When Ms. A walked into the clinic something did not feel right. She was a woman in her early thirties. She was a very beautiful woman who was shining in her old ragged synthetic saree that must have originally been yellow but was now with a brownish tinge. Her steps were measured and slow, and there was a stoop in her posture. Her face was bereft of any emotions. Her eyes just showed a blank stare. I welcomed her and asked her to take her seat. I had a young family medicine post graduate student shadowing me in the clinic that day. She sat facing the young doctor and told her, “I have this pain and swelling” and showed her left arm. She pulled up the pallu of her saree and revealed the arm where she had the pain. There was a dark blue bruise with a painful looking swelling. The young doctor touched it and the lady winced in pain. Through this small interaction and the painful moment, there were no expressions on her face. “Did you fall? Did you hurt yourself?” “No” “Did you...
Peak summer, or kathiri veyil as we refer to it in Tamil, has passed. Some uncharacteristic mild rains have also started drizzling in Chennai. But the ambient temperature and humidity continue to be oppressive. On most clinic days, this becomes an important factor in governing the mood of the day. I have been feeling a lot more irritable the past few months, especially during the start of the clinic. Slowly the body gets used to the sweltering ambient conditions and things become better as the day progresses! This irritability manifests itself as long gaps in the flow of thought, or thought blocks. A middle aged woman came the other day with complaints of intense itching all over the body. There was no rash. She does not have diabetes or hypertension. On a pleasant day my mind would have gone through a whole list of differential diagnoses for itching without rashes - liver disease, kidney disease, anemia, worm infestation, thyroid dysfunction, or sometimes even cancers. But...