From time to time I have written about this young golfer from my club who overcame the major disadvantages of poor socioeconomic and educational background, to excel in this difficult to master game of golf. Please read my blog post of 20, sept, 2007 to know about his background.
I just now finished watching him winning the Indian open in a play off and a purse of 195000 dollars is his. The manner of his win was nothing short of extraordinary. His tee shot [drive] found the edge of a bunker on a downhill lie. He choose to hit over an intervening tree when the easy option would have been to chip the ball on to the fair way there by loosing distance but making sure he is on the fairway for the next shot. He managed to hit a brilliant lob from the thick grassy lie and the ball flew over the tree to lie perfectly on the fairway giving him an easy approach shot which he hit with in ten feet from the pin to hole out with a birdie and win!
This is his first major win and he has made all of us who have supported him very proud.
Congratulations, Mr. Chinnasamy Muniappa. You have done it and in style.
Sunday, October 11, 2009
Thursday, October 8, 2009
Bakasura
He sat some distance away from us. We were four. I was a fledging medical student and the two with me were elders from my home town and one of them was the father of the youngman who sat away from us. They had come to see me to get help to access a psychiatrist in one of the premier neuropsychiatric institutes of the country [true even after 50 years, the Institute I mean]. As a medical student I could get them to see the specialist without much hassle. But before that we had to have our lunch and we had gone to a nearby eating place. The patient in question chose to sit apart or the seniors made him sit apart I don’t know.
The problem was that the youngman was not like others of his age. He hardly talked, was not much interested in dress, took bath several times a day, extremely poor in scholastic performance [he was 20 but had not passed his metric [high school], very fond of animals but cruel to his brothers and sisters, disobeyed orders etc. They were advised to see a psychiatrist and this commodity of doctors were hardly there in those days and only ones present were in this institute. If they had taken all the trouble to come from such a far off place, there must be really something wrong with the man I surmised. Then who am I to decide, my job was to take them and make then see the nut cracker [psychiatrist].
We ordered meals for four. Those days, food was very cheap and came in unlimited quantities. For half a rupee [three cents] one could eat a stomachful. The tray had rice, lentils, pickles, three vegetables, a bowl of curd and four rotis [kind of flat whet bread]. You can order a refill of any of the items any number of times! We were all finishing our respective meals when the waiter came to our table and pointing to the youngman sitting at a distance asked us,’ is he the part of your party?’. We said yes. He said, ’please tell him we have run out of roti dough’.’ You are supposed to serve unlimited number, how can you run out of food’ I asked the waiter. ‘Yes, what you say is correct under normal working conditions, but he, again pointing an accusing finger at the distant figure, has already eaten 25 rotis and is demanding more’
25 rotis! Enough to fill stomachs of five normal persons and here is this thin built man who has eaten 25 rotis and is demanding some more!’ 'You tell him that that is all you can serve him and no more’ I told him. ‘I did that and he is showing the board [which declared unlimited food] and has also taken out his pocket knife and is making threatening gestures. He is part of you guys and you please handle him’ said the waiter.
We were now faced with a new problem. I asked the father about his violent nature and the prodigious appetite of his son. He said,’ sometimes he becomes violent for silly reason and after a while he calms down but I have not seen him eating this much before. I will go and tell him that the food is over and he has to stop eating’. The father went to his son and tried to explain. After some loud altercation the son seemed to simmer down and there was peace once again in that hotel. The father returned to our table and said,'this is another problem, you never can tell what this fellow will do next, I only hope the doctor will help him’
Bakasura is the name of a demon mentioned in the Indian epic Mahabharata, who terrorized villagers around and demanded and got a cartful of food daily. His appetite was so great that he not only ate the food but also the bullocks and the cart man! How the distressed villagers were saved by Bhim is part of the story of Mahabharath. Looking at this thin tall man I just couldn’t believe his stomach could accommodate so much of food. A true modern day Bakasura I thought.
Consultation was duly done that afternoon and he was prescribed some medication and the party went back to the village. Many years later I came to know that this youngman, though academically a failure, became a successful agriculturist, married and raised a family with no apparent problems!
This brings me to the problem I have often faced in my practice. Who is really psychiatrically ill? How many of the patients who are presently being treated as ill are victims of the oppressive or unacceptable environment and their reaction is interpreted as psychiatric illness? Are we doctors dumping patients who are normal and because we cannot find anything wrong, as mentally ill and treating them?
Today’s psychiatrically ill, may be tomorrow’s normal person?
The problem was that the youngman was not like others of his age. He hardly talked, was not much interested in dress, took bath several times a day, extremely poor in scholastic performance [he was 20 but had not passed his metric [high school], very fond of animals but cruel to his brothers and sisters, disobeyed orders etc. They were advised to see a psychiatrist and this commodity of doctors were hardly there in those days and only ones present were in this institute. If they had taken all the trouble to come from such a far off place, there must be really something wrong with the man I surmised. Then who am I to decide, my job was to take them and make then see the nut cracker [psychiatrist].
We ordered meals for four. Those days, food was very cheap and came in unlimited quantities. For half a rupee [three cents] one could eat a stomachful. The tray had rice, lentils, pickles, three vegetables, a bowl of curd and four rotis [kind of flat whet bread]. You can order a refill of any of the items any number of times! We were all finishing our respective meals when the waiter came to our table and pointing to the youngman sitting at a distance asked us,’ is he the part of your party?’. We said yes. He said, ’please tell him we have run out of roti dough’.’ You are supposed to serve unlimited number, how can you run out of food’ I asked the waiter. ‘Yes, what you say is correct under normal working conditions, but he, again pointing an accusing finger at the distant figure, has already eaten 25 rotis and is demanding more’
25 rotis! Enough to fill stomachs of five normal persons and here is this thin built man who has eaten 25 rotis and is demanding some more!’ 'You tell him that that is all you can serve him and no more’ I told him. ‘I did that and he is showing the board [which declared unlimited food] and has also taken out his pocket knife and is making threatening gestures. He is part of you guys and you please handle him’ said the waiter.
We were now faced with a new problem. I asked the father about his violent nature and the prodigious appetite of his son. He said,’ sometimes he becomes violent for silly reason and after a while he calms down but I have not seen him eating this much before. I will go and tell him that the food is over and he has to stop eating’. The father went to his son and tried to explain. After some loud altercation the son seemed to simmer down and there was peace once again in that hotel. The father returned to our table and said,'this is another problem, you never can tell what this fellow will do next, I only hope the doctor will help him’
Bakasura is the name of a demon mentioned in the Indian epic Mahabharata, who terrorized villagers around and demanded and got a cartful of food daily. His appetite was so great that he not only ate the food but also the bullocks and the cart man! How the distressed villagers were saved by Bhim is part of the story of Mahabharath. Looking at this thin tall man I just couldn’t believe his stomach could accommodate so much of food. A true modern day Bakasura I thought.
Consultation was duly done that afternoon and he was prescribed some medication and the party went back to the village. Many years later I came to know that this youngman, though academically a failure, became a successful agriculturist, married and raised a family with no apparent problems!
This brings me to the problem I have often faced in my practice. Who is really psychiatrically ill? How many of the patients who are presently being treated as ill are victims of the oppressive or unacceptable environment and their reaction is interpreted as psychiatric illness? Are we doctors dumping patients who are normal and because we cannot find anything wrong, as mentally ill and treating them?
Today’s psychiatrically ill, may be tomorrow’s normal person?
Tuesday, October 6, 2009
Conversations with a guide
I don’t know why he chose me for comfort and advice. It all began like this.
‘Sir, I hope you don’t mind me asking you’ he said. I said. ‘certainly will not’
‘Sir, I don’t know why Mr. R doesn’t like me?’ I asked him how does he know. ‘Yes I know, I heard him say, I take cut from the shops I take you people to’. I asked him, ‘Santo,’ have you ever worked as a cook’?. This question took him by surprise. He must have been wondering what cook has to do with the problem he has come to discuss with me. He said no, he has no experience as a cook. ‘Supposing you worked in a kitchen as a cook, will you not taste the food? Now he brightened up a bit. He said,’ yes sir I will, otherwise how I know food is good? I said, ‘the same thing is true with tour guides. They must taste the items they make the tourists buy’. Now he was visibly happy. ‘Sir you really think so? I said yes. But still he lingered on. ‘But sir, he thinks I take money. I told him it doesn’t matter which ever form one tastes. ‘Sir I cannot do it, I am Buddhist’. I said Buddhist or no you are a guide and you must first taste the food before you make us eat’. ‘Thank you sir for your advice’ and he left.
Another day he came to the room,’ sir I have one more problem. I asked him what it is now. ‘Sir that old man [all of us are old but he singled out one] Mr. P asks difficult questions. I said we tourists don’t know which questions are difficult and which are not. But sir, ‘it is not once but many times,’ today he asked me why Buddhists don’t follow family planning? I told him,’ sir there is no state policy’. He says state doesn’t say when one has to have sex, it is individual’s decision, you are a Buddhist you should know. ‘Sir how can I answer this question?’ I said,’ you be quiet and don’t answer such questions. ‘Sir I did, but he won’t leave me. ‘Santo, he tell me, why are you quiet? You not answered my question? ‘What did you tell him?’ I asked him. ‘Sir I told him I don’t know about Hindus but we Buddhists enjoy sex’. I came to like Santo. I asked him what he [Mr P] said to that. ‘Sir he became quiet but I see he not happy with the answer’. I told him I was very happy with the answer. Santo appeared pleased with my response, but ‘sir,’ I cannot upset people’. I told him not to worry.’ Mr. P will be secretly happy, any way old men of our age just talk about sex where as you guys actually do it’. A very pleased Santo left me.
‘Sir another problem’ Mrs. K thinks that the store where we went this morning sells fake jewelry. I told him all costume jewelry is fake. ‘Why sir, you too think so? I said the jewelry sold is not made of silver or gold, they are all plated. ‘Aaah,’that kind of fake,’ that everyone knows’. ‘But Mrs. K doesn’t’ I told him.’ she must have heard that in Srilanka jewelry is cheap and she must have been disappointed to find it is cheap because it is plated. ‘I will be careful hereafter and tell all Indian women tourist that the jewelry is plated, they will not blame me for taking them to a fake store’ Santo said before leaving.
Another day another problem, Sir that man who always has a serious face; he found it difficult to remember the name. I told him he is Mr. S. ‘Yes, Mr. S,’ he says why is it raining here always? You should provide umbrellas to all’. ‘Sir, he continued, do I make rain? I said no. ‘That too not in season?’ For this also I said no. ‘Then why sir, this gentleman wants umbrella at all times?’ I told him, ‘see Santos, why some people wear a coat at all times? Even when it is hot? He said he doesn’t know. ‘That is because it is a habit. Mr. S carries an umbrella all the time when he is in Bangalore and that is why he wants you to provide an umbrella and because he cares for others he has included all of us’. But sir,’ giving umbrella to all 21 is difficult, but still I will tell the company for future [he made a note in his diary]. From umbrella he jumped to another topic. He said sir,’ I am also a sportsman’. I became interested and wondered why he was telling me this. I asked him what sports he plays. He said,’ I play Billiard’. I said,’ very good ‘[felt the game suits his paunch] ‘Sir, you play billiard?’ I said no. ‘Sir Billiard is also like golf, you put ball in the hole, but area of play is small, not like golf’. He waited for my reaction. I said.’ Yes Santo,’ but Golf is easy.’ No sir,’ golf very difficult,’ in golf you have to walk all over, get wet, hit a small ball with a long stick, get leg pain, then sir you have to drink beer after you finish’. I agreed with most of what he said but not the last part. I told him drinking beer is not compulsory. We drank beer because Srilankan beer is very good; He beamed with this appreciation of Srilankan beer. ‘But sir there is one gentleman, Mr. P who drinks only Srilankan Arrack, not good for his age, you are a doctor, you tell him not to drink like that’. I told him, ‘Santo that Mr P can drink a bottle of arrack and still play a round of golf’.’ OK, then sir don’t tell him, let him drink Srilankan arrack, only two days left [for the tour to finish] you know’.
Another day. ‘Mr S, he don’t like me. ‘Why not, I saw him with you talking and laughing this afternoon’ I said. ‘Talking yes but no laughing no sir’. ‘Why does he not like you?’ I asked. ‘Not liking, not in that sense sir, he does not like me sitting with you yesterday at dinner table. I think he belongs to superior caste. In India, I think you have this caste superior and inferior, I have heard’. Santos, I said, ‘You are a Buddhist, you belong to the most superior caste and you have right to sit at the centre of any table’. ‘Sir then why he told me so?’ Santos asked. ‘See Santos, that Mr. S, he is big businessman, he wants to talk business and if you sit with him he cannot talk business, but only about tour, that is why he told you not to sit at the table’. This placated him. ‘Oho so, but I will be careful [another note in his diary].
‘Sir, Janak thinks you all are very good people’ .This unasked for compliment from the bus driver took me by surprise. I asked him how he has classified us thus. He says,’ all of you wish him before getting into the bus ’. If being good is just wishing then the whole world would have been of good people. I kept quiet. ‘But there is one person, Mr. S who has not wished him so far’ Santos complained. I asked him, ‘why are you telling me this’. He said,’ I must tell for your future reference’. What it meant I don’t know.
On the day of leaving Santo came to see me one last time, He said,’ sir this tour was very good, you all are such good educated people, your wives also’ he added as an afterthought. I asked him, ‘but you had so many complaints’. He said,’ sir that is for my education, last tour group had only Germans, I suffered so much I cannot tell you, your group very good’
On that salutary note our Srilankan golf cum sightseeing tour ended.
[Some facts and lots of fiction]
‘Sir, I hope you don’t mind me asking you’ he said. I said. ‘certainly will not’
‘Sir, I don’t know why Mr. R doesn’t like me?’ I asked him how does he know. ‘Yes I know, I heard him say, I take cut from the shops I take you people to’. I asked him, ‘Santo,’ have you ever worked as a cook’?. This question took him by surprise. He must have been wondering what cook has to do with the problem he has come to discuss with me. He said no, he has no experience as a cook. ‘Supposing you worked in a kitchen as a cook, will you not taste the food? Now he brightened up a bit. He said,’ yes sir I will, otherwise how I know food is good? I said, ‘the same thing is true with tour guides. They must taste the items they make the tourists buy’. Now he was visibly happy. ‘Sir you really think so? I said yes. But still he lingered on. ‘But sir, he thinks I take money. I told him it doesn’t matter which ever form one tastes. ‘Sir I cannot do it, I am Buddhist’. I said Buddhist or no you are a guide and you must first taste the food before you make us eat’. ‘Thank you sir for your advice’ and he left.
Another day he came to the room,’ sir I have one more problem. I asked him what it is now. ‘Sir that old man [all of us are old but he singled out one] Mr. P asks difficult questions. I said we tourists don’t know which questions are difficult and which are not. But sir, ‘it is not once but many times,’ today he asked me why Buddhists don’t follow family planning? I told him,’ sir there is no state policy’. He says state doesn’t say when one has to have sex, it is individual’s decision, you are a Buddhist you should know. ‘Sir how can I answer this question?’ I said,’ you be quiet and don’t answer such questions. ‘Sir I did, but he won’t leave me. ‘Santo, he tell me, why are you quiet? You not answered my question? ‘What did you tell him?’ I asked him. ‘Sir I told him I don’t know about Hindus but we Buddhists enjoy sex’. I came to like Santo. I asked him what he [Mr P] said to that. ‘Sir he became quiet but I see he not happy with the answer’. I told him I was very happy with the answer. Santo appeared pleased with my response, but ‘sir,’ I cannot upset people’. I told him not to worry.’ Mr. P will be secretly happy, any way old men of our age just talk about sex where as you guys actually do it’. A very pleased Santo left me.
‘Sir another problem’ Mrs. K thinks that the store where we went this morning sells fake jewelry. I told him all costume jewelry is fake. ‘Why sir, you too think so? I said the jewelry sold is not made of silver or gold, they are all plated. ‘Aaah,’that kind of fake,’ that everyone knows’. ‘But Mrs. K doesn’t’ I told him.’ she must have heard that in Srilanka jewelry is cheap and she must have been disappointed to find it is cheap because it is plated. ‘I will be careful hereafter and tell all Indian women tourist that the jewelry is plated, they will not blame me for taking them to a fake store’ Santo said before leaving.
Another day another problem, Sir that man who always has a serious face; he found it difficult to remember the name. I told him he is Mr. S. ‘Yes, Mr. S,’ he says why is it raining here always? You should provide umbrellas to all’. ‘Sir, he continued, do I make rain? I said no. ‘That too not in season?’ For this also I said no. ‘Then why sir, this gentleman wants umbrella at all times?’ I told him, ‘see Santos, why some people wear a coat at all times? Even when it is hot? He said he doesn’t know. ‘That is because it is a habit. Mr. S carries an umbrella all the time when he is in Bangalore and that is why he wants you to provide an umbrella and because he cares for others he has included all of us’. But sir,’ giving umbrella to all 21 is difficult, but still I will tell the company for future [he made a note in his diary]. From umbrella he jumped to another topic. He said sir,’ I am also a sportsman’. I became interested and wondered why he was telling me this. I asked him what sports he plays. He said,’ I play Billiard’. I said,’ very good ‘[felt the game suits his paunch] ‘Sir, you play billiard?’ I said no. ‘Sir Billiard is also like golf, you put ball in the hole, but area of play is small, not like golf’. He waited for my reaction. I said.’ Yes Santo,’ but Golf is easy.’ No sir,’ golf very difficult,’ in golf you have to walk all over, get wet, hit a small ball with a long stick, get leg pain, then sir you have to drink beer after you finish’. I agreed with most of what he said but not the last part. I told him drinking beer is not compulsory. We drank beer because Srilankan beer is very good; He beamed with this appreciation of Srilankan beer. ‘But sir there is one gentleman, Mr. P who drinks only Srilankan Arrack, not good for his age, you are a doctor, you tell him not to drink like that’. I told him, ‘Santo that Mr P can drink a bottle of arrack and still play a round of golf’.’ OK, then sir don’t tell him, let him drink Srilankan arrack, only two days left [for the tour to finish] you know’.
Another day. ‘Mr S, he don’t like me. ‘Why not, I saw him with you talking and laughing this afternoon’ I said. ‘Talking yes but no laughing no sir’. ‘Why does he not like you?’ I asked. ‘Not liking, not in that sense sir, he does not like me sitting with you yesterday at dinner table. I think he belongs to superior caste. In India, I think you have this caste superior and inferior, I have heard’. Santos, I said, ‘You are a Buddhist, you belong to the most superior caste and you have right to sit at the centre of any table’. ‘Sir then why he told me so?’ Santos asked. ‘See Santos, that Mr. S, he is big businessman, he wants to talk business and if you sit with him he cannot talk business, but only about tour, that is why he told you not to sit at the table’. This placated him. ‘Oho so, but I will be careful [another note in his diary].
‘Sir, Janak thinks you all are very good people’ .This unasked for compliment from the bus driver took me by surprise. I asked him how he has classified us thus. He says,’ all of you wish him before getting into the bus ’. If being good is just wishing then the whole world would have been of good people. I kept quiet. ‘But there is one person, Mr. S who has not wished him so far’ Santos complained. I asked him, ‘why are you telling me this’. He said,’ I must tell for your future reference’. What it meant I don’t know.
On the day of leaving Santo came to see me one last time, He said,’ sir this tour was very good, you all are such good educated people, your wives also’ he added as an afterthought. I asked him, ‘but you had so many complaints’. He said,’ sir that is for my education, last tour group had only Germans, I suffered so much I cannot tell you, your group very good’
On that salutary note our Srilankan golf cum sightseeing tour ended.
[Some facts and lots of fiction]
Thursday, September 24, 2009
Chappal doctor
They should have named him mercury but he was called Chotu, fondly by all of us. His real name is Kailash. He is now a prim and proper 12 year old, but when the incident occurred he was around three or four years old. I have tremendous admiration for his mother Arti who being a mid level [now senior] business executive for managing this boy and his less troublesome elder brother, a very sick mother and still successful in her job which also needed constant travel. From the day Chotu saw me after his pediatrician gave up [not really, more so, because it was more convenient to see me] he decided that I am one person with whom he can do whatever he wants and get away with. He also found my clinic a treasure house of material with which he can play. I have a tray which has many odds and ends on it and these he found fascinating. Before his mother could stop him he would pick up a pen or a pencil or even my Knee hammer and throw it on the ground for his mother to pick up. This done he would go to the window and try and close it with a bang. Then he would hop on to the examination couch and curl up so that I cannot examine him unless I straighten him which took all our effort. Would he keep quiet when he was doing all this? He would be shrieking with unadulterated joy. I have never seen a child who got so much of pleasure with so little. These antics of his took more time than actual examination. His favourite position for getting examined was to sit on my lap. No other position was acceptable. If I tried to put him on the table he would jump down or cry loudly. Soon I realized that to get his cooperation I had to make to do with examining him as best as I can in this position of his sitting on my lap with feet dangling. This position he was most cooperative and would open his mouth if asked him to do. But imagine my plight. How would I examine his throat or for that matter his abdomen with him astride on my lap?
Chotu began getting sudden episodes of abdominal pain. He would hold his abdomen and double up with pain. He would also give out loud howls. You have not have had the benefit of listening to Chotu’s howl. It brought the roof down along with the neighbors of the two houses on either side of Chotu’s house. When the concerned neighbors arrived they would find a laughing and smiling Chotu whose pain would have gone by then. Occasionally the same would happen when the panic stricken mother would bring to him to me. I began to suspect whether he like my other child friend like Meghna [see Meghna’s ear pain] is feigning pain to get his mother to bring him to see me and he can have his fun. He would get better whatever I gave him; even a glass of hot water did the trick.
But I was not satisfied. No child would do this repeatedly to attract attention even it meant fun with the grandfatherly doctor. I got an ultrasound scan done. The boy had narrowing at the junction of the funnel like structure which collects the urine [pelvis] that is produced by the kidney and the conduit which brings the urine [ureter] down to the collecting bag [bladder]. When sufficient urine got collected in the pelvis [funnel], it would try to push it down and the portion of the tube where the obstruction was, would not respond due to a defect [present since birth but came to light at this age in Chotu’ s case]. This would result in a colicky pain which could be pretty severe. This was the reason for Chotu's pains.
Dr R is my choice for handling surgical problems of my pediatric patients. Chotu was duly sent to Dr R. Some more tests later it was decided only surgery will provide lasting cure. Chotu came to see me with his mother. First thing Chotu said to me was,‘I don’t like your friend doctor who wants to cut my stomach’. I was very surprised. I thought the boy might be very scared of the surgery. I told him not to worry as it will be painless and he will be pain free after wards. 'I am not afraid' he said with his chest thrust forwards. He said, ‘you come there and do operation’. This kind of confidence is a bit unnerving. I explained to him why Dr R should do it and why I cannot do it. Chotu said, ‘he has coat, shoe, tie and the nurse holds me tight’. Now I knew the reason why my little friend doesn’t like Dr R whose nurse must have held him tight when he was being examined and Dr R must have appeared to be forbidding in his dress.
His mother added,'he has been telling me, ‘take me to chappal doctor', this is what he has been calling you ever since we started visiting the hospital where he is seeing all the doctors dressed in suits’! The boy is comfortable with this grandfatherly doctor with grey hair with his feet in chappals, who allows him to ride on his laps, sit on his table, play with all the odds and ends in the consulting room and thus thinks he is more qualified to operate on him!
Consultants and doctors who work in the hospitals wear either jackets or white coats. This is because of tradition and habit. One consultant friend who came to the golf course on a sweaty hot Sunday afternoon after his hospital rounds was in his full regalia of suit and matching tie. When I asked him how come even on a hot Sunday afternoon he wore a jacket,’ he said,'I feel naked if I did not wear my jacket’!
In contrast I have no such inhibitions. My normal working dress is a half sleeved shirt and trousers with Hawaii chappals [slippers] for the feet. On the rare occasions when I am forced to wear a suit [once or twice a year] I feel like being in a straight jacket!
Nevertheless it was comforting to know, at least my children patients appreciate my dress code!
The boy duly got surgical repair done and became pain free.
Chotu began getting sudden episodes of abdominal pain. He would hold his abdomen and double up with pain. He would also give out loud howls. You have not have had the benefit of listening to Chotu’s howl. It brought the roof down along with the neighbors of the two houses on either side of Chotu’s house. When the concerned neighbors arrived they would find a laughing and smiling Chotu whose pain would have gone by then. Occasionally the same would happen when the panic stricken mother would bring to him to me. I began to suspect whether he like my other child friend like Meghna [see Meghna’s ear pain] is feigning pain to get his mother to bring him to see me and he can have his fun. He would get better whatever I gave him; even a glass of hot water did the trick.
But I was not satisfied. No child would do this repeatedly to attract attention even it meant fun with the grandfatherly doctor. I got an ultrasound scan done. The boy had narrowing at the junction of the funnel like structure which collects the urine [pelvis] that is produced by the kidney and the conduit which brings the urine [ureter] down to the collecting bag [bladder]. When sufficient urine got collected in the pelvis [funnel], it would try to push it down and the portion of the tube where the obstruction was, would not respond due to a defect [present since birth but came to light at this age in Chotu’ s case]. This would result in a colicky pain which could be pretty severe. This was the reason for Chotu's pains.
Dr R is my choice for handling surgical problems of my pediatric patients. Chotu was duly sent to Dr R. Some more tests later it was decided only surgery will provide lasting cure. Chotu came to see me with his mother. First thing Chotu said to me was,‘I don’t like your friend doctor who wants to cut my stomach’. I was very surprised. I thought the boy might be very scared of the surgery. I told him not to worry as it will be painless and he will be pain free after wards. 'I am not afraid' he said with his chest thrust forwards. He said, ‘you come there and do operation’. This kind of confidence is a bit unnerving. I explained to him why Dr R should do it and why I cannot do it. Chotu said, ‘he has coat, shoe, tie and the nurse holds me tight’. Now I knew the reason why my little friend doesn’t like Dr R whose nurse must have held him tight when he was being examined and Dr R must have appeared to be forbidding in his dress.
His mother added,'he has been telling me, ‘take me to chappal doctor', this is what he has been calling you ever since we started visiting the hospital where he is seeing all the doctors dressed in suits’! The boy is comfortable with this grandfatherly doctor with grey hair with his feet in chappals, who allows him to ride on his laps, sit on his table, play with all the odds and ends in the consulting room and thus thinks he is more qualified to operate on him!
Consultants and doctors who work in the hospitals wear either jackets or white coats. This is because of tradition and habit. One consultant friend who came to the golf course on a sweaty hot Sunday afternoon after his hospital rounds was in his full regalia of suit and matching tie. When I asked him how come even on a hot Sunday afternoon he wore a jacket,’ he said,'I feel naked if I did not wear my jacket’!
In contrast I have no such inhibitions. My normal working dress is a half sleeved shirt and trousers with Hawaii chappals [slippers] for the feet. On the rare occasions when I am forced to wear a suit [once or twice a year] I feel like being in a straight jacket!
Nevertheless it was comforting to know, at least my children patients appreciate my dress code!
The boy duly got surgical repair done and became pain free.
Sunday, September 20, 2009
Convert to allopathy
Worry writ large on her face, she sat stiffly facing me. I asked her, ‘How come you are here?’
This will appear a strange question to ask a patient, you may think. But you don’t know Saroj as I do. Her first court of appeal is her favorite family homeopath who is also her close friend. By the way of answer she gave me a hard stony look. Her husband, Sanjay prompted her,’ go ahead tell him’. Thus encouraged, she said,’ I have it again’. What you have it again? I asked her. She said doctor,’donot make fun of me, you know what I am referring to, I have it again’. Those of you who have read my last posting know Saroj’s travails with tuberculosis of her neck glands and how she was managed by her homeopath.’ If you have it again why come here when your homeopath friend is still around and kicking’ I couldn’t help taking a dig at her half jokingly and half seriously. She was quiet. That meant only one thing. She had already consulted with her friend and then has come here. I told her, ‘first of all I don’t know what you have got, let me have a look’ and then I said rather pointedly, ‘with your cooperation this time, we will tackle the problem, provided you keep your friend away when you are under my care’.
Her being quiet meant acquiescence. I proceeded to examine her.
Her right neck was empty in the sense there was no tissue under her skin, thanks to her old infection, the lymph nodes have been wiped out there and only an ugly scar was seen and felt. But the picture was different on the left neck. There were several matted [adhered to one another] nodes, a hall mark of gland TB. She also had low grade fever and felt unwell. She agreed to whatever I said. A piece of tissue was taken out of the lymph node and it confirmed TB. She also agreed to take the treatment for the next six months and come for follow up as advised. Not even a whimper about drug induced side effects etc. This kind of resigned acceptance is not in keeping with the character of this spirited young woman. ‘What? You have no questions, I asked her’. ‘What questions?’ she said, ‘what I am going to go through with your treatment cannot be worse than what I went through last time when I had this illness’. That said it all.
Had she taken, in the first instance, the six months anti tubercular chemotherapy she would not have had this relapse as the organisms would have been effectively removed from her body. I was prudent enough not drive home the point.
Later I came to know from Sanjay that they both had done an extensive net search and found the consultation with the homeopath did not answer their questions as well as mine did! She successfully finished the treatment about a month ago and I can now say I have a convert to allopathy.
Sometime later I will tell you all how Saroj saved her homeopath friend’s life, which is another story.
This will appear a strange question to ask a patient, you may think. But you don’t know Saroj as I do. Her first court of appeal is her favorite family homeopath who is also her close friend. By the way of answer she gave me a hard stony look. Her husband, Sanjay prompted her,’ go ahead tell him’. Thus encouraged, she said,’ I have it again’. What you have it again? I asked her. She said doctor,’donot make fun of me, you know what I am referring to, I have it again’. Those of you who have read my last posting know Saroj’s travails with tuberculosis of her neck glands and how she was managed by her homeopath.’ If you have it again why come here when your homeopath friend is still around and kicking’ I couldn’t help taking a dig at her half jokingly and half seriously. She was quiet. That meant only one thing. She had already consulted with her friend and then has come here. I told her, ‘first of all I don’t know what you have got, let me have a look’ and then I said rather pointedly, ‘with your cooperation this time, we will tackle the problem, provided you keep your friend away when you are under my care’.
Her being quiet meant acquiescence. I proceeded to examine her.
Her right neck was empty in the sense there was no tissue under her skin, thanks to her old infection, the lymph nodes have been wiped out there and only an ugly scar was seen and felt. But the picture was different on the left neck. There were several matted [adhered to one another] nodes, a hall mark of gland TB. She also had low grade fever and felt unwell. She agreed to whatever I said. A piece of tissue was taken out of the lymph node and it confirmed TB. She also agreed to take the treatment for the next six months and come for follow up as advised. Not even a whimper about drug induced side effects etc. This kind of resigned acceptance is not in keeping with the character of this spirited young woman. ‘What? You have no questions, I asked her’. ‘What questions?’ she said, ‘what I am going to go through with your treatment cannot be worse than what I went through last time when I had this illness’. That said it all.
Had she taken, in the first instance, the six months anti tubercular chemotherapy she would not have had this relapse as the organisms would have been effectively removed from her body. I was prudent enough not drive home the point.
Later I came to know from Sanjay that they both had done an extensive net search and found the consultation with the homeopath did not answer their questions as well as mine did! She successfully finished the treatment about a month ago and I can now say I have a convert to allopathy.
Sometime later I will tell you all how Saroj saved her homeopath friend’s life, which is another story.
Wednesday, September 16, 2009
Belief and faith
I have known Saroj since her school days. The young man she fell in love with and married to is also a patient of mine. This does not mean she always came to me. It needed two separate disease incidents to make her believe that the system of medicine that I practiced compared with her and more importantly her mother’s diehard belief in the curative powers of homeopathy.
It was some six years ago that she came with a swelling on the right side of her neck. Gradually increasing in size she ignored it for a few weeks wishing it to go away. The swelling did no such a thing. Instead it grew some more and she was brought by her husband Sanjay to see me. It was obvious that it is a lymph node mass and by the way it felt most likely cause was tuberculosis, Tuberculosis popularly known as TB spares no one in our country and I sometimes feel it is an Indian’s birth right to suffer this disease. A fine needle aspiration showed the typical histology of lymph node tuberculosis. When she came this time for review it was with her mother who was grief stricken that her precious daughter has TB and her attitude said that the doctor [me] is taking it lightly. This to certain extent was true because I was happy that the swelling turned out to be tuberculosis and not lymph node cancer. We doctors practicing in India eat and drink TB and at any given time a doctor has couple of TB patients taking medication and TB, especially gland TB is eminently treatable. I told the mother that it is easy to treat this provided she [the daughter] took the prescribed treatment for the duration of six months. The mother ignored this excellent prognosis. She said,’ none in our family has had this terrible disease, how did my girl get it?’ ‘What crime she has committed to be punished like this?’ I couldn’t relate to this grandiose idea of suffering and said that it is our birthright to get it as it so widely prevalent and family and ancestry has nothing to do with this. This, instead of satisfying her seems to upset her more. She said I don’t understand her problem. I agreed. I asked her daughter who is the patient whether she is willing to take treatment and almost certainly get cured.
She [the daughter] asked me one simple question. Will you promise me that he drugs will have no side effects? I said,’ I cannot promise’. She then said, ‘my homeopath has promised me that she will cure this disease without causing any side effects’. Now I knew that the mother and daughter combination has made up their mind to take Homeopathic treatment and were enacting a drama to get rid of my nuisance. I felt bad not because a homeopath has scored over me which has happened often enough, but because the suffering this young woman is going to go through if she were to take homeopathic medications. I told her the swellings will increase in size and will become soft in the centre and in a matter of few months will burst and ooze pus which will form tracks and will ultimately heal leaving ugly scars. They said nothing and took my leave.
Few months passed. I met Sanjay one evening and asked him how Saroja was doing? He said, ‘doctor, the swelling has burst and the pus is oozing out and the homeopath says that is what exactly the medication does and all the pus will drain out and she will heal’. My wife is virtually home bound with a bandage tied around her neck. I don’t know when the misery will end’. The misery ended some months later and as expected the natural healing took place with a hideous scar. Fortunately the scar was in the dimple next to the inner end of the collar bone and Saroj was able to hide it well with a strategically placed necklace. The matters thus stood for a few years and the homeopath continued to manage them. Saroj’s husband however kept in touch with me and came to me whenever he had a problem.
Their daughter Kusum is a pretty fifteen year old who occasionally came to see me with her father. The homeopath was managing her too, till she came down with a mysterious illness. She began having fever which would come and go and the girl would complain of fatigue and was listless. This went on for a few days and the family homeopath’s ministrations were tried but the problem continued. Now the family thought it best to get an opinion from yours truly. Fortunately that inveterate believer in the merits of Homeopathy as a cure all form of medical discipline, the mother of Saroj, did not accompany Kusum when she came to visit me. The girl was really off colour, had fever and had palpable glands in her neck and armpits. She also had enlarged tonsils which were unusually red. Her spleen was palpable. These signs and symptoms in this age group could be harbingers of serious disease. I kept the possibility of serious illness to myself and asked them to get some tests done. The results came back as positive to Glandular fever or what we call in medical term Infectious mononucleosis, a disease of viral etiology which after a variable course of time limits itself. The girl and parents were accordingly advised as to the need for no active interference and were asked to see me a week later. When she came for review a week later she was back to normal. I later came to know that the grand mother took her to the homeopath after the diagnosis was made and administered the recommended medications and the spontaneous cure was attributed to Homeopathic medication
I often face these situations. I have one simple philosophy, if a treatment does no harm I will not interfere. If I know that it is going to cause problems I try to interfere but often fail as it happened in the mother’s case of gland TB. But then, I did not really fail as the post script to this posting will show next week.
It was some six years ago that she came with a swelling on the right side of her neck. Gradually increasing in size she ignored it for a few weeks wishing it to go away. The swelling did no such a thing. Instead it grew some more and she was brought by her husband Sanjay to see me. It was obvious that it is a lymph node mass and by the way it felt most likely cause was tuberculosis, Tuberculosis popularly known as TB spares no one in our country and I sometimes feel it is an Indian’s birth right to suffer this disease. A fine needle aspiration showed the typical histology of lymph node tuberculosis. When she came this time for review it was with her mother who was grief stricken that her precious daughter has TB and her attitude said that the doctor [me] is taking it lightly. This to certain extent was true because I was happy that the swelling turned out to be tuberculosis and not lymph node cancer. We doctors practicing in India eat and drink TB and at any given time a doctor has couple of TB patients taking medication and TB, especially gland TB is eminently treatable. I told the mother that it is easy to treat this provided she [the daughter] took the prescribed treatment for the duration of six months. The mother ignored this excellent prognosis. She said,’ none in our family has had this terrible disease, how did my girl get it?’ ‘What crime she has committed to be punished like this?’ I couldn’t relate to this grandiose idea of suffering and said that it is our birthright to get it as it so widely prevalent and family and ancestry has nothing to do with this. This, instead of satisfying her seems to upset her more. She said I don’t understand her problem. I agreed. I asked her daughter who is the patient whether she is willing to take treatment and almost certainly get cured.
She [the daughter] asked me one simple question. Will you promise me that he drugs will have no side effects? I said,’ I cannot promise’. She then said, ‘my homeopath has promised me that she will cure this disease without causing any side effects’. Now I knew that the mother and daughter combination has made up their mind to take Homeopathic treatment and were enacting a drama to get rid of my nuisance. I felt bad not because a homeopath has scored over me which has happened often enough, but because the suffering this young woman is going to go through if she were to take homeopathic medications. I told her the swellings will increase in size and will become soft in the centre and in a matter of few months will burst and ooze pus which will form tracks and will ultimately heal leaving ugly scars. They said nothing and took my leave.
Few months passed. I met Sanjay one evening and asked him how Saroja was doing? He said, ‘doctor, the swelling has burst and the pus is oozing out and the homeopath says that is what exactly the medication does and all the pus will drain out and she will heal’. My wife is virtually home bound with a bandage tied around her neck. I don’t know when the misery will end’. The misery ended some months later and as expected the natural healing took place with a hideous scar. Fortunately the scar was in the dimple next to the inner end of the collar bone and Saroj was able to hide it well with a strategically placed necklace. The matters thus stood for a few years and the homeopath continued to manage them. Saroj’s husband however kept in touch with me and came to me whenever he had a problem.
Their daughter Kusum is a pretty fifteen year old who occasionally came to see me with her father. The homeopath was managing her too, till she came down with a mysterious illness. She began having fever which would come and go and the girl would complain of fatigue and was listless. This went on for a few days and the family homeopath’s ministrations were tried but the problem continued. Now the family thought it best to get an opinion from yours truly. Fortunately that inveterate believer in the merits of Homeopathy as a cure all form of medical discipline, the mother of Saroj, did not accompany Kusum when she came to visit me. The girl was really off colour, had fever and had palpable glands in her neck and armpits. She also had enlarged tonsils which were unusually red. Her spleen was palpable. These signs and symptoms in this age group could be harbingers of serious disease. I kept the possibility of serious illness to myself and asked them to get some tests done. The results came back as positive to Glandular fever or what we call in medical term Infectious mononucleosis, a disease of viral etiology which after a variable course of time limits itself. The girl and parents were accordingly advised as to the need for no active interference and were asked to see me a week later. When she came for review a week later she was back to normal. I later came to know that the grand mother took her to the homeopath after the diagnosis was made and administered the recommended medications and the spontaneous cure was attributed to Homeopathic medication
I often face these situations. I have one simple philosophy, if a treatment does no harm I will not interfere. If I know that it is going to cause problems I try to interfere but often fail as it happened in the mother’s case of gland TB. But then, I did not really fail as the post script to this posting will show next week.
Sunday, September 13, 2009
Dropping a brick
Some time ago I wrote about the numerous castes and sub castes that divide us Indians. One such caste is the Brahmins. Among this large group there are hundreds if not thousands of subgroups and one of them is the predominantly Tulu [a dialect] speaking Brahmins who reside in the coastal region of Karnataka. Like in any other caste for the social functions of these communities only those who belong to this sub caste are invited and therefore when I found a Tambram [short form for Tamil Brahmin] Thyagarajan in one such function, I was naturally surprised. I know Thyagarajan pretty well and wondered whether his wife is a Tulu Brahmin and he by marriage qualified for the invitation. But I had met with his wife and she did not look or behave like a Tulu Brahmin woman. Still I was glad to see him after two years and went to him to exchange pleasantries. Seeing me he gave a smile of recognition and asked me how am I doing. I said fine and asked him, ‘Thyagu, how is that you are here at this function?’ He appeared surprised,’ he said, my name is not Thyagu, it is Srikrishna and Col Acharya is my father in law'. The function was a housewarming ceremony of Col’s new home and naturally the son in law has the right to be invited. A bit crestfallen at the mistaken Identity, I apologized which was well received.
Some months later I met him again in another function which was secular and there were persons belonging to all communities as the local bank had called a customer meeting. This time when I confronted him I began,’ you know Thyagu, what happened last time’, and proceeded to narrate the story of mistaken identity. He heard the story in stoic silence and said,’ doctor, I am sorry to disappoint you, but I am not Thyagu, My name is Srikrishna and we met last time at my father in law’s house warming ceremony’. I was taken aback. Such uncanny resemblance and speech! Again apologies were in order but were accepted with some asperity.
There was another function where the participants were mostly Tulu speaking Brahmins and this time too I found Thyagarajan, sorry, Srikrishna. I made sure that he is indeed Srikrishna and then went to meet with him and to prove correct the third time. On seeing me coming towards him, he hurriedly got up and walked to another corner obviously afraid that I would once more call him Thyagu!
I did not have the heart to chase him to prove to him that this time I have indeed made the recognition right.
Some months later I met him again in another function which was secular and there were persons belonging to all communities as the local bank had called a customer meeting. This time when I confronted him I began,’ you know Thyagu, what happened last time’, and proceeded to narrate the story of mistaken identity. He heard the story in stoic silence and said,’ doctor, I am sorry to disappoint you, but I am not Thyagu, My name is Srikrishna and we met last time at my father in law’s house warming ceremony’. I was taken aback. Such uncanny resemblance and speech! Again apologies were in order but were accepted with some asperity.
There was another function where the participants were mostly Tulu speaking Brahmins and this time too I found Thyagarajan, sorry, Srikrishna. I made sure that he is indeed Srikrishna and then went to meet with him and to prove correct the third time. On seeing me coming towards him, he hurriedly got up and walked to another corner obviously afraid that I would once more call him Thyagu!
I did not have the heart to chase him to prove to him that this time I have indeed made the recognition right.
Subscribe to:
Posts (Atom)