Units, Tens, Hundreds and Thousands.

        Each of us some song or one-liner associated with an important event in our lives. And that is what makes it all the more so special. Well, for me as I realised today, it is a chapter in my textbook that too has evoked euphoric memories. I have my share of songs also, my favourite ones being “Yaad sataye Teri” from Phir Hera-Pheri,

“Paisa-Paisa karti hai” from De Dhana Dhan

and the most recent being “Saibo”.

Anyways, talking of this special incident, it isn’t one that is all happy happy and goody goody. Still, it is a unique one.

        
         As I decided to start “revising” my ophthalmology as the prelims are around the corner, I opened “that” chapter after about 6 months. (Actually that’s the duration after which I have actually opened my ophthalmology textbook.) With the noise going on outside it is anyways difficult to concentrate. Then again, there is the England India test match going on. Not that it is any great, but my favourite cricketer Rahul Dravid 

has just hit a century and I hope that India are able to save their face in this test.  So, the best thing to do in such a situation is to enjoy those memories that flash back and relive those moments.

         
          After some days about six months ago, when it suddenly dawned onto me that I was in the last ophthal post and will have none before the exams, studies began. It felt good to be reading again. The teacher that I was posted under is perhaps the most dreaded in the entire college. For, one, her very shrill voice. Two, her taunting comments. Three, her bad memory. You may be following her as a shadow for two weeks. She’ll ask you your name. You’ll be happy that finally you’ve been noticed. And the very next day, she’ll demand the attendance sheet and will want to mark you absent for the entire two weeks for “she hasn’t seen you!!!” Four, her unpredictable temper and mood. You never know what to expect from her! And fifth, for herself.

        But, still, some gutsy personalities such as myself who are fond of going against the tide and “taking ‘em on” will try our luck and chances. I had heard stories about her even before my first post last year. And as a very good student asked her on my very first day,” Madam, I am a second MBBS student. This is my first ophthal post. I don’t know anything and won’t have the time to read everything as I am appearing for completely different subjects. Hence, what are the things that I am supposed to know by the end of this term?” She was taken aback, shocked perhaps. Squeezing her eyes she gave me” that” look and frowning her brow bluntly and rudely replied, “You are supposed to know everything.”

        That was then. And I thought how she forgot that she too was once an undergraduate who knew nothing! Then, during this last post, when she was in one of her good moods and relating to us instances from her residency days recollected how she had given a tight dressing to a patient that had caused a collapse of the anterior chamber and how her bosses got mad at her. But, she defended herself saying that “No one told her what to do and it was her first time”. Doesn’t it ring a bell madam, I thought. If you know how bad first time experiences can be and you definitely did not like it, you could have been a little more “considerate”.

        Anyways, that was a good week for she was in a good mood the next day also. She called me and asked, “Do you know maths?” I said,” Yes!” I always take pride in declaring where ever possible that even though I have taken up medicine; my knowledge of maths is as intact as ever. I can still solve those trigonometry, differentiation and integration problems! So, I thought that she’ll give me a simple arithmetic to do at the most. But, the task she entrusted to me was to “teach counting and addition” to our canteen boy. Hmmm, canteen boy, how old can he probably be? Well, he was 35.

        As it turned out, this professor had a humane side to her as well. I don’t know how but she had found out that this fellow was uneducated. Not only that but he was also keen on learning. So, she had been sending him to tuitions to learn basic things which most of us have learnt and forgotten since our nurseries. So, while 35 year olds residents at one hand pursue super specialties in our college, we mug up from books which are at least 3500 pages

 

and no less than 5 kgs in weight as a rule and this fellow at the age of 35 still had to learn to count up to 3500!

        And, I forgot to mention that, she had been paying his tuition fees as well. Extra fees also, for he was a “special” student. The man was intelligent, but there are ages at which you learn certain skills the best. You cannot learn them before, and definitely not later. But, this that tutor did not know. So, he/she was always frustrated why this fellow won’t grasp things and concepts which even a seven year old would grasp easily. And, so my professor felt that “the tutor was being harsh on him”. Hence she wanted me to teach him addition of three digit numbers. And to do that explain to him the concept of “Units, Tens, Hundreds and Thousands”.

 

        Well, the next day the fellow brought a 2^nd standard maths textbook. Other patients in the OPD may have thought that it would be for his child, but it actually was for him. So, for about a couple of hours I tried to teach him. How well I taught I do not know. But, I did give it my best. I have taught maths to standard 10 students, but that was first experience teaching standard 2 stuff. It was difficult. Things that we take for granted, are not. It is difficult to understand, how that person is unaware to simple things. But the fact is that he is and you have to try and make him aware. That remains a very memorable experience and learning in itself for me, “Never take things for granted”. We live in very cosy homes and easy lives. There are situations starkly opposite in the society.

 Then when he came to take her leave, she told him to teach others all that he had learnt today. Knowledge has to be spread. It grows only by sharing. “You know no body taught them.” She told me. “Yes ma’am”, I replied. “No body has taught us either!!” (This I did not tell her). “Do not expect us to solve great riddles and puzzles with knowing the basics. We too need to be taught the “Units, Tens, Hundreds and Thousands”.

What surprises the most is this human behavior. The person considered to be tyrannical, actually has such a huge heart. She knows what the difficulties are. Yet, again they are identified only in some, and in others it is taken for granted. I am not complaining. Our problems are nothing compared to that man. And we are smart enough to fend for ourselves. I have been lucky to post this. And you have been lucky to read this.

  
Just making an observation. Food for thought perhaps.

The Unanswered Questions.

             I was in the ward  at around 8.00 in the evening, taking a "case" to present the next day. Just a terminology, but surprisingly, how easily it takes away the feelings and emotions attached when you interact with a patient! And after that, around 9.00 went to collect a donation cheque. I was happy, cause the case was excellent with good findings and I had some money in the Bank, and walking happily in the corridor, when I heard something that felt like some one calling out to me from behind. I turned to see an old lady sobbing loudly, "Ae BABA ...... AE". No, she wasnt calling out for me. Neither to anyone else in that fairly crowded corridor. She was calling out to some one more powerful . After sparing her a second, I continued to walk on. For, two reasons, I di not know why she was sobbing, second, I did not know how I could be helpful to her.
            The next morning rounds were no better. As the rounds were going on in the female ward, two of our servants brought in a stretcher. Behaving very freely, the experienced one said to the novice, " मेरे साथ रहेगा तो सब सिखा दूंगा . दो दिन भी नहीं लगेगा.  ये अपना रोज का काम है ."

 At first I thought they were probably taking someone for an X-ray or something, but as my vision followed course, they nicely picked up the body, and wrapped it in the same bed sheet on which she was lying, covered up the face, and took it away as if it was a bundle of रद्धि. I was shocked at this lax attitude, but then again I was reminded that the previous night I was chatting with the sister-in-charge the previous evening and unknown to her an old man had come up behind her to ask for some cotton wool. She casually asked me, "कुठल्या गावातून आला तू?". And the old man, thinking that she had asked him, said "Kolhapur'. But she was so embarrassed that the old man thought she called him "TU". She kept on appologising to him and as far as I remember, told him about a dozen times,"आजोबा में तुम्हाला 'तू' कशी म्हणू?", even though he had no objections. Yet in the morning, a lifeless body, had no value. So, it is life only that garners respect. And as we will be celebrating our 65th Independence day today, we will be remembering and celebrating the martyrs and their contributions. No, then it means death garners respect. Complex!!!

            On the way out from the wards, we found a woman fallen unconscious in the corridors. In all probability she had an epileptic fit. The HOU directed us to take to casualty. On enquiry, the relations informed me that her husband had just expired. 

            Such is the beauty of medicine, it enriches you. There are innumerable such experiences that keep on happening every second. Every moment here you have to make a decision, are you supposed to be happy or be. Should I be happy for I have seen a patient with a rare disease and learnt some great things. Or am I supposed to be sad, that this individual is going to suffer a slow painful death, and in our setting not even perhaps afford the cost of his treatment, even after all possible donations and concessions.

               I strongly remember,  my HOU in surgery telling the houseman not to delay the discharge of a patient and in his own words, "For you this cost may be nothing, but for him, he may have to sell his farm and house." That dictum I want to remember and follow.

                But, as people fall sick, and sometimes the situations are such that despite wanting, you cant do anything, and then death becomes a daily affair, you try your best to preserve life, but death takes the upper hand. I think if you remain overtly sensitive, you will not be able to survive. You need to distance your self a bit. But, there are also complains now of doctors losing their personal touch. So, there is a fine line between attachment and detachment. Till where it extends, I do not know now.

              These are just thoughts in my mind, to which I think only time shall provide the answer . Perhaps tomorrow, perhaps after a decade, or perhaps even later. Whether I will comply with the dictum I now have set for me, or will I be forced to surrender to other forces and stresses, I do not know. I know some, but much I do not know.

             But, this is what medicine is: striving to find the answers. There will always be some questions unanswered. And on an personal note, that is precisely the reason, why I enjoy medicine- it gives you the opportunity to be a student for life.

            And that is why a doctor is always a practitioner, and never a perfectionist, because perfection marks the end of learning! These are some unanswered questions.

The Sthethoscope Poem

There was a young man in a boston town,

He bought him a stethoscope nice and new

All mounted and finished and polished down,

with an ivory cap and a stopper too.

It happened a spider within did crawl,

And spun him a web of ample size

Wherein there chanced one day to fall

A couple of very imprudent flies.

Now being from Paris but recently

This fine young man would show his skill.

And so they gave him his hand to try

A hospital patient extremely ill.

Then out his stethoscope he took

And on it placed his curious ear,

Mon Dieu! said he with a knowing look

Where here is a sound that's mighty queer

.

There is a empyema beyond a doubt,

We'll plunge a trocar in his side

The diagnosis was made out-

They tapped the patient ;so he died.

Then six young damsels,slight & frail,

Received this kind young doctor's care

They all were getting slim and pale,

And short of breath on mounting stairs.

They all made rhymes with ''sighs" and "skies"

And loathed their puddings and buttered rolls,

And dieted much to their friends surprise,

On pickles and pencils and chalks and coals.

So fast their hearts did bound,

That frightened insects buzzed more;

So over all their chest he found,

The rale siffilant and rale sonore

He shook his Head.

There's Grave's disease,-

I greatly fear you all must die;

A slight postmortem,and if you please,

Surving friend would gratify.

The six young damsels wept aloud.

which so prevailed on six young men.

That each his honest love avowed,

where they all got well again.

This poor young man was all aghast;

The price of stethoscope came down;

And so he was reduced at last,

To practice in a country town.

Now use your ears,all that you can,

But don't forget to mind your eyes.

Or you may be cheated, like this young man.

By a couple of silly,abnormal,flies.

By Oliver Wendell Holmes- An American physician & Poet Harvard Medical School.