Saturday, October 21, 2006

Doctoring On

“…and it came upon me suddenly that I was profoundly happy in my profession, in which I would never aspire to administrative power or prominence so long as I could remain close, heart and hands, to the problems of disease. “As I Remember Him”, autobiography of Dr. Hans Zinsser, renowned Harvard Medical School Teacher and bacteriologist who isolated the typhus and helped develop the mass production of the typhus vaccine
A half doctor near is better than a whole one far away. ~German Proverb

It is one of the most spectacular drives that I have ever seen. Driving through Coorg, en route to Mangalore from Mysore. The show begins a little after Madkeri town and the feeling is one of entering the womb of Nature. Hushed, greenly dark, fragrant and moist; everything growing out of everything else, everything entwined in everything else in a timeless, primordial embrace of procreation. I turn my head this way and that, dazed and awestruck as the car gingerly makes its way on what seems like a narrow ribbon of a road that has been threaded through the hair of this spectacular lushness. Trees rise like mighty, imperious edifices, blocking out the sunlight that even so, manages to creep through as timorous, vapoury wisps and patches, holding their breaths as they dare to fall on and gently poke this nook, dapple that patch.
And as if to show that it is no less mighty, as high as the trees rise, the ground suddenly falls as deep, hundreds of feet into huge, cavernous maws - Nature yawning lazily to show all her green glory. My breath whooshes out of my chest and plummets into one of those maws as I stare, terrified and wonderstruck, all at once thinking how little it will take to nudge my flimsy little car off that narrow ribbon into it…
And suddenly, I sight what should be the impossible. At the bottom of the maw…a house! No two….. three! Tinier than dinky toys, thatched with little faded maroon flecks of what must be tiles. I am thinking they must be some long abandoned dwellings – surely no one could be living there. When out scurry a few creatures. Humans, as normal as I and me, getting on with the business of living.
Thoughts eddy in my head in crazy whirlpools as the ribbon moves away from the edge of the maw and begins to wraps itself around a steep incline… How would these people ever get a Pizza Hut man to deliver? Okay, no pizza but what about the milkman? (I couldn’t see any cows.) Post? And what if you are cooking and suddenly discover that you are clean out of salt? How did they get the bricks down to build those houses in the first place? Do they have babies down there? (They must … I saw a couple of kids.) How do you get a pregnant woman up that vertical slope? Or an ambulance down it? (Maybe they have a place somewhere else where they go, make and have the baby and come back with it?) And can you grow old down there? Would you heart stand for it? And what if you have a heart attack? What if you break a leg? (A real possibility…..)
And I remembered the time that I did….
I broke it not in a remote, lush, verdant place several hundred feet inside Mother Nature but in Mumbai city, where the best medical help is always on the tap. Within minutes of breaking my right leg – a clean break a few inches above my ankle – I was whisked away to what is considered one of the best hospitals in the country. At least it must be, going by the steady stream of film stars, industrialists and politicians that regularly dot its patient list. To cut a long story short, by the afternoon, I was in and out of anesthesia, my fracture set and put into plaster by a gentleman who is considered – like the hospital – one of the best orthopedic surgeons in India. Naturally. And I was safely and cozily tucked into a bright, airy private room whose large window overlooked the beautiful hospital garden. The food was delicious and I had a steady stream of visitors and gifts and flowers and life wasn’t too bad except that…
The orthopedic surgeon told us that given the site of the fracture, it might not heal on its own and may require surgery, maybe even the insertion of a metal plate. My parents had arrived from Mysore by then and we were faced with making the very difficult decision of whether to go in for surgery or not. You’re thinking - surely that should have been made easy based on the doctor’s recommendation? Well, what we got from him was a menu – you could go in for surgery. Or then wait because she is young and the fracture may heal on it own. We opted to wait…
After a week’s stay at the hospital, I was discharged. It was a relief because by now, my poor parents were fairly frazzled by the hour-long trip each way from my home in the suburbs to the mid-town hospital and back that they made everyday. We were hopeful that the check up scheduled a fortnight later would yield some direction on future treatment. Nothing. The doctor remained as noncommittal, even after examining the last x-ray. Was it healing? Too soon to tell.
Surgery or wait? Well….you decide.
We did. That it would be best to go back to Mysore for further treatment, whatever that might be. It might seem to be an odd decision – I mean, where else but in Mumbai would you get the best medical help. And I already had a head start both with the hospital and the doctor, right? Perhaps. But our decision was based on our belief that the best place to be in when you are in a crisis like this is home. Mysore was my parents’ home. We had relatives there. Also being a retired railway officer, my dad had access to the Railway hospital, which was not only competent but had attached to it several competent private surgeons and specialists. Most of all, Mysore was familiar territory, comfort zone in which my parents knew their way around, not just physically but psychologically and emotionally as well.
As it turned out, the fracture did not heal on its own. According to the orthopedic surgeon who treated me in Mysore and looked at the x-rays, the way the fracture had been set, it wouldn’t have because the broken surfaces which needed to be touching each other for them to “knit” together were not. And since more than a month had now lapsed since the fracture, even if it was reset, it was too late. So surgery was inevitable, not only to reset and clean up the fracture but also to add a bone graft from my hipbone to it to help it heal, besides a metal plate.
The surgery was a success and except for the surgical scar, I walk perfectly now. More importantly, the whole event was relatively stress free because we were in our hometown. There were aunts and uncles to do hospital duty; my parents’ home was just a few minutes drive away to go back to for baths and meals. The only regret is that what would had healed in a few months took almost a year.
I tell this story because I want to make the following points...
First that we are a nation of over a billion people, most of us living in small towns and villages, or even in places as remote and inaccessible as the one I saw in Coorg. And many of these billion people will require serious medical attention at some point in time or the other in their lives. For most of them, that will come from local doctors practicing their medicine in often what are the most basic medical facilities. No 64-slice CT scan, no state-of-the-art operating theatres. And the string of letters affixed after many of these doctors’ names will be just a modest “MBBS”. So called “ordinary” doctors who not just make do but do a darn good job by using that thing that is always state-of-art – just honest-to-goodness doctoring talent.
So, it is natural for talent to gravitate to the big cities and that is true as much for doctors as it is to software engineers. And big city specialty hospitals and hotshot specialists are necessary to keep breast with the latest developments in medical science. But - and keeping aside the cliché that there is only room for a few at the top - the fact of the matter is that there never will be enough room in them for the wealth of exceptional doctors that India has, who work tirelessly, often thanklessly and almost always unnoticed, unsung to heal and save lives, practicing in the remotest corners of this land. And there shouldn’t be, otherwise how will we keep a nation of one billion people healthy?
Second - there is no place like home. In good times but especially in bad times. Apart from the practicality of having money and the support system of friends and relatives within easy reach, there is nothing more comforting and reassuring than being amongst your own people and in familiar surroundings when you or a loved one is sick. So, unless it is an unavoidable situation, the effort has to be to make health care available locally. To empower the “ordinary” doctors and hospitals to be competent enough to provide this so that people don’t have to go to alien, frighteningly unfamiliar environments when they are sick. And that empowerment is as much the responsibility of the government and the medical community as it is yours and mine. Word of mouth is a very powerful tool. And these days, it is popular practice to exchange doctor-hospital horror stories. But perhaps we also need to make it as much a habit to tell each other about a good doctor, a good hospital, about a successful healing experience.
Finally, they say money makes the world go round. I’d like to change “money” to “trust”. Nothing is possible if you don’t trust something. In in business or a marriage, the word of your partner. In the case of those families living down in that place in Coorg – life itself. And in the case of a sick person, the doctor. As American journalist, author and world peace advocate put it, “Drugs are not always necessary. Belief in recovery always is.”