Saturday, February 16, 2008
kill the patient and get thanked
I was on the phone with the patient's wife. She was asking me if can suggest some medication for her husband who was having severe nasal block and was unable to sleep.I told her the name of an anti histamine and told her that it will give him relief and added for a good measure,'it will also put him to sleep'. She in turn thanked me and wished me goodnight!
Thursday, February 14, 2008
Diagnosis of deafness and aftermath
She looked familiar. The thin figure with the pinched up face and hurried gait. I went across ad accosted her. She was the same person as I thought. 15 years had gone by and she said I was often in her thoughts. It was the same with me.
When I first saw her daughter she was just past two years of age. A little delightful toddler she was but was given to unexplained temper tantrums. The parents and I were at our wits end to know why. There was some suggestion that it could be one form of autism! I found it hard to believe. I found out the cause more by accident than by design. One day after the consult, I called out her name but got no response. I turned her around and got a nice smile and response. The delayed speech was attributed by the ENT doctor as normal and the parents were reassured that all would be well.
Now I was not so sure. The girl was born deaf and we had not recognized it in time. Had we done that, even in those times, Cochlear implant could have been attempted. I spent time with the kid and parents and once we understood her problems our attitude towards her changed and her tantrums became less and in the course of next two years disappeared.
Today routine screening of newborn is done in major institutions and Cochlear implant has also become common which, done early restores hearing to near normal.
What followed is worth recording. The father changed his job to another which gave him more time to spend with the daughter. Mother [the lady mentioned above] gave up her job to spend full time with the daughter. They did a lot of research on deafness [I too learnt a lot from them] and how to manage a deaf child. Both learnt sign language and how to teach phonation. They also decided not to have another child. Their sacrifice and effort paid off. The mother in particular showed enormous strength of character and courage and after tiding over the crisis period started working again!
The girl is now a normal 17 year old pursuing her studies in a boarding school!
These are the real life experiences that I cherish. Nothing else in life, gives this kind of satisfaction and pleasure.
Progress
Meditation. It takes 35 minutes of five sessions of seven minutes each. I can now last four sessions of squatting without pain. A month ago it was 14 minutes! Progress indeed! What about the mental health which it is supposed to improve? I cannot make this assessment and none of the near and dear have done so yet!
When I first saw her daughter she was just past two years of age. A little delightful toddler she was but was given to unexplained temper tantrums. The parents and I were at our wits end to know why. There was some suggestion that it could be one form of autism! I found it hard to believe. I found out the cause more by accident than by design. One day after the consult, I called out her name but got no response. I turned her around and got a nice smile and response. The delayed speech was attributed by the ENT doctor as normal and the parents were reassured that all would be well.
Now I was not so sure. The girl was born deaf and we had not recognized it in time. Had we done that, even in those times, Cochlear implant could have been attempted. I spent time with the kid and parents and once we understood her problems our attitude towards her changed and her tantrums became less and in the course of next two years disappeared.
Today routine screening of newborn is done in major institutions and Cochlear implant has also become common which, done early restores hearing to near normal.
What followed is worth recording. The father changed his job to another which gave him more time to spend with the daughter. Mother [the lady mentioned above] gave up her job to spend full time with the daughter. They did a lot of research on deafness [I too learnt a lot from them] and how to manage a deaf child. Both learnt sign language and how to teach phonation. They also decided not to have another child. Their sacrifice and effort paid off. The mother in particular showed enormous strength of character and courage and after tiding over the crisis period started working again!
The girl is now a normal 17 year old pursuing her studies in a boarding school!
These are the real life experiences that I cherish. Nothing else in life, gives this kind of satisfaction and pleasure.
Progress
Meditation. It takes 35 minutes of five sessions of seven minutes each. I can now last four sessions of squatting without pain. A month ago it was 14 minutes! Progress indeed! What about the mental health which it is supposed to improve? I cannot make this assessment and none of the near and dear have done so yet!
Wednesday, February 6, 2008
Dignity in death
His name was Madhavan Nayar. I must reassure the many Madhavan Nayars who are alive and kicking, and some who are my patients, that this is a pseudonym.
It must have been 30 years since I had known him and, as it happens with us general practitioners, initially as a patient and over the years, also as a friend. Now looking at him lying in disheveled clothes in a badly made bed, made me think not of the indignity of death but the peculiar personality of Mr Nayar and what drew us to each other.
I keep a fairly tidy examination room with a fresh white sheet spread over the examination couch each day and some times twice a day. Despite this, there would be a few discernible smudges, especially at the foot end of the bed. No one minded this till I met Mr Madhavan Nayar.When his turn came to be examined, he took one quick look at the table, excused himself politely, said he would return in the evening if I did not mind, and went away. When he returned in the evening he had a small bag with him. From this bag he took out a clean white sheet and proceeded to spread it on my examination couch, all the while apologizing for his action and requesting me not to get offended. I did not, having met many with much stranger personalities than this one. After the examination was over he neatly folded the sheet and put it back in his bag.
That is how we met. Since then, each time he visited me he had followed this procedure. The fastidious nature was in keeping with the general character of the man. He was one of the few patients of mine who always telephoned me before coming despite knowing the fact that I don’t follow the appointment system. He was always on time even if it meant waiting for his turn.
Since we lived in the same area and belonged to the same club, we also had the same barber. On one occasion, I bumped into him while he was coming out of the barber’s shop. His usual bag was with him and I of course knew what it contained. When I went in, I asked the barber about the bag. Like the other members of his tribe this one too loved telling a story. Not only did he have a white sheet for his exclusive use but had a whole range of barbering equipment to the last new blade, well packed in a special case. He made the barber wash his hands and dip his hands in a solution of disinfectant before allowing him to touch his head. When I heard this I wondered why he did not make me wash my hands before examining him. May be he had watched me washing hands after examining each patient and therefore did not feel the need. But I certainly don’t dip my hands in disinfectant! I had wondered then, when he would make this request of me and if he did, what must I do?
We met occasionally at the club over a drink. His order was precise. A small whiskey of a specific brand, two cubes of ice and an equal amount of water. Ice cubes to go into the glass first. When the glass with whiskey arrived he would hold up the glass to the light and give it a close look to see if there were finger prints. If he found any the order would be repeated. Needless to say the waiters were wise to his ways and his glass was always well wiped before the drink was poured.
I would often wonder whether he was an obsessive psychotic. Even if he was one, no one was unhappy, not the least Mr Nayar. He had a very happy family life and a close circle of friends who liked him. He was also a very successful business man.
But in death he was like any of us. After the certification formalities were over, I asked his son to get me his shaving kit. We gave him a good shave taking care to use a new blade. Dressed him in a new shirt and a mundu and spread a clean sheet over him after changing the old bed sheet with a new one. Now I thought he was ready to receive the mourning friends and relatives in his accustomed style.
I returned home with mixed feelings. A sense of sorrow for having lost a friend and a sense of satisfaction for having done something for him. This I am sure,he would have appreciated, had he been alive.
It must have been 30 years since I had known him and, as it happens with us general practitioners, initially as a patient and over the years, also as a friend. Now looking at him lying in disheveled clothes in a badly made bed, made me think not of the indignity of death but the peculiar personality of Mr Nayar and what drew us to each other.
I keep a fairly tidy examination room with a fresh white sheet spread over the examination couch each day and some times twice a day. Despite this, there would be a few discernible smudges, especially at the foot end of the bed. No one minded this till I met Mr Madhavan Nayar.When his turn came to be examined, he took one quick look at the table, excused himself politely, said he would return in the evening if I did not mind, and went away. When he returned in the evening he had a small bag with him. From this bag he took out a clean white sheet and proceeded to spread it on my examination couch, all the while apologizing for his action and requesting me not to get offended. I did not, having met many with much stranger personalities than this one. After the examination was over he neatly folded the sheet and put it back in his bag.
That is how we met. Since then, each time he visited me he had followed this procedure. The fastidious nature was in keeping with the general character of the man. He was one of the few patients of mine who always telephoned me before coming despite knowing the fact that I don’t follow the appointment system. He was always on time even if it meant waiting for his turn.
Since we lived in the same area and belonged to the same club, we also had the same barber. On one occasion, I bumped into him while he was coming out of the barber’s shop. His usual bag was with him and I of course knew what it contained. When I went in, I asked the barber about the bag. Like the other members of his tribe this one too loved telling a story. Not only did he have a white sheet for his exclusive use but had a whole range of barbering equipment to the last new blade, well packed in a special case. He made the barber wash his hands and dip his hands in a solution of disinfectant before allowing him to touch his head. When I heard this I wondered why he did not make me wash my hands before examining him. May be he had watched me washing hands after examining each patient and therefore did not feel the need. But I certainly don’t dip my hands in disinfectant! I had wondered then, when he would make this request of me and if he did, what must I do?
We met occasionally at the club over a drink. His order was precise. A small whiskey of a specific brand, two cubes of ice and an equal amount of water. Ice cubes to go into the glass first. When the glass with whiskey arrived he would hold up the glass to the light and give it a close look to see if there were finger prints. If he found any the order would be repeated. Needless to say the waiters were wise to his ways and his glass was always well wiped before the drink was poured.
I would often wonder whether he was an obsessive psychotic. Even if he was one, no one was unhappy, not the least Mr Nayar. He had a very happy family life and a close circle of friends who liked him. He was also a very successful business man.
But in death he was like any of us. After the certification formalities were over, I asked his son to get me his shaving kit. We gave him a good shave taking care to use a new blade. Dressed him in a new shirt and a mundu and spread a clean sheet over him after changing the old bed sheet with a new one. Now I thought he was ready to receive the mourning friends and relatives in his accustomed style.
I returned home with mixed feelings. A sense of sorrow for having lost a friend and a sense of satisfaction for having done something for him. This I am sure,he would have appreciated, had he been alive.
Sunday, February 3, 2008
Egypt visit
Those of you who hit my blog regularly must be wondering what must have happened to me during the past two weeks! I was away touring Egypt! Why Egypt of all the countries? This is because Egypt has the earliest written evidence of history. This goes back to 5,000 years! It was fascinating to see it firsthand.
But the sight of the huge pyramids, the secret passage to the burial chamber and the goodies that were left behind, the mummification process of preserving the dead, the colossal temples, all done 1000 to 4000 years B.C, was exciting and also depressing. Exciting because of the human ingenuity that was involved in performing these engineering feats in those times and depressing because of the immense suffering it must have caused to the hundreds and thousands of human slaves who worked at these sites.
How do we leave behind evidence of what we were so that posterity will know? Do we have to build huge temples and graves? Is there any need at all to leave the traces of our existence? Why should death preoccupy out present life so much as it did during the days of Pharaohs who spent their lives in creating these and stocking them with worldly goodies only to be looted later?
But the sight of the huge pyramids, the secret passage to the burial chamber and the goodies that were left behind, the mummification process of preserving the dead, the colossal temples, all done 1000 to 4000 years B.C, was exciting and also depressing. Exciting because of the human ingenuity that was involved in performing these engineering feats in those times and depressing because of the immense suffering it must have caused to the hundreds and thousands of human slaves who worked at these sites.
How do we leave behind evidence of what we were so that posterity will know? Do we have to build huge temples and graves? Is there any need at all to leave the traces of our existence? Why should death preoccupy out present life so much as it did during the days of Pharaohs who spent their lives in creating these and stocking them with worldly goodies only to be looted later?
Sunday, January 20, 2008
What irritates me?
When in a group one speaks in a language that others don’t understand.
When one speaks out of turn.
When one asks a question when he knows the answer.
When one speaks louder than required.
When one coughs or sneezes without a hanky covering his mouth/nose.
Gives information culled from that morning’s newspaper.
Gives opinion without a knowledge base.
Doesn’t know when to stop.
This happens frequently in day to day dealings.
Now you know why I have taken to meditation!
When one speaks out of turn.
When one asks a question when he knows the answer.
When one speaks louder than required.
When one coughs or sneezes without a hanky covering his mouth/nose.
Gives information culled from that morning’s newspaper.
Gives opinion without a knowledge base.
Doesn’t know when to stop.
This happens frequently in day to day dealings.
Now you know why I have taken to meditation!
Tuesday, January 15, 2008
Hole in one
In the game of golf, hole in one has a special place. This means that on a three par hole your shot from the tee box lands the ball in to the hole. You will not get the same recognition if you were to do a four par in two strokes when it is called a birdie or a five par in three when it is called an eagle. Getting birdies and eagles is not uncommon but to get a hole in one is extremely rare and a golfer holds this as an achievement despite the fact that there is an element of luck in addition to skilled shot making in achieving this feat.
Life time of playing and you may not get his distinction and one may get it in the very first year of playing. It happened to a friend of mine within three months of playing and he couldn’t understand all the fuss the others made of this because he still was not aware of the rarity of the feat. Another one who achieved this after three decades of golf did it in the most unusual way. He mishit he shot which rolled all the way to the green and dropped into the hole. When he went in search of the ball which had sped and having not found it anywhere around he looked casually and found it resting at the bottom of the hole. A bad shot getting rewarded was his comment. This did not prevent his friends and others in the clubhouse extracting their pound of flesh in the form of several rounds of drinks at his cost.
I achieved this feat two Sundays ago. This short three par 135 yards, has a visible green and when the good seven Iron shot soared high and dropped near the pin I had no idea that it had dropped inside the hole till the caddies who could actually see the ball disappearing into the hole jumped up and screamed ‘ hole in one’. It took a few seconds to sink in and then it was few minutes of pure ecstasy and then on to some elated mood. That I had to stand rounds of drinks was a pleasure. It took nearly 20 years of playing this game to get this distinction.
Our club rewards the getter of a hole in one with a branded travel bag, ten cases of beer, 5 bottles of whiskey, six bottles of vodka and one case of white wine. As I couldn’t carry this booty in my small car, I had to requisition the club’s van to transport this to my home. My drinking is confined to an occasional weekend beer and the only way to get rid of this quantity of liquor which was occupying the much needed space in my garage was to give it away. I spread the word around that I am holding a garage offer. It took just three days for my friends to clear the whole lot to my delight!
Many of these wished me to keep getting hole in ones.
Silence
To remain silent needs a lot of discipline. Natural outlet for ones thought is to give expression and the best way is to mouth it. Most people love to talk and very few to listen. Even when they listen their brain is thinking what to say to what they are listening. When one is alone and the mouth is therefore necessarily shut one can remain silent. Easy said than done. The mind is active and the run of thoughts is incessant and thus you are not silent though you are not making noises. Emptying the mind of all thoughts, I believe, gives one bliss and meditation helps you to achieve this. I have just started with one technique that was taught to me and hopefully when it happens I will let you all know. At present I am at the stage of learning to sit cross-legged on the floor for the 35 minutes and let me tell you that it is no bliss.
Life time of playing and you may not get his distinction and one may get it in the very first year of playing. It happened to a friend of mine within three months of playing and he couldn’t understand all the fuss the others made of this because he still was not aware of the rarity of the feat. Another one who achieved this after three decades of golf did it in the most unusual way. He mishit he shot which rolled all the way to the green and dropped into the hole. When he went in search of the ball which had sped and having not found it anywhere around he looked casually and found it resting at the bottom of the hole. A bad shot getting rewarded was his comment. This did not prevent his friends and others in the clubhouse extracting their pound of flesh in the form of several rounds of drinks at his cost.
I achieved this feat two Sundays ago. This short three par 135 yards, has a visible green and when the good seven Iron shot soared high and dropped near the pin I had no idea that it had dropped inside the hole till the caddies who could actually see the ball disappearing into the hole jumped up and screamed ‘ hole in one’. It took a few seconds to sink in and then it was few minutes of pure ecstasy and then on to some elated mood. That I had to stand rounds of drinks was a pleasure. It took nearly 20 years of playing this game to get this distinction.
Our club rewards the getter of a hole in one with a branded travel bag, ten cases of beer, 5 bottles of whiskey, six bottles of vodka and one case of white wine. As I couldn’t carry this booty in my small car, I had to requisition the club’s van to transport this to my home. My drinking is confined to an occasional weekend beer and the only way to get rid of this quantity of liquor which was occupying the much needed space in my garage was to give it away. I spread the word around that I am holding a garage offer. It took just three days for my friends to clear the whole lot to my delight!
Many of these wished me to keep getting hole in ones.
Silence
To remain silent needs a lot of discipline. Natural outlet for ones thought is to give expression and the best way is to mouth it. Most people love to talk and very few to listen. Even when they listen their brain is thinking what to say to what they are listening. When one is alone and the mouth is therefore necessarily shut one can remain silent. Easy said than done. The mind is active and the run of thoughts is incessant and thus you are not silent though you are not making noises. Emptying the mind of all thoughts, I believe, gives one bliss and meditation helps you to achieve this. I have just started with one technique that was taught to me and hopefully when it happens I will let you all know. At present I am at the stage of learning to sit cross-legged on the floor for the 35 minutes and let me tell you that it is no bliss.
Tuesday, January 8, 2008
Female Infanticide
One of the worst crimes that is being committed is selective killing of female fetuses and infants soon after birth. Occasionally it is the mother who is responsible adds more tragedy to this crime. India takes the pride of place in committing and helping to perpetrate this most heinous crime against female life. Calling ourselves a developing nation is meaningless unless we give equal social and economic status to our women and treat them with respect they deserve with out being condescending. Hopefully with women’s empowerment this crime will become less and will in the course of time disappear.
I like to quote Dr.M.K.Mani a renowned Nephrologist and a sensitive human being from Chennai.
Cradle baby scheme
One or other illegal, worse, criminal action that governments all over the country have been unable to prevent is large scale murder of female infants. In 2002, the government of Tamilnadu introduced a scheme to prevent murder by persuasion if not by enforcement. Cradles were placed outside government hospitals and the girl babies could be deposited there. No questions were asked and the children were sent to orphanages to be brought up there. In few instances the parents openly brought their chideern over. They were counseled and in some cases they changed their minds and took the children back. The Dahrmapuri government hospital reported recently that it had received 955 babies since the scheme started. 39 were boys; 50 of the children were taken back by their parents. Despite this way out, many parents still resort to infanticide and between 35 and 70 cases are reported every year. Our neighboring Salem district the female to male birth ratio was 850 females to every 1000 males in the year 2000. Later studies are not available for the district as a whole, but studies from different primary health centres [PHCs] and villages show depressing ratios of between 706 and 901.Perhaps the cradle baby scheme needs more publicity in rural areas.
Pretty dismal isn’t it?
Kill the patient?
This morning while examining a patient I got a phone call. I told the caller that I will call him back after I finish this patient! The patient had the grace not to believe me and stayed put on the examination table.
I like to quote Dr.M.K.Mani a renowned Nephrologist and a sensitive human being from Chennai.
Cradle baby scheme
One or other illegal, worse, criminal action that governments all over the country have been unable to prevent is large scale murder of female infants. In 2002, the government of Tamilnadu introduced a scheme to prevent murder by persuasion if not by enforcement. Cradles were placed outside government hospitals and the girl babies could be deposited there. No questions were asked and the children were sent to orphanages to be brought up there. In few instances the parents openly brought their chideern over. They were counseled and in some cases they changed their minds and took the children back. The Dahrmapuri government hospital reported recently that it had received 955 babies since the scheme started. 39 were boys; 50 of the children were taken back by their parents. Despite this way out, many parents still resort to infanticide and between 35 and 70 cases are reported every year. Our neighboring Salem district the female to male birth ratio was 850 females to every 1000 males in the year 2000. Later studies are not available for the district as a whole, but studies from different primary health centres [PHCs] and villages show depressing ratios of between 706 and 901.Perhaps the cradle baby scheme needs more publicity in rural areas.
Pretty dismal isn’t it?
Kill the patient?
This morning while examining a patient I got a phone call. I told the caller that I will call him back after I finish this patient! The patient had the grace not to believe me and stayed put on the examination table.
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