Thursday, November 6, 2008

Count Narayan Rao

Both Narayan Rao and his wife are no more. Count died many years ago and madam Rao a few years ago. They had lived not far from my clinic and as Count had many health problems, I was a frequent visitor to their home. He very rarely visited my clinic and would joke with me,’ If I came there, I would get some more illnesses with all those patients there coughing and sneezing.’ This opinion I shared with him and have often marveled at the very few times I have fallen ill considering the number of times and patients with infections that I am exposed to over the years.

Narayan Rao, when he passed away was in his early seventies. He was related to a classmate of mine and that was their reference to see me. He had retired from a corporate executives’ job, but the habits of corporate life remained with him. To look at, he was a tall fair and handsome man, with a red, florid face. He spoke with naturally accented good English. He reminded me of characters I had seen in the movies and read in Wodehouse novels and that is the reason why I came to call him Count Narayan rao. In the course of our brief association I came to call him simply as count.

I looked forward to the visits I made to his home, because I never returned without feeling good and happy after the visit. The reason was not money. As a matter of fact because of the close relationship I did not take any fees from him. The feel good factor was the man himself. He enjoyed life and wanted to share his enjoyment with others which happily included me. He suffered from diabetes, has had several heart attacks and was in early chronic heart failure. But the disease that bugged him most was Gout. I used to make fun of him that he had a rich man’s disease [Gout affects royalty more than others is the popular notion]. Narayan rao was not rich but he led a rich life. Both of them were socialites of the then Bangalore and often they would be out of home attending this party or the other, despite his sickness.

Out of necessity he had to take multiple drugs and that included anti gout drugs. Like it is now then too, the treatment of acute gout was with either colchicine or Indomethacin.Count did not tolerate colchicine so I had no option but to give him Indomethacin, a toxic drug, especially given his other problems. Naturally my prescriptions were niggardly and never more than ten tablets at a time.

Once Count became breathless and I had to rush and see him. His wife was not at home and count was alone and with great difficulty he came and opened the door for me. Then he went back and lay down on his bed. After examining him I found his lungs filling up and wanted to know how much of the prescribed diuretic he was taking. He said he did not know but directed me to the cupboard where his records were kept. I opened cupboard and found a mini pharmacy there along with my notes in one of the drawers.

After giving him an injection of a diuretic, I returned to the pharmacy. I found lots of drugs which he was taking but not prescribed by me, and also several strips of Indomethacin. How did he get hold of this many tablets and has been using them without my knowledge?

I was very worried not only with the toxic Indomethacin but also the variety of unnamed pills and tonics many of them belonging to the class called herbal medicines. The injection had the desired effect and in a short while his breathing eased off. I asked him, He not only agreed that he took the tablets liberally and stocked them as they gave him very good relief. Sometimes he took three to four of them in a day. Horror! This despite my very clear instructions to the contrary. I was so upset that I had to admonish him, out of respect for age rather gently. He said,’ it is I who gets the pain, not you’. For this, I had no adequate repartee, so I kept quiet. After a while I asked him, how he managed to get the tablets without a prescription? He said it was very easy. He tore a white paper out of his letter pad, cut out the portion that had his printed name, wrote out Narayan rao and age and below which wrote the trade name of the drug and the required quantity. Signed my name underneath! He said no druggist has ever refused him so far! He felt no guilt what so ever! This reminded of my old pharmacology professor who used to say, ‘in this country committing suicide is very easy, you just have to go to the nearest chemist’

I stopped all the herbal medicines and told him how this over dosage of Indomethacin was having an adverse effect on his heart’s condition and his diabetes. He became less liberal in the use of that drug. Whatever may be the reason, his condition improved and he lived a few more years and died ultimately at home with chronic heart failure, in my presence.

Few days before his death when I was there with him, a party of his socialite friends had come to see him. By then the news of his seriousness had spread. When they were leaving, count called me aside and pointing to one of the women, whispered,’ that fellow with her is her third husband; I hope she will not have a fourth one’. His wit never left him, so was his jest for life.

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