Dr TL Perumallu —An Eventful Journey from Angaluru to America

We all know that our life is limited, and have to end up ultimately underneath a white sheet, never to get up again. And yet, it is always a pain when it happens to someone we love. It’s not even easy to get used to the fact of someone being gone, for just as we think it’s reconciled, accepted, when someone or some incident associated with the gone points out to him/her, you just get hit all over again. And, ever since Rajani called us one morning from the US and with a brief prelude muttered, “Pedababu is no more”, that’s what’s going on with us. 

It’s not a year or two; it’s an association that dates back to the early 70s. To be precise, it was on June 20, 1973 that I met Dr Perumallu for the first time at his marriage. I still remember that late sultry night in Mangalagiri, when he, entering the choultry in the attire of a bridegroom accompanied by a doting battery of people, looked for a place to recline, I, being from the bride’s side, hurriedly went out and fetched a cot for him to lie down. Next day, after the marriage, he spoke to me with such warmth as if we knew each other since ages.

Such long conversations continued thereafter uninterruptedly... either on phone or in person. In one such chats, he narrated about his days in Andhra Medical College (AMC), Visakhapatnam as a PG student of general medicine. A known voracious reader of every book that had landed in the library, he almost became a sort of ready-reckoner for fellow doctors. No wonder, if he with his up-to-date medical knowledge, unwittingly, had become an affront to the faculty!

Being known for his thorough clinical as well as theoretical knowledge of medicine, when once a top-notch politician, a minister in the then Central cabinet, one Mr Bezawada Gopal Reddy, who was on a special visit to the city, was admitted to the Rajendraprasad ward of KGH for a sudden medical support, Dr Perumallu was asked by Prof Raghunathan, to be the physician in attendance to the minister. This PG student, in his usual style, opening a dialogue with the minister to elicit information about his habits to diagnose the problem, and examining him thoroughly, said: “See, cardiomyopathy is a condition that can be corrected if you give off alcohol. Well. We may, at best, give you a temporary relief with medication, but ultimately, unless you quit alcohol, no permanent cure can be assured”, hearing which the attending staff turned queer, while the minister, bursting into a laugh, uttered, “Oh, my young doctor!”

But ironically, this dependable doctor cum PG student in general medicine under Prof Raghunathan, was not found good enough for awarding MD even after appearing twice. In the cross fire of petty caste politics, petty conflicts between the internal and external examiners, etc., he had to quit the program in 1968 in sheer frustration.

But he was not the man to walk out silently: he went to Prof Raghunathan’s house and on knowing he was not at home, asked his wife to convey Dr Perumallu’s “good bye” to him and also to inform him, “Dr Perumallu’s failure to get MD is not a shame to Perumallu alone, it is equally a shame to Prof Raghunathan, for after all, he was his student.”

Of course, this brave young doctor was not the one to lose nerves; instead, in August 1968 he boarded a plane bound to Heathrow with a kettleful kajjikayalu (traditional sweet) given by his elder sister in Delhi and eight pounds in pocket to redeem his fortune… After landing in London, of course, he was to pass through harrowing experiences till he secured a job. Staying in YMCA hostel, rolled on the days by eating kajjikayalu and drinking water; and then as his eight pounds evaporated, at the advice of a fellow-boarder approached DWP to seek Jobseeker’s allowance and once secured aid, started actively visiting a few hospitals for giving interviews. Finally, he joined Brighton General Hospital, Brighton as a general physician in the geriatric ward. Within no time, he could relate himself with the old folks in the ward so much by attentively listening to their narrations/woes and explain about the functioning/dis-functioning of their organs due to wear and tear/old age, that everybody used to wait for this young Indian doctor’s visit to the ward longingly. Immediately after getting salary, he said that he bought a blazer to keep himself warm in that biting cold and shifted to a private accommodation.

Talking about his experiences in Brighton Hospital, he narrated an interesting anecdote: listening to patients systematically describing their problem, he seemed to have felt as though reading the textbook of medicine once again. These interactions with patients finally led him to realize that the symptoms of various diseases that he read in textbooks back home was not that of the authors of the textbooks but a mere compilation of what the patients had narrated to them.

In June 1970, he shifted to the US, where he did his internship in internal medicine at Toledo General Hospital, Toledo, Ohio. In July 1971, he moved to Independence, Iowa and did his first year residency (July 1971-June 72) in Psychiatry at a State Hospital in Independence. While relentlessly pursuing his desire to acquire as much knowledge as he could of various facets of medicine, he stayed focused on making a few extra bucks by attending to all kinds of hospital work, all in the anxiety of quickly pooling sufficient money for marrying off his youngest sister back home. This is one trait of him—the trait of devotedly supporting his widowed mother in managing the family, discharging his familial obligations such as marrying off his sisters, etc., that I respect most, indeed this won my reverence for him. Perhaps, feeling enough dough had been pooled up, he returned to India in July 1972 to get his youngest sister married.

In 1973, he married Dr Anjana Devi, FRCS, on 20^th June. Then marrying off his youngest sister to a doctor, he went back to US in July 1974 along with his wife to work for four to five years, make enough money and return to establish a hospital of his own in Guntur. After finishing his 2^nd and 3^rd year Residency in Psychiatry at the State Hospital, Independence, Iowa, he moved to Danville, Illinois in June 1976 to work at VA Hospital as Chief of the Psychiatry Dept. Later in June 1978, he moved to Cherry Hospital in Goldsboro, North Carolina as Staff Psychiatrist. He, working in that hospital in various capacities: Liaison Psychiatrist, Director of Behaviour Modification Unit, etc., took early retirement in December 1998 due to health problems.   

Family loyalty was a deeply held ideal for him. True to our tradition, he looked at the family from a ‘collectivistic’ perspective and was always concerned about belongingness, dependency, empathy and reciprocity with his family members. He had tremendous love for his mother, sisters and their families. This doctor, who went to the US with a specific objective and with a definite understanding to return to India, after accomplishing the said objectives, to start private practice in Guntur, was to abandon the idea hearing about the untimely, unexpected and unnatural demise of his beloved mother in 1981. It took quite a long for him to come out of that shock.

It was only after three years of his mother’s death that he came to India, in 1984, along with his family and stayed with us for a month and a half. Of course, thereafter he kept visiting us once in every two-three years. During those visits, we used to have long hours of conversations on various topics. He was such an avid conversationalist that he could relate himself with anyone in no time and make them feel at home with his cheerful disposition. He was very good at framing acronyms to explain his philosophy of life/ his faith in spiritualism. 

Once, he narrated his school experiences in Bandar that were pretty interesting to listen. Showing scars on his shoulder, he spoke about how he used to fetch water for his college-going sisters every morning from a distant well by keeping a bangy (a yoke, to whose both ends a rope-net is hanged to place the filchers filled with water) on shoulder. He fondly recalls his school teachers by their names … and narrates how he used to carry vegetables, etc. from Angalur for them… He warmly recalls the prayer that his history teacher—the teacher who is famously known after his fictional wife, Kantam, Munimanikyam Narasimha Rao—asked him to recite in the mornings: “Saraswati namastubhyam varade kamarupini / vidyarambham karishyami, siddhirbhavatu me sada …”

At times our conversation would veer to farming, which we both were attached to very longingly.  Even as a student of MBBS at AMC, Visakhapatnam, he used to attend to important farm activities. During his visit to India in 1999, I was to accompany him to Angalur, Masulipatnam and back to Guntur. While returning from Angalur, he stopped the cab on the road side under a Palmyra grove and showing me the fields that were a little away from the road, narrated how he as a student of AMC, every year in December, used to come to Angalur to get their paddy crop threshed, and even happily slept in the nights at the threshing flour in the company of a labor and brought paddy home securely. For, that was the only source of income for funding his education and other needs of the family as a whole.

On his every visit to India, he invariably used to visit his former professor of medicine, Dr Kodandaramaiah, at AMC, Visakhapatnam, perhaps to express his reverence for all the clinical knowledge, particularly the skill of differential diagnosis that he had imparted to him at KGH. In one such visit, as the professor narrated to him the events that led to his son’s death on his way to Chennai for medical aid, he seems to have at once exclaimed in wonder: “Professor-garu! What you said in KGH in our third year clinical-rounds is still ringing vividly in my ears: ‘If a patient complains about itching between the fingers, with no accompanying visible symptoms, your hand should immediately reach out for the kidneys.’ How is it, of all the people, you failed to diagnose the breakdown of the functioning of your own son’s kidney, that too, when he complained about an itching sensation continuously for a day or two”. Fighting back his tears and holding his hands, the Professor summoning enough energy to mutter: “Perumallu-garu … meekinka avanee gurthu unaayaa—you still remember all those lectures … you are such a good student, naaku andaruu inkolaa chepparu—but I was misled by others… it’s all quirk of fate … by the time it struck to my mind, it was too late.” This realization was indeed too late both in the case of his son and Dr Perumallu as well. Later, sharing this incident with me, he, being what he was, felt bad of his reminding him of his lectures and thereby multiplying his guilt-led anguish.

Ever since he took pre-matured retirement from the Cherry Hospital, Goldsboro, he had been calling me on phone on every alternate Sunday and we used to chat for hours together. Sometimes, he would take me on tour of Gray’s Anatomy… At times it would steer around cardiovascular diseases and the emergence of coronary collaterals, etc… It was such a pleasure discussing with him on such diversified topics, particularly psychology and psychiatry, for I was also interested in knowing a little more about human relationships, particularly, pathological relationships, transactional analysis, behaviour modification, etc., ... they were simply enchanting.

One Sunday, during such conversations suddenly, he landed on that short and burly neurophysiologist, Prof Brahmayya Sastry of AMC … Sharing his relation with him, he narrated how he got his sister who just got her PhD employed in his lab for undertaking research in one of his ICMR-aided projects. He had a high regard for him, not because he gave job to his sister but because he instilled in his young mind in the 60s how important it is to take physiology of a patient, particularly, the importance of Na, Ca, and K in maintaining cardiac stability, into consideration while evaluating his condition and prescribing medication. I too have an admiration for this Professor for he was one of the few Indian physiologists whose work was quoted in that bulky Physiology text of Medicos, which I read with interest as I was then fascinated about ACh, its synthesis, AChE, synaptic transmissions, neurotransmitters, etc. Having that at the back of my mind, I could hang on to the phone with interest listening to his talking a lot on the related issues. And, listening to him while he takes me on tour of such diversified topics was a sheer pleasure.  

The last few months had however turned out to be a little threatening. For, his health started deteriorating fast. Yet, he kept on sharing with me his philosophy of life, his varied interests, and his encyclopaedic knowledge of medicine that was intact till the end on phone but sensing his tired tone, I was to cut the conversations short. But he was as usual talking as though nothing had happened. But the very word ‘cancer’ was such a shuddering for me and my wife that it became difficult to put up long silences… used to eagerly look forward for his telephone ring on Sundays  … and as the days advanced with his experimentation with new drugs and listening to his getting in and out of hospitals for one correction or the other, and yet his speaking to us… always with a cheer in his tone… it was all nice to listen to him but deep in the heart, there was always a tug in the corner …

And finally, as the day came for the end of his journey from Angalur to America, everything was peaceful: On that fateful evening of 7^th December 2020 he,  in medical parlance due to cardiac arrest, passed away peacefully, “Unto the Shepherd’s arm!” while conversing with his younger daughter. All that I could now think of is: just to ruminate on his talks … on what he once told me, “We meet to part” … and silently offer my Śraddhānjali to him….