Showing posts with label careless procedures. Show all posts
Showing posts with label careless procedures. Show all posts

Thursday, May 05, 2011

Medication and Sense

Besides enjoying writing a bit of prose, and foisting poetry on unsuspecting individuals, word got around from an ex-colleague that I also have a thyroid website. Nothing out of this world, but something that happened, because, 10 years ago, (a) I had collected tons of information about the thyroid for personal reasons, and (b) a geeky chap who sat next to me at work, inspired me to write HTML from scratch and make a website, in those, pre-blogging, pre facebook and nontwittering days. (When I retired, it shifted , along with me , to blogspot).

The reason it comes to mind, is I was stopped by someone and asked about this. Out of a sense of altruism, I asked if the person was a case of hypo or hyperthyroid, and was completely aghast to know that the person was diagnosed , taking meds, but couldn't be bothered to find out if the condition was hyper or hypothyroid, and offered to show me the test readings. Much like a person habituated to AC 4-wheel drives, professing ignorance about, say, the Mumbai buses. Naturally, I declined.

There is a similar attitude amongst those taking a variety of daily medication. They take "green pills" and "yellow and grey capsules" but are supremely unconcerned about names and dosages. And very often, the more educated the person, the more careless the attitude.

Sometimes , this careless and so called unconcerned attitude is seen , even amongst those whose vocation it is to sell medicine.

A few years ago, my father was bedridden , and my son went down to spend a few days with him before leaving for higher studies abroad. I was the sole caretaker , and was in a permanent state of travel between Mumbai and Pune, looking after two abodes, , and there were two trained attendant ladies doing shift duty, attending to my father, along with several normal house staff, including our trusted live-in help for over 50 years. During my son's visit, one of the ladies had a headache coming on, and asked and went downstairs to the chemist to buy some meds, while my son sat with his grandfather. She soon returned, and got herself a glass of water, and swallowed the pill. After which all hell broke loose.

She suddenly collapsed and slipped to the floor, and lay inert. No amount of sprinkling water, offering sugar water to drink, slapping the face etc, elicited a response, and so my son organized help, got the car ready, and bundled the lady off to the hospital after checking with her parent agency (that sent her to us ). My father did not use a car, and it was providence that my son was there, with transport, so that the lady got immediate help. The agency people also landed up there, and we were wondering the next day, what was happening, when the lady herself, comes up the stairs!

Turns out that she had asked the pharmacist for some headache meds, there were many people at the counter, and she probably picked up something meant for someone else. Maybe a diabetic medication, who knows. So much for careless dispensing. But what if it was psychotropic medicine, what if it was blood pressure medicine, anything could have happened.

But when things happen due to meds given by the doctor himself, things get a bit serious.

Two days ago, my household help, S., about whom I have blogged many times, came to work, coughing away, eyes red, with a splitting headache, and a body racked with pain. She often asks me for paracetamol(tylenol), but this time she had been to the doctor the previous evening and he had given her some yellow capsules. Everytime she took one, she said, she felt as if her head was vibrating. Things were getting alarming. I offered her some hot nicely sugared tea with milk and a fresh chapati thinking, maybe, she had taken stuff on an empty stomach, asked her to take the day off and she left.

Next thing I heard was that she had just managed to cross the heavily trafficked road outside, before she simply collapsed. People ran, someone called her sons, and someone else offered her sugar water, after which she revived, and was helped home.

The story turned out to be, that sundry general doctors, near where she stayed, were routinely prescribing something called levofloxacin, a fluoroquinone, ( for a population that was suffering from some infectious disease), that was known to have side effects, like red eyes, cough collecting in the chest, and lowering of blood sugar. No one had told her that. No one even checked her sugar levels. There was no written prescription, as the doc himself counted the capsules and gave them to the patients. I told her son about this, and instructed him to go tell the doctor about this. She also now carries a bottle of glucose water with her on her way to work, where she must walk in the summer sun.

But think of those who will collapse in the middle of the road, or have some other problem because of this blatantly given medicine, and have no one to help.

I recently read in the paper the story about an old man, a tailor, the only earning member of his family, who was prescribed , on paper, a blood pressure medication. The pharmacist gave him methotrexate, a cancer medication. Two days later, the poor man broke out into a deadly rash, collapsed, and died on admission to a hospital.

These kind of things are not just India specific. A pregnant lady in Colorado, USA, was prescribed methotrexate, which she took. It causes non-surgical abortion, , but she continues to be prgenant, and no one knows what is happening.

Fingers will be pointed, people will blame doctors, their illegible writing, the super busy pharmacist, the urge to sell a more expensive drug, the patient's simple , educated but non-medical mind, and the tendency to regard pharmacists as next in line to doctors.

But the problem is us. We do not respect our bodies. And we are careless about what we put into it. Food, drink or medication. The patient being educated has nothing to do with it. The doctor could either improve his handwriting, or start typing the prescription on a computer system. The patient needs to come back and confirm with the doctor about the medicine. When medicines are being handed out by the doctor himself, like in S's case, just 5 minutes more explaining the possible side effects would change a life.

We do not have a system or , even a habit, of reading ingredients of a medication. Or checking the dosage. So many of us just blindly take the medication from the shiny strips. I wonder how many of us read the little paper that often comes inside a medication packaging that tells us where the medication should not be used, or should be used with caution. Everyone has a cell phone, doctors have several, but no one wants to call the doctor , when in doubt, before buying, what could be a wrong medication. And all this holds for "educated people" too.

And so I often get the feeling that we as a society , have taken a huge leap somewhere, much like someone earning a huge lottery. We forgot the learning that happens, when life progresses at a natural slower pace. And we then tend to try everything new immediately.

In each strata of society this attitude manifests itself. The higher class educated types, reveling in the ignorance of minor things like their medications, think it infra-dig to worry about their bodies, and leave it to the n-star hospital doctors, something that enhances their status in their own myopic view. The pharmacy folks , probably carelessly read things in the big hurry to maximise sales; possibly even employ untrained folks in the shop.

And doctors serving large populations, let patients like my household help, stagger through their drug side effects, and only providence allows them a life, as they cross an arterial heavy traffic road, and then collapse .


But it is worrisome. What use is science , and learning, and having a large pool of technical talent, if communication abilities are non existent ? And nobody has the time to listen ?

So typical of Mumbai, where we are now the third most expensive city in the world, (real estate wise) , but have infrastructure that is at least 25 years behind. Inefficient communication channels.

And the knowledge vehicle goes further and further, speeding....

To oblivion ? Who knows ?

Friday, July 25, 2008

Affidavits, notaries, and keeping your cool....क्या कूल है हम



For some time now, my time has been dedicated to perusing various forms and documents , and getting guidance from various offices and entities on legal and not-so-legal procedures. A lot of my researching time is spent in the environs of courts. Lest you think that I am currently defending myself against a plethora of accusations, I hasten to clarify, that good-old-middle-class me, is involved in doing very simple things like getting things notarized and preparing affidavits, subsequent to a family death.

Cut to the very narrow lane leading to the Andheri court premises. As I turn into this lane, a bunch of guys in black coats, and sheaves of important looking papers kind of sidle up to you in a Pssst kind of way. The low tone chants of "Affidavit, affidavit", " notarize,notarize" draw my attention. I silently salute the bhajiwallas for their patenting of this approach, and half expect someone to say, " Today only !", "Notarize 2, one free" , or "Do one affidavit and get one notarization free" etc.

Back to the present....

I state my requirement : notarizing a bunch of copies of a death certificate. One of the chaps, (his judicial brethren watching the fun from the background), eyebrows raised, desperately trying to look important asks to see the original. I show it. An imperceptible shake of the head . Eyebrows shoot up further. A look trying to ascertain my stupidity. "This death has happened in Pune . " , he said. Trying to look my stupidest, I ask , "So" ?

"That will cost you more to notarize. 125 Rs a copy".

Its time for me to look up and raise my eyebrows (which are much better than his anyway). "Pune is in India, a citizen is free to live and die anywhere, I think you are misguiding and overcharging, and if you have a problem with that, let me have your registration number ", I said. I ask for my papers back, ready to look for a more ethical lawyer.

There is an amazing change . He is troubled by my non-stupidity. A bunch of his aforementioned brethren, vanish, and head down, my documents in hand, he asks me to follow. In my best running-behind-the-coolie-on-the-railway-platform-lest-my-lugguage-disappear style, I sprint after him, to land up at some broken concrete structure, next to a tree, all this in the paan-stained environment of the court. There is another man leaning filmy style, sunglasses and all, against the tree, pen in hand. He is the, notary ! In an amazing display of co-operative work, one guy stamps , one guy sticks, another guy makes some entries, and the stuff is given to the notary who signs it , changing his angle against the tree, as he endeavours to look important,wise and superior , simultaneously.

The notary has not even asked me to show the original, even once.

Out of sheer compulsion, I have become a great fan of "affidavits". Particularly when done in Pune. I was directed to this place by a well meaning gentleman, who saw me repeatedly looking unsuccessfully for stamp vendors in the official set up in Pune, after being told that they exist under various trees and behind courtyards within the official premises.


Far from the madding city crowd, on the other bank of the river, stands a ruin of an old hotel. Broken staircases creaking up three floors, flapping cracked and loosened window frames, assorted clothes drying in unexpected places , maybe they use it as a film set at night. Then there is a huge courtyard, where of all things, a large number of huge Volvo buses are being cleaned and washed. If you follow the various resulting streams and trickles of water that converge on to, what may be called a reasonably level piece of land , you reach a stamp vendor, a lady. A fine professional, she follows all the required procedures, gets you to sign at various places and in various registers, shouts at people who try to bypass the queue, and you get your stamp paper. The uneven rocky terrain is studded with multicoloured beach umbrellas, under which are guys in black coats and collars, sitting/standing next to typewriters, which would have delighted the late Mr Remington . (I assume Mr Rand is a different person, and I suppose he would be delighted too).

You show them or dictate the affidavit text, sitting next to them on a stool which always has uneven legs, and you inadvertently do Kegel's exercises, and exercises that tone your abs and quadriceps, as you try and balance yourself, sitting on a stool that is actually meant for a child. They ask you some very pointed questions as they do the needful. Ten minutes, a few angry glares at the muttering neighboring advocate, a few requests to the next customer to wait, a confident swish of the lever, and my affidavit is done.

Notarizing the affidavit is so much better here than in Andheri. You sit in front of an elderly gent, who sits with a pen in hand, while assorted minions affix various stamps, seals, , make entries, and do everything short of holding the gentleman's hand while he signs. In the meanwhile, the old gentleman makes small talk with you about big things. What the world is coming to, how bad the politicians are, how everything is expensive, how the oil companies that give us the cooking gas cylinders are being unnecessarily difficult about transferring names , even though connections are now much easier to get, etc etc. Just when he is cursing someone orally, his hand sort of flies across your affidavit, and lo behold, it's his notary signature !

Once again, no one really cares to check the numbers in my gas consumer book against those in the affidavit, before notarizing . A crisp fee of a hundred rupees is smilingly charged, and happily accepted.

I find my way out through a rocky terrain, clutching the sheets, and checking the original documents which no one wanted to look at.

A sudden rocky obstruction, a slight twist of an ankle followed by an involuntary loosening of my chappal straps. My next project has just presented itself. Search for a cobbler . I try and walk regardless, then drag my foot a bit, in an effort to cover some ground. No good. I bend down to remove the offending chappal and try fixing it with a safety pin. No success. Taking a deep breath, cursing the judiciary that has these creative locations for doing this terribly non creative work, I look up and notice a very ornamental sign, above a ramshackle shed. "Notary Canteen . Cutting chai : Rs 3"

That seems to be the first sensible thing I have seen all day.