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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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.

How bad is it, doc?

doctors There are many cliches associated with being doctors. The near dictum that doctors are next to Gods. That practicing medicine is a noble, respectable, ideal profession. In the nineties, most children in India, I would safely say, grew up with an idea that their life would be made if they became doctors, or engineers. It was the rare parent that would allow his child to choose a profession apart from these two.

According to a recent study by the WHO, despite medical schools mushrooming all over India, we still are short of doctors.  The state of a patient in rural India, who needs some form of emergency medicine is still abysmally bad. So,yes,we do need doctors.

But suddenly, it almost feels like doctors are everyone’s favorite punching bag. It is as if we are a group of individuals with dubious reputations, unscrupulous, unethical and those trying to make a buck out of the poor patient’s pocket.

It is therefore probably the right time to remind ourselves that medicine is, basically, just another profession. Yes, compassion is important, as well as a sense of responsibility. But then, those with an aptitude for both should not have difficulty in finding their way into this field, just as someone with good computing skills takes up computer engineering. To deglamorise, doctors study five and a half years for a degree which tells them how tackle certain ills in a scientific manner. We do not claim to be Gods, nor are we the devil reincarnate.

I do agree that there is a lot going wrong with the practice of medicine in India. But these wrongs mainly stem from a flawed, aged, system rather than the individual doctor.

Children as young as seventeen, I believe, rarely have the maturity to realize the seriousness of a profession like medicine. In the west, medical school would be an option to only those with an undergraduate degree under their belt. I personally know of kids who take up medicine because of the glamour associated with it or because of parental pressure. When you choose a profession for the wrong reasons, the outcome seems near obviously bad.

The presence of corruption in a system which deals with life itself. In conversation with one of vice chancellors of a medical school, I get to understand that the seat matrix in any medical school across India is decided by how many palms are greased rather than, how good the patient student ratio in the teaching hospital is. We see around us a number of med schools where professors exist only on office papers, and the teaching hospital needs to be filled with fake patients who are hired during MCI inspections. We PRACTICE MEDICINE. And where the practice of teaching is poor, the confidence of a doctor to handle a patient is obviously poor.

The weird attitude that once we choose to become doctors, we, as individuals, need to give up on material gains. The salaries of doctors in rural service is pathetically low for the amount of risk that they take. To quote Atul Gawande in his book, “Better” ,doctors in rural India are the most innovative and efficient. They need to work with patchy electricity, minus specialist help, have to work against unhealthy  but traditional practices to the convince the family to get the patient treated. Hence, they learn to work with enormous amount of common sense. But, the rewards materialistically or otherwise are poor. They have poor roads, horrible infrastructure, no legal aid, their children have no good schools, due to which they would have to be sent away for their education. All the while, when media glaringly shows them, that their counterparts, with half the years of education, are earning fat sums, driving the newest eye candy, spending time in malls, living in penthouses, working in centrally air conditioned offices and sending their children to international schools. Who in their right mind would choose rural service?

As doctors we ultimately deal with lives. And people. And people with a million different personalities. And these personalities, when they are under stress of illness. But nowhere in medical schools are we taught the importance of good communication, on dealing with grief, on being calm during periods of stress or emergency. It is as if we are expected to magically source this information from some place in the universe and imbibe it. The art of counseling, is not hereditary. It needs to be taught. And as my dean in med school, Prof. Dr.B.M.Hegde would quote, doctors, needed to be trained to “cure rarely, care often and comfort always”. Poor counseling skills, automatically translates to poor patient care.

Law concerning self protection, medical insurance and negligence are alien subjects when we study medicine. We only get to hear these terms when we land, slap bang in the middle of a controversy. We do make mistakes. We are human. But, mostly the health of our egos and our bank balance depend on the good health of our patients. The pleasure we get when we see a critically ill patient walk back home with a smile on his face, is probably what keeps most of my fellow doctors in the profession, despite the grueling hours and non existant social life. Hence, if we were to be taught what to do when we err, we would definitely tread with more caution, rather be caught on tv appearing like a petty criminal.

If we are a society concerned with health, then we have to understand that we have an individual responsibility towards our health. Poor lifestyle habits, not following the doctor’s advice and skipping doses, and then blaming the doctor for poor health despite taking expensive medicines is simply playing the blame game. Not acceptable.

To summarize, we need a multi pronged approach to start a change in most of these areas. Able law makers,thinkers, senior doctors and the public at large who should first understand the flawed but totteringly functional system completely. And then attempt change. Only then, we can hope for the health of the country as well as its doctors.  Till then, still happy to be a doctor and enjoying it despite the hurdles!