Between thoughts and words

Imad (name changed) pushed open the door to my room and walked in with a broad smile on his face. I did not recognize him at first because he had grown into a young man of 15. The last I saw him was when he was a little boy, when his mother used to bring him for childhood asthma. Imad and his mother used to be frequent visitors to the clinic and so we had a friendly bond. I recognized Imad only after I saw his mother walking in quietly behind him.     “Good morning doctor. How are you?” Imad beamed at me. By now, I was grinning back at him ear to ear, having recognized him and feeling so happy to see him again. I welcomed his mother and asked them both to have their seat. There was a bruise on Imad’s face just above his right eye and adjacent to the bruise was a swelling which looked quite painful. I saw it and asked, “What happened? Sports injury?” Imad laughed when I asked this, but his mother was quite upset and she said, “No doctor, he got into a fight with some hooligans ...

  “I know what works for me and what doesn’t. This is not your body it is mine. I am living and suffering the back pain every minute. So just give me the injection when I ask you for it. I don’t need your lecture. It is the injection that I need.”    - Mr. A   “Sir, I am suffering badly with the foot ulcer. The pain is unbearable. Most days I am unable to sleep because of the pain. I spend the entire day sitting and staring at the roof, crying silently and suffering in pain. Please….please…please give me the injection.” – Mr. S   The past week has been rough. We travelled into interior villages in our project area to interact with people. The heat was oppressive. I missed the intellectual companion with whom I used to travel these same villages to interact with people. The experience of sharing surprised looks when the community says things which are totally unexpected, the long discussions during the travel to and from the village talking about the “why?”, “how...

  During a recent discussion on the dynamics of doctor patient relationships, we were talking about professionalism and professional boundaries. When practicing medicine in underserved rural areas, professional boundaries are blurred. The other day, a patient with a chronic skin condition whom I was treating in my clinic, saw me in the bus on my way to the clinic. He lifted his t shirt then and there to show me his skin rash over the abdomen. That is one extreme of how loosely defined professional boundaries are. How does the doctor balance being connected with the patient, maintaining good rapport and relationships, being sensitive to the local culture, and at the same time maintaining professional boundaries? I can make sure that I don’t breach professional boundaries with my patients, but how do I handle it when patients liberally transgress the boundaries?    Mr. M was a 65 year old man with cancer of the voice box. He was treated in a government regional cancer hospi...

Mr. R is a 29-year-old man, a cab driver who lives in a village near our clinic but operates out of Chennai. He finished his bachelor’s in mathematics from a private arts and science college in Chengalpet, and after hunting for jobs for several months, decided to drive a taxi for his living. He has been working as a cab driver for 7 years now and has earned a decent amount to build their own home in the village. His mother, younger sister and he live in the house. His sister has just finished her bachelor’s in education from a private college and is preparing for exams to get into the government service.   Mr. R came to our clinic about 3 years ago. While on a long trip of more than 300 KM on the road, he had developed severe breathlessness, profuse sweating and palpitations and had to stop driving and rest for a few minutes. It frightened him and so as soon as the trip was completed, he came home and the very next day came to our clinic to see me. He looked tired and his face was ...

Every Tuesday I meet with the community health workers who are the face of our community health program in the rural area where we serve. They are an enthusiastic bunch of 10 people from the local villages, 8 women and 2 men. Hailing from modest backgrounds, they are workers with excellent people skills, cool conversationalists and go-getters who can accomplish tasks assigned to them with perfection. Every Tuesday when we meet, we start with greetings and the broad opening question, “How are you all today? How has the last week been?” Some days they are silent and take time to warm up and start talking, on most other days they just start talking about the activities of the week, the challenges they faced, the unique problems they solved and the doubts they have regarding their work. Our meeting room is the noisiest space in the office and sometimes we end up disturbing the work of others in the office. But, I think this dynamic and vibrant discussion space has been one crucial factor t...

Yesterday there were two women who came to the clinic. Both of them had chest pain which was disturbing them. They had diabetes and hypertension for a long time and were taking medicines for it. Both came alone to the clinic, and were in obvious distress. I did ECG for both. One, Mrs. S showed features of long term heart disease that remained unrecognized and unattended (which happens often with patients with diabetes as they do not have symptoms) and the other, Mrs. AK showed a heart disease condition that is recent in onset. Both these women were relatively young (in their 50s), and so prompt consultation with a cardiologist, coronary angiogram, and treatment would be the next steps in their care pathway. But there was no scope for all this in either of their lives.     Mrs. S lives alone as her spouse left her for another woman many years ago and she doesn’t have children. She has an older sister and brother, both of whom are unwell and cannot accompany her to the hospital ...