Between thoughts and words

  Mr. V had not come to the clinic in a while. He was otherwise a regular fortnightly visitor. An octogenarian, with a hearty and reverberating laughter, he always brings with him the sunshine when he enters the clinic. The white hair, thick white moustache and the wrinkles on the skin on his hands are the only signs that this man is aging, otherwise he is a young lad of 18. He comes to our clinic to get his prescription refill for diabetes, hypertension and a chronic skin condition. Yesterday even before he came in, one of our staff, Mr. V’s daughter in law, dropped by my room to say, “Sir, my father-in-law has come. He recently had a heart attack and was admitted in the hospital. He got discharged day before yesterday and insisted that he will come to see you today. Shall I bring him in?” I requested her to bring him in and stood up to receive him.     As Mr. V walked into the room, I noticed that the usual skip in his step was missing. He was wearing a monkey-cap and h...

  Yesterday, I saw a middle-aged woman, in the clinic. She was breathing heavily with a lot of difficulty even as she entered my room. As she came and sat down in the chair in front of me, she looked me in the eye and could not start talking for some time due to the breathlessness. Her main problem has been worsening breathlessness that has now prevented her from even taking small steps inside her own home. She is a person living with diabetes and high blood pressure since 10 years and has been on regular medications. She developed a heart attack 4 years ago for which she was admitted in the government general hospital and treated. She is taking medicines for that too. This breathlessness started last year, and it has progressively worsened over the year.   “I am tired of this breathlessness. I cannot deal with this anymore” she said, broke down and took out a big bunch of thick folders, notebooks and loose sheets of paper and dropped them all on the table.    One of...

  “If you cannot prevent yourself from getting sick, then what does it mean for all of us?” This is one of the most difficult and often annoying questions I face in the clinic on days when I am unwell. I have been down with a viral upper respiratory infection since the past 4 days that is typical of this time of the year. It comes with a running nose, cough, clogged-up sinuses and a thick heavy nasal twang in the voice and some hoarseness. Sometimes my face also gets bloated with all the congestion that goes on inside it. My nose, throat and sinus anatomy is such a way that it leaves very little for the imagination when I am down with a cold. Every time I run the clinic with such a cold, I have patients expressing all kinds of emotions to me.  1.          Sympathy – By far, this is the commonest emotion that my cold evokes. People feel bad for me and suggest that I soothe my throat with some warm water. They give me well-meaning home rem...

Two patients over the span of three months made me understand intersectionality like never before. Intersectionality is a way of understanding the world where people are seen as having multiple overlapping identities and seeing each of these separately gives an incomplete picture. For example, gender, caste, socioeconomic status are intersecting identities that people live with. Therefore while trying to understand gender based violence, looking at gender as an isolated identity would do injustice to understanding the phenomenon, as gender intersects with caste and class to complicate gender based violence. Dalit women living in poverty experience gender based violence of a worse order than upper class dominant caste women. A poor Dalit woman’s experience of gender based violence is not just the sum of Poverty + Caste + Gender, but there are interacting effects that she experiences that are beyond the sum total of these effects. Though I had a theoretical grasp of this through reading ...

We diagnosed Mrs. R with breast cancer last year around the same time. We have been treating her for diabetes and hypertension for several years, but Mrs. R never once complained about a lump in her breast. We also failed to perform a routine clinical breast examination. Suddenly last year she hesitantly told me, “I don’t know how to say this to you. I am thinking of you like my own son and saying this. I have a small peanut sized swelling in my right breast. I don’t know how to handle this. Will you help me?” From here all subsequent events flowed in a frenzy from a detailed physical examination to referral to the tertiary care hospital, a diagnosis of advanced breast cancer stage IV, till radiation therapy to remove some tumor in the breast. Mrs. R was given a bad prognosis and was told that nothing much can be done about her cancer as it had spread to her lungs and all bones.     Through this entire ordeal Mrs. R and her 28 year old son S would regularly visit me and sit an...

  “I thought God dealt me a raw deal with diabetes and high BP. Not just that. He constantly beats and pushes me down. I am the unluckiest person on earth” Mr. K lamented at the close of our clinical encounter. It was Mr. K’s first visit to our clinic. I see patients in the clinic on Mondays and Fridays and it was a Monday morning. There were not many patients waiting and so we had some time to talk. After obtaining clinical information from him, we were discussing about his life.     Mr. K recently retired as a clerk from the registrar’s office. He worked there for more than 25 years. Registrar’s offices are fertile grounds for corruption and bribe. “On an average day we would earn 14-15 lakh rupees in bribes for land registrations” Mr. K did not even bat an eyelid when he said this. This amount is way more than my annual income, and I struggled hard to keep my jaw from dropping.    “The sub-registrar would make all the collections and put them in a cloth bag. ...