Emotional sister, over bearing brother in law and a neglected brother: a triangular story.
Emotional sister, over bearing brother in law and a neglected brother: a triangular story.
Vijay Gopichandran
Thirty-year-old Vignesh looked emaciated and sick. He had no fat or muscle anywhere in his body and was just skin and bones. He had a very sad look on his face as he walked up to where we were seeing the patients on Sunday. Right behind him were three people – his elder sister, her husband, and their 4-year-old daughter. I had seen Vignesh in the past, I could very vaguely recollect his face. If we take one look at him, it looked like he must have either tuberculosis (TB) or HIV, two conditions that can cause severe wasting in a person. The brother in law was the first person to talk. He said, “doctor, do you remember us? We came to see you almost 8 months ago. My brother in law here is very sick now. He has diabetes and has been off medicines for many months now. We found him like this in Chennai, at his home and brought him back here with us yesterday. Help us.”
Now I recollected who this guy was. Almost 8 months ago, Vignesh had come with his sister and brother in law to my clinic for Type 1 diabetes. I had started him on insulin and had asked him to review at least once a week for the first month, till his body adjusts to the dose of insulin. It is not common to see Type 1 diabetes – which happens due to self-destruction of the insulin-producing beta cells of the pancreas – at 30 years of age. It usually presents much earlier, during school days. I remember inquiring about symptoms of diabetes such as increased urination, dryness of mouth, increased hunger, etc. Vignesh had all these right from school days, but they had ignored all the symptoms. But after that visit, I had never seen Vignesh again and I couldn’t follow up either because they were not residents of our project villages.
One thing I remembered distinctly was that the brother in law kept saying repeatedly, “This guy is a burden on my family. I am the one who is feeding him and taking care of him.” Vignesh and his sister had been orphaned when they were very young. His sister had been married off to her own maternal uncle, who was 8 years older than her. Both sister and brother had moved together to the uncle’s house, the sister as a wife and the brother like a son to the couple. From then the brother in law had provided for both. Vignesh did not study well and dropped out of school after 10th standard. He had started working in a mechanic shop in the nearby town. As he started earning and growing up, he couldn’t take the insults and the jibes that the brother in law was giving. So one fine day Vignesh left his sister and brother in law’s home and moved out to Chennai. There he took a job as a courier delivery boy and started living in a working men’s hostel on his own. It was when he was living alone in Chennai that he developed seizures one day. He was rushed to a hospital where he was found to be diabetic. There they did some special tests to identify that he was Type 1 diabetic. It was at that time that he had seen me.
I started asking Vignesh, “what happened? How are you now? What is the problem”. He did not speak a word and just kept staring at the open space. His sister opened up and said, “We went to Chennai for a work last week. We wanted to visit him and so went to his home in Chennai. There we fond him so weak and emaciated. We found him lying down in his home and immediately brought him back with us. His neighbors told us that he had stopped coming out of the house for a couple of months. We were really worried about him and so brought him here.” I asked him one more time, “Vignesh, what happened? Tell me, what is troubling you?” He mumbled something in a low voice whose meaning I couldn’t figure out. As I started straining to hear and understand him, his brother in law shouted out loudly to his sister, “ask your stupid brother to answer properly to the good doctor. Otherwise, he has to just die”. Those words stung me really bad. But I was watching, and Vignesh’s face showed no expression – neither sadness nor disgust nor anger. The family dynamics were becoming very clear. The sister was emotionally attached to the brother. She wanted her husband to take care of her brother, who is like a son to her. But the brother in law found Vignesh to be an unnecessary extra mouth to feed. Chronically unwanted, ignored, disliked and considered a burden, Vignesh had lost interest in life and had emerged a complete cynic, who had a gloomy picture of life. So, whenever he had some money in hand he would buy insulin and take it regularly. But when he ran out of enough money, he would stop the insulin. While for someone with Vignesh’s condition insulin is mandatory on a day to day basis, Vignesh’ depression and lack of enthusiasm in life, made it optional. He had stopped insulin since 4 months and in that period had lost a lot of weight and developed several complications.
He was unable to eat because his whole mouth, throat and food pipe was full of growth by a fungus called candida. He was having blurring of his eyesight because of diabetic retina damage. His muscles were all wasted. He also looked very pale and when we drew some blood to run some tests, his blood looked like it was diluted with water, indicating anemia. He was also having a hacking cough, which was worse at night. Probably due to tuberculosis in the lungs, which could happen in poorly controlled patients with diabetes. His blood sugar value tested using a glucometer was more than 600 mg/dl (about 6 times more than normal).
There was very little I could do for Vignesh other than refer him to a tertiary care center. I referred him to Chengalpet General Hospital. When they were all ready to go, the brother in law came aside and asked me “Doctor, you are saying that his sugar is very high. And you are also saying that because of the sugar he is having TB, fungus and other infections. Will the infections spread to me and my child?” I did not know whether I should answer that question. I looked at the child. The innocent child was playing with a toy. If I told the brother in law about disease transmission, then Vignesh would be on the street, completely abandoned. But if I did not warn him adequately the innocent child, the sister and the brother in law himself would be exposed to TB. I told him that if Vignesh did have TB, then there is a chance of TB spread to close household contacts.
Throughout the short period of time the four of them spent in the clinic, they kept changing the decision about the brother’s hospitalization. First, they said they want to take treatment with me as an outpatient. Next, when I said that there is a risk of transmission, they wanted to just get rid of the risk and so decided that they will move him to Chengalpet GH. Then they realized that if they had to put him in the hospital, the hospital authorities will ask for an attendant to stay back with him, which they couldn’t afford to do as the child was too young and school going. So they decided one more time that they will consider treating with me. Finally, sense prevailed and they decided to take him to the government general hospital in Chennai.
While the sister and the brother in law were making these decisions amidst loud unpleasant conversations, Vignesh was a silent spectator. While the storyline of his life was slowly taking several twists and turns, Vignesh could only be a quiet audience. There are so many things I learned from Vignesh’s life:
I have sent Vignesh to a tertiary care center. Now, as I wait to hear of his health or see him when he comes back from the hospital, I am wondering what plan of action I should adopt to prevent relapse of this kind of self-neglect. The answer probably lies in strengthening Vignesh’s ego and psyche and making him understand that even without his overpowering brother in law, sister and sister’s child, his life could still be meaningful. The answer also probably lies in helping him realize that he is a good human being and humans have the capacity to work, enjoy, help, care and give nurture. Sometimes the most intense of answers are for the simplest of questions.
Vijay Gopichandran
Thirty-year-old Vignesh looked emaciated and sick. He had no fat or muscle anywhere in his body and was just skin and bones. He had a very sad look on his face as he walked up to where we were seeing the patients on Sunday. Right behind him were three people – his elder sister, her husband, and their 4-year-old daughter. I had seen Vignesh in the past, I could very vaguely recollect his face. If we take one look at him, it looked like he must have either tuberculosis (TB) or HIV, two conditions that can cause severe wasting in a person. The brother in law was the first person to talk. He said, “doctor, do you remember us? We came to see you almost 8 months ago. My brother in law here is very sick now. He has diabetes and has been off medicines for many months now. We found him like this in Chennai, at his home and brought him back here with us yesterday. Help us.”
Now I recollected who this guy was. Almost 8 months ago, Vignesh had come with his sister and brother in law to my clinic for Type 1 diabetes. I had started him on insulin and had asked him to review at least once a week for the first month, till his body adjusts to the dose of insulin. It is not common to see Type 1 diabetes – which happens due to self-destruction of the insulin-producing beta cells of the pancreas – at 30 years of age. It usually presents much earlier, during school days. I remember inquiring about symptoms of diabetes such as increased urination, dryness of mouth, increased hunger, etc. Vignesh had all these right from school days, but they had ignored all the symptoms. But after that visit, I had never seen Vignesh again and I couldn’t follow up either because they were not residents of our project villages.
One thing I remembered distinctly was that the brother in law kept saying repeatedly, “This guy is a burden on my family. I am the one who is feeding him and taking care of him.” Vignesh and his sister had been orphaned when they were very young. His sister had been married off to her own maternal uncle, who was 8 years older than her. Both sister and brother had moved together to the uncle’s house, the sister as a wife and the brother like a son to the couple. From then the brother in law had provided for both. Vignesh did not study well and dropped out of school after 10th standard. He had started working in a mechanic shop in the nearby town. As he started earning and growing up, he couldn’t take the insults and the jibes that the brother in law was giving. So one fine day Vignesh left his sister and brother in law’s home and moved out to Chennai. There he took a job as a courier delivery boy and started living in a working men’s hostel on his own. It was when he was living alone in Chennai that he developed seizures one day. He was rushed to a hospital where he was found to be diabetic. There they did some special tests to identify that he was Type 1 diabetic. It was at that time that he had seen me.
I started asking Vignesh, “what happened? How are you now? What is the problem”. He did not speak a word and just kept staring at the open space. His sister opened up and said, “We went to Chennai for a work last week. We wanted to visit him and so went to his home in Chennai. There we fond him so weak and emaciated. We found him lying down in his home and immediately brought him back with us. His neighbors told us that he had stopped coming out of the house for a couple of months. We were really worried about him and so brought him here.” I asked him one more time, “Vignesh, what happened? Tell me, what is troubling you?” He mumbled something in a low voice whose meaning I couldn’t figure out. As I started straining to hear and understand him, his brother in law shouted out loudly to his sister, “ask your stupid brother to answer properly to the good doctor. Otherwise, he has to just die”. Those words stung me really bad. But I was watching, and Vignesh’s face showed no expression – neither sadness nor disgust nor anger. The family dynamics were becoming very clear. The sister was emotionally attached to the brother. She wanted her husband to take care of her brother, who is like a son to her. But the brother in law found Vignesh to be an unnecessary extra mouth to feed. Chronically unwanted, ignored, disliked and considered a burden, Vignesh had lost interest in life and had emerged a complete cynic, who had a gloomy picture of life. So, whenever he had some money in hand he would buy insulin and take it regularly. But when he ran out of enough money, he would stop the insulin. While for someone with Vignesh’s condition insulin is mandatory on a day to day basis, Vignesh’ depression and lack of enthusiasm in life, made it optional. He had stopped insulin since 4 months and in that period had lost a lot of weight and developed several complications.
He was unable to eat because his whole mouth, throat and food pipe was full of growth by a fungus called candida. He was having blurring of his eyesight because of diabetic retina damage. His muscles were all wasted. He also looked very pale and when we drew some blood to run some tests, his blood looked like it was diluted with water, indicating anemia. He was also having a hacking cough, which was worse at night. Probably due to tuberculosis in the lungs, which could happen in poorly controlled patients with diabetes. His blood sugar value tested using a glucometer was more than 600 mg/dl (about 6 times more than normal).
There was very little I could do for Vignesh other than refer him to a tertiary care center. I referred him to Chengalpet General Hospital. When they were all ready to go, the brother in law came aside and asked me “Doctor, you are saying that his sugar is very high. And you are also saying that because of the sugar he is having TB, fungus and other infections. Will the infections spread to me and my child?” I did not know whether I should answer that question. I looked at the child. The innocent child was playing with a toy. If I told the brother in law about disease transmission, then Vignesh would be on the street, completely abandoned. But if I did not warn him adequately the innocent child, the sister and the brother in law himself would be exposed to TB. I told him that if Vignesh did have TB, then there is a chance of TB spread to close household contacts.
Throughout the short period of time the four of them spent in the clinic, they kept changing the decision about the brother’s hospitalization. First, they said they want to take treatment with me as an outpatient. Next, when I said that there is a risk of transmission, they wanted to just get rid of the risk and so decided that they will move him to Chengalpet GH. Then they realized that if they had to put him in the hospital, the hospital authorities will ask for an attendant to stay back with him, which they couldn’t afford to do as the child was too young and school going. So they decided one more time that they will consider treating with me. Finally, sense prevailed and they decided to take him to the government general hospital in Chennai.
While the sister and the brother in law were making these decisions amidst loud unpleasant conversations, Vignesh was a silent spectator. While the storyline of his life was slowly taking several twists and turns, Vignesh could only be a quiet audience. There are so many things I learned from Vignesh’s life:
1. Diabetes is a social disease for a substantial part. Social and family support is essential for proper diabetes care.
2. Depression and psychological factors play a major role in the treatment and control of diabetes. Vignesh was depressed and had very low self-esteem. This led him to not care for his disease or his body.
3. When a person becomes sick and dependent, then others tend to take advantage of the situation and play on the person’s vulnerability. They make decisions for him/her because the person is seen as just a diseases body and not as a feeling, emoting human being.
Comments
Post a Comment