Cough Cure

I could hear her violent bouts of cough through the door leading to the waiting room. She came in with her son who has been my patient for some years now. This was the first time she was seeing me. A well preserved and groomed lady of around 65 years, when asked what the problem is, began,’ can’t you hear my problem, this cough; I am having this since the last three months. I have tried many medicines but of no use’ she stopped to let go another bout of cough.
The list of medications consisted of three types of antibiotics, several anti allergic drugs including oral steroids and currently she has been taking copious quantities of syrup of codeine and suffered as a consequence, severe constipation.

I asked,’ where are the prescriptions’?

‘What prescriptions? I don’t need any prescriptions? I am a doctor’. She stopped at that.
Her son added,’ doc, I should have told you, my mother retired as professor of Pharmacology from Orissa few years ago and she has come here for a visit and has come to see you only because I forced her to.’

This explained a lot of things. She has been a senior teacher of Pharmacology and knew in depth all about medicines, but had no practical knowledge about diseases! Having retired she must have felt odd to seek help from her colleagues, most of whom must have been her students. She had made a self diagnosis [many] and has been medicating herself.

I was a worried man. I am dealing with senior medical personality who has come to seek help from a GP at the instance of her son. We GPs are considered as know nothings by many specialists and like many of us GPs thinking them to be doctors with blinkers on and knowing more and more of less and less. In reality both these assumptions are incorrect. I did not know what to make of this lady, a senior professor and teacher who has been neglecting a cough for over three months. But saying so will only make matters worse, this I know by experience.
For a while I kept quiet. By then she had told me few more complaints which were not very relevant like not sleeping well, dry mouth etc.

I asked her,’ have you got any tests done’? She said no but has been planning to get some done. This was like adding insult to injury. Three months of cough and no tests done!

I proceeded to examine her. But for repeated bouts of dry cough, she was alright with fairly clear lungs. I told her so and said I will have to get some tests done which included a chest X-ray, blood and sputum tests. She asked me,’ what you are suspecting? You think I have TB? Sounded more as an accusation than a statement. ‘In this country, madam, that is the first illness that I would want to exclude, though I don’t think it is TB, but one can never be sure ‘. ‘Then what do you think it is? This is another problem we doctors face. When I am not sure how can I tell her what is the problem? I told her that is the reason why I was getting these tests done. She would not leave me. You must have some idea before you asked for these tests’ she said. I had to reply. I said,’ madam it can be any illness starting from TB to asthma to cancer. No, No, No, I cannot be having cancer; I have never smoked in my life, asthma! I don’t have any breathing difficulty, it must be something else’. How can I argue with this professor that all the three diseases are still possible and why. It is simply a waste of time and prolonging the argument which was taking us nowhere.

I felt it is best o keep quiet. She said at last, ‘OK, we will do the tests and get back to you’.

Couple of days later, she and her son returned to see me with reports of the tests done.
One look at her told me that something was seriously wrong. Her face was ashen and her lips and hands were trembling. Here was a lady who was frightened out of her wits. I made them sit down. Even before I asked her any question, she said,’ doctor you are right, I have miliary tuberculosis’. Miliary tuberculosis is very serious form of tuberculosis where in the tubercular germ has widely disseminated and the patient is very seriously ill. I asked her how does she know. She showed me the radiologist’s report which accompanied the chest X-ray. It read,’ fine diffuse nodular opacities in both lung fields. Consistent with military tuberculosis. Please correlate clinically’

The X-ray reader sees and reports on what he sees. He has no clinical experience as he does not see the patient. His job is to report what he sees and that is what he has done. Strictly speaking he should have stopped at diffuse nodular opacities seen and not hinted at military TB. That is the clinician’s job. But the radiologists do commit this mistake of suggesting which they should not do. Our professor has put this finding and her cough and surmised that she has serious form of TB.

I went through the other reports. She had very high percentage of a type of white cell called eosinophil. Eosinophil developed over thousands of years to particularly attack worms [not germs] which infest our body. Especially so, those worms which tend to travel around in our tissues. Coming from Orissa the diagnosis was very easy to make. She had Filariasis.

In Filaria, after the infected mosquito bites, the released larvae of the filarial worm migrates and gets stuck in the lung tissue where the eosinophils too go in large numbers and attack them. The reaction results in small pinhead sized nodules which are seen in the X-ray. The same happens in a different way in TB where another specialist cell called Lymphocyte does the same. X- ray picture of both is near identical. The flood of eosinophils is also seen in the blood much more than what is normally seen. In fact this condition is known as tropical eosinophilia.

I explained to her in detail and also prescribed the 15 day course of a drug called Diethyl Carbamazine that will bring about a near miraculous cure.

She brightened visibly. Next ten minutes were spent not in thanking me but in giving me a lecture on Diethyl Carbamazine.

After all, was she not a professor of Pharmacology?

Ushering in yet another year

A year is about to end and another about to begin and time has come to share my thoughts and feelings and say thank you.
These are:
To those of you who are my patients, a big thank you for keeping me active in the profession and for the confidence, love and affection you continue to shower,
To those of my friends, especially my golfing and badminton buddies, for having kept me happy and healthy,
To my small scattered family for continued support and love,
To the colorful plant and bird life which continues to give me so much of visual pleasure,
To readers of my Blog for the encouragement which has helped me to keep writing,
And lastly, to that mighty force which has kept me mentally fit and physically active, given me the ability to enjoy and appreciate the little things in the evening of my life.

Hope you don’t mind a bit of advice from an old doctor.

Eat less, consume less, exercise more, laugh whenever you can, help out, forget the past, enjoy the present and don’t worry about future.

These are the same ones expressed last year.I could not do any better this year.Therefore I have posted the same!

Travesty of Justice

• I did not know whether to laugh or weep on hearing the news of Dr Binayak Sen being found Guilty of sedition by a judge in Chattisgarh. In this country the state machinery can be used to bend justice to suit its ways and Dr Sen being found guilty is one such. It is not difficult to create documents, get witnesses to testify against anyone the state doenot like and there are any number of officials willing to cater to the whims of the state.
  
  That he was a nuisance to the state machinery was true. His ways of helping the poor and down trodden was not to the liking of the state. He took the health and nutrition care where it was most needed, to the poorest of the poor and to their doorstep. He found by experience that these people had no voice and willy nilly became their voice in the form a human rights activist. To equate this activity as that of a naxalite is shameful to say the least and this is exactly the state government has done. It should have followed his example and reached out to people and won them over instead of giving in to the influential interests of the landed gentry.
  
  Of course the higher judiciary will not be that stupid as the lower courts and will see that he justice will be done, but then if a person of Dr Sen’s eminence can be found guilty, imagine the plight of an ordinary citizen in this country who has been wronged by the state.

Hollow

I was idly rummaging through my collection of books and came across this one. Bound in a buff cover, pages yellowing, the book had a small legend written by my hand. 25/2/77 H.A.L. airport and the scrawled signature of yours truly. It brought back memories of those years. The airport was small and served few domestic flights. Those going abroad had to go to Bombay [oops sorry Mumbai] and take an international flight from there. The road to the airport was a narrow lane with hardly space for two vehicles to pass each other. Vehicles were few and the ride to the airport was hassle free. I rode my motorcycle and would reach the airport in ten minutes. What surprised me was that I had bought that book and that too from the airport bookstall paying obviously much more than in the town’s book stores. Normally my buying was from the second hand book store located off MG road called Rao’s. Mr Rao specialized in second hand books and enjoyed his trade. He had few stools placed outside his tiny store over flowing with books for not too well off customers like me to sit and browse.

The book’s name is Hollow and late Dame Agatha Christie the author. I read the book once again. Set in the post war England where one still suffered [or enjoyed] class distinctions, in the rural countryside, it made good reading. Agatha usually kills her victims with poison but here the murder weapon was a revolver. The story meanders to an unexpected conclusion in typically Agatha way. What was interesting is that after 30 years I could still read it and enjoy doing so. I cannot say the same with some authors whom I greatly admired in the yester years. One such is A.J. Cronin. I read one of his novels and found it too artificial. Whereas, his book of stories relating to Drs Finlay and Cameron remains an all-time favorite. There was a crime writer called Earl Stanly Gardener whose books I avidly read and now I wonder how I could do so. Works of others like P.G. Wodehouse, P.D.James, John Mortimer [Rumpole stories] can be read over and over again without the loss of pleasure.

40 years ago, in the beginning years of my practice, I had oceans of time and one way of spending time in the clinic was reading and those days there were lot of way side book shops in the Cantonment area and near Majestic circle. Commuting was easy unlike now and I would be a regular visitor to these shops. It was quite entertaining in a way especially visiting Rao’s. Old man Rao passed away some twenty odd years ago and now his son [Murthy?] manages the book shop located some distance away with equal enthusiasm. Then there was Premier Book shop run by Mr. Shanbhag who ended up becoming my friend and about whom I have written earlier in these columns. In the last five years there is another bookshop called blossoms that has come up in Church street which too specializes in old books but the owners are not knowledgeable like Rao and Shanbhag who knew exactly what I would be looking for and would put ten books in front of me to choose from.

I miss them

Holding the breath

That was an unusual complaint. She said every time she went for a walk she was forced to hold her breath. ‘You mean you were breathless? I asked. She said,’ no doc, I had to stop breathing for a few seconds and then I can proceed with normal breathing’. She said she had no chest discomfort or radiating pain. This 65 year old woman has been my patient for several years and not given to exaggeration though the unfeeling husband seemed to think that she was imagining a complaint! I knew that an exercise ECG and an angiogram [done for similar complaint?] two years ago were normal.

I did not like it despite her BP being normal and a regular pulse. I sent her to my cardiologist friend and forced him to do an exercise ECG. He called me from the hospital and said she had severe supraventricular tachycardia [very fast uncontrolled heart rate] and atrial fibrillation [another kind of serious rhythm disturbance] within two minutes of excercise! The stopping of her breath was due to inadequate perfusion from a heart which was in serious trouble. She was rescued with medication and another possible disaster avoided!

Tendulkar and Bradman

The present generations of cricket lovers all over, including the Australians seem to think Tendulkar is better of the two. One should really not compare the two in the first place. But if you force me to do it I would place Bradman above Tendulkar. In the era Bradman played, except Leg guards there was no protective gear. One exposed the body and head to the fast bowlers. He had a phenomenal average of more than 90. He may have played fewer tests but that is not taking away from the basic facts of brilliant batsmanship. They had to design the famous bodyline attack to keep him quiet. Nothing of that sort ever happened to the well protected Tendulkar. Given the conditions of modern cricket it is possible that he is one of the greatest batsmen the world has seen in recent times. But then who am I to opine when the majority of voters are young hero-worshippers?

Update

Many of you must have wondered at the prolonged period of not writing on my blog and what may have happened to the old man? Recently one of my patients took objection to my calling myself an old man. When one is old what is wrong with the term? After all the body has to get old but what is important is the feeling. If one feels good in whatever one does and keeps active then one is not ‘old’. In that sense I am not old. Incidentally I have updated my age which should have been done six months back.

Returning to the question of why I did not write for six months, is not due to my passing away or due to ill health, lack of material or sheer laziness, but because of one important factor which constantly and even now disturbs me when I take up to write. This is the thought of the state of my country. This not new and I was able to put these aside and get on with life and my writing. But lately the level to which the governance and corruption has sunk to, is so mind boggling that I am compelled to write only about this and most of you are quite bored with my constant rantings.

But then I have a reason. I was a toddler when the country became independent. We were abject poor but were reasonably administered by the British before that. Our poverty was due mostly to the siphoning of the resources and funds to our host country and to the ravages of world war which made every one poor including the British. They thought it fit quit rather than manage us and there was also the nuisance called Gandhi. So we became independent and I grew up in this independent India. We had visions of a well managed state where in every one lived in harmony and comfort. Gradually reality took over and we realized that aspiration is one thing and achievement is another. The former was high and the latter very low. The real colours of the ruling class [politicians and beurocrats] became apparent as the years went by. Corruption and poor governance which were not rampant in the initial years gradually became common and even worse it came to be accepted by the society and corrupt wealth came to be accepted and even respected! This happened at the cost of development is easy to understand and what we are seeing today is this cancer that is destroying the country and the magnitude of this illness is what the media is highlighting. Then what is this that you hear that India is an emerging economic power and is going to be a world leader? This is because we are a large and populous nation and a small percentage of this population is wealthy it is like the whole of Europe being wealthy. That is what one sees .The doings of this 5% of the population [which includes most of the corrupt]. The state of remaining is going from bad to worse leading to a frightening discordance. It is a joke that this country becoming a world leader. What is then the solution?
Radical surgery is the cure. Not so long ago, corruption was rampant in the state of Singapore. It needed one man [Lee Kon Yew] to set things right. Quick justice and accountability is what he did and you see the results. We need another Lee to save us.

Till then you have not many choices, rant and rave and be called a misfit, get into a self created cocoon [of golf, music and infrequent writing like I have done]and let the world be or become a revolutionary [which may take the country to even worse situation]

New Patient

These days, as I grow older [also wiser?], I am reluctant to take new patients and added responsibility. The main reason is that I have come to value my private time much more than before. Another reason is the fear that I may not be able to give an efficient service by my own standards. Be that may, I still have to take a few because of many compulsions. One such is my own friends who bring their dear and near, and I owe it to them, so I accept. Here is one such patient.

This old lady walks in and tells me that she is a very good friend of Mr G and because of his recommendation she has come to see me.

‘You look good’ she said by the way of opening the consultation. I am used to patients telling me their complaints and not complimenting me on my looks. I sat looking at her rather confused and did not know how to respond. She must have guessed,’ you don’t know how to take a compliment’. This is true; it leaves me uncomfortable because I suspect the motive which is not really the right thing to do.

I said belated thanks and asked her what I could do for her.
She sat thinking. Few minutes passed. I asked her what the reason why she has come to see me. ‘Oh, that is because G told me to see you’, she said.

We were now back to square one. Many of us old persons are forgetful and I thought this one must be one of those who has forgotten. So I asked her,’ have you forgotten why you are here?’ ‘Common doctor, I am not that old, I remember all my problems, the trouble is that there are so many of them, I don’t know where to begin’.

This was enough to make my heart sink.

She began her complaints with unusual gusto.
Thirty years ago, I was involved in an accident and since then I have this periodic head ache. She went on to give a graphic description of how the accident took place, the number of doctors she has seen and the investigations that have been done and the medications she is presently on and the diet she has been following.

Seeing me getting ready to examine her, she said 'hold on,’ I also have diabetes and high blood pressure.’ She proceeded to give another lengthy description.
Then came the description of her knee joint pains. Then her gas in the belly,

There was a brief intermission when she was collecting her thoughts as to her next problem.

‘Ha, I also have this ache in my back and pricking sensations in my legs. Sometimes I get up too often at night and this disturbs my husband’. A description of how irritable a husband she has, followed.

You may think that I sat there docile without interrupting her. My attempts were firmly put down,’ wait a second, I will come to that, or some such comment to keep me in my place.

At last, after nearly half an hour, she allowed me to examine her. There was not much wrong with her. I was able to get her medications down from the twelve drugs to six essential ones. I thought she would be happy. Instead she said,’ but doc, I have been taking these for over ten years. A mild argument as to the need to cut down unnecessary medication ensued. She reluctantly agreed to do so.

By now, I was feeling the beginning of a small ache in my head and was having visions of my mid morning tea.

‘When should I come back? She asked. ‘Six months from now’ I said. She was taken aback,’ but my doctor sees my every fifteen days’. I said,’ see him every fifteen days but see me once in six months’.

She gave a strange look, thanked me and went. I heaved a sigh of relief that I don’t have to see her for six months.

Red Herring

Often we doctors go astray chasing the wrong diagnosis and causing avoidable distress to our patients. This is one such story which happened in my practice recently.

I am now treating the fourth generation of Pillays. The old man Pillay who came to Bangalore from the state of Kerala some 60 years back died many years ago. The young man in question is 25 years old Mr S is the grandson who is employed as an engineer in a private company. He suffers from stone disease of his kidneys and every now and then develops pain in his back and down the track of his ureter [the tube that drains the urine to the bladder] and ends up either with me or at the nearby hospital’s outpatient department.

He developed one such episode of severe backache and ended up in the hospital and a scan of his abdomen revealed Kidney stones though none was visible in the ureters. Going by the past story he was given pain killers and asked to come next day. He did not get better and developed urinary urgency and frequency and constipation. The physician thought the urinary symptoms to be due to possible infection and suggested a urine study. The patient’s complaint of constipation was attributed to taking painkillers and his feeling of tingling sensations in his legs to anxiety. Pending urine study he was given antibiotics and sent home.

He came over to see me next day. His pain back was localized and on both sides. He had abnormal pain and touch sensations and improper control of his bladder and was unable to evacuate his bowels. Examination revealed grossly abnormal neurological signs in both lower legs and there was bladder and bowel involvement. I was dealing with a serious illness called Transverse Myelitis which needed urgent expert management.

Myelitis is a general term used to describe all inflammatory conditions that affect the sheath [cover] of the nerves and nerve cells. It can be due to infection or immunological insult. The latter was the case with this young man and he was saved the dire consequences of possible paralysis of his body from navel downwards by massive doses of steroids and only a week’s hospitalization. At the time of writing the story he is near normal.

He still has stones in the substance of the kidney but sitting quietly for the present.

India Today

Whenever there is talk or writing about India’s great strides as an emerging superpower I get upset. A patriotic Indian likes to hear and read this so called greatness of ours and you may not like what I write. The sheen of prosperity one sees is mostly confined to metropolitan India. The shopping malls, eating and drinking places are full of well dressed young people spending freely. These are not our people. The Indian I talk about has not set his foot in any of these places and he forms the majority, some sociologists put this percentage to be 90 out of 100.This must be 98 out of 100 in rural India. But this 10 percent is what the other world sees. It also sees the Indian who is more visible and successful abroad and many make the mistake of his success as his country’s. These expatriates are runaways and escapees from the real India.

The real India exists in utter misery. It is malnourished, disease stricken, poor, and roofless with no body to look up to for help. The delivery mechanism of our so called welfare state is virtually nonexistent and the benefits that should reach these people generally end up lining the pockets of those who are supposed to deliver. Our primary and secondary health care systems are in shambles. We have no social security worth the name. We have no food reaching the needy and malnourishment is rampant. And these poor children end up as stunted adults. The politicians and beurocrats who are supposed to get us out of this morass are busy in participating in one type of scam or the other and care a damn as to what happens to the 90%.

The silver lining is some Individuals like the Drs Amte [many such], business houses like the Tatas and other NGOs. But the work that is being done by these is a drop in the ocean for a vast country like India.

So please stop talking about the country’s progress.

Rohan Bopanna

When I first met Rohan he was a thin gangly 11 year old. His father Prabha [Bopanna] is the younger brother of Raja [Nanjappa] who is a very dear friend and neighbor [also golfing buddy of over twenty years!].’Doc, look at this boy, he wants to play tennis, how can he ever with his eating habits’ Prabha said pointing to the grinning boy. ‘What eating habits’ I asked. He likes only bread and honey and occasional glass of milk the father said. This worried statement made both of us laugh and I don’t remember exactly what advice I gave the boy then. Kodagas [Coorgs] like their meat and no meal is complete if there is no meat dish preferably pork and naturally the father was worried about this bread and honey eating boy.

Then on there have been many occasions when I met Rohan either as a patient or when he came to stay with his uncle [Raja]. His build makes him Injury prone and his whole carrier is bedeviled by many injuries mainly to his right shoulder [serving arm]. As a matter of fact with his ability and character he should have achieved much more as a singles player but for his injuries. Rohan is one of the most self effacing boy [man] I have ever met. Success sits very lightly on his head. He is the same Rohan whom I met for the first time some 15 years ago.

He met Aslam [Qureshi] about ten years back and they have started playing doubles together some five years back when Rohan shifted his priority from singles to doubles and the pair began making history. Their reaching Wimbledon QF and now US open final has made all of us very happy and proud. So much so, despite winning today’s golf match and the bet of beer, Raja did not allow our opponents to buy and celebrated Rohan’s victory by buying drinks for all of us!

It is very big news for us In India and many like us I am sure in Pakistan,to see these two men who have shown how the two countries can get along and as Aslam rightly said,’ leave religion and politics behind and play tennis!’

Not their cup of tea

I read with interest two news items, one recently and the other some time ago. The one I read a couple of days ago described the travails of the dean of a government medical college. This dean after a lot of struggle had succeeded in building a state of the art mortuary for his teaching hospital and wanted a dignitary to inaugurate this building. In India no public function is complete without this formality and generally the preferred dignitary is a politician of some standing, usually belonging to the ruling party. Thus the first choice was the chief minister of the state who declined and the next two were the health and the medical education ministers. They too refused. The number of ministers in each of our states is sometimes equals that of the legislators. This is to accommodate as many of the winning legislators as possible and give them some status and power. This in turn leads to massive corruption is every ones guess and no one’s concern. So after many ministers refusing it was the turn of beurocrats. The dean met with the same kind of reluctance. At last he was driven to inaugurate the building himself accompanied by few of his trusted staff.

Obviously those who refused to do the honors believed that by doing so they may end up in the morgue before their time is up!

The other news item is about a constituency named Chamarajnagar. Since last twenty odd years no Chief minister has visited this place. Do you know why? In the earlier years those who did lost their chief ministership with in a short time after the visit. So the place is stuck with this taboo and no one has dared to break this voodoo!

We humans are strangely superstitious. It is all over but we Indians must take the cake. We have a right time and a wrong time to do anything and everything. There are Pundits who prepare almanacs giving the exact good and bad timings each day. No auspicious function is held without consulting these experts. I have known many daughters who have remained unmarried because of some blemish in their horoscopes [birth charts]. Strangely there appears to be less stringency where sons are concerned! I have on an earlier occasion written about my not being able to find a friend’s home because he had changed the entrance to the house following such advice. My friend who is an architect tells me that he has to use all his ingenuity to satisfy this belief and also make the house look good and livable!

Looting the public

We are a poor nation with rich people. With a teeming population of over 100 crores of people even a small percent say 5 percent rich is like having the whole of Europe living in India. The other side is people who live below the poverty line, so abject poor that they have not enough to eat, leave alone other necessities of life. These people periodically elect their regional and central representatives to govern the states and the central government. They are called legislators and parliamentarians or MLAs and MPs.

These representatives of the poor gave themselves a salary hike of 300%! I don’t think this kind of self indulgence by so called public servants has not been heard of anywhere in the world. But my country is special. Anywhere else there would have been violent protests and chaos. Here we accepted this gross and open looting of public money without even a whimper of a protest. They even gave themselves a sumptuous pension!

Looting the public has long been a pastime of those who ruled this country. From the days of Rajas and Nawabs to the rule of the company [East India Company] and later the British, all have done it. We have become so used to this kind of indulgence, extravagance and often sheer waste that it has even become a part of our life! I have on one occasion written about a friend who spent Rs 500,000 only on flowers during his daughter’s marriage! This kind of ugly extravagance is being seen more and more in most of our public and private functions, particularly so in Indian weddings.

Not so long ago there lived in this country a man called Mohandas Karamchand Gandhi who in addition to fighting the British get us Indians freedom, but also tried to teach us the virtues of simple life by personal example. Instead of following his advice we promptly made him a deity and called him Mahatma Gandhi [great soul!] and as quickly forgot him. He must be turning in his grave many times over.

There have been volumes written on M.K. Gandhi. But a quaint little book on some persons who have tried to follow Gandhian way of life and worked to better the lives of their fellow suffering humans, came my way some time ago. I strongly recommend you all to read it. Name of the book is ‘Bapu Kuti’ and the author is Ms Rajani Bhakshi.

Mind over matter

Many illnesses are directly linked to brain activity. Two patients who came one after the other illustrate this. This happened just a week ago.

This patient who is on blood pressure medication records her pressure at home and more often than not it is within the normal range. But whenever I take her pressure it is way above normal. I tried consoling her that this is a well known phenomenon and we have even coined this as white coat hypertension. She was not convinced and said,’ I am a calm person, I have known you for many years and there is nothing here to get excited about [this is true!], your measuring instrument is showing wrong reading’. I have learnt not to argue with some patients and this is one of them. I said, ‘right then, you bring your instrument tomorrow and we will check the pressure with both the machines and see which one shows the correct reading’

She came next day. I don’t know which one of us was more anxious! She took her blood pressure which showed even higher reading than the previous days! Then I took her pressure using her instrument first and then mine. The readings were actually less than hers! She was convinced but wanted to know why the reading done by me was lower than hers. ‘The excitement was already over when I took the reading, therefore the figures were lower’ I said. I presume she will have more faith in me and my equipment henceforth!

The Swoon and after
I have heard and read stories of persons collapsing and even having a heart attack sometimes resulting in death when they hear distressing news. In my 40 odd years of being a doctor and having broken unpleasant news to many of my patients and having watched their agony, I had not come across anyone who has swooned, had a stroke, heart attack or who died. That is till a week ago, soon after the above mentioned patient [lady with high BP] left.

This 50 year old Mrs. P came in with a young man; Mr S. Mr S is a house guest with Mrs. P and will remain with her till he finds an accommodation. The reason why she brought him is that Mr S had fever since the past three days and felt very dizzy the previous night and with difficulty prevented a fall. She made fun of the youngster saying how little resistance the modern youngsters have when compared to people of her age and gave her own example of good health and how infrequently she saw doctors. In fact she asked me,’ when was the last time that you saw me?’ I really did not know and in fact her face was just vaguely familiar, if she had not told me I would not even think she was ever my patient. I told her truthfully that it must have been long time ago. ‘See, what did I tell you?’ she said looking accusingly at Mr S, as if by falling sick he has committed some form of crime.

There was not much wrong with the young man except for lower than normal blood pressure which combined with his fever must have caused some momentary dizziness. I reassured him of the nature of illness which would probably limit itself and he should be alright in couple of day’s time. Mrs. could not help saying,’ I told you it is nothing to worry, but you would not listen, see now doctor too tells you the same’. The tone clearly indicating that it is waste of time coming over to see me.

She would not leave. ‘Doctor, she said, will you please check my blood pressure also’. This kind of free additional consultation is part of the game and I don’t mind doing it these days. I proceeded to check her blood pressure and to my surprise this super fit [her assumption] had pretty high blood pressure. I told her so and get back in the evening for a recheck and take a note for some basic tests before beginning the treatment. She did not answer; instead she said she is feeling giddy. I made her sit in the waiting area and proceeded to see the next patient. Few minutes later comes Mr S and says,’ doctor come and see her, she is not talking’ I went out and found her head had rolled to one side. We put her down and she threw a fit [convulsed]. Soon after that she opened her eyes and obviously surprised at finding herself on the floor instead of sitting on the char. By now I had again taken her blood pressure which had dropped to near normal levels, heart rate and rhythm were normal and she seemed to be fine.

She wanted to go home having profusely apologized for creating a scene. I would not let her. A person with high BP who swoons and had an observed fit and BP drop could have had a heart attack or a stroke or even a tumor in her brain for all one knows. I had explained why it is necessary for her to go to a hospital. My suggestion that I call an ambulance was vetoed by her. By now she had recovered well enough to call a friend to come over to take her to the hospital. The friend duly arrived and the prostate lady was slowly moved to the car and taken away.
The drama took over an hour of my time. I went back to work. After half an hour Mr S comes in and asks,’ doctor do you know where Mrs. P lives? They have left me here and have gone to the hospital. I don’t have her phone number or her address. I don’t know how to go back!

Now I am faced with a new problem. How to get this man home? I did not know where MRs P lived except somewhere nearby. I told him that he has options of sitting in the waiting room till such time MRs P and or her companion realizes that they have left him behind or go over to the hospital and chase them. Poor man’s face fell, faced with this daunting task. He quietly returned to the waiting area.

I went out an hour later and found that he had gone.

The consultant from the hospital called to say that the lady’s BP was normal and her ECG was also normal and they are waiting for the brain scan reports to arrive.

It is nearly a week since the incident; Mrs. P came to see me with all the reports. All were normal. It only confirmed that what she had was indeed a syncopal fit on hearing the bad news!
She has reluctantly agreed to begin taking medications for her raised blood pressure.

Impressions 4

My friend asked me what I missed most when I was away. I said without any hesitation,’ my morning newspaper’! Don’t be under the impression that our newspapers carry some earth shatteringly important news that we cannot do without. It is not that. It is just a question of habit. It reminds me of an elderly patient of mine who was admitted to the hospital and became constipated. Moving the bowels daily for many is the most important ritual of the day and if unperformed will ruin their day. He made such a big issue of this that the girl who was in charge, made preparations to give him an enema. He would have none of this and he made her call me and he spoke to me. He said,’ please tell this stupid girl to get me Hindu [a popular daily of South India], it will act better than this enema business.’ Why did not you ask her’ I said. ‘I did and she laughs at me’ he said. I made him give the phone to the nurse and asked her to get him the paper even if it is against the hospital rules. She did and my patient took the paper and sat on the commode. Lo and behold, the job was done!

Though I had no such dependence the habit took some time to get over. Americans unlike us don’t miss their daily that is if they have one. Most are virtual rags giving bizarre local news like some ones dog missing or someone having a social evening or what the local school boys did when they took a trip to another state or the local Rugby team did against a visiting team. Ask them what is happening in the next state unless it is a major shooting spree they wouldn’t know! Even the TV coverage is I believe very sketchy [I did not have the opportunity to watch TV as my hosts fortunately or otherwise did not have the connection! To get the news of the world I had to go the internet but it is not the same like getting it from a newspaper.

Even small towns in the US now have centers that teach Yoga and meditation. The teachers are generally trained locals but have a generous sprinkling of Indians. It is common to see advertisements especially in the media [ specially meant for Indian readers] announcing visit of that this or that Swami or Guru who teaches yoga/meditation/ makes astrological predictions/performs rituals for ones’ wellbeing in the true traditional Indian style. The consulting hours and the fee charged are also given in the true American style!

I visited a fair on a week end that was held in the town’s main street which was closed for traffic for the day. In the nearly kilometer stretch, the road had at least 200 tents displaying all sorts of goods and crafts. The road and the footpath were chockfull of people with their families out to have fun. The area has a sizeable Indian population and I found very few of them. When asked the reason why I was told they tend to use holidays to visit each other or spend time goading their children to study! There were many Chinese and compared to my last I found many more of them. At this rate of Chinese immigration soon California will be renamed Chinafornia.

Impressions 3

My friend asked me what I missed most when I was away. I said without any hesitation,’ my morning newspaper’! Don’t be under the impression that our newspapers carry some earth shatteringly important news that we cannot do without. It is not that. It is just a question of habit. It reminds me of an elderly patient of mine who was admitted to the hospital and became constipated. Moving the bowels daily for many is the most important ritual of the day and if unperformed will ruin their day. He made such a big issue of this that the girl who was in charge, made preparations to give him an enema. He would have none of this and he made her call me and he spoke to me. He said,’ please tell this stupid girl to get me Hindu [a popular daily of South India], it will act better than this enema business.’ Why did not you ask her’ I said. ‘I did and she laughs at me’ he said. I made him give the phone to the nurse and asked her to get him the paper even if it is against the hospital rules. She did and my patient took the paper and sat on the commode. Lo and behold, the job was done!

Though I had no such dependence the habit took some time to get over. Americans unlike us don’t miss their daily that is if they have one. Most are virtual rags giving bizarre local news like some ones dog missing or someone having a social evening or what the local school boys did when they took a trip to another state or the local Rugby team did against a visiting team. Ask them what is happening in the next state unless it is a major shooting spree they wouldn’t know! Even the TV coverage is I believe very sketchy [I did not have the opportunity to watch TV as my hosts fortunately or otherwise did not have the connection! To get the news of the world I had to go the internet but it is not the same like getting it from a newspaper.

Even small towns in the US now have centers that teach Yoga and meditation. The teachers are generally trained locals but have a generous sprinkling of Indians. It is common to see advertisements especially in the media [ specially meant for Indian readers] announcing visit of that this or that Swami or Guru who teaches yoga/meditation/ makes astrological predictions/performs rituals for ones’ wellbeing in the true traditional Indian style. The consulting hours and the fee charged are also given in the true American style!

I visited a fair on a week end that was held in the town’s main street which was closed for traffic for the day. In the nearly kilometer stretch, the road had at least 200 tents displaying all sorts of goods and crafts. The road and the footpath were chockfull of people with their families out to have fun. The area has a sizeable Indian population and I found very few of them. When asked the reason why I was told they tend to use holidays to visit each other or spend time goading their children to study! There were many Chinese and compared to my last I found many more of them. At this rate of Chinese immigration soon California will be renamed Chinafornia.

Evaluating success

An old oxford don was being felicitated by the alumni for having completed 50 years of academia. After the dinner, over a glass of sherry one of his admirers asked the old Don,’ Sir how come so many of your students have done well in life. How did to value their dissertations?’

‘In the early years I used to take lots of time and trouble to evaluate the papers. But in my later years I found a foolproof method. I placed all the files on the top step of the staircase and gave the pile a kick and gave maximum marks to the ones that fell nearest to me and the ones falling farthest got the k least marks. Gentlemen most of you are products of this system’ He sat down amidst stunned silence.

In life what matters is individual enterprise, creativity, using or making opportunities and not book learning.

Did you know?

This interesting material was sent to me by good friend and relative Sheena Hebbar

Where did Piss Poor come from?They used to use urine to tan animal skins, so families used to all pee in a pot & then once a day it was taken &Sold to the tannery..... ..if you had to do this to survive you were "Piss Poor"But worse than that were the really poor folk who couldn't even afford to buy a pot......they "didn't have a pot to piss in" & were the lowest of the lowThe next time you are washing your hands and complain because the water temperature isn't just how you like it, think about how things used to be.

Here are some facts about the 1500s: Most people got married in June because they took their yearly bath in May, and they still smelled pretty good by June.. However, since they were starting to smell Brides carried a bouquet of flowers to hide the body odor. Hence the custom today of carrying a bouquet when getting married.Baths consisted of a big tub filled with hot water. The man of the house had the privilege of the nice clean water, then all the other sons and men, then the women and finally the children. Last of all the babies. By then the water was so dirty you could actually lose someone in it.. Hence the saying, "Don't throw the baby out with the Bath water!"Houses had thatched roofs-thick straw-piled high, with no wood underneath. It was the only place for animals to get warm, so all the cats and other small animals (mice, bugs) lived in the roof. When it rained it became slippery and sometimes the animals would slip and fall off the roof. Hence the saying "It's raining cats and dogs."There was nothing to stop things from falling into the house. This posed a real problem in the bedroom where bugs and other droppings could mess up your nice clean bed. Hence, a bed with big posts and a sheet hung over the top afforded some protection. That's how canopy beds came into existence.The floor was dirt. Only the wealthy had something other than dirt. Hence the saying, "Dirt poor." The wealthy had slate floors that would get slippery in the winter when wet, so they spread thresh (straw) on floor to help keep their footing. As the winter wore on, they added more thresh until when you opened the door, it would all start slipping outside. A piece of wood was placed in the entrance-way.Hence: a thresh hold.(Getting quite an education, aren't you?)In those old days, they cooked in the kitchen with a big kettle that always hung over the fire.. Every day they lit the fire and added things to the pot. They ate mostly vegetables and did not get much meat. They would eat the stew for dinner, leaving leftovers in the pot to get cold overnight and then start over the next day. Sometimes stew had food in it that had been there for quite a while. Hence the rhyme: Peas porridge hot, peas porridge cold, peas porridge in the pot nine days old.

Sometimes they could obtain pork, which made them feel quite special. When visitors came over, they would hang up their bacon to show off. It was a sign of wealth that a man could, "bring home the bacon." They would cut off a little to share with guests and would all sit around and chew the fat.Those with money had plates made of pewter. Food with high acid content caused some of the lead to leach onto the food, causing lead poisoning death. This happened most often with tomatoes, so for the next 400 years or so, tomatoes were considered poisonous.Bread was divided according to status. Workers got the burnt bottom of the loaf, the family got the middle, and guests got the top, or the upper crust.Lead cups were used to drink ale or whisky. The combination would sometimes knock the imbibers out for a couple of days. Someone walking along the road would take them for dead and prepare them for burial. They were laid out on the kitchen table for a couple of days and the family would gather around and eat and drink and wait and see if they would wake up. Hence the custom of holding a wake.England is old and small and the local folks started running out of places to bury people. So they would dig up coffins and would take the bones to a bone-house, and reuse the grave. When reopening these coffins, 1 out of 25 coffins were found to have scratch marks on the inside and they realized they had been burying people alive... So they would tie a string on the wrist of the corpse, lead it through the coffin and up through the ground and tie it to a bell. Someone would have to sit out in the graveyard all night (the graveyard shift.) to listen for the bell; thus someone could be, saved by the bell or was considered a dead ringer.And that's the truth....Now, whoever said History was boring!!!So...get out there and educate someone! ~~~

Impressions 2

I am fortunate in having my daughters and their American husbands as nature lovers and sharing my love for outdoor life. Americans with rare exceptions love sun and exposing their skin to sunlight, a feature which I don’t share. California is a sun drenched state and when I was there the mercury often touched 35 degrees [c] and more. I with my ankle length trousers with full sleeved shirt and wife with her saree made a striking contrast to the hordes of minimally attired Americans who were out to enjoy their sun. The motto appeared to be less clothing you have on your body the more pleasure you get. This is not only with the young who have well proportioned beautiful bodies to show but also the fat and the elderly with sagging bellies and bottoms. That excess of sunlight exposure positively harms and the publicity given to skin cancer is more than offset by the sales promotion and use of sun screen lotions! Having played golf in the afternoon Indian sun for over ten years and having my forearms burnt to the extent that the skin appears like a thin wrinkled parchment, I have become wise and use only long sleeved shirt whenever I go out in to the sun and during my California sojourn I did the same, but could not help wonder how these people manage to avoid the effects of sun exposure. Indians living in the US especially in places where there is limited months of sunlight seem to suffer more from Vit D deficiency in contrast to the native Americans [I don’t mean American Indians] I have had two young women in the US who had to be given D supplements!

The shopping malls are thriving given the penchant for shopping. I can understand if one were to shop for what is necessary. But buying for pleasure is something I fail to understand. In my country too there is this illness but it appears to be widespread in the US. The whole culture is aimed at consumption needed and not needed. I found large displays of storage houses. Americans move about a lot and it is understandable that they need to store their belongings when they are away. But part of this storage is used to store unwanted purchases made for want of space in their own homes! If I buy a shirt I tend to use it till it frays and then it goes to someone else as a donation or it is used as a mopping cloth. It will last for years and I rarely get bored with it. Not so in the US. Dress trends keep changing and one buys to keep up with the trend not for utility. The economy survives on conspicuous consumption! The Automobile industry is suffering because they no longer change their car every two years. So are the manufacturers of golfing paraphernalia. Americans no longer change their sets every two years!

Sequoia tree and our night out
Sequoia and King canyon national parks are located in the Sierra mountain range, four hours drive from Los Angeles. These trees grow at heights ranging from 5000 to 10,000 ft. The oldest tree [named after Gen Grant] is more than 3000 years. Its height is over 250 feet and the diameter is more than 100 ft. It is still growing. There are hundreds of these matriarchs in that splendidly maintained park where we were privileged to stay. Imagine that they have existed even before the civilization as we know began. The Pheraohs’ of Egypt when they were building the pyramids, these trees were already there! I could not help but give a respectful homage to these ancients who have managed to survive god knows how many natural calamities. They would not have survived humans but for the timely intervention of some naturalists [J. Muir] and others like President Theodore Roosevelt who enacted the natural park laws. This is also the natural habitat of bears and there are frequent encounters between humans and bears without much damage to either. My younger daughter and husband decided to camp in the open to see the star lit sky in this bear infested mountains. I love animals alright, but this outing with lurking danger, that too at night is one I am unlikely forget. With their programmed GPS aids they could locate all the planets and the stars and I had not seen so clear a sky with that kind of display of stars ever before in my life. This and the constant threat of bear invasion made that an eventful night, to say the least!

Impressions

Every time I travel out of India and return I feel good and also bad. I feel good because I am made to feel good by my patients and friends who genuinely miss me and make me feel needed. To be back in your own home, sitting in your favourite chair and doing what you are best at, in your own set environment which you have struggled and built over so many years, has its own charm which nothing can replace.

But for a few days I become very depressed. This is not because I have left behind those who are very dear to me and possibly will not see them for another year or two, or because of the effects of Jet lag, but because of what I see here and what I have seen abroad and despite the knowledge that comparison is bad I cannot help doing it.

The first thing that strikes me is relative absence of squalor and dirt. By this I don’t mean absence of poverty, but sheer human degradation that is present here. The other is our lack of historical sense and appreciation of beauty. We have plenty of places which are worth preserving and showcasing but have no sense to do it and thus allow our own extra ordinarily beautiful heritage places and sites to degenerate.

Americans have developed some new habits since I visited them last. One is the extensive use of bottled mineral water and it is common to see water being supplied to households periodically. This I felt was unnecessary in a country where supply of clean water is the norm and only adds to the recycling burden. I also noticed many carrying metal water bottles instead of plastic ones when they are out of their homes. The habit of drinking gallons of thin and tepid coffee seems to have grown. They also seem to be taking to drinking more wine. I found on my drive from Los Angeles to San Francisco thousands of acres of newly laid vineyards and my comment that they are converting precious water into wine was well taken.

Universal use of tissue paper for cleansing from top to toe has only increased. I used to see few still using handkerchiefs in my earlier visits. This time however I found none. How many trees are sacrificed to meet this avoidable habit? But unlike here I found none who threw the used tissue on to the road side. The roads are thus free of litter which was a joy.

America is heaven for dogs. They come in all shapes and sizes. There were many I just couldn’t identify and walking their dogs is fast becoming the most important pastime for most Americans, at least to the retired community. The locality where I lived there is a club of dog walkers. They start from their homes at the same time and stop at a large public lawn and gossip while their pets do their job and run around [leashed]. The dogshit is carefully picked by the gloved hand of the owner and placed in a plastic bag for later disposal. Here I pick up arguments with such walkers who think my home front is ideal place for their dog ablutions!

One car, one driver mentality persists despite wide appeals for car pooling. But a greater number of smaller cars are on the roads. Four lane high ways are becoming six lanes and the lessons of reducing dependency on this wasteful mode of transport don’t seem to have sunk into the heads of these people. We here are heading towards disaster if we continue to allow the cars to congest our narrow roads. America can indulge in this folly for some more years, but we cannot.

We never seem to learn some basic lessons. Or are we by nature arrogant that we just don’t want to?

More when I write next.

Holiday Time

I was away for nearly two months and did not write in my blog. I promise you will get to hear from me regularly hence forth.

God fearing

Some years ago I used to get help from a surgeon who lived and practiced close by. The set up he had was good for minor procedures but not major surgery.

One morning I saw a patient who was in severe pain around his anal area which made him sit on one half of his bottom. And seeing me smile looking at the way he sat he said,’ you are laughing, you don’t know what it means to have pain there,’ pointing to his posterior. The smile was quickly replaced by concern and I made him strip and had a close look. The man had a small abscess [collection of pus] next to the anal margin, an extremely painful condition. What he needed was a simple procedure of draining of the pus.

I sent him with a note to this surgeon requesting urgent help.

An hour later the patient came back. I was happy with such prompt attention and thought he has come to thank me. Instead the patient said with irritation in his voice,’ Please doctor send me to some other doctor, your friend is no good, he spends more time doing his prayers than attending to patients’

I agreed to send him elsewhere but was curious to know what had transpired. I asked him. He said, ‘I went there and waited in his waiting area with other patients, your friend came, went to his room and came out with a burning joss stick and proceeded to perform a ritualistic prayer to each of the gods photos he has hung in the waiting area, I got cheesed off, he should be attending to us first and do his prayers at home, I lost my patience and confidence in that man and decided to come back here’

So he went to another surgeon and got the abscess drained.
The surgeon in question became a drug addict and alcoholic and died few years ago!

Lump and Ache

New patients are naturally wary of the doctor. They don’t know what they are going to get in the consult. It may not be a pleasant experience for both parties. Who knows, in a worst case scenario, the doctor may not hesitate to pass a death sentence on the hapless patient.

This patient who gate crashed [came without prior information] into my clinic had severe anxiety writ large on his face. I asked him to sit and try and relax. He sat on the front of the chair and I could see the hands tremble. He was perspiring. I waited for him to begin.
After a minute or so he said, ‘I have a tumor on the lower part of my back and it is hurting me’
Normally patients don’t say tumor, they say swelling or lump. If someone says tumor I am certain he has already seen another doctor and has borrowed the terminology. We doctors as a tribe don’t know how [or don’t want to] to put our diagnosis in simple lingo. We have to say myocardial Infarction instead of heart attack, Cholecystitis instead of infected gallbladder. Sometimes when we don’t know how to describe an illness appropriately enough with a high sounding name, like when one has vertigo due to vestibular disease then we call it BPPV which stands for benign paroxysmal positional vertigo which in real terms mean a benign form of vertigo which comes in paroxysms related to position of the head!

So this tumor word had me worried because it connotes a growth of some type and could be serious especially when it is also causing back ache. After getting the history that the swelling was noticed several years ago and the pain from the last two months, I asked him to undress and lie down on the couch.

This is what I found. He had a small mobile lump and he had a stiff lower back. The lump belongs to group of fibro fatty innocent tumors called fibromas/ lipomas. The rigid back needed to be investigated. I told him so and assured him that he two are unrelated. He said he has already been extensively investigated which included an MRI scan. He proceeded to take out as sheaf of papers from his sling bag. The MRI showed slightly indented cord but not serious enough to have caused his back ache. His other reports were normal.

What this young man needed was posture correction at work and a set of exercises to stretch his low back. His lump needed no intervention. I told him so.

‘Doctor, are you sure’? He asked.
‘As sure as one can be, going by the evidence’, I said. Then he took out another set of papers in which a surgeon had advised admission for removal of the tumor and surgery for the disc prolapsed!

I sat in silence for a while not knowing what to do or say. I told him, ’you have come to me for an opinion and advice, according to me you need no surgery, try out these exercises and get back to me after six weeks, we will review you back problem. The lipoma needs no removal, not now and not in foreseeable future’.

That was two months ago. He came to see me few days ago. His back ache was very much better and his much feared lump didnot seem to bother him.

Fat cats don't hunt

I am one of those who never liked the 20/20 version of cricket. It is more like a slam bang jamboree rather than real cricket. Indian version of this is called IPL and it was over about two weeks ago. Just after this the team went to West Indies for the world cup of the same format. It came as no surprise to me that the much hyped team India got a through drubbing. This was mainly due to what commentator Ian Bishop aptly described as spineless batting.

On docile Indian pitches even the fastest bowler is rendered innocuous and our heroes are used to this and away it is a different story. The ball comes at you at an uncomfortable height and you should be quick on your feet and eye to either ward off or hit the ball. Our players did neither and preferred to get out! They were such a jaded and faded lot after the hectic IPL that even a child could see that they were an unfit lot. Adding insult to injury there seemed to be no pride representing the national side. This is entirely due to the fact that there is so much more money in domestic IPL than world cricket and our team full of fat cats were not hungry for a win. As the legendry Imran Khan commented that there may come a time when players may prefer to stay away from representing their country and prefer to play for their club!

Now coming to the sordid affairs of the IPL. When money, glamour, business and politics become bedfellows, it is foolish to expect honesty and straight forward deals. The high flying commissioner of the league, Mr Lilith Mody was found wanting on many counts and was summarily booted out, few tears were shed by the viewing public. Few were indeed shed for another IPL casualty, the articulate blabber mouth, Sashi Taroor.

I consciousness

My friend, patient and reader of my blog, Dip Ghosh dropped in to see me the other day. He made a chance remark as to why I write so much on matters concerning the evening of one’s life? This made me laugh and also had me thinking. What is my contact with young people and their lives? [morning of life], except when they come to see me as patients. What I know and hear about their lives is so far removed from my own that writing about it can only be second hand. I am also not well qualified to write about young people even those whom I know. I don’t understand their craze for modern Gizmos, their spending spare time wandering and shopping in the glitzy malls, their way of eating out at fancy places paying unacceptably large sums of money on unacceptable food. When they come as patients I sometimes tell them but their attitude is one of bored listening to an old man who is out of tune with the modern world [this is true]

I have on the other hand firsthand experience of the evening of life. Many of my patients are old and in their sickness and other wise I understand them better. I often wonder how our own I consciousness wanes slowly as we age and becomes hazy because of lack of recognition by others. I am I because others see me as I. When others see me as one who is on his way out, this recognition and feeling of real or contrived importance recedes. But does it die entirely? Sadly it will not and the recognition of its lessening importance is occasionally galling to the ego. When does it do and what happens to it? The development of I consciousness begins early in life when the child begins to understand the body limitations and begins to develop and understand language. The skin cover of the body tells the brain the limitation of the body in relation to the exterior and the senses tell the brain who it is visa vi the external environment. But for all this there must be original something to develop. This is I. When I die what happens this my I? Is it kept in suspended animation? Does it have some sort of structure that we don’t know of? Does it consist of some special form of intelligence which doesn’t need senses to be appreciated? I have no answers to these questions.

The belief that this I consciousness is transferable after death gives some meaning to existence. But truth eludes us and the proliferation of God men and women is a proof to this quest to know. Some glimpse of understanding will come to you if you read the book,’my stroke of insight’

Like it sometime happens, I begin with something and end up with something else . This week end happens to be one of those where in I have been having these recurring thoughts and felt that I should share some of them with you.

The Little Green Barbet

Eleven years ago I did a study with the help of an expert bird watcher, of the birds that are found in and around our golf course. Recently I was asked to do so again. This time however I needed no expert and I know by heart, sound [call] and sight and flight the number of birds that still survive and thrive. There are still 40 varieties of them seen in the last one year out of the 50 odd that were listed ten years ago. Some have disappeared and the numbers of many has come down drastically [Rosy Pastor]. Some however continue to thrive like the common Myna and the Crow both the house and the jungle.

But what drew my attention was the surprise missing of Little Green Barbet seen in such profusion now but not mentioned at all in that list made ten years ago. How can this be? We, or at least not the expert who was with me [refer: birds and others, Sunday, Nov 25, 2007] could have missed seeing this bird or at least listening to his call?

Some time ago I wrote about sighting and listening to the call of the Red vented bulbul in my backyard. Any time a new species arrives and thrives in new ecological environs, it lifts me out my gloom. The profuse sighting of the green barbet in recent years is one such event. This bird which is smaller than a Mina is colored green with rufus and white mixed front and a beak with bristles. Its flight is like an arrow shot from a bow. The call is a staccato cuttroo cutroo repeated over and over. Perhaps this is one of the early callers in the morning that wakes you from your slumber. I have often wondered how such a small bird can produce such a loud sound.

From the tenth green we walk to the eleventh Tee box and next to this path there stands a dead tree awaiting the axe. The trunk of the tree abruptly divides into three branches. At this cleavage is located the circular entrance of a Barbet’s nest. It is so well located; one can only see it from one angle. All others are hidden out of sight. What is even amazing is that despite the almost continuous walk of golfers within a few feet of the tree, the bird has managed to dig a hole for its nest. How is it possible? One day I took up a position and watched. Between one batch of four golfers leaving the putting area [green] and another batch coming there is an interval of ten minutes. That is when I saw the birds do their job of nest building, cleaning, feeding and what else. Remarkable is not it?

I did observe one pair of Sand Pipers coming into the course every summer and they still do after ten years. Are they same? I wonder. I used to see Rosy Pastors, Yellow wagtails and Wood Mynas in their hundreds, but I see a measly few now. All around the course there is so called development [concrete jungle] How much time before they convert the golf course which is the only refuge for these birds into some government sponsored monstrocity?

Golfing woes

Mr S is a fellow golfer and also my patient. He took to golf when he was past fifty and I have been observing his progress [or regress?] since then. Even when he began he was not very good, as it often happens when you take up a new sport at that age. Except for the walking that is involved in golf and swinging the club attempting to hit the golf ball squarely, he does no other exercise and as he has grown older his never very good golf swing has become shorter and stiffer. This is because he finds it difficult to turn his body fully and shift weight from one leg to the other. Though this is the lot of most of us ageing golfers and most of us have come to accept this as another aspect of ageing process and still continue to enjoy the game [more observant amongst my readers may have noticed that my handicap has gone up from 15 to 18].

This is not so with S. He cannot accept that his bad golf is because of his age and stiffness. He came to see me the other day and his opening remark was, ’Doc,’ I am giving up golf’. I kept quiet. On many a bad day I too have felt like doing so, but have gone back to play. The infernal game is like that. No other physical activity [with the possible exception of sex] is as addictive and frustrating as golf. ‘ I am not able to strike the ball, and when I do it, it is a slice [the ball taking of to the right in an ugly arc], I have become abusive and ill tempered, no caddy is prepared to carry my bag, my partners barely tolerate me and when I go home, I am so irritable that wife doesn’t even want to speak with me’ he stopped.

He sat quiet staring at me. I can understand the turmoil he was going through. Golf is one game where maximum consultations are done with sport Psychologists and in their absence my friend has found me to help him. I know that telling him that he has become old and it is natural that his game will deteriorate will only depress him more.

‘What you want me to do’ I asked him.

‘Give me something that will make me less irritable, I don’t want to lose my temper on the golf course’ he said. ‘But then, how will it improve your swing? Have you gone and seen the club’s pro?’ I asked him. ‘Yes I did. Took two lessons, He wanted to correct my twenty years swing, impossible at my age, it was a bloody waste of money’ he said.

Any way you have decided to give up golf, why then you need medication to quieten you’? I asked. I want to give it a last try, He said. I gave him a prescription for a minor anti anxiety drug to be taken half an hour before the start of the game. I also told him it might cause some drowsiness. He took the prescription and left.

Couple of weeks later I met with him on the golf course and asked him about his golf. He said, ’I am much better, I have stopped using my driver, 3 wood and long irons[ less forgiving of the 14 clubs a golfer is allowed to carry] and my slice is now much less though my handicap remains the same’. ‘How is your temper?’ I asked him. ‘I am paying my caddy twice the amount so that he can put up with me’ he replied. This meant he was bribing the caddy to accept his short temper [I will tell the caddy’s version in another story]. ‘So the medicine is working’ I asked. Yes, he said but not while playing golf, I take it at night with my evening drink, doc let me tell you I never had a better cocktail, I have never slept this well, you should recommend this to your other patients’ he said.

Demand from the drunks

The Citizens of the city of Bangalore are now in the throes of selecting their ward representatives [carporators] who will administer the city for the next five years. This time over there are two hundred of them. Normally one would expect the contestants to be educated with a flair for social service with administrative ability and leadership qualities. Going by the newspaper reports and what I have seen and heard these candidates on TV, a large percentage of them appear to be slum lords, gangsters and extortionists, undercover dons who have come over ground only to contest the elections. Many of them have the additional qualification of being school drop outs. Their sole qualification in getting nomination from the major political parties is winnabllity.

Most are locally well known in their respective wards not for any acts of gallantry or for social work, but because of creating nuisance such as extorting, creating ruckus during festivals and taking out processions, boot legging and it should come as no surprise that many are rowdy sheeters registered with the local police stations. But they all have one additional qualification, that is money. This enables them to hire unemployed youth from the slums and shanty towns of the city where majority of voters live for doing election work. One TV channel showed these young men having a good time after the day’s electioneering, sitting in happy groups drinking and dancing. The electioneering involves visiting the voters with hands folded during day time and clandestine visits during the evenings to distribute goodies like clothing, kitchen utensils, cash and the prince of all gifts, alcohol.

Hooch is the term commonly used for illicit liquor sold without license. This city is in love with alcohol. Many years ago when prohibition was introduced [driven down the throats of people] all over the country, Bangalore was the only city that was spared. This city has many legacies left over by our erstwhile masters, the Britishers. One of them is the habit of drinking. Depending on affordability and class, there are three types of drinking men [and women]. The first are economically well off who drink the high end of spirits [scotch and other imported stuff], the second are the not so well off who drink what is called IMFL [Indian made foreign liquor] and the last are the weaker sections who drink the cheapest available that includes illicit alcohol. It is not uncommon to see many dying after consuming this illicit brew contaminated with methyl alcohol. But across the board we Bangaloreans love our drink and come election time we give free vent to this love of ours.

Alcohol users form the majority of voting public, and this time they have put forth their own demands to the prospective candidates. Stop making impossible promises like providing nonstop water, electricity, clearing the clogged drains and the like and work towards meeting the following demands.

Provide shelters near liquor shops where inebriated persons can spend the nights instead of on the footpaths and roadside as it is done now.

In case one was to be found sleeping off in the above unacceptable areas, see that they are not disturbed by the police and the good Samaritans who pass by. This applies to street dogs also.

When we are zigzagging our way back home late at night, passing vehicles must slow down and allow us to go our way. We should have the right of way and not these crazy drivers. Policemen should leave us alone and not drag us to the police station and disturb our sleep and pleasure.

Wives are a major problem. They don’t seem to understand the importance of alcohol in our lives. They scream and shout at us when all we want is to get our well earned sleep. Often we are made to sleep on the door steps of our own homes. This must stop.

Last but not the least; we are the major revenue earners for the government. Excise levy on liquor forms 40% of the state’s revenue. It is therefore the duty of all the future carporators to work to reduce the duty on liquor and all of us then can afford to drink quality liquor and need not risk our lives drinking illicit hooch.

Maya's garlands

Indians are immune to the news, both visual and written, giving details of corruption in public life. If there is one single reason why we have progressed much less than what we could have, is because of this. I have written on several occasions on this and how we have come to accept and even appreciate the corrupt.

The latest is the felicitation ceremony of the corrupt politician queen, madam Mayavati. This scion and savior of Dalits [name given to the socially and economically backward section of Indians] is ruling the largest and the most populous state of the union called Utter Pradesh. On the occasion of the 25th anniversary of the birth of her party, she was profusely garlanded by her party men [sycophants].The garlands were made up of currency notes of 1000rupee denomination. The garlands were huge and were engulfing the diminutive Mayavati and they [garlands] had to be supported by her faithful. Was there any sense of shame or remorse on her face? No fears. There was a glow of great pleasure. Obviously there is no need to account for this money that must have come by some sort of coercion, when it is collected by politicians. There was an interesting TV discussion on this question of acceptance of money in this manner and one of the participants defended her saying that she has the guts to do it openly in contrast o others who do it under hand!

God save this country.

IPL 3

The slam bang cricket jamboree that goes by the name of 20/20 [twenty twenty cricket] is back to haunt the likes of me. For the next two months there will be no other news or sports show on our TV channels and I have no option but to watch it. Having said I prefer the longer version of the game, I am not averse to watching it. But the kind of entertainment this provides is aesthetically less satisfying compared to the game played in other formats. But that is not the younger generation thinks and feels. The stadia are full of young people watching [if you call making lewd noise as watching]. The viewer is bombarded with commercial clips not only at thee end of the over but even between balls!. Commercial interests have completely taken over this game and we are witnessing the death of real cricket.

Most of the viewing and paying public is young. This generation has grown up in a frenzy of change. They are used to loud sounds, lewd language, explicit sex, no leisure, traffic snarls, violence in real life and on the screens, corrupt private and public life and the IPL in its third successful season, reflects all this. Sad but true.

Demise of Hockey

Field Hockey is a delightful game to watch and a dangerous game to play. It involves speed, stick work, body feint and stamina. There was a time we were the uncrowned champions of this game and won successive gold medals till the early fifties. Then on till early sixties we shared the glory with another great hockey playing nation Pakistan. We were called,’ wizards with the stick’. Such was our domination. I remember as a college student going to watch hockey matches to packed audiences. There was a lot of enthusiasm amongst the watching public and more number of youngsters would play this game. If I remember right our Leander Pais’s father Vace Pais was an ace player who played for the country. The decline began in the late sixties and never really has recovered as evidenced by the recent drubbings the team received from Australians and Spaniards [at the time of writing].

The question that comes to one’s mind how and why this has happened? My own guess is because of two reasons. One is that the other nations took up to this game in right earnest and prospered. The other is that we let the game take a back seat and allowed Cricket to take over. No youngster wants to be hockey star, they all want o become Tendulkars. So the base pool of players has dried up. It is often said that Europeans win because of their better physique and speed. This is no argument to defend our poor performance. A sardar youngster is as big built as any European and our tribal boys from Jharkhand are speedier than the Europeans.
The only way to avoid being the last ranked among the playing nations is to give Hockey the status and money. The talent will automatically follow because we are natural to this game.

I hope I will live long enough to see that day when India again becomes a top hockey playing nation.

We paid for our lunch

At last this old fool is showing signs of growing senile; you may feel when you read this caption. Who else will pay you may think, I don’t blame you if you do so. But we doctors are special. We allow others to pay and that is why I thought it is worth writing about this lunch when doctors attending the meeting [actually the association of ours] paid for the lunch before the CME [continuing medical education] programme.

It was in 1980, more than thirty years ago, That I along with a few of my friends started an organization which later came to be known as family physicians association[FPA], entirely devoted to the CME needs of family physicians then called general practitioners [I still like that name]. Was there no such body to look after the learning needs? There was the local branch of the Indian Medical Association. But they never were able to understand that GP is funny kind of specimen who needs special education and this is spread across all specialties. He is not interested in the intricacies of how an MRI machine works but only wants to know how to differentiate a cyst from a solid tumor. If the learned speaker teacher spends an hour explaining how the MRI works, he can be rest assured to hear loud snores from the audience. Mine and other’s attempts at getting the august body of the IMA see reason failed and that made us after nearly five years of struggle, to go ahead and start a new organization with a small number of twenty doctors. This steadily grew and now it has on its roll six hundred!

Initially we met at the local medical association’s premises where we didn’t have to pay rent and managed the expenses of a cup of tea and biscuits from our own pockets. Soon the association asked us to pay rent. This meant our expenditure went up and also the expectations of our members who by now had begun feeling that a tea meeting left hem hungry and wanted to have something more substantial to eat. They came from different parts of the town and some went straight to their clinics from the CME and naturally a lunch was preferable to tea and biscuits. But who will pay for this?

By now, the original manageable, like minded twenty had grown and the members felt there is no harm in getting sponsorship. My advice then that it is better we pay for our lunches and for hiring the meeting place fell on deaf years. Sponsorship meant approaching Pharma companies and at that time FPA was not well known and did not have the clout which it has now. This meant us [office bearers] going with a begging bowl requesting sponsorship. What was difficult became increasingly easy and members got used to eating free lunch. Then why is this sudden desire to pay and learn?

Let me tell you a real life story which will make you appreciate why. I had a medical school friend who came up the very hard way. His initial years were very difficult and he had no money to pay for his daily needs and his education. He had to entirely depend upon the goodwill of his donors for this. Some paid his school fee, some his lodging and some for his food. The last named was according to him was most demeaning. He would go a house each day for his mid day meal. Some households received him with courtesy and tried to make him feel at home. Some would feed him only after the entire household was fed and some would give him previous days left overs. Very few thought he had a right to self respect. Beggars are no choosers and my friend was a kind of beggar. Receiver of help is always at a disadvantage and in most cases your self respect is at stake. Though my friend became very successful later in life he never would forget the indignity of this free meal.

Then am I right in comparing this with the four course lunch that Pharma companies give us in the sponsored CMEs? I see no difference. At least those who fed Satya [my friend’s name] did it without expecting anything in return. They were thus more altruistic. Whereas Pharma companies expect us doctors to help them to sell their products. Even if one does not do that they know when their sales person meets the doctor he will be received well. This is a perfect example of you scratch my back and I yours. As they are interested in product promotion it was often difficult o have the CME unrelated to product promotion. So the sponsored education remained lopsided. Nevertheless I like many others felt lopsided education is better than no education but the desire to free us from this dependence on Pharma companies was always at the back of our minds [though not all of us!].

Five years ago we took a decision to make the participants of our CME programme to pay a small sum of Rupees fifty [less than a dollar] as a registration fee. There was a mountain of protest. Many came to me and castigated me for having forced them to pay what was earlier free. Their argument was that the sponsor who pays for the programme and lunch does so because he benefits from this either directly or indirectly and who are you [I] to spoil this perfect I scratch your back and you scratch mine arrangement.

Logic almost always defeats reason. It never occurs to us that there is dignity in paying for our learning especially when we can afford to do so. But the logic that when there is someone else who is paying why go and upset the apple cart is still quite strong.

So a beginning has been made and a compromise has been arrived at. We will not go and ask for sponsorship. If someone comes along and sponsors on our terms [speaker and subject of our choice] don’t say no. If none comes forward then pay from your pocket. This is what we did.

We paid for our lunch!

B.P

B.P are his initials. His expanded name is Badri Prasad. I called him BP as visits to me caused some anxiety and raised my blood pressure! He did not mind me calling him BP and the name stuck. It must have been twenty odd years since BP became my patient. During these long years BP must have seen me some five hundred times. Every practice has a percentage of patients who have no real disease [or we have not found any] but have plenty of symptoms.

Twenty years back, when he came for the first time it was for radiating chest pain. The history was so typical that I thought he must be having a heart attack and told him to get admitted under the care of a cardiologist. BP was unmoved; he slowly took out a folder and placed it in front of me. In side I found reports of every available test for heart disease available in the city at that point of time. All tests were normal but BP continued to have pain. I then said it could be something wrong with his neck which could be causing the pain. He took out another folder and gave it to me. It had all the reports pertaining to his neck. There was another folder which had investigations pertaining to his liver, stomach and gall bladder. All were normal. I asked him what medications he was taking. He showed me a list of seven medications and none really required. I told him so and asked him to stop all of them and see what happens.

He came a week later and said he felt much better and wanted to get his BP checked. After getting his BP checked he would not leave. He requested me to feel his abdomen as he was feeling queasy. That done he most reluctantly took my leave with the parting threat that if things are not alright he would soon be back.

Things can never be alright all the time. Many minor ailments we are privy to, are self limiting and we don’t go to the doctor. BP did. In the course of time it became a habit and after due examination I would say,’ you are OK’ and he would go till next time which was not far away. My worry was in the midst of this normal would I be missing something serious? [Every physician’s nightmare]. Another problem was his habit of consulting all kinds of doctors and then reporting back to me to find out if he can follow the advice given. More often than not I said in the negative and he would ask why. This entailed often laborious [to me] explanation. He would go but would leave behind a lurking doubt in my mind what if the opinion given by another doctor was right!
Now you begin to understand why I would become anxious with his visits. You are justified in wondering why I put up with him and not refuse to see him. Times without number I must have told him, ’BP, you are wasting your money and time, I cannot help you, please stop coming to see me’ His reply was ‘it is my time and my money, why are you bothered’! This unhappy state of affairs continued till fate intervened to solve the problem once and for all.

BP died some time ago due to septicemia [virulent infection] unrelated to his myriad complaints. He was 75. What were my feelings on hearing of his death? Mixed. Relief that I do not have to suffer him and that a troubled life ended and some sorrow that I would not see this familiar figure with his huge bundle of medical records. I confess relief more than sorrow.

Tendulkar's dive

Yesterday, India won the one dayer against South Africa by one run! It was cliffhanger of a match when the South African’s needed only 10 runs of the last six balls to win. The combative medium pacer Praveen Kumar who has the ability to swing the ball both ways was trusted with the ball by the Captain M S Dhoni to bowl the final over of six balls. The first ball was placed for a single. None runs to win with five balls to go. The second ball was runless. The third ball was dispatched for a four. Five to get and three balls to go. Fourth ball was bowled and the batsman swept pulled the ball which sped towards the boundary. All appeared lost when Tendulkar, who was fielding deep, ran some thirty yards and flung his 37 years old body at the ball and stopped the ball crossing the ropes thus conceding three but saving one run. Two balls remaining and Kumar in his anxiety to avoid the bat bowled a wide ball with the visitors needing only two runs to win. The next ball was flicked towards the leg side and the batsmen ran a single and attempted the second. The not very accurate throw from the deep was gathered and the stumps were put down by the captain wicket keeper MSD with the batsman short. India won the match by one run!

Had Tendulkar played safe and not dived risking serious injury India would either have tied the match or in all probability lost this thriller of a match. It was an extra ordinary feat considering he has been plagued by injury issues throughout his carrier and no one would have blamed him had he not dived like he did on the rough and hard outfield risking serious injury. But Tendu dived and won the match for the country!

Rosy Pastor

Englishmen whiled away their spare time in pre independent India pursuing many productive activities. One of them was watching birds and trees and naming them. This was a major contribution to our knowledge of plant and birdlife around us. Amongst the others was the production of a delightful community of mixed blood called Anglo Indians. Rosy Pastor is the name given to a bird [size of a common Myna] which has a rose colored front with a black hooded head and has a peculiar habit of looking down [appears to do so]. Imagine a Pastor [priest] with his rich robes castigating you for some mischief you have done and You have the Rosy Pastor. What an apt name!

Rosy pastors [I don’t like the new name of Rosy Starling] breed and live in Eastern Europe and migrate to India during the months of September to March. 15 years ago I used to see thousands of them. On one occasion, during the fruiting season, the orange berries of the ficus tree were completely hidden from view by the avidly feeding Rosy Pastors. In the early 1930s a bird watcher observed ‘the sky went dark when a flock of rosy pastors flew by’ such was their number. This has decreased so much that I did not see any last year and thought I would not see them this year too. But I was in for a delightfully surprising experience.

I went golfing the other day to a golf course located some distance away in a semi rural set up. While I was about to putt on one of the greens, I heard the unmistakable chirp of the Rosy Pastor. Looking up I saw a row of these Pastors resplendent in their rose colored front with blackish hoods raised, chirping [praying I thought] for my putt to drop into the hole. There were at least thirty of them sitting on the silk cotton tree branches all looking in the same direction. It took some pressure from my partners to make me leave that spot. The putt of course was missed what with me imagining a row of red fronted and black hooded priests perched on the tree branch in supplication. You can’t putt with this kind of funny images disturbing you. The missed putt was worth the sight nevertheless.

Some of you must have heard of the names Brahmany and Pariah kite. The Britisher who thus named the two widely seen kites must have been well versed with the caste system and the looks of different castes of the country. The colorful white and russet brown kite was named Brahmany [Brahmin] and the rugged dark grey kite the Pariah, though both raptors live on the dead and rotting flesh!

Sir Garfield Sobers

Garry Sobers as he was popularly known played international cricket representing West Indies for a period of twenty years from 1954 to 74. He was probably the most naturally gifted cricketer ever to have played the game. Coached players play the game by the rules. Players to whom the game comes naturally do it differently and Sir Garry was one of them. Many rate Sir Donald Bradman and our own Sachin Tendulkar among the best who have played cricket but my choice goes to this West Indian from the island of Barbados as the greatest of them all. Do I have reasons to rate him higher than the other two? Yes, many. Sobers was ambidextrous, though he preferred to bowl and bat left handed as it gave him a natural advantage. He scored 360 odd runs in one test match, a record which stood for many years. He bowled leg spin, off spin, medium pace and fast. He could also swing the ball very late. He excelled as a fielder both close in and out field. They said he could also keep wickets! Those who were fortunate to watch him action told that they have never seen the likes of him. He was a five in one all-rounder and enjoyed himself as only a West Indian could.

There are many stories attributed to Sobers. One of them was that he spent a whole night partying and one did not expect him to be on the field next morning. To everyone’s surprise he was there on the field cold sober! West Indian cricketers are exciting to watch. They seem to have the ability to transmit their joy to the viewers. They play their cricket like no others do. Very few of them like to defend. For them the ball is bowled at them to be hit. Hit hey did and in the bargain many times they do get out cheaply. Despite this trait they have produced some all time greats, the latest of them, Brian Lara.

In 1974 the West Indian team visited Bangalore and the present Chinnaswamy stadium was under construction and the stands were made up of Bamboo! I remember one shot vividly. I don’t know who the fast bowler was but the Batsman was Alwn Kallicharan. He went down on his knee and hook pulled the ball out of the stadium. They were like that. They made shots which were not seen before.

Sobers once hit six sixes in an over in a first class match which was done again many years later by our own Ravi Shastri and more by recently by Yuvaraj Singh. Remember that Sobers played his cricket in the pre helmet days!

Sir Garry took to serious golf after he quit cricket. Like many ex cricketers [our own Kapil dev and Roger Binny] he too excelled in the game. Being ambidextrous he played both right and left handed. His handicap during his best days was 1 left handed and 2 right handed!

Sobers is now 75 and lives in his home country and takes active interest in promoting cricket in the West Indies.

My Stroke of Insight

Just finished reading this remarkable book. The author is a neuroscientist, Jill Bolte Taylor who suffered a hemorrhagic stroke when she was thirty seven and the book is the story of her recovery. If it was one of those rehab stories I would not have thought fit to write about it. It is much more than that. During the process of recovery she discovers the nature and location of human mind and the many facets of I consciousness. The intricate interplay of the right and the left cerebral hemispheres and what happens when one dominates the other are very well brought out. More than that, it gives some very valid and acceptable explanations of our relation with life, death and the larger universe that we are part of. A must read for bigots, believers, atheists and agnostics.

Those of us who have valued and enjoyed the immense beauty of our existence, this book gives a fresh evidence why it is so.


Most corrupt country

Surely, India ranks at the top. There was a news report of an Indian Administrative Service officer [these are the blue eyed boys of the government service] getting caught with a mind boggling amount of ill gotten money, 300,000,000,000 Rupees! The story found a tiny place in our newspapers. The same news papers carried full page news with photographs of the scion of our political royal family taking a train ride in the city of Mumbai. We have degenerated so much that we now accept and even appreciate the corrupt!

Dermatitis Medicamentosa

It was closing time when Shabbir came in. Seeing me getting ready to leave, he said, ‘doctor saab, 'I will come some other time, it is nothing urgent’ But his face was tense and I was pretty sure that there was something important he wants to discuss and at the same time he was trying to avoid and postpone the consultation. ‘I have plenty of time, especially for my friend Shabbir’ so saying I took him inside and made him sit down and said, 'now you tell me what is the problem’.

Shabbir, when the incident occurred, was a young man of thirty [twenty five years ago] and an up and coming business man. His work took him to many cities of the country. He had a young wife and a two year old daughter and I was pretty close to the family having been the doctor even for his parents.

He would not begin his story right away and needed some more prodding from me. And at last he began in Urdu. When one is in serious trouble it is the mother tongue that comes to the rescue and not the acquired language English which he usually spoke whenever he met with me. Urdu is a rich language which developed over centuries in this country and it has borrowed liberally from Persian, Hindi and Sanskritand many local dialects. The fun is that the language spoken in north India is different from that spoken in south ad even in south Urdu spoken in Hyderabad is different from one spoken in Bangalore. 'Doctor saab, I feel shy to tell you this trouble I am having since six months, I have gone to many doctors before coming to you’ he stopped to catch his breath and resumed, I got his problem when I went to Bombay on business and since then what to tell you, my life has become one hell’ he stopped. 'You still have not told me your problem’ I said. ‘Yes, yes I am coming to that, please don’t scold me, you know mw I am not such a person but this one time mistake happened'. ‘What mistake happened’ I asked him. ‘Woman mistake’ he said virtually breaking down. I came back from Bombay and my skin there began burning and I was too scared to see you so I went first to Dr-- and he gave me ointment and tablets. I took them for one week. I felt no better and he sent me to hospital specialist who did all tests for VD [Venereal Disease] and gave me injections and some more ointment. I felt little better but the skin peeling continued. I have seen another doctor and even tried homeopathy. You don’t know the tension I am going through, I have not touched Nafiza [his wife] and she is very angry and thinks that I am seeing another woman [bibi bambdy mar is the word he used], you please help me’.

I asked him to undress and had a look at his genitals. The penile and scrotal skin was abraded and covered with whitish scabs. There was no evidence of severe infection. I had a look at the prescriptions he was carrying. He had been given all possible antibiotics that were available in the market and extensively investigated and treated for venereal disease. There was no definite evidence of VD except for the history of having had sex with a strange woman. I asked him to stop applying the two types of ointments he was using liberally and just to wash the skin with soap once a day and see me after one week. When he came after a week he looked much relieved. The skin looked far better. Another week of doing nothing, Shabbir’s allegedVenereal disease got completely cured!

What had happened was that he had developed allergy to the ointments he was applying and those days we used to call this condition, 'dermatitis medicamentosa’. Our Shabbir did not have VD but DM.

Peace once again prevailed in the Shabbir household and has remained so since then!