On Thursday I lost my composure with a patient.
Mr. G. is a 55-year-old man. He has diabetes and hypertension. He also had a massive stroke that affected the entire left side of his body 3 years ago. He has recovered from the stroke. Medical research says that when a person has had a stroke or a heart attack once, they are likely to get more episodes. A person may get lucky with the first one, but subsequent episodes will keep weakening the body and he may not make such a full recovery. So, Mr. G. was supposed to be extremely careful. But he was not. I had put him on Insulin, maximum doses of diabetes medicines and stroke medicines. It looked like he was not taking most of them. His blood sugar level on Thursday was more than 400 mg/dL. It was alarmingly high. I asked him if he was taking medicines. He promised that he was.
Mr. G is this typical ‘religious guy’ with the vibhooti ash on his forehead, the rudraksham on his neck and dressed in crisply starched and ironed white shirt - white veshti. I have over the years understood that many people who dress up like this do it just to convince themselves that they are ‘good people’. Some also need the validation and acceptance that they get from the society by wearing this attire. I caught myself judging Mr. G and stopped myself.
I asked him calmly, “Please tell me openly whether you are taking your medicines regularly. Because if you are taking the medicines and despite taking them your sugars are so high, my line of treatment will be different from if you are not taking the medicines.” He did not say anything for a few seconds. Then he said he is taking the medicines. But his wife who was sitting by the side was getting uncomfortable. I then said, “If despite taking the medicines and insulin your sugars are high, I am going to refer you to the city hospital to see a specialist because it is beyond my capacity to treat such complex conditions here.” As soon as I said this, Mr. G. got agitated. He had this very angry and anxious look on his face and told me in a hurried manner, “No, no doctor. Don’t send me to the big hospital. Write me the same medicines as last time. I will come back next month with a good blood test report. Just give me one more chance.”
I was starting to understand that this man is lying about taking the medicines, or he is doing something like binging on sweets and that is why he is asking for ‘one more chance’. I said, “Sir this is not like a school exam. We cannot take a repeat exam and undo all the harms that were done during the previous month. The high sugars that you had this month have already started affecting your body. So please go and get an opinion from a specialist.” Mr. G.’s wife seemed disturbed by now and she spoke up. “Doctor, he is lying. He thinks none of us at home know about it. But he is not taking the medicines regularly. He is not telling you the truth.” The man was staring at her in a very ugly and angry manner. He looked like he would pounce on her right then and there and beat her. He turned to me and said, “No doctor, that is not the case. I have some problems. But I cannot talk to you in front of her. Ask her to get out.” He was so angry when he said this. I requested her to wait outside in the waiting hall.
Mr. G then said, “I married the wrong woman. Because of her my business failed. I recently went to a Swamiji and surrendered to him. My Swamiji said that I have taken this birth to exhaust all my karmic debt. This is my last birth. After this I will join God in heaven. I have diabetes, hypertension and stroke because of my karma. This suffering is all my karma getting spent. That is why I am not taking treatment. If I take treatment my suffering will reduce. If the suffering reduces, I cannot exhaust my karmic debt. So please understand and allow me to do this my way.”
I have never heard anything like this before. But this man seemed to believe this karma theory so strongly. I did not want to disturb or interfere with his belief system. So, I asked him, “Sir, I understand what you are saying. Yes, I have heard about karma and suffering and how suffering exhausts karmic debt. But if that is your goal, why have you come here?” Mr. G. looked confused. He did not have an answer. He said, “My Swamiji asked me to keep visiting you. In case there is any danger to my life, or any serious complication, then he asked me to take your help and get better. Once I am better, I can then peacefully continue my karmic cleansing. If I die without exhausting all the karmic debt, then I will be born again.”
I was losing my calm at this point of the conversation. I was getting a clear picture of what this man was doing. But for a few minutes my professional self was hurt by what he said. He was disregarding my professional opinion, my integrity as a clinician, and using me as per the instructions of a Swamiji, who in my opinion seemed to be ill informed about how diabetes, hypertension, and stroke work. From a biomedical perspective, chronic diseases like these need continuous ongoing treatment and support to prevent complications. I was also not comfortable writing a repeat prescription for this man with his high sugar levels. Any reasonable clinician would find my prescription negligent by medical standards.
I told him, “I respect your opinion. Just like how you have a Swamiji who has guided you to do the treatment this way, I have many Guruji’s, my teachers who have taught me my commitment to patients and how I should treat them. Are you asking me to disrespect my Gurujis? Would you disregard and disrespect your Swamiji because I asked you to?” There were several loopholes in this argument. But I posed it anyways. And a look of absolute confusion descended on his face. He was going through a serious conflict in his mind. I had spoken a language that he understood. Our discussion was no longer centered on the kidney, brain, pancreas, and blood vessels, it was focused on the sacred guru-shishya covenant. I realized that so long I was fighting an unfair battle biomedicine against religious belief. Now it was an even footed conflict – his integrity versus mine. After some quiet time, he stood up. He said, “I will go to the specialist. Please write a letter for me.” I was pleasantly surprised to hear him say that. I wrote a letter and sent him.
I don’t know if he will go to the specialist. Likely he will go back to his Swamiji and ask him about this conflict. My guru-shishya commitment versus his guru-shishya commitment. The Swamiji might have a convoluted response to it. Or the Swamiji might also understand and encourage him to carry forward with his treatments. But I learned a big lesson. People hide truth because they are afraid of facing the conversations and discussions that would follow revealing the truth. But open discussion of the truth will help reach those spaces within our own minds that we never reach and address.
In recent times I have started compiling such patient narratives into short story collections. I have published four such collections, two in English and two in Tamil. They are available in the Kindle format for those of you who are interested.
“Hearing the Unspoken : Stories of Health, Illness, and the Human Condition”
"Glimpses through a Fragile Façade: Stories of Illness, Vulnerability, and Healing"
ஆற்றுதலின் கதைகள் : உடல் நலம், நோய், சிகிச்சைக்கு இடையே எழுதப்படாத நிகழ்வுகளின் தொகுப்பு
மருந்தினின் தோன்றும் மாந்தர்கள்
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