Friday, 18 March 2016

Doctor in village 4

One of the first things that you learn as you train as a Child Specialist is that the dose of medicines you prescribe is crucially dependent on the weight of the child. Nowadays for many drugs body surface area is used. It is more accurate but difficult to use since you need a ready reckoner. The reckoner will give you surface area from the weight and height of the child. When I started my Paediatric practice therefore the weighing machine was an important instrument that I purchased. By experience you learn to guess the weight from age and appearance especially in busy out-patient departments. But when you have just started to practice you are more scientific .
So when this young woman and ( apparently) her mother walked into my OPD with a toddler hanging on to their hands I understood there was trouble in store. Most parents make their young children stand on the weighing machine ,without realising that they might start crying when left alone. Simple alternative is to weigh both parent and child while the parent carries them,and then subtract the weight of the parent.
When my examination of the child was over , I turned to them and said
" We need to check his weight "
The young woman promptly tried to make the already apprehensive three year old stand on the machine . He promptly started to whimper. Before his whimper turned into a cry ,I told the older woman
" You hold the child. We can take the mothers weight first. Then we can take their weight together and find out his weight"
The young woman hesitated and said
" But doctor ,there is a problem "
" What? " I asked .
" I am not his mother " she said solemnly.
I almost fell off the chair laughing ....

Saturday, 12 March 2016

Doctor in village 3

Doctor in village 3

It was in his forties that my father decided to pursue specialisation in Child Health. When he started practising Medicine there was no need for specialisation to make a decent living. The general practitioner was well respected and derived a lot of job satisfaction. But as years rolled on, the need to specialise increased and there were lots of peer and job pressure on GPs to go in  for specialisation . Being in the Government Health services gave my father the opportunity to pursue specialisation under special rules for In-Service candidates. Admission to this "Service quota " was strictly according to seniority and therefore he was 45 by the time he completed Paediatrics PG course. When he started specialty practice he however continued to see older patients as well. This story is about a hilarious incident in Paediatric practice. It is very important to be able to examine a calm child to make a correct diagnosis . Most Paediatric texts advise that extremely young infants be examined in the lying position. However most toddlers become restless when forced to lie down,so this age group that is from about 8 or 9 months till about five years the children are best examined while they are seated in the mother's or father's lap. Many parents have the habit of placing their two or three year old in the examining chair in front of the Doctor and stand behind them. This is a sure recipe for the child to scream and make the whole interaction unpleasant. So when one afternoon a young mother made the same mistake ,my father gently chided her.
" Please ," he said " keep him on the lap".
" No doctor," the young mother hesitated " it will be inconvenient "
" What ? " he asked incredulously " to keep a child in lap is inconvenient ? "
With a lot of hesitation ,the young mother placed her one year old on the lap ...
...of the doctor!
My father did not know whether to laugh or cry ,but the infant knew. He cried and before his mother finally understood the mistake,had made the doctors lap his urinal.

My father used to say about the incident as an example of how communicating correctly to patients is important .

Tuesday, 8 March 2016

The Missed Call

The Missed Call

In the hazy dawn that greets you in winter
I see a missed call from a dear friend
One that tried to wake me up at three
Have I missed a call or missed a cry ?

Through the window I see our past
The long talks ,the long waits ,the pleasure
Of knowing without looking
That it was you at the other end of my cell

It was not mine to take the call you took
Of putting in your life with a love you chose
Friends we parted did we not ?
Even when you didn't call on me forever

And yes the call you made last summer
When your cries muffled the phone
With violent violations of your soul and mind
The darkness of it all snuffing out the day

But what to say my dear friend of a life
When darkness descends on your life
I stand helpless as an estranged soul
But remember this will pass soon

You will rise from the ashes of bad memories
And the future will bring not a flower but a spring
So get going ,I am there with you all the way
Whether we talk or not over a piece of cord.

Sunday, 6 March 2016

மனதில் ஒரு மழை

முகில்கள்களின் வருடாந்திர பரிசாக பருவமழை
உடைகிறது மௌனம் ,பொழிகிறது வானம்
வரண்டுவிட்ட புவியில் மகிழ்ச்சி வெள்ளம்
விரிசல்கள் ஆறுகளாக பச்சை கிளைகள் உலகமெங்கும்

ஒட்டுக்கூரைகளின் சிரிப்பும்,மண்ணின் வாசமும
அறைக்குள் ஜன்னலின் சாரலும் ,வெளியில் கொஞ்சும் அடிகளும்
மறந்ததும் மறைந்ததும் விழிகளில் மலர்வது ஏனோ
மழையினால் அழிக்க முடியாத விழிகளின் வழிகள்

உன் புன்னகை கேட்டதும் உன் பாடலை பார்த்ததும்
விழித்த கண்களை மறைத்து நான் உன்னை அணைத்ததும
கண்ணின் அசைவினால் ஒரே இசை ரசித்ததும்
வாழ்கையின் உண்மை நம் காதலின் கண்ணை துடைத்ததும்

ஞாபகங்கள் வானத்தை மறைக்கும் பருவமழையில்
வருத்தங்கள் மௌனத்தை உடைக்கும் தருணங்களில்
மனம் வழிகின்றது ஆசைகளின் பெருமழையில்
இந்த மழை அழைக்கும் வசந்தம் கனவா இல்ல நனவா

Saturday, 5 March 2016

Doctor in Village 2

Doctor in village 2

In the days when my father started practising House Calls were an important duty of the general practitioner. For the new generation let me explain that this was when the doctor went to the house of the patient and examined him or her. There were no ambulances then in rural areas and bed ridden patients used to get care by these House Calls. For the new practitioner this also represented an opportunity at better payment because house calls were always better paid. The caregivers who wanted house calls always waited with a taxi till the last patient in the doctors queue was seen. These visits also strengthened the bond between the doctor and the people. Often this meant wading through dirt and walking through fields but at the end it gave a satisfaction that's difficult to recreate in the current scenario . The essential equipments for this visit like stethoscope, BP apparatus and some medicines were always kept ready in a small briefcase earmarked for this purpose. What I about to talk about is an interesting incident in one of these house visits. My father used to be called frequently to see an octogenarian grandmother. Let's call her Mary for convenience. She was the typical devout Christian lady always clad in the chatta and mundu. While as family doctor my father was familiar with most families it was near impossible to be in the know of everything . So house visits were one opportunity to banter about the events in the family like marriages . So it happened that one evening he was called in again to  see Mrs. Mary at her house. After finishing his examination and prescribing medicines he started some chat to humour the old lady.
" So,how is your elder daughter doing? " he asked " she's in Irinjalakkuda,no ? "
Mrs. Mary looked at him and nonchalantly asked
" So you did not know it doctor ? "
My father was perplexed since he did not know what he was supposed to know.
He nodded " No".
" She died two months back doctor "the octogenarian replied stoically.
My father was shocked and said
" I am so sorry to hear that, " he said " you must be feeling terrible "
Her reply was instantaneous.
" Oh no,was she not old doctor? She was past sixty "she replied and went back to her rosary counting ..

Thursday, 3 March 2016

Doctor in Village - 1

Doctor in Village 1

Movies always begin with acknowledgements ,so let me also start by acknowledging that these write ups have been prompted by writings of my friend Srinivasa Raghavan about his legal career. But I had written some of these earlier but it did not occur to me to post it in FB. Some of this is my own,but most experiences are my father's and shared with us when he was alive.

My father Dr Rajagopal moved into Ollur then a sleepy village near a sleepier town,Trichur ,Kerala in 1970,the year I was born. He was then in his late twenties ,full of zest and the aspiration to succeed. He joined the ESI dispensary in Ollur as its Medical Officer in charge . For the uninitiated,ESI stands for Employees State Insurance , a government entity providing health services to the organised labour class. Although he was a fresh hand ,my father was given charge specially by the then Director of ESI Dr. Chitran Nambudirippad apparently to end bickering between two existing doctors. When he landed up in the village ,he was provided a quarter behind the dispensary. Years later I joined government service in the very same dispensary. I went around the quarter where I had probably crawled around. It was by then a dilapidated wreck.
Anyhow even then the quarter had its share of surprises,commonest of which were poisonous snakes! But this is not about any of those crawling creatures!
This story is about the two doctors who were then practising. I shall refrain from naming them correctly since one is very much alive. They lived and practised on two nearby streets. They were the only doctors then and competition was tough. Fees were minimal at two or five rupees ,so your survival depended on the number of patients .
The way they tried to maximise their clientele was rather stunning. They kept two youngsters at the start of the streets where they practised. Let's call them Dr Samuel and Dr John. When a family start walking towards Dr Johns clinic cum house,the youngster employed by his rival will come  forward
" Hey you are going to Dr John? Do you know he gives all the wrong medicines ? You will get cured only slowly. Turn back and go to Dr Samuel. Now, there is a fine doctor."
At this if they turn back ,at the corner,the other youngster will accost them,pretending to be an innocent passer by.
" Going to see Samuel Dr,? you really value the life of your child or......"
Imagine the plight of the poor family ! There were also smarter ones who escaped paying fees with one doctor by pouring abuse on the other.
When my dad started  to practise,first thing he did was to befriend one of his competitors. The other one had already left.
They remained friends till my fathers death in 2012. Their camaraderie despite competition was legendary and locals found it initially difficult to believe. Indeed many of my friends in school believed they were adversarial. To this day i remember the support given by this " adversary" when my father was unwell due to any reason.Such were the times ......