Thursday, November 4, 2010

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.