadership of Subra, the young Venugopal plunged into the subject immediately, picking up the latest techniques in pediatric cardiac surgery, the latest equipment in use and noted down all details, mailing them to Dr Gopinath, who would preserve all the mails as ‘best practices in cardiac surgery’. The next fellowship was at Texas Heart Institute with the famous Dr Denton Cooley, followed by a second stint at Buffalo. Dr Venugopal returned to AIIMS in 1974 with 5 suitcases of surgical disposables, and a mind bursting with ideas, both of which would be used till many years later at AIIMS. Cardiac surgery in North India was still primitive then, while in South and Central India, centres, such as CMC Vellore and KEM, Bombay, were miles ahead and routinely performing open heart surgery. The Department of CTVS at AIIMS had by then settled into the comfort zone of thoracic and vascular procedures. Under Dr Venugopal’s persuasion, Dr Gopinath agreed to launch AIIMS into the arena of cardiac surgery. At the same time, Prof IM Rao returned from training with Sir Brian Barratt-Boyes in New Zealand and together, they embarked on this new project. The beginnings of the programme were in the 7th floor department of the old AIIMS building with a four-bedded intensive care unit (ICU), a single operating room and an annual budget of Rs. 12,000/year! Meanwhile, a proposal of 1971 to set up a stand-alone cardio-neuro centre within AIIMS was taking shape. Dr Sampath, Dr ML Sharma, Dr Balram Airan and later, many younger faculty joined in and participated in the building of AIIMS cardiothoracic surgery as we know it today. When Dr Venugopal took over as head of the Department of CTVS AIIMS in 1982, the new CN centre building was complete but just a shell. There were no more funds to proceed further. Dr Venugopal single-handedly took up the gauntlet of arranging funds from the government of the day – He first got Rs. 150 Cr sanctioned in 1985, but when the then AIIMS director decided the amount should be distributed between all AIIMS specialities, he then got another Rs. 450 Cr cleared for use in the cardiac centre alone. With this latter amount cleared, a 4½ operating rooms, 16-bedded ICU and 18-bedded recovery, and the whole cardiac centre with a bed strength of 300 with incorporation of the latest US equipment in use in the best US hospitals came up. An independent blood bank, a separate manifold room and augmented staffing at all levels were added. He got ad hoc staff regularisation to permanent posts in the CN centre approved, so that it was now the perview of the CN centre alone, without external interference. The strength of thoracic surgical residents increased from 2 to 16. By 1990’s 8–10 operations were being done daily, the waiting list had been rendered non-existent. The drain of resources by patients going to the US for expensive treatments, often at cost to the public exchequer, was finally stemmed. Today the cardiac center of AIIMS has 9 operating rooms and conducts in excess of 3000 operations/year. Simultaneously, working on the request of Sri Satya Sai Baba, Dr Venugopal oversaw the construction of a brand new cardiac hospital in Puttaparthy, the native place of Sri SaiBaba, in Andhra Pradesh. The project began in May 1991 from scratch and was completed in 6 months. In the year 2000, he was instrumental in installing another Satya Sai superspeciality hospital in Whitefield Bangalore. Both hospitals were completely free of cost for all patients and continue to do great service to suffering humanity to this day. Soon after passage of the Transplantation of Human Organs Act by the Indian Parliament in 1994, the first successful heart transplant was carried out by Dr Venugopal on August 3, 1994. In 1998, Dr Venugopal was bestowed the Padma Bhushan for his contributions in the field of Medicine and Surgery. In 2003, Dr Venugopal took over as the 9th director of AIIMS, his alma mater. Six AIIMS Regional Hospitals were launched all over the country, to be constructed in the shape of the original AIIMS, New Delhi. While the New Delhi AIIMS itself underwent rapid upgradation. Advancements with him at the helm came at a rapid pace, characteristic of Dr Venugopal. Within the first 2 years, a rapid upgradation of AIIMS began with the blessings of then health minister Sushma Swaraj sanctioning Rs. 600 Cr for the project. The notoriously congested AIIMS outpatient department (OPD) was redesigned and the new Raj Kumari Amrit Kaur OPD came up, a new private ward was constructed, the open drain next to Gautam Nagar was covered up, creating precious extra space. A new multistorey dental centre was established. The plan was to set up 13 stand-alone superspeciality centres along the line of the CN centre. The amazing fact was that all the above were inaugurated by the then PM in one go. A new trauma centre was set up. Here too, as in the CN centre earlier, he got the provision enforced, wherein faculty who had been occupying ad hoc positions could now be regularised depending on their merit, thus stemming the loss of trained precious faculty to the private sector, a problem that had assumed serious proportions. An amazing factoid regarding the pace of development at AIIMS: Capacity enhancement year 2003–2008 – 2400 beds; Capacity enhancement year 1967–2003 – 2200 beds. However, the situation was too good to last. With the new government came a new health minister. Differences cropped up for uncertain reasons between the 2 and the new minister took it upon himself to attack the AIIMS director and challenge the very autonomy of the post of AIIMS director and AIIMS. Dr Venugopal had little option but to give up office and take legal recourse. His stand was finally vindicated when he was reinstated to his office, to finally retire as director of AIIMS in 2008, his due retirement date. The state of India and the right Ho’nble health minister suffered a resounding defeat as declared in the judgement by the Supreme Court. The tragedy of this wasted time was that AIIMS was robbed of the potential advantages that a visionary like Dr Venugopal had planned for his alma mater for the remainder of his period of directorship. Evidence of this is still in view in the AIIMS. Today, the AIIMS campus faculty quarters have been emptied of all its faculty where a massive clinical facility expansion was planned. However, the project is held up for lack of funds with ghost uninhabited faculty residences mute spectators to the complete lack of planning, foresight and ability. To ask the question if this situation was even thinkable in His era is completely superfluous. Post-retirement, Dr Venugopal was invited by many private centres. Some of these positions he accepted in advisory capacity. Patients and surgeons consulted him for useful advice. Failing health prevented a more active career. A splendid inspiring autobiography by himself and Mrs Priya Venugopal came up in these years and provides snapshots into his inspiring career. Seven years after retirement, in 2015, the AIIMS bestowed on her student the Lifetime Achievement Award handed to him by PM Narendra Modi, at the same auditorium where he had been awarded the MBBS gold medal by Nehru. Life had come full circle. Dr Venugopal sadly left us on October 2024, at the age of 82. THE LEGACY So how was Dr Venugopal the clinician, the teacher and the mentor? In his entire surgical career, Dr Venugopal would have performed cardiac surgery for over 50,000 patients, all potentially lifesaving. Innumerable cardiac surgeons received direct or indirect training by him or his trainees and have spread out throughout the country and the world and owe their success to him. I myself had the pride of being one of his trainees. Training in AIIMS CTVS under Dr Venugopal was training by fire. There was no leave to be asked for, work was extremely demanding and weddings and family expansions had to wait and be timed on either side of the residency period. All the private hospitals of the day were totally government-like in front of the functioning of AIIMS CTVS under him. Dr Venugopal would often appear in the ICU at 3 in the morning for rounds and look up his patients and make a note of devoted residents being in the ICU, despite not being on call. His shoes at the front door of ICU were the Oppenheimer-like nuclear deterrent that brought pin drop silence till the farthest corner of the department. No strike by the resident doctor association ever effected the functioning of this department because of the simple philosophy that the patient should not be harmed at any cost. CTVS residents would be at their positions before daybreak while the strikers slept in their hostel rooms. This tough exterior was totally inscrutable in the work environment, but outside hospital, at home, he was a completely different personality. This one would stuff dosas into your plate, entertain you with his own hands, if you ever happened to visit or were ever invited to his spartan, no-frills home. The training one got at Dr Venugopal’s CTVS would leave one a resident for life once a resident, always a resident. For he himself always remained one. His faith in his own staff and his trainees is evident by the fact that he selected Dr Akshay Bishoi, his own student, to perform his coronary bypass surgery, instead of going abroad or to a senior surgeon of his own or another hospital. The DNA of department of CTVS AIIMS till this day is the Venugopal DNA. Saiansha, you are not the only one with his DNA! Dr Venugopal’s DNA has entered, plasmid-like, into the genome of all of us, his trainees, who were exposed to him, much to the benefit of so many of our patients and, doubtless, the consternation of our better halves and our families! To Quote ‘Heartfelt’: ‘Few of us realise the journey that has gotten the AIIMS and specifically, AIIMS CTVS, so far-a sobering thought, when we take so much for granted now’. ‘Long after all of us are gone, the CN Center AIIMS will continue to stand as a lighthouse for the best cardiac care for the poor and the needy of the country’. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.