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

2

 

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

1

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

1

 

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.

 

Essentials of Obstetrics and Gynecology

1

The Obstetrics and Gynecology precinct in every general hospital of India, is a wonderland. Every nook, corner and crevice of that arena holds a sight to behold, and conversations that leave the residents and onlookers alike, astounded.

The welcoming note coming from the unit, as soon as you enter its hallowed walls, is that of the wails and the shrieks emanating from the labour room. And of the labour room song, that every fresher is taught on the first day.

“ Lagao, lagao, zor lagao,

Tatti ke raste zor lagao !

Saans mat roko, zor lagao,

Chalo bibi, himmat jagao !”

Step inside though, and every now and then, you’d find a woman in labour, shouting the most prolific Hindi profanities. BK, BC, MC and every possible permutation and combination of Ch***** in a sentence. You are left flabbergasted that a women could say, nay know, all those below the belt gaalis, that would put the nukkar- ke- lafangez to shame.  It takes a while to realize, that those alarming atrocities are not directed at you, but at the woman’s husband. That narak-me- jale-jallad who put in the seed, and then put her there. And with every push, the outburst erupts to jolt the room out of the calm before the storm. Igniting a chain reaction, with the other hitherto quiet and patient labouring women, breaking into a crying crescendo cacophony.

Unpublished statistics report that every third lady visiting the department, is a Mrs Devi and no matter what her chronological age, her biological age, as reported by the relatives in the hospital records, is always 45.

“ Kitne saal ki hain ?”

“ Paitalis ki hongi .”

“ Hongi ka kya matlab ? Apko apni maa ki umar nahi pata ? Aap kitne saal ke ho ?”

“ Jee tees –paitees.”

“ Fir aapki maa paitalis ki kaise ho gaiyeen ? Unki das saal ki umar par shaadi ho gayi thi kya ?”

“ Chalo pachaas samjho.”

While you try to reason and bargain the age of the atleast-over-60 lady with her son, her daughter-in-law tries to explain their reason for coming to the outpatient department.

“ Chat gir gayi hai.”

“ Huh?”

“ Chat gir gayi hai. Isliye aaie hain.”

“ Arey, to hospital kyun aae ho?  Main mistry thori na hun !”

Giggling under her pallu, the daughter-in-law retorts, “ Aap samjhe nahi. Maaji ki chat gir gayi hai !”

As you stare dumfounded at the relative you are sure has gone bonkers, other women in the OPD break into peals of laughter. And then one patient quietly comes up to you and whispers in a hushed voice, “ Madam, woh keh rahin hain ki unke patient ka shareer bahar nikal aaya hai.”

“Shareer bahar nikal aaya hai ?” you exclaim incredulously, imagining the out-of- body experiences this woman proclaims to be having, secretly trying to remember the extension to the Psychiatry OPD.

“ Bacche daani Madam. Bacche dani, bahar nikal aayi hai,” the peon finally tells you smugly, putting an end to your woes. And that is how you encounter your first prolapse patient, as a first year OBGYN resident.

The Gynecology OPD is full of such ordeals. If you are posted in the Infertility Clinic, you learn, often the hard way, that it is not appropriate to ask the patient how many times she has sex with her husband in a week, at least not in so many words. Asking the infertile couple about sex in open dialogue is tut-tuted upon by the junta.

So it is absolutely inappropriate to pose a question like “ Hafte mein kitne baar sambandh hota hai ?” As the patients and the peons and the security guards teach you, it is wise to be discreet and ask instead, “ Pati se baat hoti hai ? … Har roz ?… Nahi ? … Kyun ?”

Imagine the resident’s plight then, when forced to ask for superficial and deep dyspareunia in the negative history during exams !  And if the patient or her husband face any difficulties during the ‘baatcheet.’

Ask the patient whether her husband has any swellings, malformations or anatomical or physiological deviations in the ‘local parts’ and she breaks into suppressed chuckles, half amused and half horrified at your audacity. In fact, I dare you to try asking for erectile dysfunction in Hindi, with a straight face, like a gynae resident. Looking unflinchingly into the patient’s face, and saying, for example, “ Khade rehne mein koi problem hoti hai ?” And when the male partner’s semen analysis shows oligospermia, the deemed correct way of breaking the bad news, you are ‘taught,’ is “ Apke pati ke pani mein jantu / keetanu kam hain.”  Because there is no better way to describe a sperm in an infertility clinic, than calling it an ‘animal’ or a ‘germ.’

Amidst the countless hours of duties, the OBGYN resident is trodden with such euphemisms which she or he is expected to know by heart, just as she or he should remember the FIGO staging of gynecological cancers.  The commonest gynecological complaint – safed pani – should be probed into with detective details. What is the ‘maatra’ of pani  – chhoti chamacch, badi chamacch, katori bhar, lota bhar or balti bhar ? Is it really safed or is it a mix of laal, hara, peela ? Is it khujli-ful or khujli-less ? Is it khushboodaar or badboodaar ? What type of undies does the woman wear – biodegradable or non-biodegradable ? Is her pati parmeshwar also suffering from safed pani ? And if you may be so bold as to ask about promiscuity, the gynae morse code for the same is “ Bahar jaate ho kya ? Pati bahar jaate hain ?”

The wonders and the stupefactions never cease in the Gynecology unit. Every OPD or ward encounter, chance or otherwise, is a learning lesson, leaving the resident enriched with unforgettable, enduring memories, giving her or him valuable schooling in the public affairs of Indian way of life. No wonder then, that these heroes emerge, not only as experts in their fields, but also as connoisseurs in the matters of female tribulations, truly making them the ‘Lady Doctors!’