Between thoughts and words

"I do not want to go to the Government Hospital again. Please don't send me there. Send me home. I would rather die at home", these were the desperate pleas of Mr. G, a 50 year old man in our clinic yesterday. Seeing and interacting with Mr. G put us in a major ethical dilemma. The collective empathy of all the clinic staff could not arrive at the ethically right course of action for him.  Mr. G lives in a village near our clinic. He has a disease where the blood vessels in his lower limbs were not working well, thus compromising the blood flow to his legs. It all started as rotting away of his toes several years ago. We had referred him to the Government General Hospital (GGH) in Chennai. They did extensive tests and found that the major arteries supplying blood to his lower limbs were occluded. Over the past 6 years Mr. G has undergone 8 surgeries of the blood vessels in his lower limbs. Gradually parts of his feet and legs were amputated and removed as they had died du...

Doctors sometimes have patients who are 'difficult'. When a person comes to me for treatment, they are often not in the best frame of mind. Some of them are in distress, some are unhappy, some are suffering in pain. Some of the patients do not have the luxury of being in their best behaviour when they come to me. Therefore, patience, understanding and empathy are always taught as core values in the practice of medicine. One category of the 'difficult' patient is someone who is not in their best frame of mind and so the clinical encounter becomes terse. Another category is patients who come with some preconceived notions about their illness, often misinformed by wrong information, and find it challenging to accept an alternate explanation. This blog is about a third category namely, patients with 'wicked problems'.  A wicked problem is defined as a problem that is almost impossible to solve because of contradicting knowledge related to the problem, complex interp...

A blog I wrote recently on mental health received a wide range of comments and feedback. Some of them were feedback where the reader said they related to what was being mentioned. The others were differences with the stand I had taken in the blog. Some of the feedback was because of gaps in communication between what I intended to write, what I wrote and what the reader interpreted from it. I have had some chance to reflect more on mental health, mental illness, coping and resilience. Here is a follow up to my previous blog on mental health and coping.  The main premise of the previous blog was that people who live in uncertain life situations, typically those who live in poverty, but could also include others who have uncertainties other than money in their life,  may have better coping styles. Alternatively they may not have the time or space to address their mental health issues, which they may brush under the carpet and move on with life. My friend and I have been discuss...

21 March 2024; Thiruvarur municipality, Tamil Nadu; 9.00 AM. We got ready and left in a car to the centre of all the activity. Police stopped our vehicle on the way, asked us to get on foot and walk about 3 km to the venue. There were thousands of people walking all around us, everyone barefoot. It had just rained a little around 8 AM and the heat had not started rising. Even as we walked amidst the sea of people, I felt like I was a small part of something huge and larger than life. As we neared the centre of the activity, the distant rhythm of drums was wafting through the air. It was the annual ஆழித்தேர் திருவிழா annual chariot festival of Lord Thiyagaraja (Shiva) and Goddess Kamalambigai (Parvati) of Thiruvarur. We exited a narrow by lane and turned and suddenly we were in the middle of the buzz of activity. There were layers of people filling the vast mada veethi  or the street on which the chariot will go. At the far end of this crowd was the huge 350 tonne, 100 feet tal...

Javier Zamora, writer poet, published his book Solito: a Memoir in September 2022. In this book Javier Zamora, recollects his journey of illegal immigration from El Salvador to the United States as a 9 year old boy. My friends gifted this book to me and I started reading it during a long car ride. The highly engaging book was a no-put-downer and I finished reading the book during the ride. I have  two friends, both of whom have migrated illegally as refugees from politically tense situations, one from Vietnam to the United States and one from Iran to Australia. I have listened to their harrowing narratives of the hardships they have faced while crossing the mountains, deserts and seas to reach a safe space. When I started reading the book, I was expecting it to be similar to those narratives. I was not ready for the emotional roller coster that this book would take me on.  Zamora's parents had already migrated to the US during the Salvadoran civil war. The pre-adolescent boy i...

I was listening to the narrative of a friend who had recently been diagnosed to have a mental illness and started on medications. "My parents are hard working and have struggled to bring me and my siblings to the social status that we currently belong to. My siblings and I are all suffering from some mental illness, and my parents are unable to wrap their heads around it. They had never experienced mental illnesses in all their life." In the medical college where I worked I was witness to the increasing 'outbreak' of various types and degrees of mental illnesses within campus. This exposure to increasing mental illnesses among the young, and the interaction with my friend who spoke about her mental illness, got me thinking about the social roots and origins of mental illnesses. Is increasing mental illness a by-product of development? Is it a disease of affluence? Is it the price we pay for moving up the social ladder?  My young friend's parents were from very hum...

I recently quit from an ethics committee in which I serve. The decision was a gradual and cumulative one. I found some of the members and the chairperson to be very dismissive and disrespectful of researchers. I have been member of some ethics committees before and I have always believed that being an advocate for the welfare of the community does not mean one needs to be rude, raise one's voice and be belligerent. This committee in which I was serving was toxic and some of the members were unnecessarily being rude and disrespectful. After patiently listening to a string of rude remarks and discussions, I decided to step down from the committee because the toxicity was getting on to me. I have been thinking about this decision to leave the committee and these are my reflections.  When something is not going well, is quitting a good response? People have told me before that it takes much more grit and strength to stay and fight toxicity than to quit and go. I have also been told tha...

One of the greatest challenges in working as a team is striking the balance between team coherence and emergence of individuality of the members. There have been times when I have enjoyed the dynamics of working in my team with each member complementing the skills of each other and bridging all the pitfalls within the team. But there have been other times when I have felt that I have not contributed enough to the project that we are working on and feel like an "imposter" claiming wrongful credit where it doesn't belong. I recently withdrew from a team effort because I felt that my contributions were not enough. My team mates were very upset with the fact that I withdrew. I have been reflecting on whether what I did was right or wrong. Here are some of my thoughts: The main reason I withdrew from the team work was because I felt that I had not contributed "enough". I am wondering if anyone can ever contribute 'enough' to a project in a team. Each person c...

Yesterday I was engaged in an interesting discussion over prioritisation of competing needs for a fixed amount of money. We had received an unrestricted grant for improvement of services in our rural clinic. Two important options are on the table.  (1) Paying regular salaries for the clinic staff for a year  (2) Setting up an upgraded basic laboratory facility in the clinic We were discussing which of these must be prioritised. I am reflecting on this discussion because, it helped me think through some issues that I think are important.  To provide some context, we are a non-governmental organisation providing basic level primary health care services including services for diabetes and hypertension in the local rural community. We are a low cost, fair quality service, which many locals prefer because of the calm, quiet, non-threatening and respectful ambience. Currently due to the poor finances we are able to run the clinic only on three days a week, and pay the staff onl...

Mr. Kanniyappan (name changed) whom I saw yesterday in the clinic, is a known patient of hypertension and diabetes taking regular treatment with us in our clinic.  "Doctor, I am having severe swelling in both my feet. My feet feel so heavy that I am not able to lift them and walk anywhere."  This was Mr. Kanniyappan's main complaint. This is not the first time that he has come to the clinic with this complaint. I knew immediately what to do. I usually ask him to bring his tablets, which he gets from the public health system. He laid out the tablets on my table and I sorted them out.  This is how his tablets look. Mr. Kanniyappan has poor vision due to cataracts in both his eyes. The ophthalmologist we referred him to keeps deferring the surgery because when his sugars are under control, his BP is sky high and when the BP is under fair control, the sugars are off the charts and when both are under fair control, there is nobody to accompany him to the hospital for the surge...