Friday, August 28, 2009


When I first met Cyril Naronha he was past seventy. That was some twenty-five years ago. He just peeped into my clinic one day and having found no patient waiting, sat for a while chatting. I later realized that it was his nature to be pleasant to everyone around him that included the daily sweeper of his house and the neighbor’s gardener. He spoke Kannada with a delightful Mangalorean accent. He spoke the language out of choice, though he could speak impeccable English when the occasion arose. In contrast his wife, Miriam Naronha always spoke to me in English. Not that she couldn’t speak Kannada. But English came naturally to her and she was comfortable conversing in it. At home they spoke Konkani, a language which I spoke as a child but since have forgotten to speak but can understand very well. This came in handy when there was any conversation between husband and wife in Konkani that they thought was private and excluded the doctor. This occasionally led to hilarious situations.

Mr.Naronha always paid my fee with a new note. He sometimes took the trouble of going to the bank and exchanged the soiled one with a new one before visiting me. His wife had no such compunctions. When they visited me together, she being the cashier of the house would pay. Once she paid my fee and the notes were visibly dirty. An irritated Naronha told her, ‘I did not know of your love for the old and the decrepit, extended to the old notes; do you think our doctor is there to dump your filthy torn notes?’ She would have none of this unjustified criticism, she said, ‘my husband, what can you expect out of a wife who has had to make do with second hand things most of her life, including the husband! [He was her second husband]!

There were other features that made me like Cyril. He was always impeccably dressed. He had braces to hold his trousers up, first time ever that I saw them. He told me that when young with a bulging belly he needed them to keep the trousers up and now that he had lost he midline bulge he needed the braces to keep them slipping down and making him liable to the charge of indecent exposure! He also had a tie on, that had seen better days. In winter he would have a coat on and in summer he would do without. All this meant, given the slowness of age, he took more time dressing and undressing than the time spent in examination, quite exasperating when you have a houseful of patients waiting. But he more than made up for this by his humor I don’t remember an occasion when he went without making me laugh. Though he did not need to visit me frequently he made it a point to come once a month usually during the first week when he still had his pension money to spend as he once said. My guess is that he came any way to spend some time chatting up with my patients and my attendant and then with me and thus to have a good time. It is only after his death that I realized how much his visits meant to me.

He also told me some home truths about us doctors. Once he compared to Church priests. Both spoke in a language that the clients did not understand. The priest said his prayers in Latin and though doctors spoke in English it is as bad as speaking in Latin. The priest took confessions and the patients too did that with their doctors. He had a very valid explanation for obesity. It was his belief that when you diet you put on weight and when you don’t you remain normal! He gave his own experience of weight gain and loss. When in service he was careful with what he ate and drank but still gained weight. But now in his old age he ate everything edible and drank good wine but had lost the weight and felt never better. He joked that in this country when you hold official position of power it not only swells ones head but also one’s belly! He did not much like my habit of not giving medication when none is needed. He once told me that one must always give something even if not required. He said the bitter the medicine the better the patient felt. He was all for the mixtures [name for liquid medicines doctors made up those days] dispensed as part of the treatment. He compared this with the practice of temple priests giving something away to the devotee in return for the prayers offered. That is one way of getting the till filled he said. When I told him the psychological and placebo value of these mostly useless ministrations and the need to educate the patients, he said patients will always remain ignorant, and felt it is good for their health not to know too much!

He suffered from stable angina and lived with it for several years. The basic investigation those days was the two-step treadmill, and it was strongly positive. They had just begun doing angiography in few centers and no one did it for a seventy plus person. They were destined to be treated conservatively with the mainstay drugs, the nitrates. Cyril did very well with three four tablets of these a day. I visited him on one of those occasions when he had just recovered from an attack of chest pain. He was not sure where the pain actually was. Was it located in the upper abdomen, lower chest or both? This kind of confusion was not unusual and we had no way of knowing whether the patient has had an ischemic episode, a full-blown infarct or just an episode of hyperacidity. We relied mostly on the resting ECG, the patient’s history and our past knowledge of the patient. I found the ECG no different from his previous ones; his blood pressure and pulse were stable. I reassured him and joked that he will live to a hundred and came home.

That night Cyril died in his sleep. They realized it when he did not wake up in the morning. I was now sure that the previous day’s pain was the beginning of a heart attack yet to show in the ECG. I felt terribly guilty not having sent him to the hospital. Instead I had assured him 100 years of life! I went to his place feeling terrible. There was a somber atmosphere with the body laid in the main hall. The parish priest had just left and I went to his wife and couldn’t help apologizing. She said, ‘doc, it is good you did not send him to the hospital, he died peacefully with no suffering, thank you very much for all that you did for him’

Few years later, Miriam too died. Their son, from Cyril’s first wife, comes periodically to Bangalore to visit his mother in law who lives here and drops in to see me. Except for the central bulge he is a replica of his father.

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