In the morning, between newspaper and coffee I choose reading the newspaper and let my wife have the pleasure of making coffee. Surely I miss out on the misty, smoky, hill-station-like atmosphere of the kitchen, but you cannot have it all, the best of everything. The deal is clear. Once she hands over the hot cup of coffee to me, within the next two hours I give her the cold newspaper in return; that works fine for me.
My wife is an expert in nutrition, and believes in evidence-based science. That’s why two thin arrowroot biscuits come bundled with the coffee, to make sure that neither of my family traits of diabetes and hair-loss affects me.
“The maid’s husband’s brother’s cholesterol report is here,” she points to the neatly folded paper under the saucer. “I think the cholesterol level is high. Why don’t you write out some medicines?” my wife asked in a matter-of-fact way.
Over the years I have learnt that friendly suggestions from the admin are to be always taken as orders.
I am reminded of the article that recently appeared in the medical journal Lancet on ‘kerb-side consultation’, advising doctors not to write out a prescription unless they thoroughly examine a patient and is aware of the past medical details. “The risk involved in casual consultation is unacceptable,” it commented.
Let’s say you meet your architect during the morning walk, your plumber in the fish market, or the advocate in the shopping mall. Would you think it appropriate to ask the architect whether you can have the kitchen relocated; the plumber about the leaky faucet, or the advocate for his legal advice on your impending divorce?
But for a doctor it is different. “Hello uncle, how are you,” is invariably answered with, “I have some ‘gas’ problem; can you tell me some good medicines?” This will be followed by a statement like, “Your aunty is the worrying type and thinks gas trouble may actually be some heart problem, so I thought you are the best person to ask.”
“But the narrow aisle between the shelves of the margin-free market is not just the best place…” But social etiquette forces me to keep quiet.
Look at a water-filled beaker by passing an oblique ray of light; and you see randomly moving particles. Physics students call it ‘Brownian movement’: chaos, in simple terms. But to a doctor, the real chaos is an overcrowded medical out-patient department. Suffering patients, irate ‘bystanders’, angry nurses and hypothyroid secretaries and expressionless doctors make a perfect combination of chaos.
As I am trying to concentrate on the lub-dup with the stethoscope on his chest, the patient takes out a paper from his trouser pocket. “Reports,” he smiles. I feel irritated, but give a glance at the report. “Your blood sugar level is too high.”
“Actually that’s my wife’s sugar report, you had asked me to bring it when I came to see you.” And I’m stumped.
A middle-aged man and an elderly lady compete with each other to hand me their blood report and X-ray images. I try to replay my memory at double speed to play back as to why I had asked for them.
“Do you have my old prescription?”
“No, doctor, but you asked me to do all these tests seven days back.” In the week I had seen 50 patients a day with 50 different problems. And I have grown one week older; don’t you know that with age, memory deteriorates? But silence is golden.
After examining token number 43, an elderly lady, I notice that the person who accompanied her, a man in his 20s, has a swollen neck. “Do you have thyroid complaints?” “No, sir.”
I called him aside and examined his neck. It was an unusually hard thyroid nodule, and I got the strong suspicion that it was not a good sign. I asked him to consult the surgeon. “No, not next week, not tomorrow. Today,” I insisted.
The surgeon confirmed the diagnosis as papillary carcinoma, a type of thyroid cancer. Three days later he had a total thyroid gland removal surgery. That was five years ago; he still comes with his mother for follow-up.
The young girl standing beside her grandmother looked normal except for a little fidgety nature that many 10-year-olds have. But this was different. It looked like a case of chorea (not connected to the country that was in the news meddling with nukes). It’s actually a movement disorder that affects kids with rheumatic fever. A referral to the neurologist confirmed the unusual disease and he cured it.
In the chaos-prone health system in India, kerb-side consultation is indispensable; as indispensable as the ‘autorickshaw’ and ‘mango-pickles’.
The author is the head of the Department of Cardiology in a major hospital in Thiruvananthapuram. Email: tinynair@gmail.com