A Saga Of Love

Internship, in a way to put it, is in itself an independent phase of life. An era in itself. You are no longer a student, but aren't a doctor either; you are somewhere in between, and sometimes you wonder, if even that is where you belong? There are many a trials and tribulations in the intern's life, frustrated housemen, frustrating schedules, depressing backlogs and demotivating Government Resolutions.

And yet, just somewhere in between, someone comes around, whose pain supersedes your pain, whose confusion makes you realize how lucky you are, that you at least have a rough idea of what you want in life, someone who you just cant pass off as just another incidence......

It was my 4 th night shift on the trot in the EMS - I can boast of it and I will, but I wasn't particularly comfortable or happy doing it! The three of us were chatting with each other as we mechanically cannulated IVs in the que of patients lined up ahead of us..... a que which had no end till so far as the eye could see...., simultaneous collecting blood samples 2 EDTA, 2 Heparin and 3 Plain bulbs, filling out forms and pausing our conversations briefly as we shouted out the instructions, simultaneously surveying the arms of the next patient for a good vein. This whole routine was so intense that it occurred almost at a spinal level, the only higher function involved was in our conversations.

In this din, trolleyed in a patient- not an occurrence of significance in our part of the world. He was a typical patient, cachexic, dehydrated, semiconscious and accompanied by two cash-strapped relatives. I got up and proceeded to his trolley holding a cannula, a spirit soaked cotton swab in my double gloved right hand and a 3-way attached to a syringe in the left, collection bulbs and a strip of dynaplast in the pockets of my apron. The man seemed to be in his late 60s, was bare chested and only a bermuda covered him below the waist. As I set out to do my job  I was interrupted rather annoyed by his wife who asked me, "Will he die?"

This was annoying for two reasons, one, relatives usually asked if patients will survive, not the other way round and two, for the tone of her voice and the way she kept aloof from the patient. But, ours is a profession where personal beliefs and emotions and prejudices are kept in the locker as the white coat is retrieved from it. I did what I had come to do, and directed her to the registrar for ant further queries..... no intern knows how much his involvement in patient care is supposed to be, so prophylactically, it s safe to keep it at a bare minimum.

The registrar asked her for the history, she annoyed him by her attitude, her obsession with the patient's death and her ever changing answers. No one could afford to spend so much time on one patient, there were 50 others waiting in the que. So, after initiating preliminary treatment the Reg moved on to others, leaving minute intricacies of his history for such later time as would be possible.

For the next three hours that followed, the female ensured that she was noticed by everyone in the EMS by her mannerisms and high pitched quarrels with a semi-conscious husband. It was becoming very irritating for all present..... when we were racing against time to save lives, she was one we could do without.

Finally, at around 5 am the que ended, the reg began interrogating her. She enjoyed every bit of feeding us mis-information and backtracking on her previous statements. By now it was clear that the patient has acute renal failure and would require dialysis for the near foreseeable future. Even if we are a government set-up, procedures such as these cost money, howsoever less that it may be. And she replied, "I don't have the money. If you don't give him dialysis, will he die?" We left it at that, your patient, your decision.

With that had to be asked asked, with all that had to be explained explained, the reg moved on to covering up other formalities. "What is your relation with him?" the Reg asked. The obvious two answers could be sister or wife. And this is where the mystery unfolded. She answered, "Wife...."

And then after a few seconds, glanced back at the patient, her eyes lit up with a resolution and she murmured  as she tried to control a sort of a wicked smile..... "Friend...."

With a startle, the Reg asked, "Wife or friend? Make up your mind."
"Friend" she confirmed.

"Is he married?"
"His wife stays here only, In Elphinstone...." she answered, "but he come to me when ever he is sick."

"Give us his family's address".
"Why? Why do you want his family's address? I have brought him here, I have given my address..."

"If he dies, we have to inform his family."

"Ah.....!" That wicked smile smile finally broke through. 'He dies' - this is what she was waiting to hear for so long.... this is why she was pestering us since the time they has wheeled in.
I think, she had received  a very straight forward answer for her question, no element for ambiguity. But may be, she had some other calculations in her mind. "One minute..." she said. And walked to the trolley which was barely a meter away. I thought, she wanted to whisper something into the patient's ear. But, she echoed, "Doctor is telling you will die. Who will take your body?"
"My wife" he answered, with a smug.
"Why? She does not take care of you. Who will take your body?" she echoed again.
"My uncle's son" he answered in the same demeanor.

At this point, our irritation had been blown away so beyond the roof- added with the exhaustion- that this whole incidence started appearing entertaining, so to say. Both of them were past 60, yet they quarreled like newbies in love exchanging sweet little nothings. The question was not of life-death-suffering, it was of establishing authority.

It was 8am and the next intern came to relieve me. As much as I wanted to stay back and audience this conversation till its end, all my senses were overwhelmed by the prospect of a good shower and the much deprived sleep that would follow.

On my way home I thought over the conversation and the female's obsession with death. It was a very Barbarian emotion that she harboured. Greed - to get what she wanted, at what ever cost it came or closure, that she finally got the recognition she deserved?.

His dead body, a trophy symbolizing her victory in the war, where she had lost every battle or, a conquest over what had been stolen from her? Till death did others apart, but he would be her's even after his death!

This is the beauty of medicine, it isnt just disease and treatment and minting money out of it, it is taking the understanding life and its various aspects to a completely different level. It is understanding the human behaviour- Human behaviour with all its simplicity, with all its complexities, with all its benevolence and malevolence. An opportunity to understand human psyches and emotions.

A skeptic like me will describe her emotions as extreme possessiveness, at it lowest, sickest level.
A die-hard romantic may counter it as eternal love, an epic romantic tragedy  - A Saga Of Love !

STATUS DIPLOMATICUS

(The author wishes to thank the voices in his head for continuously guiding and inspiring him and their help in writing this article)

Status Diplomaticus is a condition of unknown aetiology, characterised by extremely sweet behaviour, inability to speak ill about others and perpetual Risus Sardonicus. The condition is strongly associated with the Type A personalities.

Historical Background:

Status diplomaticus though being described in literature for the first time has been known to the mankind since ages. It is widely believed that many Egyptian Papyruses dating back to 2500 BC have described the condition, but the claim cannot be ascertained as no one has, however, been able to decipher them.

Modern History:

The attention of the author was drawn to this condition when during one of his surgery OPDs a few years ago when he was still learning his clinical skills, that someone happened to ask, "Are you the CR because of your good PR skills, or do you have good PR skills because you are the CR?" (The author urges the readers to kindly read, understand and most importantly imagine 'Public Relations'.) The lone study was conducted by the author for which no ethics committee permission was deemed necessary and barring a few unsuspecting humans, no animals were involved.

Pathophysiology:

The precipitating event is usually an involuntary involvement in a conflicting situation usually in early childhood. Each situation precipitates the next. The condition progresses slowly until about adolescence, when it becomes prominent and is characterized by a shift to voluntary involvement (involvementohphilia). It is characterized by periods of remission during which no such voluntary activity is seen, probable mechanisms being fatigue of the CNS pathways or proximity of an examination. It recurrence may be precipitated by involuntary involvement or may be spontaneous. Complete remission is never seen.

Signs and Symptoms:

The individuals usually present as very informative, friendly and accommodating. They are usually resistant to heat and pressure upto 100 friendPascals. Some variants are non-compromising in varied amounts. They are reliable. Most of them are very non-committal. Workoholism may be seen in most. They usually have "freshness of ideas" and "risk taking behaviour". They have a very strong past history of similar events and though it may appear to be easy, it is quite difficult to predict the occurrence of next precipitating event. Inability to divulge clinically significant information is pathognomonic of the condition.

Laboratory diagnosis:

1. Demonstration of high titres of self-interest protective antibodies. However, it doesnot have any detrimental effects on the well being of those associated with them.

2. Any demonstration of any iota of commitment in any sample of conversation strongly rules out the diagnosis. It may rarely be false positive.

The Differential Diagnosis:

Differentials though few, are very important because misdiagnosis can lead to improper categorization of the individual which can have far reaching social and mental consequences.

1. The chameleon:

Though the initial presentation is similar, they can be differentiated easily whenever a conflicting situation arises. In some lucky cases however, no such condition may occur for years together and they may be well treated.

2. The opportunist:

The condition is characterised by periods of over friendly behaviour, alternating with periods of extreme aggression or selective mutism. Individuals are usually of good nature until a clash of interest develops. This is one condition which is relatively easy to diagnose. They usually have a past history of similar episodes. One interaction with an opportunist will definitely provide understanding that lasts almost a life time in about 95% of the general population.

3. Chaatooism:

In India a special type of population is identified. The term 'chaatoo' roughly translates to 'lickers'. A current study is underway in which extracts from chaatoos are being administered to individuals with Sjogren’s syndrome. 

Diagnosis:
i. Tailing and trailing are two important signs that are easy to pick up and are pathognomonic of Chaatooism.
ii. Excessive drooling of saliva, actual or apparent, in the absence of identifiable causes such as Downs Syndrome, Mental Retardation, Cretinism, etc. must raise a suspicion of this disorder.
Complications: 
Though no fatalities have been recorded as of yet, they are a high risk population for aspirating and choking on their own drool and a strong theoretical concern prevails.
Treatment:
Vaseline is preferred treatment of contact/friction glossitis which may be seen in some cases.
Nystatin is the Drug of Choice for oral thrush.

4. Vaccardia (Latin; vacca-cow):

This is a very harmless and benign and innocuous condition. It is again easily differentiated by demonstration of diminished power in the challenging situations test. The power gradually diminishes on consequent exposure to challenging situations. It is usually an acquired condition.

Multiple conditions may co-exist in the same individual and may manifest themselves in response to varied precipitating conditions. Vaccardia and Status Diplomaticus are pure forms and no association with any other condition has been identified.

Treatment:

Isolated attempts at treatment have been made in the past by administering electrical shocks, psychotherapy in the form of threats and the 'pinching' technique. However, in the author's personal opinion and experience, such drastic modalities need not be attempted. Tender love and care are sufficient.

The Future:

The author wishes to start a support group for individuals with Status Diplomaticus and their caretakers. 
He hopes to receive a Nobel Prize for his contribution towards the understanding of the condition and also hopes that International Diplomaticus Day be celebrated on 24th November, which happens to coincide with his Birthday.

Once Vroomed, Forever Doomed!

                When we were in pre-school, we would start our essays with ‘I have many friends, but Ramu is my best friend.......' Thus, allow me to start this piece with, I have many friends. Most of them are on the internet and I have never met them per se. Others whom I have met, are graded as no better than acquaintances, friends and ta..da.... Best friends! This piece of literature is dedicated to one of my better friends. Let us call him Ramu for ease of communication.

                So, about a couple of years ago Ramu fell victim to Cupid. The girl was a very nice girl. Well behaved and polite. I was very fond of her only till so long as I had nothing to do with her or as the saying goes around, ‘Dur se hi Ram-Ram’. Usually I do not bother who my friends hang out with, but come on; we are talking about Ramu here. And, it nothing less than pained me to see my simpleton friend being dominated by that pathetic excuse for a human being. In a typical bollywood movie plot, I would go and tell my friend about my evaluation of his bride-to-be (I know this fellow and his day dreaming habits!). Then we would disagree, have a fight, he would perhaps hit me, and that would end our friendship. Then after the chewing gum had been extracted off its last bit of flavour and no longer good enough to be blown into even a bubble, the lady would spit him into a gutter. Then there would be an interval and after that we would meet in a disco, he would apologise and we would sing a hit musical number. Friendship rekindled.

                Now talking about real life! There is no background score, no make-up artist or no body double to take a pasting on my behalf. On top of it, I am not particularly “Hippy” to sing and dance, let alone visit a disco. So, when he introduced me to her, I did what I do the best, lie through my teeth. With a smile that I sport so well for all my emotions, I said, “I am very happy for you!” While at the same time I prayed that the forces of the universe come to his rescue. Whether it was the mutual dislike I shared with the Madame, or she was as sly as a fox or just basic primate instincts on the part of Ramu, I observed that he had become aloof of all of humankind in general. He started writing poetry, surprising, because in school poetry recital was in his words,”Yuck!” And now he was doing the yuck, even more yuckily. Even his actions had become so yucky- he started taking a bath on a daily basis, his monthly expenses shifted from deodorants to fairness soaps for men, he became punctual, dressed like an uncle and had a moronishly happy look on his face all the time. All this pain I suffered, with a smile on a face. What fate had come upon a high IQed beautiful mind? What had that witch (you can use b as well) turned him into? Ramu, as we had known for 20 years, was no more. But, like the old mother in old Hindi movies who would wear black clothes and utter “Mere Karan-Arjun aayenge”, I kept consoling myself.

                Then one day, Boom-Boom-Boomer was launched in India. It was juicier and had a new flavour. And Big-Bubblehead soon fell to disrepute, lost his favour with Cruella (actually she lost interest) and into the drains he was cast even before he could realise what had struck him. I knew this day was to come. I knew it because I am a very innocent little boy and God always answers well behaved children’s prayers. “Duaa ki shakti”. I did what any good friend would do in this situation; enjoy the sight of cockroaches crawl all over him.

But poor Ramu was still love struck. I saw the Hindi version of Makkhi. Innovative and all that, but what I realised at the end of it was that the poor love smitten sole of the protagonist has been doomed for all eternity. He dies only to be reborn as a Maakhi. Neither will he ever let the girl settle in life nor will he get any action himself! He is a drone bee if you realised!

I took him in my fold on his path to rehabilitation. One day he stopped playing the guitar, no more poetry. Such a relief! One could look at his face and tell what all stuff he had eaten over the past three days at least. Karan-Arjun had reincarnated! Ramu was back.

The reason I write this piece is that very recently I saw Madam Maya with my friend. Yes it was raining and the bus stop was all crowded, so I pray that it be nothing more than an awkward encounter. But the buzz also doing the rounds is that there may have been some sparks flying and the irrational romantics are happy. I am afraid that my greatest nightmare is coming true. The dung cake is attracting the flies! Poor Ramu does not realise however that, he isn’t the only fly hovering around this piece of manure. But maakhis do not have such IQs, definitely not drones! They just live to serve the queen, do all the donkey work and die without even expecting any reward.

Once bitten twice shy is an age old idiom, perhaps I can add a few more

Once smitten, always ‘bee’ten!

Once vroomed, forever doomed!