Doctor diaries – English Vinglish in the hospital.

 

wrong english
Ha, ha note what is tasted here!

Though the English left India 70 years ago, their language and its symbolization as superior and powerful has continued. It is a rare parent who does not beam with joy when his child speaks some English. Parents make sure they scrape their hard earned money to put their child through an English medium (which means elite in other words) school. Schools charge their students a fine if they are caught speaking their mother tongue on campus. Even parents of special children who come to my consultation room, coax their kids to “Say” in English, the answer to any question that I ask in kannada.

A knowledge of English is seen somewhat as a sign of superiority, a matter of pride and a way out of future poverty. Phew! So much burden for one language to carry! And I am sure that if English were a person, she would have crumbled under this intense pressure (which is probably more than what P.V.Sindhu faced on the eve of her final match at Rio) of millions of Indian parents for long long years. She would have probably scooted the country far before the British did. But she did not. And here we are –grappling with realities.

I love the fact that we live in a country with so many languages. Each language with its own flavor and essence. English, I love –because I studied in it for most part and knowing it, helped me expand my horizons. Kannada because it is the language of my land. I enjoy the strangeness of my mother tongue Konkani. I love the way Tamil and Marathi sound. Hindi seems to me, a way to understand tv, my North Indian patients and our prime minister’s ‘Man ki baat’! Though I worry about landing with a twisted tongue, I did learn quite a few sentences of Malayalam! I love the fact that we are a language potpourri. English words which have been Indianised and used ever so casually with an air of ownership. My daughter and son believe that “bussu”, “caru”, “traffic jamu” “hotelu” are essentially kannada!

So, it is not that I have anything against the language. I am not a language fanatic nor a grammar nazi.  Nor am I a snob who believes that people who speak english incorrectly are imbeciles. I understand that it comes from learning with limited means and lack of practice. But I believe in people knowing their limitations. That they are fluent in a few languages and have to treat the others with caution. Or if they did want to use it conversationally, it would happen with hard work rather than over confidence.

Well, that does not seem to be the case with our poor English. Apart from being put on the podium as a status symbol, she is also tortured continuously and most times hilariously. A lot of it which I get to see in my hospital.

Starting from my internship.  Along with my co intern, I had spent the night filling in patient information into files, when the hospital attendant announced that the head nurse wanted the “cassettes”. We looked back blank. “Which cassettes?”.  “The ones you are filling.” Realization dawned. He meant the “case sheets”.

Or when the duty nurse sent me a note from the far flung recesses of the TB ward. The note read “Doctor, the patient in ward 9 has not passed urine or stools since two days. Please come and pass it”.

When in my residency, we were posted in a  Government hospital whose cassette, sorry case sheet carried a mandatory question of finding out why the patient had landed in that particular hospital for treatment. Most patients would reply that they had come over for free “statement”-meaning “treatment”. “Please give my son good statement”, they would ask of us. And after the free statement was given, they would profusely say “TANK you” and leave us sufficiently tanked in their wake!

Once I started my practice, I realized the all encompassing power of the word “aunty”. There was once this eighty year old man who called me ‘aunty’ at the end of Each. And. Every. Sentence. Which was promptly followed up by his obedient wife, who was almost seventy and had only one single tobacco stained tooth in her mouth. The auntying got so severe that I caught myself unconsciously smoothing my hair to cover my grey strands for the next one hour!

The best was yet to come. There was once a concerned husband who hovered around after I finished counselling his wife. He then came over and whispered conspirationally,  “Madam, can my wife try property?”.

I thought that he wanted to be sure that his depressed wife was lucid enough to make decisions about her finances and real estate.”Sure, no harm”, I replied. “She is smart enough to handle and plan her finances”.

He did not seem convinced. “But property?”, he insisted.

Now, this instantly made me suspicious. I wondered whether he was planning to cheat her and do away with her money.

“Why exactly are you asking me this?”, I  queried.

He must have caught my tone of irritation.”Madam, I care about my wife and her health. We wanted to be sure to have a gap of three years between our kids”.

Now, I was confused. Family planning and real estate. No bells rang. I finally asked him to explain what exactly he meant.

He looked at me rather pityingly, at my lack of common medical knowledge. “Madam, you know that thing they use nowadays to prevent pregnancy-they insert it into the uterus- it is called property. Never mind. I will ask my wife’s gynecologist about it”

Turns out he meant “copper T”.

I rest my case.

 

Learn yourself English.

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Are we treating the right person??

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Doctor Diaries….

Each department of medicine has its own challenges. If it is long tedious hours in emergency medicine, the unexpectedness in surgery or obstetrics, or the sense of futility which sometimes goes with oncology, I feel that in general, doctors have these “times” where you really start to wonder whether you are doing the right thing!

There are many such unique challenges which belong to the realm of psychiatry, when as a consultant, you feel as if you are bound by some invisible shackles which prevent you from doing the best for your patient.

Mental illhealth has always been considered with suspicion, even by some of the most intelligent brains in the world, mainly because of its slippery definitions. Also because of the fact that there are no diagnostic tests which can surely classify a patient as mentally ill. Other than the obviously aggressive or flagrantly abnormal patient, most times,  we need to tease out the the history from many of their kith and kin to arrive at a diagnosis by circumstantial evidence aka Sherlock Holmes!

And when we do so, many a times, we end up realizing that we may be, cut that, we ARE trying to treat the wrong person!

Let me elucidate…

Take the case of a woman who has been referred because of a near lethal attempt at deliberate self harm( which is just a fancy name for attempted suicide). The woman, on enquiry, confesses that she is tired of her life, and one of the main cause is the unnecessary amount of suspicion which the husband has developed, in part because of his alcohol habit. He does not allow her to talk with her friends, has made her give up the job she loved and beats her up when intoxicated. Her maternal family, expectedly tells her that she has to “adjust”. So here she is.

Take another example of a child who is sullen, angry and puts zero efforts into his study. The father who is a teacher explains that his son is so ‘dumb’ that he needs to be spanked everyday before he sits down to do his homework. He also explains that he gets so frustrated with his son that, on occasion, he has branded him with a hot iron for his follies. The son was diagnosed to be having learning disability.

In another case, the son who has been a patient of childhood schizophrenia gently chides his mother, who has accompanied him, not to interrupt me multiple times before I complete even one sentence of what I say. “Calm down, Ma” he says and looks at me resignedly. He has probably experienced this phenomena all his childhood, and I can pity him, for I am already exhausted by her!

Such situations are tricky.

If I go on the offensive and tell the relative that he or she is the one who actually needs help, they may dissappear with the patient and never turn up again! Such are the follies of a stubborn ego. Intent on proving the other person wrong and unconsiously expecting some praise for an apparent  sacrifice which has largely gone unappreciated.In the process, I lose out on helping a person who genuinely needs the help which I am qualified to give. Granted it may not completely cure him, but atleast I can lend a much needed listening ear and psychological balm.

On the contrary,when  I  go with the version given by the relative, and reach for my prescription pad, immediately, I see a look of betrayal in my patient’s eye. “Et tu, doc” it seems to say, “I knew no one would understand”. I feel so uncomfortable when I see this look. As though I have let him down badly.

So what we do is, to talk to both of them separately; tell both of them that we understand their point of view, and other’s mistake; and promise to help as much as we can! Sounds devious?? It does,but it also is the most honest answer, according to me.

It works quite a few times, mainly because, as  people, we have real fragile egos. If someone tells us outright,that we are wrong, we suddenly become extra defensive .It takes gentle prodding and many sessions of talking for them to grudgingly accept the fact that they may have played a part in making their dear one sick! Then, we have struck gold! They are amneable to suggestion, and if necessary, medication.And slowly we begin to see a steady improvement in the patient’s condition.

But, ever so often, this does not happen. Despite subtle suggestions, followed by obvious ones, some refuse to change. And sometimes become worse, for they miscontrue that the patient has complained about them. And the patient’s eyes steadily lose their lustre.

I know that we are human, and we can only win some and etc. etc., but each time I write out a presciption for a patient who is so, because of someone else, I still cringe a little at the unfairness of it all.

Why are we treating the wrong person???

Have any of you encountered such situations?

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A little bit of empathy- Doctor diaries.

 

Monotony brings in boredom. I believe that this happens to the best of us, in whichever profession we happen to be involved in, and so medicine is no exception. Though we start of as idealistic, bright eyed, young doctors, over the years, we get jaded due to tiredness and the sheer numbers that we treat. There is hardly any time to think. Rather, we work more by force of habit, than the passion that we started of with.

Prof. B.M. Hegde, the former Vice Chancellor of MAHE University was often known to quote, that as doctors, we need to cure rarely, care often and comfort always.  But in the mad juggle of life, responsibilities and work, we sometimes lose out on the sensitivity which we need to show the patient, rather than just treating him.

As a mental health professional, the number of times that I have had to diagnose a life threatening illness is less as compared to many other branches of medicine. Rather, most of the illnesses in my bag, fall in the category of life altering. Nothing remains the same after the diagnosis is made. Both for the patient and the family. A lot of times, this causes morbidity in ways which are unseen, but cause a lot of suffering. Decisions that fall outside realm of medicine, like long term medications to be given to patients who are not so willing to swallow them, the crashing of dreams which the parents would have built for their children, the change in roles and responsibilities when the bread winner of the family falls sick, the insecurity of a relapse, the frustrations of the family which work adversely on patient outcome and the societal shaming – all of which are invisible to us, but very much a part and parcel of the illness. And as it is invisible, it often becomes easy to brush off conveniently under the carpet.

It was on one of such days when I diagnosed schizophrenia in a seventeen year old boy. The mother  broke down and started crying copiously. After customarily consoling her, I happened to remark that there were others who had worse forms of the disease, and so should consider herself lucky. To which she replied that maybe it was so, but she was crying not only for her son, but also for breakdown of her life which was painstakingly constructed for the past so many years. She told me that she had to cry so that she could grieve the loss, the burden and her son, and only then she could accept it. She asked for permission to cry, because she could not do it in front of her son or family. Once done, she walked away quietly, only to return for the next visit with a set of questions regarding how her son and family could cope better.

This small incident made me rethink my qualities as an effective counselor. As a doctor, I had thought it important to treat the disease, but forgot about the patient and his family. I could have consoled myself saying that the lack of time was the cause of this heartlessness, but it somehow seemed unforgivable. There are many instances that I have seen, where there are doctors with no super specialty degrees or  swanky clinics, but where the Que for visiting the doctor is serpentine. What they call “Kai guna” in kannada, must be the magic of sharp observation, unhurried questioning and a profound sense of empathy used together as treatment. This combination must be more potent than all the medications and hi fi equipment put together.

From then on, I resolved to spend a little more time with my patients than just enough to spot the diagnosis. And the results have been nothing short of remarkable. Now I have extended families in my patients. The caretakers know that they have a shoulder to cry on and are hence more comfortable. Each milestone they have achieved becomes partly mine. And when the seventeen year old passed his class twelve with a first class, I got home a huge box of yummy mysurpak. There seems to be no monotony anymore.