Between thoughts and words

The 80+ year old gentleman would come to the clinic with his grandson. He always dressed in clean white shirt and veshti (single piece of cloth draped around the lower part of the body). He walked with a mild stoop and with the help of a 5 foot stick, which he held in his left hand for support. A few years ago we had diagnosed him to have high blood pressure. I had started him on tablets. But he came only once in 3-6 months to visit us. He would come only when there was a dizzy spell, or a fall or some other disturbing symptom. Every time his blood pressure would be very high and we would sit and discuss the need to continue to his blood pressure tablets regularly. He would promise that he would take them regularly. But he never kept his promises. The main reason was because he was unable to visit the clinic independently and was always waiting for some younger member to bring him. The younger members were always busy and did not have the time for the old man.     Yesterday ou...

In November 2024, I started working with a nursing college. Initially I did a quality improvement exercise, evaluating their community health program and auditing some of their lectures and practical classes in the college. Over the past four months I have gained a deeper understanding of the politics of the care-giving profession. In the 20 plus years of my career as a physician, I have had the opportunity to closely work with nurses. Over this long association I have developed a deep and enduring respect for the nursing profession because I have seen how the nurse holds the burden of running the entire hospital ward on her shoulders. It is her grounded and constant presence in the hospital that keeps the work running seamlessly. At the same time I have also seen and understood how she is always treated as a second-tier citizen within the hospital ecosystem. The doctor is venerated as the hero of the medical enterprise and the nurse is often placed in a supporting role. Given this pow...

Mr. D comes on all the days I go to the rural clinic in Chengalpet to see me. Not only does he see me, he also goes all the way from his village to the Chengalpet Government Medical College Hospital, which is about 50 Km distance, and sees doctors there. He was there to see me today. Mr. L last saw me 6 years ago. He came in today to see me too, but had never seen a doctor in the past 6 years. Their visits were about 3 hours apart in today's clinic. But when I finished clinic and started to leave, I couldn't help but notice the contrast in the stories of these two men.  Mr. D first came to me 12 years ago with low back pain. After an evaluation, we diagnosed him to have lumbar disc disease with narrowing of the spinal canal. He would go on and off on physiotherapy. Subsequently Mr. D developed high blood pressure and was started on treatment. Then he developed a weakening of the electrical system of his heart called Sick Sinus Syndrome. He was advised to get a pacemaker implant...

Recently I started serving in a rural clinic in Tiruvallur district, about 40 KM from Chennai. I like the ambience of the clinic. It is spacious, well ventilated, well illuminated and clean. The staff is very friendly. Any patient who comes there is made to feel at home. The consultation chamber is a big 20 feet by 20 feet room with my table and chair in one corner. There is a clear 15 feet distance to traverse to reach my table from the door to the room. Yesterday as I sat in that room seeing patients, an elderly gentleman walked slowly through the door. He was accompanied by a young boy who was holding his right hand. The old man had a wooden stick held in his left hand to support himself while walking. He had a prominent limp as he walked across the room to my table. The young boy was full of energy, but he tried hard and wore a serious look on his face as he accompanied the older man. The old man was focussed on me and was looking at me with full attention as he moved across the ro...