Why, a doctor ?

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I thought I wanted to be an engineer. Physics and Maths were my favourite subjects, and it seemed only natural that engineering would be a straightforward choice. My mother, a gynecologist, wanted me to become a doctor. She managed to convince me to take Biology as a subject in class 11, in case I changed my mind. For one year I prepared for engineering, till in class 12, I realized something was amiss. I could not imagine myself sitting behind a computer screen for hours at end. Oddly enough, I could see myself spending those hours in a surgeon’s clothes. And that, simply, is how I changed my tracks and got in to medicine. Not because I really thought about public service as a 17 year old, not really because I wanted to honour my mother’s wishes, but simply because I wanted to see myself, in a few years, as a surgeon.

Medicine was hard, arduous and frustrating, and there were times when we slept for only two or three hours a day at a stretch. But having the support of my parents, both in the medical field, and being a day scholar made those hard times easier to bear. I often wondered how some of my classmates whose parents weren’t doctors, many of whom came from outside Delhi and stayed in the hostel, managed to keep up with the stress. In fact, sometimes, I thought what made them take medicine in the first place, for I was sure that even though I didn’t admit it, one of the reasons, albeit subconscious, that I moved in to this field was because my mother was a doctor. And that I knew that she’d always have my back. And we’d grow old together treating patients.

A few months after I finished five and a half years of medicine, I lost my mother. To pneumonia. Not an accident, not a heart attack, not cancer or any other morbid illness. To pneumonia. One week of fever and a chest infection. And she was healthier than me, even at 52 years of her age. The team of treating doctors could not save another doctor from a pneumonia. I couldn’t save her. Even with the fanciest of treatments, my mom died of an infection that should have responded to antibiotics. That’s when the faith broke. I left medicine swearing to myself I would never come back again. I had lost my mom and without her beside me, it didn’t make sense. I spent a year and a half at home, convinced that I didn’t want to be a doctor. But, as luck would have it, it was those months at home that gradually made me realize that a doctor’s job was to diagnose and treat, to the best of his ability and with the best of his intentions. Not to play God. There is no foreseeable reason why a treatment does not work in a fraction of patients, even if it is the standard of care. No way to know why a particular disease would behave in an aggressive way in some and certainly no method to predict it. Some patients have an aggressive infection, some an aggressive tumor and some are resistant to standard treatments leaving little time, and sometimes little much even doctors can do. And with my years of medical training, I could realize that, slowly but surely. As a doctor, I knew that we had done everything possible to save her. That knowledge gave me my reassurance and my answers. Without it, I’d probably be blaming Medicine or my ill fortune all my life. And so, two years after my mother’s death, I came back to Medicine again. Took gynecology to fill in my mother’s shoes. And years later, oncology.

Even today, every intubated patient in ICU reminds me of my mother on the ventilator. As oncologists, we try to keep our emotions in check because, in spite of best of our efforts, we lose some patients – to aggressive disease, to stage IV cancers, to relapses. And many times when we break the bad news to the families, we go back to our rooms and swallow our tears. We may not be going home happy everyday, but we know in our hearts that we do the best we can, striving to give hope in every way possible. If we stand for ten hours in a surgery, it is not to satisfy our egos, but because if even the smallest of efforts can make a difference to a patient’s life, it is worth it. Helping terminal patients may seem hopeless, but if we can relieve their pain, provide a quality of life and help them live their last days without suffering, trust me, there is nothing more rewarding.

To all my fellow doctors, and especially to those who lost their loved ones along the way but didn’t lose faith, a very Happy Doctor’s Day. Let us continue our work, no matter what, no matter how.

Doctor, doctor, solve the problem. ( On WhatsApp, if you please )

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Doctor, sorry to disturb you at night. My tummy has been hurting since morning.

I am sorry to hear that. Where is it hurting ?

Just at a point below the navel on the right side.

Why don’t you come to the hospital tomorrow and we will have a look.

It only hurts here. Not all the time, just every hour or two… ( follows with a pic of the stomach with a finger pointing at the indicated site ).

Sorry, that pic won’t really help. You will need to come in.

What could be the cause, doc ?

I will need to see you to find out. When you come to the hospital.

Still, what do you think could be the problem ?

I really couldn’t say, Madam. Till I see you in the hospital.

I have been looking up the net all day. Could it be syndrome XYZ ? Do you think I should get a CT scan ?

Again, I can’t tell you anything till I examine you. In the hospital. Not on WhatsApp.

The colour of my urine is more yellowish than usual. Should I collect it in a container and send you a picture ?

That, won’t be necessary. I’ll take your word for it.

When the pain starts, I have this ‘gurr-gurr’ sound in my stomach.

Did you record that on your phone ?

No ! Should I have ?!

Nevermind.

Do you think it could be gas ?

It could be. But you just said it’s likely to be syndrome XYZ.

Doc, I’m really worried.

That’s why you should come to the hospital for assessment.

Could you prescribe me some medicines ?

No can do. Not on WhatsApp.

Do you think I should start an antibiotic ? I have Norflox-TZ.

But antibiotics won’t work if it is syndrome XYZ.

So you suggest I come to the hospital ?

Bingo.

There is a clinic close to my house. Could I show myself there ? I will make their doctor speak to you.

Madam, I would still like to make my own judgment. And rule out the Google syndromes.

( Resigns ). I guess I will come to the hospital, then.

( You think )

Can you see me precisely at 9:00 am ? I need to be somewhere at 9:30.

Sure. I don’t know how long the consultation will last, though.

What do you mean ? You think this is serious, don’t you ?

I will have to sign off Madam. Why don’t you see me tomorrow morning ?

Doc. At least tell me what you think. Doc ? You there ?

Addendum to the Hippocratic Oath

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I will always respect the ‘Google Maata,’ for she is always ere and better informed than I.

I will work for more than 24 hours straight and not once, even for a minute, will I sit down for rest, lest a media hound snaps that moment of a pause for the world to see and condemn.

I will not expect any pay for my work, for my family’s needs would be taken care of by God and his men.

Any ‘personal time’ or ‘family time’ will be considered a crime, liable to persecution and legal action.

I will be expected to have a contrast enhanced CT vision, to diagnose patients’ illnesses without ordering any ‘expensive tests,’ and to pick up complications, if any, the nanosecond they happen.

I promise, never to err at any time, or subject myself to the risk of being beaten up by the patient’s relatives.

I shall expect, for my work, no respect ; rather, I could be sued anytime for wrongdoing and neglect.

I will neither eat nor drink any food or beverage, remotely linked to any disease, in any case report published by Google, even in the confines of my house, if I chance to visit it at the end of the day.

I will be under constant scrutiny, and all my doings, including the restroom breaks, will be watched over like a hawk, around the clock.

I am neither God nor a normal human being, but a healing machine with Godly powers, dutifully bound to perform miracles in the worst of sickness.

What ails Indian Medicine ? Part one

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Something is ailing in the Indian medical community. We are no longer the ‘respected’ profession, the parents – including doctors, want to push their children into. As 18 year olds, most of us were coerced into medicine by our families, prepared for the long journey in spite of all odds. The light at the end of the tunnel was becoming valued doctors, admired and appreciated by the community and the country. But the odyssey is long and arduous and full of toils and bumps and obstacles. So it takes a decade and some years more, from graduation to post graduation and then super specialization. And along the way, we come to terms with the reality of how, even in our late twenties, we are financially dependent on our parents, unlike our friends from school who are professionally settled and financially blooming. And by the time we join as consultants in government or private sectors, the rat race has begun at full throttle, to make up for the lost time.

 

There is nothing wrong with the race to the top. We are professionals, and unlike what some people may think, we have families and we’d like to be paid for the hard work, thank you very much. But unlike other professions, we deal with human lives – in sickness and in health. Ours is not just a shop to run, or a business empire to expand. Ours is not a profession to lure customers, away from the competitors into our lair. Which is why, it is disheartening to see doctors undermine and belittle their colleagues and competitors – in front of the patients and in public.

 

Professional jealousy, ego, business rivalry or the number race – no reason can justify this atrocity. Saying “ That doctor ruined your case !” or “ That doctor is a fool and knows nothing !” or “ That doctor is a fraud. He cheats his patients,” may earn someone brownie points, with the patient who has come to his clinic after a tremendous amount of doctor shopping, but disgraces medicine, and the medical community as a whole. How can we expect a patient to respect medical professionals if we don’t respect each other ? When we are out there, at each other’s throats determined to bring each other down at any cost ? How will the people trust doctors, if we ourselves, are giving them reasons not to. One doctor is trashing his rival and him, vice-versa. And the karma is turning around a full circle and giving it back to us, beating us down multifold. The irony of it all, is that the only time we seem to be standing together and watching each other’s backs, is when a few disgruntled relatives turn hooligans and thrash one of us down.

 

All of us our different, some may be more skilled than others, some may be more competent than others, but we can all agree that almost all of us strive towards a common goal – patient care. And none of us, to our knowledge, are unabashedly evil. One doctor’s approach towards a patient’s condition may be different, and what he or she did, may not be what some other doctor would do, but that doctor still acted in good faith and to the best of his or her ability. So it gives us no right to be self-righteous, and shout from the rooftops of how our ‘competitor’ mismanaged a case, and how things would have been so much better, if only the patient had come to us first. If unity binds our community in times of ordeal, when one of us has been horrifically treated by members of the public, or elected representatives thereof, the same thread should bind us in each day of our professional lives. Because though the practical world is all about the competition and the bad mouthing and the shrewd business and the numbers to show it, we are better than that.

 

A classic conversation in the life of an Indian female doctor

Doctor

“Sister!”

(I am not responding.)

“Ai … Hello sister!”

(Seriously, this is how you address people ?!)

The guy now confronts me face to face.

“Sister, main aapse baat kar rahan hun.”

“Main sister nahi hun.”

“To kya ho ?”

(Kya ho ? I am not a ‘thing’, for starters…)

“Aap hi soch kar batao bhaiyya.”

“Mujhe nahi pata.”

“To mujhe roka kyun ?”

“Arey, aap to bura maan gayi, didi.”

“Didi ?”

“Ab sister nahi to didi hi bulaenge na.”

“Bhaiyya, main aap se pehle baar mili hun. Zahir si baat hai, main aapki didi nahi hun.”

“Uff, to kya bulayen ?”

“Socho. Thoda dimaag par aur zor lagao.”

“Behenji…”

“ Behenji ?….Behenji ?!! Main tumhe behenji dikhti hun ?”

“Accha …Sir. Ab Sir to theek hai na?”

“Pata nahi. Mujhe to lagta tha ki ‘Sir’ sirf aadmiyon ke liye use karte hain.”

“Oho, acchha chalo Madam… khush ?”

(Well done !…you are getting there. At least ‘madam’ tak to pohache.)

“Haan, batao.”

“Hamare mareez ki pishab ki thaili bhar gayi hai. Usko khali karna hai.”

(Deep breaths. Deep breaths. Count to ten. Ommmm…..)

“Bhaiyya, us counter par sister baitheen hain, unko bata do. Wo orderly ko bol dengi.”

“Accha, ek baat aur. Hamey woh doctor saab keh rahe the…”

“Kaunse doctor saab?”

“Arey woh doctor saab…” and he points to a male resident in the ward.

“Acchha ! Woh doctor hain, to main kya hun ?”

“Main kya janu ?”

“Kyun, ladkiyan doctor nahi ban sakti ?”

“ Ji TV par dekha to hai. Banti hi hongi.”

“Maine bhi safed coat pehna hai. Mere gale main bhi aala hai.. aapke doctor saab ki tarah.”

“To?”

(Okay, I give up.)

“Main bhi doctor hun.”

“Accha, aap bhi doctor hain ? Batao.”

“Haan bhaiyya batana hi pada.”

“Arey koi baat nahi daactarni, bura mat mano… Philhaal, hamare mareez ka saline bhi khatam ho gaya hai, aake badal do.”