Between thoughts and words

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 ...

      “I am having severe neck pain doctor. I have taken all home remedies that were suggested to me. But it is not going away,” said a demure young woman. She was the 68 th  patient of the day. The complicated and memorable patients always seem to come to the clinic towards the fag end. Is it a pattern? Or am I vividly remembering them because they came last? The brief interaction with her left a deep impact. I was thinking about her for a long-time last evening.    Mrs. L must be all of 24-25 years of age. She must be about 5 ft 4 inches tall, thin built, pitch-black hair well oiled, parted in the middle and worn as a plait. She also had a bright  kumkumam  dot on her forehead, it was not the typical dark maroon color that most women in the area wear. It was a light red to orange colour dot, commonly worn by women belonging to the Irula tribal community. We have a practice of routinely collecting information about caste in our clinic case record...