Profligate spending

Despite all the hype which we see ad nauseum in our electronic media and in our movies which mostly reflect the lives of upper class, we as a people remain what can be called poor. May be, we are better off than we were a decade or two back but we cannot say we have come out of poverty and large sections of our population remain poor.

In contrast, we have a section, though small, who are immensely wealthy. And this section of society with few exceptions, like to show off their wealth. And recent phenomenon of destination weddings is one such example. The host plans and excecutes these expensive weddings in destinations located in other countries or expensive hotels and or resorts located away from home in our own country [ for example in Goa], Spain, Italy, Thailand appear to be the favorite foreign destinations. Guests are flown, and that too hundreds of them in specially hired airplanes to these places and they are wined and dined in addition to the expensive stays. This illness is not confined to film stars and rich sportspersons but has spread to others too, and recently I heard a not so wealthy person did this for forms sake!

Weddings down south used to be one day affairs, occasionally spilling over to the next day in most middle income weddings. Its no longer so. Three day weddings are the new normal and display of wealth in some form or the other whether one has the resources or not is the order of the day. It does not bode well that the young participants take this kind of spending on their stride and even seem to encourage their parents.

This seven star culture as I call it, for want of a better term, is detrimental to social progress as those deprived section of the society, trying to emulate these rich, may be encouraged to take to crime, extorsion, robbery as other ways of acquiring wealth is denied to this section of society. I am afraid it is already happening and we are witnessing a steep rise in violent crime in recent times.

The solution is for the rich to temper their spending and try and live a low key life. There are so many useful ways of spending their money.

Three friends depart

Last year saw three of my good friends leave this world, hopefully for better pastures.

Matianda Ganapathi Nanjappa was the first to go. He lived opposite to me and we were of the same age added to the friendship. He returned to India and Bangalore after a 20-year stint in the UK, some 40 years ago, and our friendship which began then, continued till his death. Initially as a patient and then as a neighbor and later as a golfing buddy, the friendship blossomed. As Kodavas go, he was a tall handsome man with a vey fetching smile and I am witness to many women giving him a second look. Easy going, straight forward, often reticent when it came to criticize another person, he naturally made lots of friends and it is no surprise some exploited this quality of his not that he minded it much. Though his end came after a fall and broken hip and a week of suffering, he was becoming mentally and physically slow and we would find it tough to keep a meaningful conversation going in the past year or so. Dementia in his case was not too bad and his wife was a great support in his last days. Almost every day something or the other happens which reminds me of this friend and I miss him

 

Dr Kota Subbanna Hande was the next to go. Dr Hande hailed from where too are my roots and this may have to some extent contributed to our friendship. More importantly though, his contribution to the growth of the family physician’s association which he served two terms as president and his being a regular member of the doctor’s club probably contributed much more. His stint as a family doctor in rural Yellapur and later briefly in Sri Lanka helped him to become a true family doctor. His practice in western Bangalore, in Magadi road area was large and covered across all strata of society. His case presentations were varied and always interesting and he had a unique style which often was tinged with subtle humor. Ethical to the core, compassionate, available to patients at all hours, he was an asset to the community. His death was untimely as he had many years of active life ahead of him. But then cancer is no respecter of age. His last days were full of unavoidable suffering and death came as a relief.

 

Dr U Suryanarayana, popularly known as Soori was a real-life character. His life was like that of a proverbial cat which had many lives. When he was a house surgeon, he was found unconscious after a motorcycle accident and remained so for several days before making uneventful recovery. Many a time I have wondered if his care a damn attitude was due to this accident and some form of brain shake. Another time he was involved in another accident on a highway and survived mainly because of efficient ICU service at St John’s hospital. Another time he escaped a heart attack and timely recanalization and stenting saved his life. A severe diabetic, he never believed in dieting and couldn’t resist another helping of ice-cream. Never very serious about the profession, he held many a small job and did not care much about updating. I felt his regular attendance at our doctor’s club meeting is more out of friendship and the high tea that followed rather than to any pretense at learning. He too suffered severe septicemia following a wound infection and passed away due to multi organ failure. His son told me that he remained cheerful till the last day of his death.

 

 

Mr. S S Acharya [Shagri Srinivas Acharya]

It was in the year 1970 that I first met with Mr. Acharya. I was scouting around to find a suitable place to begin my practice. This area was just beginning to develop but was mostly rural and Mr. Acharya was one of the very first to settle here after his retirement. Most of his service was in Calcutta and his  family spoke more Bengali than their native tongue Tulu. My uncle had asked me to meet up with him to get the hang of the area as a potential possibility for  my starting practice

Thus, one fine afternoon I landed at his place and rang the doorbell. It took a while for the front door to open to reveal a dour elderly gentleman dressed in Khaki shorts and a white banyan. Later, I realized that it was his standard mode of dress at all seasons. He was obviously unhappy as it was probably his siesta time and  to have abruptly woken up.

I made a quick intro and dropped my uncle’s name. At this his demaneer changed and a smile appeared on his face, and he welcomed me into the house. He made me sit on a hard chair and made himself comfortable on an easy chair. Many years later he told me that it was his ploy to make unwanted visitors uncomfortable so that they would leave early. But then he  also told me some visitors have no shame but sit on for hours despite the discomfort.

Mr. SS after having seated me on that uncomfortable metal chair and coming to know the reason for my visit, proceeded to grill me as to my origin and antecedents. Normally this sort of queries related to my personal matters end up annoying me, but then, here I am a visitor, welcome or not and had to respond to his questions. At last, after this test, he seemed to be satisfied with my pedigree, he proceeded to give me a talk on what he expects from a doctor, frequently quoting the example of his own family doctor at Calcutta and telling me that I too should be like him, available at all hours, never loosing ones cool and at all times keeping service as the primary objective in one’s life etc.

The interview lasted more that an hour and after satisfying that I am a good listener, he gave me a cup of tea and wished me good luck

Thus began our fifteen years of relationship which lasted till his death

Mr. S.S was a diabetic and was insulin dependent and the tragedy was he was also very fond of food. Though I became his trusted doctor, I don’t think I really succeeded in adequately controlling his diabetes. Being from the same area and belonging to the same clan, we would often be invited to same social function or the other and Mr. SS would wait and watch where I would be before he took a seat as far away from me as possible, so that he could eat his meal in peace  away from my watchful eyes. He took one extra dose of insulin before committing this crime!

Mr. SS owned a nondescript car which he  was very fond off and maintained it himself. Often, I would find him with greasy hands tinkering the innards of that car, Once even found him spreadeagled under the car with his scrawny legs sticking out! He would make trips to Shivajinagar raddi shops in search of spare parts for his car. Though this car was a liability [my opinion] Mr. SS did not think so, and turned a deaf ear to his wife’s entreaties to buy a new car!

He was also fond of gardening and had flower bushes and fruit trees in his back yard and on many occasions, he would bring  a fruit or two or some flowers and present these to me with pride and pleasure. As my consulting place was close to his house, it was easy for him to take a walk and see me

He had a trying time during his last couple of years. He developed complete heart block and suffered a stroke. Those days this city did not have any cardiac intervention worth the name. As he suffered frequent episodes of syncope, he needed a pacemaker. This was available in Mangalore [or is it Manipal]. Mr SS  went and got this done and though his syncopal attacks ended, and his quality of life was better in a way, his hemiplegia troubled him and put an end his many interests and for me it was painful to see him going around with a stick and the lopsided hemiplegic gait.

He suffered another CVA and lapsed into coma. I withdrew all the medications and he passed away a week later at home.

Even now, when I pass by the road where his house once stood, these memories come flooding back

Some of you might wonder at my phenomenal memory which has enabled me to recall these details of his life. This is partly due to the diary I have kept which has these record of patient stories, some of these you will find in this blog and not due to any super memory!

 

Dr [Capt.] Thimmappaiah

It was some time during 1972/73 that I came across Dr Capt. T and remained his friend till he died some years ago at the ripe old age of 92.

Those were the days, when compared to now, communication  was primitive and only way was to either personally meet or use the telephone which only few lucky ones possessed. There was three years wait list for processing this valued instrument, though on paper, doctors were supposed to get it out of turn! Having found myself out of date as for as medical knowledge goes, I was looking for avenues to update and the only active body was the local IMA branch, located in the heart of the city. I tried calling to find out if there are any ongoing programs only to find staccato noise at the other end! I decided to pay a visit to the IMA house.

IMA house then and even now houses the state and the local city branch under the same roof and one afternoon, I paid a visit. Considering the time, the building was impressive, and the city office was located on the ground floor. Few tables and couple of chairs with filing cabinets made the office. Most were empty except one which was occupied by and elderly gentleman who later I came to know was the manager and ran the office and the office bearers. I made my enquiries as to the CME programs. While I was talking with him DrT made his entry.

Dr T was always impeccably dressed in a dark-colored suit and with his tall and slim frame, he made an impressive personality. Add to this, his fame as a cricketer, athlete, social worker helped to increase this aura. At that time, I did not know all these additional attainments of his but by his demaneer could gather that he is a doctor. I introduced my self and after he came to know my army background, he became very friendly and next half an hour was spent in telling me his own army experience in the world war on the Burma front. There was not a hint of bragging in his narrating his exploits. I think he must have decided that I am worthy of being in his inner circle at that first meeting itself. He then proceeded to tell me about the various activities of the IMA and how it needed to improve its academic activities and invited me to be part of the activity.

During next couple of years, I became the secretary of the IMA college of general practitioners of the state and my friend Dr S.K Srinivasan, the state secretary. We began running a series of education programmes which sadly ended coupe of years later as the state and the local units were taken over by doctors who had little interest in academic activities, and we were forced to start our own association which came o be known as Family physicians’ association [FPA] that has grown to be a 1000-member body at the time of writing.

Let me get back to Dr T. During his school and college days T was an athlete and a stage artist. Being good looking, he was given female roles. This necessitated shaving of arms and forearms as you cannot have a hirsute playing the female role. On one occasion, after the performance the previous evening, there was an athletic meet next morning where he was taking part in the 200 meters  run. The athletes duly took their stance and next to T was Abdul Khaliq, a classmate and competitor, Khaliq tells him,’ Thimmu, what is this? all hair on your arms gone? I thought u only shave the beard area, u have now begun this new fashion of shaving arms also?’ This was to distract T. Irritated, T replies, E thuruka, u concentrate on running and not on my shaven arms!

Dr T was  more than average cricketer and played for Karnataka in the Ranji trophy matches and has the distinction of being the first one to score a century for Karnataka in a Ranji match. He was also a medium pace bowler and when he was in his mid-fifties was seen bowling to Dilip Veng Sarkar, some 30 years his junior. More than a player Dr T was known as an administrator. He along with Mr Chinn swamy, was instrumental in building the present stadium which goes by the latter’s name. After the demise of Chinna swamy, Dr T became the president and remained at the helm for several years

He was active in the affairs of the IMA, and I remember on one occasion going with him to attend a national conference at Lucknow. We were 5 of us and I have vivid memories of that trip. One of them was in chronic cardiac failure and had poor effort tolerance but who insisted on doing what others did and being the youngest, I was put in charge of this doctor. As he was on diuretic tablets, he needed to urinate often and finding a loo/convenient spot was a major problem. He would often [jokingly] threaten me with this imminency. Throughout the 3-day trip to and 3-day trip back I remember playing poker with no loss of money. Another vivid memory of Dr T on that trip was his stopping play when we approached Whitefield station on the journey back and going to the lavatory. When the train was approaching East station he emerges, clean shaven with his trademark suit on. The West Indies and India test teams were being hosted by him as president of KSCA and he was getting down at cantonment station and had asked his nephew to come to the station to ferry him to west end hotel which was close by. Ten minutes later he bid goodbye to all of us and made his regal departure.

The present IMA building came up because of Dr T and his friends. To name a few Dr Subramanyam, Dr Nagaraj, Dr Ashwathnarayan, Dr Shivram  and Dr Ramaswamy. I may have missed some names. All these stalwarts are no longer with us

He was also interested in classical music and started his lessons when he was in his mid-thirties.  A lady teacher would come home to teach. Dr Subramanyam would often pull Dr T’s legs saying, ‘our Timmu’s wife also began learning not because of any interest in music but to keep a watchful eye on the music teacher’ may not be with out substance given Dr T being so handsome

As I know he was president of a cooperative society, a bank, a music association, and the Indian red cross.

One is justified in wondering how he managed his clinic located in the  city center on Kilary road. I once asked him. He said,’ when I get time, I go there and open the doors. Patients come to know I have come and they arrive, when they are finished and go I too close the doors and go, I earn enough to keep the body and soul together’

This was Dr T

Though very fit, his last years were plagued by back ache and sciatica which he bore with lot of grace.

 

 

 

I am tired

 Mr R is a 70-year-old retired engineer. Mild diabetic and hypertensive on medication. He underwent a successful coronary artery bypass surgery eight years back and since then he has been seeing me twice a year with out fail. Lately however, he has not been able to keep up this schedule for many reasons. One of them being the strong rumor that I have given up practice and have gone away to the US to be with my daughter. Substantiating to this, Mr. R on several occasions had found my consulting chambers locked and my neighbors informing him that doctor has stopped practice. While the first one has no basis the second one has some. Two years ago, I took a deliberate decision to be available to only those who book prior appointment and to keep the doors open only at that time and keep them closed rest of the time. This information given to my well-meaning neighbors resulted in their informing those who came with out appointment and finding the doors shut to  believe that I have shut practice!

Be that as it may, let me get  to  back to Mr. R. He joyfully,[according to him] found out that I am alive and kicking and have not stopped seeing patients. And thus, here he is now, in front of me.

After the usual pleasantries, I  asked him,’ what is the problem’

I am extremely tired, can’t walk even half a km’ he said

Since when, I asked. In the past two weeks he replied.

What have been doing in the last two weeks, I asked

‘ Fearing worst, I went to see my cardiologist and got tests done, he showed me the cardiology test reports and the prescription. All the reports were normal, and he was told not to worry and take the vitamin pills  and get back when due.

I proceeded to examine him. Like his cardiologist ,I too found him with normal pulse, BP with no evidence of failing heart.

Now I am faced with the problem of why is Mr. R is having this recent onset tiredness?

A thought occurred, could he be having low sodium levels? He gave no history of vomiting, diarrhea, recent infection which could have caused his  low sodium and weakness.

How  much water, are you drinking? I asked. ‘ At least two liters in the morning and may be another two during the day, he replied. No doctor, more than that, it is now summer, he is always drinking, his wife chimed in her input.

Is he on low salt diet, ? was my next question

Yes doctor, since my surgery, I am on low salt diet, he replied

Here is a possible explanation for Mr. R’s tiredness. Onset of summer, high fluid intake, low salt intake resultant hyponatremia [low sodium] causing tiredness.

I asked the patient to get his blood electrolytes checked urgently and drink a glass of lime juice, with half spoonful of salt  three times a day and restrict his water intake awaiting the results

But then doctor, his BP will go up if he takes so much of salt, this was the wife’s worry

‘Unlikely in the short run’, I reassured her

With that, they took my leave.

That was three days ago, and there was no news from Mr R or his wife. Now I was worried. Did I miss any, is the patient alright or in serious trouble? Is he in the hospital?

I called him, His wife took the call, I asked her ,’how is your husband doing?

‘Daaktre,[doctor in kannada]’ He is perfectly normal and has now gone for his walk, I wanted to ask u, How long does he need to take this extra salt? She replied

What about the test results? I asked

We did not go, as he was feeling normal, she said and wanted to know if he still needs to do the test?

Two weeks of illness, got cured by two spoonful of salt!