Resurrection

My friend Dr.B.S.Prabhakar is a busy practitioner in the inner city area. Like many other GPs who have busy practices he too finds it difficult to make house calls during his clinic hours which often extends to late nights.

When the call came requesting an urgent visit to see an elderly patient it was 7 pm and the clinic was full of patients and there was no way he could get out leaving them waiting as the caller lived 5 kms away and going by the dense traffic it would be two hours before he would return. He however couldn’t refuse the call either as the patient was an old family friend and suffered from diabetes and heart disease. He told the caller who was the eldest son of the patient that he would try and make the call around 10 pm and if the condition of the patient is very serious, he told him to shift he patient to a nearby hospital and let him know.

At 8 pm the call came informing him that the night visit was no longer required as the patient has breathed his last. This occasionally happens to us GPs because despite advise patients refuse to go and seek help elsewhere and sometimes pay a heavy price. Doc Prabhakar was now a very unhappy man with many troubling thoughts in his head. Had he gone leaving his clinic when the call came would the patient be alive, had he failed to assess the seriousness of the call, should he have insisted that they take the patient to the hospital? He was filled with guilt and remorse. These feelings remain for weeks and months and torment us and form an unpleasant part of a GP’s life.

A shaken Prabhakar did not sleep well that night. Early next morning he went to the house of the diseased with the intention of offering his condolences to the bereaved family and to issue a death certificate. Normally the atmosphere in and around the house where a death has occurred is somber and sad. This is often contrived is a different matter. One would see groups of friends and relations of the diseased huddled and engaged in hushed conversation with grave looks on their faces. Amongst most Hindu families there would also be a small earthen pot filled with burning wood emitting smoke, a sure signal to all and sundry that a death has occurred in that home and you are at liberty to take a breather and gawk.

To Doc’s surprise and some consternation, none of these were visible outside the house. For a moment he thought that the body has already been removed and the mourners had left. Then who could have issued the death certificate without which the body cannot be cremated? Would it be that another doctor was called to attend on the diseased and has he issued the certificate? This thought made him feel a bit better. These were his thoughts when he pressed the call bell.

After a while the door opened and the old man who was supposed to be dead was standing in front with a wide grin on his face. Needless to say it was a shock and made my friend take a step back.
After a few seconds when there was no speech from either party, the old man’s son arrived on the scene and narrated the following story.

‘After I made the call to you I went back to see my father. He was restless and breathing very hard and moving his hands as though to tell me something. After few minutes he stopped breathing and his arms and legs became still and he closed his eyes. I thought he has died and I called you to tell you not to come and informed the relatives and friends of his death. Within the next half an hour people began coming and one by one they started pouring spoonfuls of milk in to the mouth as is our custom. This went on for some time when we noticed it [he pointed towards his father] moving the legs and making noises. This made the relatives scatter in a hurry. I too was frightened. A little later my father got up and looked around and asked what all these people were doing? He also said he feels very hungry. We fed him and told him what all had happened. Father has not stopped abusing me since then’ the son looked appropriately contrite.

The old diabetic had missed his lunch and taken very little food in the evening. He had taken his insulin shot later than usual that day and had gone into a coma induced by low blood sugar and the family thought he was dead and the milk that was poured into his mouth had revived him!

The old man lived for another five years and didn’t do any repeat performance and when he did die it was dead certain.

Meghna's ear pain

Meghna is delightful four year old and a frequent visitor. Frequent not because she is a sick child but because she suffers from respiratory allergy and whenever she has sniffles her anxious and intelligent mother has peace only when I clear the daughter of any major illness. The visits initially were the initiative of the mother but lately even Meghna has started demanding a visit to achachan [grandpa] doctor. That we enjoy each other’s company goes without saying.

This was the satisfactory state of affairs till her brother came onto the scene. Now the mother’s attention is necessarily more towards the infant and comparatively less towards Meghna. I must say she took it with lots of grace except on occasions as the one narrated below.

Few days ago Meghna’s mother fell ill with gastroenteritis and had to see me. When she came she brought the boy along as he too was having fever. Despite protests Meghna was left behind.

When the mother went home she found the daughter sitting with a hand over her ear and in a foul mood. She was having ear pain and she wanted to be taken to see her doctor. The mother who had just returned was in no mood to oblige and made Meghna call me. ‘I have ear pain she said, and I want to see you’. She stressed the I want o see you part of it. I told her that I will ask her mother to give her some medicine which will make her ok.That seemed to satisfy her.

She was given a dose of a pain killer which took effect within minutes! Normally any pain killer takes at least 30 minutes and here the girl got relief in two minutes! Was Meghna faking ear pain?

Next morning her ear pain appeared again and she had to be brought to see me. When I saw her she did not look sick and had a broad smile on her face. I examined her ears and found them normal. I knew now for certain that her ear pains were a ruse to get our [her mothers and mine] attention.

Her ear pain disappeared after the visit.

My worry now is what to do when she visits me next?

Power of mind and frontier science

When we look at an object, we know in an instant that it is a flower. We also know what type, what color, what flavor. We also know how and where and when to grow that plant. All these different qualities of the object flower are possible to perceive because of the highly specialized brain cells located in the cerebral cortex. When last mapped there were 30 such areas to interpret visual imagery alone! Think of our sense of smell, taste and sound and the various interpretations that we do with these sensory inputs. So is thought and its association in our brains. The latter quality has led to what we are today and has enabled human mind to construct and also destroy.

The last word has not been said about brian.There is a huge uncharted territory out there to explore. I recommend to those of you who want to know more, to read books by Vylayanur Ramachandran [the emerging mind, Phantoms in the brain]

Norman Cousins died in 1990.His life and work made me think and approach human health and disease from an angle that is different from that of the taught clinical approach of fitting the known symptoms and signs into a known disease. Keeping the human being as the centre and then looking at his or her problems gives one a different idea and the nature of the suffering and often one could solve the problems where conventional wisdom has failed. In my early days of practice it would often surprise me but now it no longer does as I am becoming aware of the enormous healing power of the human mind.

Norman Cousins wrote several hugely popular books [anatomy of an illness, healing heart]. But the lives of the likes of Cousins and Ramachandran are fascinating because they have, within the confines of our present day knowledge, tried to explain the disease phenomena and suggest unconventional cures.

What we know today about ourselves is only a fraction of what we do not know. That is why Norman Cousins called todays medicine as frontier medicine.

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!

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!

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.

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?