Between thoughts and words

(This is based on a true story and some parts are fictionalised. I leave it to you to decide which one is what.)  I stood next to the window in the dining room adjacent to the clinic space and watched outside. Lucky, the white coloured stray dog which had adopted the clinic as its home was lying in the grass and sunbathing. Just beyond the fence three women were working on the field, planting watermelon seeds. Their slow rhythmic movements reaching into the vessel containing the seeds and sowing them on the ground was synchronised perfectly. It was like a gentle rhythmic dance. I was sipping on my coffee. It was not a particularly flavourful coffee. We buy 200 ml of milk from which the entire clinic staff (all six of us) have our break time coffee made from instant coffee powder. More than nourishment or flavour, the coffee served the purpose of a little break in the middle of a hectic clinic and so it just did not matter. As I stood watching the scenery from the window, a giraffe ...

"Sister, could you please hand me the Normal Saline solution?" I called out to the staff nurse on duty. I was dressing the foot ulcer of Mr. R. He had gone to work on his groundnut fields last week, barefoot. A stray thorn had pricked the left foot. What started as a small blister the next day had developed into a deep ulcer. Fortunately, it was not infected. I was cleaning it up and applying a clean saline dressing.  "Doctor, I need some urgent change. Do you happen to have 20 rupees on you?", the nurse asked.  "I have exactly 20 rupees in my shirt pocket. However, that is all the money I have now. You have to give it back to me by evening, otherwise I will not have cash to pay for my bus ticket." I said and continued, "take it out from my pocket yourself" and I bent down so that she could reach into my pocket and take the cash, as I was wearing gloves and did not want to dirty my shirt pocket.  Mr. R and I go a long way. He came to me seven yea...

Mr. U is a Malayali gentleman settled in Tamil Nadu for more than 40 years now. He speaks Tamil with such a beautiful Malayali accent, that it sounds like poetry. He retired from a very important position in a central government organisation. You can feel the sense of pride and responsibility of having been in an important post in the way Mr. U dresses, walks, talks and carries himself.  "You won't mistake me if I ask you a few questions, would you?" He would preface his interaction after the clinical encounter with this question. After I say that it is not at all a problem, Mr. U would take out a small pocket-notebook and flip a few pages and start the questions, which he would have jotted down in it-  "Doctor, I like to eat fish curry at least 2-3 times a week. Is that alright? Will it affect my blood sugar control?" "When my grandchildren are visiting our home, my wife makes some sweets for them. I am unable to resist the temptation to taste them. Can yo...

Wishing you all a very happy new year 2025! As I sit back and think about 2024, I am overwhelmed by how much has happened in the year and how much it has enriched my life. There have been several dramatic twists and turns in the plot called life. One of the most important events that happened this year has been my career change. I vividly remember the conversation I had with a friend who had made a similar career change a few years ago. She told me, "Vijay, it is not going to be easy. But eventually you will get used to the idea that you don't have a regular job anymore. You will find yourself questioning your decision several times. But you will get used to a new normal." Those were indeed words of wisdom. I keep telling these words to myself even today when I question myself for having taken this decision.  I am now a primary care provider in a rural area. I would not characterise it as a remote area, nor would it qualify as underserved. Compared to when I started worki...

Our research assistant and I left to the far off village in our project area on his bike after the clinic on Sunday. The weather was pleasant. The wind blowing on my face, vast swathes of green fields on either side of the narrow cement road, and huge trees standing on either side of the road at periodic intervals as though watching over us as we rode towards the village, created a sense of warmth and happiness.  The bike did not have one footrest and so my left foot was cramping as I rode pillion. Other than that, it was a beautiful ride and when we reached the centre of the village, it was very quiet. 2.00 PM on a Sunday afternoon, with most people enjoying their post meal siesta, the two of us stood just outside the temple waiting for the people with diabetes to arrive. A peer support group meeting for men with diabetes had been scheduled and I had gone there to participate and interact with the participants in the meeting.  The community health worker for the village arriv...

Recently I have been working on a research study on women's lived experiences with diabetes. We interviewed several women to understand their experiences of navigating diabetes. Hopefully the findings of the study will come out in the form of a publication soon. This blog is not about that. It is about the impact of the social construct of masculinity on diabetes management.  One of the first things I do before starting the clinic is to visit the tiny hut near our clinic in which a couple run an idly shop. They make really good idly and when combined with the piping hot sambar (which must be pardoned for its watery consistency), pudina chutney and crispy lentil vada, it is a really wholesome breakfast to get the day started. My routine is 3 idlies and one vada. But getting the shopkeepers to limit the number of idlies to 3 and vadas to 1 was an uphill task. "How will 3 idlies be enough sir? you should have at least 3-4 more. Will you also have 2 poories in addition?" This...

There are age-dependent themes in conversations between friends. In the late 20s and 30s conversations tend to be about marriage, children, schools etc. In the 40s and 50s conversations move towards care of dependent elderly parents. In a typical middle class family caregiving for dependent elderly parents is included as one of the routine responsibilities. The living arrangements may not be amenable to providing physical care. Nevertheless even from a distance, the care responsibilities are often there and they are a major part of monthly budget planning and planning of day to day life. My parents are quite independent in many aspects, but the worry about how they navigate the new digital world, electronic transactions and everyday life which has now strongly become technology dependent is a constant lingering one. Yesterday I saw a patient in our clinic and her story was such a stark contrast to this situation.  Mrs. M came to the clinic with a swelling of her left foot, severe p...