Thursday, January 28, 2010

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!

Thursday, January 21, 2010

Lost and found

It was the persistent whimper that drew my attention. It appeared to be a child’s small but persistent cry. I went out to the waiting area to investigate. The waiting room was empty but for this two year old who was sitting on the floor weeping. In my clinic I am not only the doctor but also the cook, baby sitter and bottle washer. I don’t have any receptionist or a help to manage the patients and take calls. I have over the years trained my patients to be disciplined and take their turn and I take the calls myself. Though many of my friends have found managing a practice without help tough, I have found it better this way as long as you don’t do procedures needing help. So don’t wonder how the consulting area was so empty. But for this little fellow there was not a soul in sight.

Seeing me he brightened and stopped crying but that did not solve my problem. Where did he come from? None of my neighbors have a toddler of this age and he couldn’t have trespassed into my clinic from the road. The wild thought that has some one intentionally abandoned this boy in my clinic was dismissed as unreasonable. The only conclusion that I could come to was that the couple who came in last, which was some good half an hour ago, must have forgotten the boy and gone.

Though that was the only possible explanation I could not explain how one can forget a child who is with you and leave him and go? Then, was he there when they came out? Was it possible the mother made him sit outside and came in to see me and this boy went outside to investigate my little garden around the house and was not there when the parents came out after the consultation? Yes, that seemed likely. I asked the boy with gestures, did he go out? He replied in Malayalam and his Malayalam vocabulary was better than mine and what he told me was that he needs his mother. This answer was follows by another bout of crying, this time louder.
I picked him up and tried to comfort him telling him that his mother would soon be here, His cry was even louder as obviously he did not follow what I said or he had no confidence in me. I thought some bribery would help. I took him inside and gave him a piece of chocolate. He stopped crying and for the next few minutes was occupied in gobbling up the sweet. The job done he became restless again and began asking for the mother. I took him out and stood near the gate. My curious neighbor who was passing by asked me,’ so doctor at last has one grandson’ [he knows I am too old to have a son of this age]. I had to tell him why and how this little boy was not my grandson.’ If the mother doesn’t turn up he will be yours’ was his parting and rather uncharitable remark.

We came inside and by now we had become friends and the boy was not demanding the mother having probably found a better alternative who gives him an endless supply of sweets and also doesn’t mind playing with him. My worries too faded as I was busy with him. Things thus stood when I heard loud commotion outside. That was the return of the mother who had at last realized that her son was found safe and sound.

As I had thought, when she came out, the boy was not sitting where she had parked him but was out in the garden possibly not visible. She was so preoccupied with discussing her problem with her husband that both forgot about the boy. Even strange was that from my clinic they had gone to the chemist’s and then had driven home. Only when they reached home they realized that their child had gone missing. It took some time for them to deduce that he must be with me. What a relief it was to all concerned to see this reunion.

That was the first and the last time a child has been left behind. Other objects that have been found unattended include umbrellas, ladies bags and purses, shawls, briefcases, mobile phones, foot wear, spectacles, brief cases, a dead drunk patient and once a dead patient. The latter two incidents make stories in their own right and I will tell you guys’ some other time.