Sunday, October 25, 2009


When I went to the house from where the call came, I was received by a gentleman who had oriental looking face and a wide grin not at all in keeping with the one in whose family someone was sick enough to have needed a doctor to call home. Later I realized that this man Bir Bahadur had this grin on his face most of the time.

Col Sukmoy Das must have been in his seventies when I first met with him. Unlike other retired army officers he did not lead a genteel impoverished life entirely dependent on the measly pension that the army gave them. At least it was so in those days [twenty odd years ago]. He attributed everything that happened to him to lucky providence. His coming to riches too was one such. The shares that were pledged to him against a loan which was never returned by one of his friends who later died appreciated so much that he ended up a rich man. Did he then live like a rich man? If you go by the usual definition, definitely no. But my own assessment, he was a very rich man at heart. Let me explain. You can draw your own conclusions.

I told this grinning Birbahadur who I am and about the call and the reason why I am there. He became alert and for a moment his grin was replaced by some anxiety. This I have noticed on several occasions. When they see me, instead of relief they become anxious as though at the next moment I will be passing a death sentence. ‘Yes sir, saab he not well, come come, he in bedroom’, and without much of a ceremony, he escorted me to the sickroom and the job done and his grin back, he disappeared.
I found no one in the bedroom which was in considerable disarray. At that moment I heard loud sounds of retching from the closed doors obviously a bath room. A moment later an exhausted looking Col Das appeared. I introduced myself and told him about the call that came from his home. ‘Yes, yes, rather peculiar this happened, normally Hercules rum [ a popular brand those days] is of good quality, but you never can tell these days, even rum they have started adulterating’ he stopped to catch his breath before continuing, ‘normally I drink four large rums at night and I am fit as a fiddle next morning, but this time I have this violent hangover, there must be something wrong with the bloody stuff I drank yesterday night’. I did not have much to do as the diagnosis was fairly accurate. Nevertheless, I had to examine him. I found nothing wrong and he appeared quite fit considering he was past 70. I gave him a prescription for an antacid and returned home. On the way the anxious Bahadur asked me about what was wrong with his boss. When I told him the reason he wouldn’t believe me, he said,’ I drink same rum, but I am Ok, why saab get stomach trouble? I said,’ may be you drink less’. ‘No, doctor saab [Sir in Hindi] he drink four and he give me also four same same’. This master and servant sharing the same drink to gether appeared very strange because at that time I did not know the friend ship between them. I did not have a definite answer but hazarded a guess, I told him he was younger than the Col and his stomach could take the load and the older stomach of the Col couldn’t. Birbahadur did not agree. He said,’ you don’t know Col saab, he drink half bottle, and then thread a needle, maybe he eat wrong at night’. May be you are right, I said and I returned home.

I and Col became friends over the years till his death some 15 years ago. Though retired and rich, he never wasted his time. He would call me for trivial reasons when he could easily have come to my consulting room. It is quite possible he wanted my company and to share his rum [I did drink this obnoxious alcohol occasionally those days]. After getting me a drink which Bahadur brought, he would tell Bahadur in chaste Ghurkali [language of the Ghurkhas],’ fix one for yourself and join us’. The three of us would sit and spend some happy time. Of course I drank far less than these two old soldiers but it did not take away from the connival atmosphere.

He rarely called me during day time but when he did I usually found him tinkering with his car or doing odd jobs around the house or his well kept garden. His friend cum assistant usually stood around watching the boss work, occasionally handing him the tools required. He had an Ambassador car [those days this doddering hulk was the most popular car on Indian roads as other cars were not available] which he personally maintained. Once when I went to his home and asked Birbahadur where is the col, he said,’ under the car’ I went to the back of the house where the car was parked to see the col wriggling out with grease on both hands. He wanted his blood pressure checked! Another reason to get me over.

Those were the years when I was building my practice and col was aware of the many problems I faced and it was his way of helping me. He was such a gentleman that he never made me ill at ease when I was with him. My army service of few years also helped to cement our friendship.

Bir Bahadur and Col Das had served the army in the same regiment and they developed a special relationship and after his retirement Birbahadur was invited to share the living with Col Das. Birbahadur was the man Friday and his wife was the house keeper. Col had lost his wife many years ago and the only son was away living in Germany.

Col died in his sleep one night. When I went to certify the death I found Bahadur very sad with moist eyes. Later I came to know Col had made his life secure. Both Bahadur and wife went back to their native Nepal. There is a multistoried apartment complex where the house once stood and whenever I pass by that place, the memories of these two old soldiers and the happy times I had with them come flooding back.

Friday, October 23, 2009

Disappearing family doctor

Scene one

Patient A goes to his family physician and says,’ doc, I have this head ache again since this morning’ ‘When was the last time you had it?’ Doc asks. ‘Six months ago, and you gave me some pills to take for two weeks and I became Ok and now I have it again’. Doc refers to the records , quickly checks his [patients] blood pressure and temperature and gives him a prescription and tells him to see him if not better in the next two or three days. Patient thanks the doc and leaves. The whole process takes less than 15 minutes.

Scene two

Patient B finds it hard to go to a family physician or doesn’t have one to go to. But there are hospitals he can go to. He goes to one such. He struggles to find parking place and after that ordeal over he reaches the reception area and stands in the queue. When his turn comes the pretty woman asks him in a monotone about his problem. He begins describing his head ache. She cuts him short and tells him, ‘neurology’ [hospital protocol: all head ache cases are first seen by neurologist] and names a fee which is collected and a file with a doctor’s name on it is given to him. Patient follows the directional arrows leading to the neurology department and ultimately, after several false turns finds it. Another reception area and another receptionist, grim faced one this time takes the folder, looks at it and tells him to wait for the doctor to come as he is busy doing the ward rounds. When his turn comes to see the doctor it is two hours and his head ache is now crescendo. The doctor asks him how long he has had it. He says one day. Any earlier episodes? The doctor asks. Yes he replies. A 15 minutes examination later he is asked to do some tests which includes X-ray of his face [sinuses] and a MRI scan of his brain. [Hospital protocol: for all head ache patients these two investigations are to be done]. The patient trudges to the imaging section and waits in the queue. For his pictures to be done it takes another two hours. He is asked to come next day to collect the reports and see the neurologist. It is past 3 pm and the hungry patient with continuing head ache heads home. Seeing his condition, wife gives him a tablet of saridon and then his belated lunch. By evening after a much needed nap he is head ache free!

Next day he goes and meets up with the neurologist with the reports and tells him that his head ache has now gone. The neurologist prescribes a drug any way and asks him to take it for next two weeks.

The drug given to patient A and B was the same.

Patient A spent 150 Rs and patient B spent 8000 and wasted two days of his time!

The latter scene is likely to be the norm if the present tendency of directly seeking help from the hospitals continues as it is likely to be. The reason why this is happening is the gradual disappearance of family doctors.

I recently attended a CME [continuing medical education] for family physicians. Normally my preferred seat is in the front two rows where the speaker is more audible and visible and it is easy to interact if the need were to arise. But occasionally I prefer the last row. This is when for one reason or the other I find the speaker difficult to suffer and a snooze is preferable to the talk. On one such occasion occupying such a vantage seat, I had a view of all those rows of seated doctors in front. There must be about 80 of them. All the heads were either bald or covered with thinning grey. No black at all! Most were on the wrong side of fifty.

If no young doctor wants to be a family doctor what will the patient do but become patient number two?

Why the young have turned away from family medical practice?

Another post, another time.

Thursday, October 22, 2009

Appreciation of beauty

What is beauty? Generally we say she is beautiful to describe a good looking woman or it is beautiful to an object. But is it only the looks that the eyes see that matter? I don’t think so. Or am I looking at objects animate and inanimate differently? It is the feeling of joy that one experiences when looking at an object that can be described as beauty.

I had one such experience when I visited the exhibition of cartoonist Mario Miranda’s works few days back. What is it that made me so happy? Is it the brilliance of execution? Is it the humour? Is it the type of scene or objects he chooses for his paintings and drawings? Or is it the mixture of all these? I don’t know. I only know that I felt happy and I had no other thought in my mind in the three hours I spent appreciating this great artist’s work.

I bought the print of one of his paintings. It is of a failure [Hobo] leaning against a lamp post. There is such intense pathos in that picture that it is difficult to put into words. Again one should feel it as I felt it and I was compelled to buy it. Why did I do it when there were pictures which would have made me laugh which is a positive emotion instead of this picture which will make me feel sad? Appreciation of art need not always fill you with pleasure; sometimes the agony too is sort of enjoyable. I am tying myself into knots trying to explain what I felt. I hope you guys get the meaning any way.

I also bought a beautifully written book on Goa [Inside Goa] by Manohar Mulgoankar, richly illustrated my Mario Miranda. Those of you who are planning a holiday in Goa will benefit reading this book.

Sunday, October 11, 2009

Muniyappa wins the Indian Open

From time to time I have written about this young golfer from my club who overcame the major disadvantages of poor socioeconomic and educational background, to excel in this difficult to master game of golf. Please read my blog post of 20, sept, 2007 to know about his background.

I just now finished watching him winning the Indian open in a play off and a purse of 195000 dollars is his. The manner of his win was nothing short of extraordinary. His tee shot [drive] found the edge of a bunker on a downhill lie. He choose to hit over an intervening tree when the easy option would have been to chip the ball on to the fair way there by loosing distance but making sure he is on the fairway for the next shot. He managed to hit a brilliant lob from the thick grassy lie and the ball flew over the tree to lie perfectly on the fairway giving him an easy approach shot which he hit with in ten feet from the pin to hole out with a birdie and win!

This is his first major win and he has made all of us who have supported him very proud.

Congratulations, Mr. Chinnasamy Muniappa. You have done it and in style.

Thursday, October 8, 2009


He sat some distance away from us. We were four. I was a fledging medical student and the two with me were elders from my home town and one of them was the father of the youngman who sat away from us. They had come to see me to get help to access a psychiatrist in one of the premier neuropsychiatric institutes of the country [true even after 50 years, the Institute I mean]. As a medical student I could get them to see the specialist without much hassle. But before that we had to have our lunch and we had gone to a nearby eating place. The patient in question chose to sit apart or the seniors made him sit apart I don’t know.

The problem was that the youngman was not like others of his age. He hardly talked, was not much interested in dress, took bath several times a day, extremely poor in scholastic performance [he was 20 but had not passed his metric [high school], very fond of animals but cruel to his brothers and sisters, disobeyed orders etc. They were advised to see a psychiatrist and this commodity of doctors were hardly there in those days and only ones present were in this institute. If they had taken all the trouble to come from such a far off place, there must be really something wrong with the man I surmised. Then who am I to decide, my job was to take them and make then see the nut cracker [psychiatrist].

We ordered meals for four. Those days, food was very cheap and came in unlimited quantities. For half a rupee [three cents] one could eat a stomachful. The tray had rice, lentils, pickles, three vegetables, a bowl of curd and four rotis [kind of flat whet bread]. You can order a refill of any of the items any number of times! We were all finishing our respective meals when the waiter came to our table and pointing to the youngman sitting at a distance asked us,’ is he the part of your party?’. We said yes. He said, ’please tell him we have run out of roti dough’.’ You are supposed to serve unlimited number, how can you run out of food’ I asked the waiter. ‘Yes, what you say is correct under normal working conditions, but he, again pointing an accusing finger at the distant figure, has already eaten 25 rotis and is demanding more’

25 rotis! Enough to fill stomachs of five normal persons and here is this thin built man who has eaten 25 rotis and is demanding some more!’ 'You tell him that that is all you can serve him and no more’ I told him. ‘I did that and he is showing the board [which declared unlimited food] and has also taken out his pocket knife and is making threatening gestures. He is part of you guys and you please handle him’ said the waiter.

We were now faced with a new problem. I asked the father about his violent nature and the prodigious appetite of his son. He said,’ sometimes he becomes violent for silly reason and after a while he calms down but I have not seen him eating this much before. I will go and tell him that the food is over and he has to stop eating’. The father went to his son and tried to explain. After some loud altercation the son seemed to simmer down and there was peace once again in that hotel. The father returned to our table and said,'this is another problem, you never can tell what this fellow will do next, I only hope the doctor will help him’

Bakasura is the name of a demon mentioned in the Indian epic Mahabharata, who terrorized villagers around and demanded and got a cartful of food daily. His appetite was so great that he not only ate the food but also the bullocks and the cart man! How the distressed villagers were saved by Bhim is part of the story of Mahabharath. Looking at this thin tall man I just couldn’t believe his stomach could accommodate so much of food. A true modern day Bakasura I thought.

Consultation was duly done that afternoon and he was prescribed some medication and the party went back to the village. Many years later I came to know that this youngman, though academically a failure, became a successful agriculturist, married and raised a family with no apparent problems!

This brings me to the problem I have often faced in my practice. Who is really psychiatrically ill? How many of the patients who are presently being treated as ill are victims of the oppressive or unacceptable environment and their reaction is interpreted as psychiatric illness? Are we doctors dumping patients who are normal and because we cannot find anything wrong, as mentally ill and treating them?

Today’s psychiatrically ill, may be tomorrow’s normal person?

Tuesday, October 6, 2009

Conversations with a guide

I don’t know why he chose me for comfort and advice. It all began like this.
‘Sir, I hope you don’t mind me asking you’ he said. I said. ‘certainly will not’
‘Sir, I don’t know why Mr. R doesn’t like me?’ I asked him how does he know. ‘Yes I know, I heard him say, I take cut from the shops I take you people to’. I asked him, ‘Santo,’ have you ever worked as a cook’?. This question took him by surprise. He must have been wondering what cook has to do with the problem he has come to discuss with me. He said no, he has no experience as a cook. ‘Supposing you worked in a kitchen as a cook, will you not taste the food? Now he brightened up a bit. He said,’ yes sir I will, otherwise how I know food is good? I said, ‘the same thing is true with tour guides. They must taste the items they make the tourists buy’. Now he was visibly happy. ‘Sir you really think so? I said yes. But still he lingered on. ‘But sir, he thinks I take money. I told him it doesn’t matter which ever form one tastes. ‘Sir I cannot do it, I am Buddhist’. I said Buddhist or no you are a guide and you must first taste the food before you make us eat’. ‘Thank you sir for your advice’ and he left.

Another day he came to the room,’ sir I have one more problem. I asked him what it is now. ‘Sir that old man [all of us are old but he singled out one] Mr. P asks difficult questions. I said we tourists don’t know which questions are difficult and which are not. But sir, ‘it is not once but many times,’ today he asked me why Buddhists don’t follow family planning? I told him,’ sir there is no state policy’. He says state doesn’t say when one has to have sex, it is individual’s decision, you are a Buddhist you should know. ‘Sir how can I answer this question?’ I said,’ you be quiet and don’t answer such questions. ‘Sir I did, but he won’t leave me. ‘Santo, he tell me, why are you quiet? You not answered my question? ‘What did you tell him?’ I asked him. ‘Sir I told him I don’t know about Hindus but we Buddhists enjoy sex’. I came to like Santo. I asked him what he [Mr P] said to that. ‘Sir he became quiet but I see he not happy with the answer’. I told him I was very happy with the answer. Santo appeared pleased with my response, but ‘sir,’ I cannot upset people’. I told him not to worry.’ Mr. P will be secretly happy, any way old men of our age just talk about sex where as you guys actually do it’. A very pleased Santo left me.
‘Sir another problem’ Mrs. K thinks that the store where we went this morning sells fake jewelry. I told him all costume jewelry is fake. ‘Why sir, you too think so? I said the jewelry sold is not made of silver or gold, they are all plated. ‘Aaah,’that kind of fake,’ that everyone knows’. ‘But Mrs. K doesn’t’ I told him.’ she must have heard that in Srilanka jewelry is cheap and she must have been disappointed to find it is cheap because it is plated. ‘I will be careful hereafter and tell all Indian women tourist that the jewelry is plated, they will not blame me for taking them to a fake store’ Santo said before leaving.

Another day another problem, Sir that man who always has a serious face; he found it difficult to remember the name. I told him he is Mr. S. ‘Yes, Mr. S,’ he says why is it raining here always? You should provide umbrellas to all’. ‘Sir, he continued, do I make rain? I said no. ‘That too not in season?’ For this also I said no. ‘Then why sir, this gentleman wants umbrella at all times?’ I told him, ‘see Santos, why some people wear a coat at all times? Even when it is hot? He said he doesn’t know. ‘That is because it is a habit. Mr. S carries an umbrella all the time when he is in Bangalore and that is why he wants you to provide an umbrella and because he cares for others he has included all of us’. But sir,’ giving umbrella to all 21 is difficult, but still I will tell the company for future [he made a note in his diary]. From umbrella he jumped to another topic. He said sir,’ I am also a sportsman’. I became interested and wondered why he was telling me this. I asked him what sports he plays. He said,’ I play Billiard’. I said,’ very good ‘[felt the game suits his paunch] ‘Sir, you play billiard?’ I said no. ‘Sir Billiard is also like golf, you put ball in the hole, but area of play is small, not like golf’. He waited for my reaction. I said.’ Yes Santo,’ but Golf is easy.’ No sir,’ golf very difficult,’ in golf you have to walk all over, get wet, hit a small ball with a long stick, get leg pain, then sir you have to drink beer after you finish’. I agreed with most of what he said but not the last part. I told him drinking beer is not compulsory. We drank beer because Srilankan beer is very good; He beamed with this appreciation of Srilankan beer. ‘But sir there is one gentleman, Mr. P who drinks only Srilankan Arrack, not good for his age, you are a doctor, you tell him not to drink like that’. I told him, ‘Santo that Mr P can drink a bottle of arrack and still play a round of golf’.’ OK, then sir don’t tell him, let him drink Srilankan arrack, only two days left [for the tour to finish] you know’.

Another day. ‘Mr S, he don’t like me. ‘Why not, I saw him with you talking and laughing this afternoon’ I said. ‘Talking yes but no laughing no sir’. ‘Why does he not like you?’ I asked. ‘Not liking, not in that sense sir, he does not like me sitting with you yesterday at dinner table. I think he belongs to superior caste. In India, I think you have this caste superior and inferior, I have heard’. Santos, I said, ‘You are a Buddhist, you belong to the most superior caste and you have right to sit at the centre of any table’. ‘Sir then why he told me so?’ Santos asked. ‘See Santos, that Mr. S, he is big businessman, he wants to talk business and if you sit with him he cannot talk business, but only about tour, that is why he told you not to sit at the table’. This placated him. ‘Oho so, but I will be careful [another note in his diary].

‘Sir, Janak thinks you all are very good people’ .This unasked for compliment from the bus driver took me by surprise. I asked him how he has classified us thus. He says,’ all of you wish him before getting into the bus ’. If being good is just wishing then the whole world would have been of good people. I kept quiet. ‘But there is one person, Mr. S who has not wished him so far’ Santos complained. I asked him, ‘why are you telling me this’. He said,’ I must tell for your future reference’. What it meant I don’t know.

On the day of leaving Santo came to see me one last time, He said,’ sir this tour was very good, you all are such good educated people, your wives also’ he added as an afterthought. I asked him, ‘but you had so many complaints’. He said,’ sir that is for my education, last tour group had only Germans, I suffered so much I cannot tell you, your group very good’

On that salutary note our Srilankan golf cum sightseeing tour ended.
[Some facts and lots of fiction]