Preventive and social medicine?

An orthopaedician’s cup of woes runneth over.

“She is having a lot of pain in her heels, specially the right one. She cannot stand and work for even ten minutes in the kitchen…Please do something doctor.”

I turned a stern gaze at the lady who had spoken these words – burly, middle-aged and with greying hair, she presumably was the mother-in-law of the young lady sitting in front of me, whose right heel had been thrust towards me for examination, and I had enquired from her about her complaints.

‘ Madam, could you let her answer for herself…’ I said with exceeding politeness in an attempt to be sarcastic.

” What can she tell you? I am telling you na,” she blurted, shredding my attempt at sarcasm to peices. ” We even got her x-ray done 2 months ago, showed that to another doctor, but there has been no improvement. Neetu, go, get the x-ray from the car, I forgot it inside the car in the parking.”

Before I could protest that I don’t see the x-ray prior to taking the detailed history and a proper examination of the patient; Neetu, which seemed to be her name; had swiftly got up and had gone outside sulkily.

“There is nothing wrong with her heels doctor, she is very lazy, she doesn’t want to work. The whole day she is sitting upon the sofa or lying on the cot..No wonder her weight is increasing, this is why her heels are paining. Please tell her to be up and about, and do some work in the house.” said the dominating mother-in-law, as soon as her daughter-in-law had exited my consulting room.

It was a well calculated move of hers to send Neetu out of the room!

I applauded inwardly at her street-smartness and said. ‘I am an orthopedic surgeon, I can treat an orthopedic problem, not the problems of your household.’

” But you are a doctor …If you will say, she will follow your instructions.” she said unbashedly.

“Mummyji, I couldn’t find the x-ray. I think you will have to go and find it yourself.” said the so -called ‘ lazy’ – Neetu, entering the room, at that point.

As soon as her mother-in-law went out, she said- ” Sir, I deliberately didn’t bring the x-ray so that I could talk to you alone,” she continued conspiratively “please tell her not to make me work so much!…I am made to stand and run throughout the day at our home, not for a single minute I am able to sit down; what else will happen to my heels and joints other than pain? If you will tell her that so much work is not good for me then she will definitely listen. You are a doctor after all.”

‘No!’

I shouted in my mind three times and each time my head turned decisively towards her, with a loud music blaring, and my eyes glaring. This is how it is shown in the insensible ‘Saas- bahu’ drama of indian daily soaps on television, much like the one in which I found myself entangled in currently.

Indeed, it would have been so good had it been possible for me to behave in this manner. Alas! real world demands one to behave reasonably, specially from doctors, even in the face of such absurdities.

Eventually, after having seen the x-ray, and diagnosing the ailment, correctly, as Plantar fascitis due to a calcaneal spur; and in the process, disappointing both of them with my medical advise, as against the domestic advise which they desired, I exhaled a breath of relief as they left after much argument.

But the relief was short-lived because soon after, a boy of about three years, in the arms of his father, who was standing in the queue, inside my outpatient department(o.p d.) in the civil hospital Ajmer, starting bawling loudly.

“Don’t cry Bittu, or else Doctor uncle here will give you a large injection.” said the man hastily in an attempt to quiten the boy, while pointing towards me.

He was magnificently successful in this endeavor of his, as the kid stopped crying and looked at me, with his large and beautiful eyes, in a terrified state, with intermittent sobs emanating from his mouth. It would have looked to any onlooker as though the boy had glimpsed a big, ugly monester or a troll.

Now, I might not look like a Greek god, but I consider myself decently handsome at any rate, moreover, I have always had a genuine affection for kids; so it has always stung me mightily, whenever I have been treated in this manner by the parents, which was quite too often.

‘Bhaisaab, please don’t make him afraid of me, or of any Doctor, for that matter. It’s not right to instill this fear in the unsuspecting and impressionable minds of children.’

” Sir, you don’t know how difficult he is to manage, nowadays he is not even afraid of witches and babas. It’s just the fear of injection and doctors that can quell him now.”

Great! I thought. So now I am trending above babas and witches in the list of abhorrent,scary, humongous and supernatural beasts – Way to go!

‘Listen…’ I started to admonish him angrily, but stopped as I remembered the time-honored adage of my father- “Son, you cannot control how other people behave, you can just control your behaviour and attitude towards them.”

Being a famous and successful surgeon, he himself had faced such situations throughout his life and finally, he had given up protesting and had reluctantly accepted the role of – ” injection-weilding evil doctor” which our relatives, acquaintances and general public had thrust upon him from time to time. Apparently, I too was walking down the same road.

With a cold sigh, I turned to the next patient, who in the meanwhile, had come and had sat in the examination chair.

I looked at him keenly, much after the ways of Arthur Conan Doyle, a physician and the creator of Sherlock Holmes. He and his character were famous for observing and deducing important clues about a person. I had been a lifelong fan of Mr. Sherlock Holmes for nothing.

Here was a septuagenarian gentleman in a well tailored shirt and trousers, with a dignified air about him, sitting in the clinic of an orthopaedic surgeon. His knees were bent at an awkward angle and he had shuffled with some difficulty into the room earlier.

‘Hmmm… ageing… suffering and affording. ‘ I enumerated my deductions about him mentally to my imaginary Dr. Watson.

Here was a patient, at last, after my own heart! He obviously was suffering from advanced arthritis of knee, and wanted surgery for the same to be performed by me…and best part was – he seemed like he could afford it.

Feeling a wave of tenderness towards this man, I asked him in my sweetest voice – ‘Uncle, what can I do for you?’

“Doctor sahab, though my knees have degenerated and I have some pain, I am managing quite well. I will never ever get surgery done for them, this is my fierce determination. Also I don’t consume these English medicines, as I don’t believe in them. And yes, I am too old to do any physio or exercise too.”

Taken aback by the total and utter failure of my detective abilities, I was smarting under his ‘fierce determination’ of not undergoing any surgery ever. I wondered what this unusual specimen of humanity desired from me. He had already destroyed all the arrows in my quiver- surgery, medicines and physiotherapy. What else I could possibly offer him- black magic and sorcery?

‘Chacha, you have come to the wrong place. This is a hospital.’ I said, trying to be a wisecrack.

“I know,” he continued, ignoring my condescending tone, ” I want you to refer me to a good massage waala…who can give expert massages to my ageing legs, and I can again walk many miles. You must be knowing such a person, won’t you? You must be referring a lot of patients to such a person.”

I had a throbbing headache behind my temples. A gigantic anger was building up inside me, ready to unleash it’s fury on a soul.

I took few deep breaths to calm myself down, and glanced at my watch – 9:45 am!

Only 45 minutes into the o.p.d. and it had come to this!… This sorry state of helplessness, this continuum of absurdities, this flux of farce, this comical display of diagnostic and deductive mindgames; where a well qualified orthopaedic surgeon was bubbling with endless zeal to cure patients of their joint pains and muscle aches, through his knowledge, experience, training and surgical skills, but as it turned out – they didn’t want him to!

All they ever wanted was – moronic solutions of their household problems or equipped with their age-old preconceived notions about surgery and medicines, they wanted him….Him!…to refer them to a quack, who could cure them of their pathetic states.

When our teachers taught us pathology, pharmacology and surgery of a disease in the halls of medical colleges, they never told us about this social aspect of medicine, as to – what to do when confronted by a mother-in-law who was looking to make her daughter- in-law work, who was equally determined not to perform it?

There had been no lecture in those temples of wisdom, about a man badly in need of knee replacement, but who wanted a masseuse instead.

How to deal with such patients? How to overcome their ill-begoted notions, beliefs, theories, fears, superstitions, apprehensions and inhibitons? And was this a duty of mine or of any other doctor to do so?

No medical book had the answers to these searing questions, I pondered philosophically.

Unable to concentrate anymore, I signalled the two senior residents of my unit to take care of this patient and rest of the o.p.d. and I went out, intending to take rounds of the wards, and immediately bumped into Mrs. Joshi.

“Vivek…I was coming to meet you only, wanted to have a word with you.”

Mrs. Joshi and her family had been our old neighbours, when I was quite young and we had lived in our previous home. Because of this reason she treated me like her son – forcefully.

Yesterday, our unit had operated upon her husband for left sided total hip replacement and he was still in the I.C U.

He had been suffering from a disease called- Avascular necrosis of head of femur- an ailment which frequently affects chronic alcholics, and Joshi uncle was a champion alcholic.

“Vivek..look what has your uncle brought upon us due to this wretched drinking habbit of his- this surgery!”

“It’s high time that he leaves this addiction immediately or we will be ruined “

I nodded sympathetically, wondering where this was leading to.

“Vivek, beta, talk to your uncle and instill some sense in him, so that he never touches alcohol again…do it right now!”

‘Me?’ the sympathetic attitude that I had for her was suddenly turned towards – precious ‘me’.

‘How can I talk to uncle about this?… You know it will be awkward.. he would feel insulted.’ I pleaded in front of her.

“Nonsense, you no longer are a kid who used to play cricket in our garden, look at you- you are a big doctor now! I am so proud of you. Talk to him like a senior doctor..he will definitely listen and obey you “

I surveyed her keenly- muscularly built and strong- jawed, she had a fearsome reputation when I was young, and had seen many kids wilt in front of her gaze and bitter words.

If this fair maiden could not mend her knight’s ways, if this representative of fairer sex – bold, sharp-tongoued and strong-willed- could not bring her husband to his senses; then what chance- I; a mere practitioner of Hippocratic oath, a common wielder of orthopaedic hammer,screws and nails; had?

In my experience and opinion, if a wife; with her constant meddlesome presence, omnipresent manipulations about her home, kids, money,food etc, devastating weapons of her love, tears, beauty, coyness and bickering words; could not control and change her life partner’s addictive ways, then nobody could.

But she dragged me to I.C.U. with her, where I approached Mr. Joshi with a lot of ebullience, very low confidence and zero moral authority.

‘Good morning uncle, you seem to be doing quite well today. The surgery went absolutely fine and in no time you will be running again.’

“All thanks to you Vivek. Yes I am doing all right, a little pain but nothing serious.”

‘Ahem..ugh.. Uncle..you know the reason why you ended up here.. don’t you? I think it’s the time to say goodbye to your magnificent drinking glasses.’

“How right you are…I won’t touch a drop from now on.” He replied smilingly and added a wink at the end!

I should have known that my words would have no effect…he was an old campaigner, impervious to my words.

But Mrs. Joshi went off the handle and started a big fight with him, and was hushed and sent out of I.C.U. I turned quietly and was about to exit the door, when I heard a voice..

“Psst… sir, please come here..over here.”

I looked in the direction of the voice and found that it was originating from the mouth of Mrs. Sarita’s husband standing near his wife, who was lying on the first cot.

Mrs. Sarita had met with a serious accident two days ago and had sustained three fractures, two on left leg and one in right thigh. We had operated her throughout the night and now both her legs were in plaster from upper thigh to toes.

‘Yes..what is it?’

“Sir..hee-hee..umm..I just wanted to know that in your expert opinion, how much time should we let elapse, before…you know…we could be together?” He said in a low voice while throwing furtive glances around.

‘Together?..I didn’t get you.” I fully understood what he meant, but I wanted to prolong this vile man’s agony.

“Err..meaning sir…you know…when can we behave like ..like a man and wife again?”

I glanced towards his wife, who was giving him a thouroghly disgusted look and as I saw, she turned her face to other side and hid her face inside the sheet covering her.

Wait a minute!..I had seen that look.

Having received a fair number of such looks from my wife over the years I was no stranger to such a facial expression, which conveyed- I don’t know how I ended up with this man, there were so many eligible men…but I had such rotten luck!”

Suddenly I was cheerful- I wasn’t alone in being the recipient of wife’s ire. There were others!

I felt a bond of brotherhood with this man, repulsive as he was, he deserved my compassion nonetheless.

‘Look, your wife has sustained grevious injuries, though we have fixed the fractures but it will be weeks before we will allow her to stand, and months before you can do what you are hinting at.’

“Months!” he exploded,” what is the use of these surgeries then, so much money spent and no use. Has medical science not progressed even one bit in last fifty years?”

‘Listen mister’ I growled, the bond of brotherhood had quickly evaporated, ‘ we don’t do surgeries to heal bones faster, that nature does in its own time, but we operate so that bones unite in a correct position.’

As he apologized to me, I went out fuming and returned to my o.p.d.

The moment I sat upon my chair, sister Estella, the incharge of our operation theatre, entered followed by a plumpy man, bordering on obese.

“Good Marning sir,” sister said in her malyali accent.

‘Good morning sister, how can I help you?’

“Sir, this is my husbund – Michael- I have called him here to consult you “

‘What is his problem? He seems quite healthy to me.’

“That is the prablem sir…he is tooo healty. See how his tummy is growing nicely. He does not listan to me…whole day he is only eating and eating.”

” Please tell him to go on strict diet and do regular exercises. He will listan to you…you are a doctor no sir…”

——-///—-///—///—///—-///—–///—–///—-///—

Till this day sister Estella does not understand why I started shouting on her that day, even after a lot of apologising and cajoling done profusely and repeatedly by me.

She has been in a ‘cold war’ mode since then, and religiously blocks all my surgeries at first, then after a lot of pleading I get the worst schedule, that too with an uncooperative staff and non-working equipments.

The only happy person to have emerged out of this gruesome episode has been her husband, who is still eating away merrily. Her wife’s attention and energies have been engaged, and diverted elsewhere since then – in devising ever-new devilish plots to stall and vanquish her new nemesis — Yours truly!….