Between thoughts and words

  “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 ...