Between thoughts and words

  Mr. D is a 70 year old gentleman from the nearby village. He has been visiting our clinic over the past three weeks. He has a corn on his left foot. The corn caused severe pain which restricted his mobility. He went to a local traditional healer, who took a blade to it and shaved off the upper layers of the corn. But it only worsened his pain, and he came to us for treatment. I have been doing the standard conservative treatment which includes changing to softer footwear, applying creams that will dissolve the hard tissue and pain killers. But the corn was adamant and the pain relief was marginal. “The pain just doesn’t go away doctor. I am unable to place my foot on the ground early in the morning when I get up. I don’t know when this pain will go away” Mr. D was in severe distress yesterday morning when I saw him.    Over the past three weeks I had gotten to know Mr. D a bit more than just his calloused foot. He lives alone in a small makeshift house made of tin sheet...

She ela could barely walk the three steps across our clinic threshold without gasping for air. She was in her late thirties, pale, fragile, and drowning in her own lungs. Beside her, half-carrying her frame, was her husband, David, thin, exhausted, with dark hollows beneath his eyes. Eight years earlier, just after the birth of their second child, her immune system had turned on itself. The diagnosis was systemic lupus erythematosus. Within two years, it had destroyed her kidneys.    “From the time we got the SLE, we would visit the government hospital clinic every month. We even made friends among other young women her age and their spouses” said David. Through the years they saw several of their SLE-sisters slowly fade away with kidney disease, go on dialysis, and ultimately die within a few years. Even before she developed kidney disease, she knew what could eventually happen.    “Nothing is more horrible than waiting for the inevitable to happen to you. We would ...

Three years ago I read a novella “Yaanai Doctor” (Elephant doctor) in Tamil, by Jeyamohan. It is a heartwarming and deeply moving narrative of the life of Dr. V. Krishnamurthy, a forest department veterinary surgeon who dedicated his life to conservation and treatment of wild elephants in south India. The book moved me deeply through its arresting narrative style and the inspiring tribute that it paid to a humble unsung hero. Dr. V.K ‘s beautiful journey with the elephants in the forest and the way they understand, respect and love him felt inspiring. The book stood for ‘empathetic science’, scientific knowledge laced with compassionate empathy for all life forms. Though I read the book long ago, the feeling that it gave me never left me.   Today, I received the book “Echoes from the Atoll: Inside India’s first TB-free islands” which I had ordered a week ago. Written by Dr. Rakesh P.S., my dear friend, the book is published by Clever Fox Publishing, Chennai. Rakesh sent me a messag...

    Centre for Health and Enquiry into Allied Themes (CEHAT) in collaboration with Agents of Ishq have created a six part video series titled “Good Doctor”. The series addresses an important question in health care delivery – “Who is a good doctor?” Each of the six videos is around 10 minutes in running time. Each episode in this series depicts important aspects of patient care including empathy, understanding social determinants of health, including them in clinical decision making, ethical issues including autonomy, right to health care, and gender sensitive health care. These are important aspects of the practice of medicine which are often overlooked. These videos are in Hindi with English subtitles. They combine humour, depiction of realistic clinical scenarios from the Indian context, and intelligent use of dramatic elements to convey these important messages.    There are two main characters Dr. Hoshiyaar, the young resident doctor in training played by Sawan ...

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...