Saturday, April 09, 2011

Hello Hippocrates !

When I was in the 6th grade, I went to a school in Pune that subscribed to, what was then called "Senior Cambridge" school board. It was affiliated with something in England, the things we learned were slightly different than those prescribed by the local State board, and we had a favourite subject called Physiology and Hygiene, where we learnt lots of anatomy names.

I used to love this, and it so came to pass that one day, when my mother was on the phone with our family doctor consulting about my non healing sore throat, I told her in a hugely hoarse voice to say that I had an "inflammation of the pharynx". She got a bit alarmed and handed over the phone to me. Doctor Uncle was completely amused, and he continued to be immensely amused even many years later, when I took my children to him on my trips to see my parents.

It also helped that I went to school by the municipal city bus, and that my school was very close to Pune's well known B. J. Medical College. The bus would be full of lady medical students , in sarees, holding thick books , we became friends, and I absolutely enjoyed leafing through their Gray's Anatomy's, and marvelling at pictures of bones and skeletons, something we were learning in class too.

I actually did marginally better in Biology than in Maths in college, but the system then allowed us to choose one or the other, and it was more or less expected that I choose Maths. Which I did. I wont say the world missed out on a decent doctor, but since then, I have had an abiding sustained interest, in all things medical and anatomical, to the immense disgust , wonder and surprise of not just family, but also some doctors.

Fortunately or unfortunately (depends on who is thinking), I have had doctor friends from across the age spectrum. I recently lost one who was in her mid-eighties, another is almost my age, and never complains about being treated as an encyclopedia, and even being questioned . Another friend , is the above mentioned Doctor Uncle's grandson, who is my son's age, but did home visits for my (late) ailing father, every alternate day, simply because I requested it, and was bombarded by lots of troubled questions by me when I was witness to the marvellous fight back capacities of a body, when faced with a terminal slowing down.

Over the years, I have come to the conclusion, that the best doctors are those who explain things to you, don't glare in a superior manner when you ask questions, and appreciate the fact that you want to know, and possibly learn something. It's your body, so the attitude should not surprise anyone. I suspect , that those that brush away your questions rudely saying "how is it your concern", are actually insecure about their knowledge or about communicating it to a layman.

Many doctors of the old school love getting questions. A close family elder, who was diabetic had just had surgery, and I was posted in his room, while others went downstairs to attend some paperwork and stuff. A nurse suddenly appeared with an injection. I asked her what it was , and she told me it was a maintenance dose of insulin.

I got alarmed; I had been a close witness to this relative getting into an hypoglycemic (low sugar levels) coma once, because he didn't reduce his dose corresponding to his reduced food intake during a digestive infection. Prior to surgery his intake had been very light. I knew the signs of a coma first hand, and I appealed to her to give that injection only in the doctor's presence. An argument ensued, and went on till everyone returned with the doctor, a very respected senior name in the field, now no more today.

He heard me out, asked us to keep a banana ready along with some fruit juice, and the injection , as prescribed was given. Within moments, the words became slurred, eyes kind of unfocussed, and the doctor , who was holding the patients hand , noticed the signs even before me, and asked us to give him the juice. The patient was able to stand the insulin dose needed post surgery, and the great doctor, smiled, patted me on my shoulder, nodded at the nurse and left.

Many times it has been a skirmish for knowledge, in a dicey health situation. Skirmish, because , very clearly, some doctors don't like to be asked. It has become a habit to ask details about any medicines that someone recommends that I take. Sometimes one has read something about a particular medicine, and has some questions about safety.

Caretaking of elders of the willful type often needs a different interaction with the doctor. I once did this for someone who was the type who threatened to do what he liked after prostate surgery , like cycling , and lifting luggage up the stairs.

The urologist surgeon was totally amused to see me with a chart, listing out do's and dont's , contraindicated Yoga postures, and instructions for medications , all written in large letters for someone with a cataractic eye. I thanked him for his suggestions to my questions, requested him to sign at the bottom, and had the hospital office put a bunch of stamps there. This particular doctor had a lot of geriatric patients and he even asked me for a copy of the chart !

When the elder in question, lifted his bag on reaching home , and pooh-poohed my suggestion, I whipped out the chart. And no further words were required. Even the rickshawallah who transported us was amused.

This tendency of asking questions , has somehow seeped into the anatomy. I have had general anaesthesia given to me for various things in my lifetime, and the one noticeable feature has been that I always tend to come out of it before anyone expects me to.

While science sometimes says, that it has to do with the amount of fat in your body , that can absorb a particular type of anaesthesia, I think it's the tendency to question stuff that is embroidered in the DNA, so to speak, that keeps something ticking below all that anesthesia.

And so I can fully understand the irritation in the voice of the surgeon, who was helping to wheel me out into a recovery area after an investigative procedure, and had me suddenly asking him , from under heavily lidded but desperately trying-to-open eyes, as to "What he found ...".... I was politely told to rest .

While the Internet has been a gift from the Gods for someone like me, who likes to check out her own diagnoses with the doctor's, not many doctors are thrilled about answering questions, starting with "Why" . But some are amused.

The knees started to pain a couple of years after I had a fall that fractured the ribs in 2005. I poured over pictures of muscles, ligaments, tendons, and read related articles on the Net. Finally, I was convinced about the ligament (Anterior Cruciate ligament) that was not behaving itself. I went to my doctor friend, who was not surprised at all this, and possibly agreed with my discovery, but she advised X-rays, and a consultation with the more experienced Orthopaedic expert.

And so there I was lying on the examination table. My doctor friend had come along, as this was in the same hospital premises where she worked. The orthopaedic expert had me move my legs, bend them, and then did some twisting and turning of his own , eliciting some occasional painful exclamations fro me. He then turned to my friend , muttering, something-something of the Anterior Cruciate Ligament, and proceeded to write up something in my file.

To this day he cannot figure out why a bad injury should have brought a wide smile on my face, and why I barely stopped myself from hi-fiving my doctor friend, who was trying to hide a smile. He advised some knee caps and physiotherapy etc, which was duly followed.

But to this day , he always smiles when he sees me otherwise.

And then there was the time, I was waiting for the aforementioned investigative procedure, and suddenly the nurse turns up to ask about the next of kin. The husband had stepped out to make a call. It seems they needed his signature to say that it was OK to put me under anesthesia.

This was too much. I wasn't invalid,was in my complete senses (though some folks tend to disagree occasionally), this was my body they were discussing and if anyone was going to give permission to put me under, it would be me. The nurse looked stricken at hearing this. Such things were not done. They must have a finger to point at someone who signed and gave permission, in case something happened to me. She disappeared to return some time later with the doctor

The doctor came, took one look at me, shook his head, and allowed me to sign. If I was well enough to have a surgery, my vital signs were fine, and this was a minor procedure, then I should be qualified to sign . That's what I thought. The doctor actually just wanted to get over with it. :-) ....

This post came about after I read this blog post. About maintaining secrecy about the patients treatment file. About the nurse mentioning how the particular doctor did not like nurses to see it too.

I have always thought , that the file or chart for the patient that is maintained at the bedside , lists chronologically the treatment he/she has received, the recommendations of visiting experts, and instructions for modifying doses etc. I don't see why nurse cannot see the stuff. In fact, they must.

Not that it is legible or understandable, but It possibly makes sense to keep the stuff confidential from relatives who visit.

But just think of how the this problem can be solved, if the doctor could quietly explain the stuff to the attending relatives, in addition to writing it down. There would be more confidence , less doubts , about what was going on.

Its about your body. You need to ask questions, and demand answers.

And so, it hurts when one sees, those who spend enormous amounts of time getting technical about cars and cellphones, talk about taking "red pills", and "white pills", and "green capsules", without finding out what they do.

Maybe it's time for some senior citizen lady type to tap them on their shoulder, smile a toothy smile , and ask how their Anterior Cruciate Ligament is doing, or why their Bundle of His in their heart , is twitching so much .....

And enjoy the look on their faces......:-))


  1. :-) Maybe just maybe they try to hide because they are not confident enough to explain as you mentioned.

    I could relate with you about being the enthusiastic bit w.r.t human anatomy.

    I was taking a prolonged treatment for a symtom and was half doctor myself through it. I knew what medicines the doctor would advise and what does all that medical jargons mean

    I had a minor surgery and when the anesthetic came in to administer anesthesia; I was smiling at him.

    He said "you are probably the first patient I have seen in my 30 years of service smiling while lying on the operating table" Well..what else did he expect?

  2. Anterior cruciate ligament

    hopefully is not bugging you anymore. is it?

    humorous post... :)

  3. :) he he he i remember I had a hockey match and we were suppsoedly t owin the league that year .. anyway in the final match i ended up hurt and my knee cap almsot smashed :) ouch I know

    and that same very day it was the World cup for hockey :) and india were in finals yeha i know it does not happen so often but we were ...
    anyway i remember asking the doc to get it done as fast cause i need to get home to watch the match and he was like you might not be able ot WALK again and i was like ok,, but still can we get this thing over and done cause i had to go and watch the match ...


  4. I hope that ACL business is behind you now !

    On another note, its a pretty striaght forward thing. There are docs who do explain. There are those that dont. Its dependent on the doc. The doc that explains, has me show up with more confidence. The doc that doesnt, well, you know the one with 13 alphabets behind is name, the one with a mole on his nose, who wears the faded jacket...well, yes the one that prescribes a colour to me, well, I shun !

  5. :-D

    I remember the amused looks when I took a question list along during my pregnancy. It was a new hospital and an experienced doctor and she took the time to explain everything to me. And for those questions whose answer was 'no!', they got those facilities soon enough. And I like to take the credit! :-D

    Of course we need to know why. I think if we do, we might temper our movements or do things to strengthen that can help out in recuperation. And it is our body, last time I looked!

  6. We have this in common! I have a thick and heavy volume of 'Complete Home Medical Guide' by American College of Physicians by my bedside, which I used during the years before the internet became such a part of our lives (until 1999-2001 at our place), and sometimes even now, because it also has lists of sites to turn to.

    I feel patient files should be accesible to the patients also - and maybe not to the relatives, but definitely the parents and spouse, or whoever the patient permits.

    I once had a dentist complain that she disapproves of patients who do not trust her and double check her treatment by turning to the internet! I didn't even complete my root canal with her and found another, more confident dentist, who also offered information as ruotine.

    A dear doctor friend told me if a doctor does not want to answer your questions there is a chance that they do not know or atleast not well enough to explain. So I agree there also.

  7. Super post...Hope the ACL is better now :)
    Its always always always important to ask questions..I learnt it the hard way after having a traumatic time while giving birth to R...smooth pregnancy didnt result in a smooth child birth..I have learnt that I should always always ask my doubts no matter how stupid they sound :)

  8. Love the post. Can't stand docs who act arrogant about answering questions or justifying treatment decisions...have walked out of private clinics and top hospitals because of this.

    I have no qualms about reading patient charts, and have had long involved discussion with appreciative doctors, learning a lot and giving them a lot to think about too!!!

  9. hey quite funny and obviously sarcastic that was.... and I wish more of medical community read these kind of stuffs so that they will realize their mistakes and be patient while deaing with their patients.
    I must admit I did learn some lessons from this post.... and next time I definitely wouldn't give a sarcy smile to a patient who asks me about whats wrong with her/his bundle of his :) hope yours is doing well ... tc and keep posting :)

  10. U are fantastic Suranga....some ppl are medically inclined, even if they are not doctors or nurses.

    And I totally agree on the part where the patients need to know whats happening with their body or what treatments are being done to them.

    When Dad was first admitted to a hospital, the neurologist who saw him, refused to talk to any one of us....he insisted on talking to my Dad only. While its good to make sure the patient knows whats happening, we were totally against it, as my Dad was unconscious half the time. Even if he was awake, when the Doc spoke with him, he was not being awake to share it with us. The Doc shld really know when to talk with patients and when to the support people.