So much to learn each day

So much to learn each day

Vijay Gopichandran

Hello my dear readers! It has been a long time since I wrote this blog. I was on a break doing a different kind of writing and taking some courses on how to write better. If you notice something different in my writing and find it good, then the credit goes to my teachers in the writing course. However, if you find my writing has gone from decent to horrible, I take full responsibility for it! There is so much to write about. I decided I will stick to the events of my clinic. I went to clinic today alone, no colleague, no students, like old days before 2016! Two interesting events took place and they have me thinking a lot about myself as a person and my profession as a doctor.


“Sir, a man has come to the clinic with massive bleeding from his right hand. Shall I bring him inside?” asked our laboratory technician who was doubling up as a crowd controller in the overcrowded OPD today. I was seeing another elderly lady with diabetes and hypertension. I gestured to the lady that I will be right back and rushed to the procedure room to see the man with the bleeding.


There sat an approximately 5 feet 8 inches tall man, dark complexioned, bulky and muscular, head full of pitch-black hair combed in a stylish manner. He was wearing white sleeveless vest with dark red boxer shorts. He was sweating profusely and was reeking of alcohol. Remember it is Sunday and it is rare to find a young male in the village who is sober on a Sunday. His entire right hand was hidden inside a huge bundle of cloth. It was the lungi cloth, which is a checked cotton cloth usually worn by men as night dress and casual wear. I gathered that he had removed his own lungi and tied it tightly round and round over his right hand trying to stop the bleeding. He gave me a completely apathetic look as I entered the room. I put on my gloves and started peeling off the lungi. I was reminded of the famous scene in Mahabharata where Dusshasana disrobes Draupadi. He keeps pulling her saree and thanks to Krishna who keeps supplying an infinite roll of cloth for Draupadi, the saree never comes off. Taking off the lungi bandage reminded me of that scene. At last the lungi came off and on the upper part of his right hand in the middle was a deep cut. It had completely stopped bleeding. I touched the hand around the cut and could feel a crunchy sensation. In clinical medicine, this crunchy sensation is called a “crepitation”. I hadn’t even asked him details of what happened to his hand. When a bone is broken to pieces, the pieces give rise to this kind of a crepitation. My clinical brain associated the crunchy sensation to a fracture, and I said, “Sir, looks like you have fractured your hand”.


The man looked away from me immediately, gave a frustrated look which indicated something like “why do I have to deal with such incompetent nincompoops” and waved his other hand at me and snapped, “there is no fracture”. His dismissive attitude touched a very sensitive nerve and I touched the area again and felt the same crepitations. With all the politeness that I could muster from within my completely exhausted self, I said, “no sir, please listen to me. when we feel this kind of a crunchy sensation, it usually means there is a fracture….” I hadn’t even finished my sentence, he raised his voice and yelled at me, “I am telling you there is no fracture. I know what a fracture feels like. Don’t tell me that it is a fracture. Just stich up the cut and I will go…” By now, I was really upset with this man. He was challenging my “clinical authority”. I composed myself and looked once again at the cut. The cut was 2 cm long, quite deep, but not bleeding. So I called the nurse and said, “Sister, please clean up this would and put a tight bandage.” The man heard this and literally jumped off the examination couch. He gave me the nastiest look that anyone has ever given me. It was a mixture of 'you-incompetent-fool', and 'you-worthless-piece-of-shit' looks. He said, “I would rather go and die than take treatment from someone like you” and started walking away. It was 2.30 PM, I hadn’t had my breakfast yet (no, I don't mean lunch, I mean breakfast, the first meal of the day!), and the day had been the most hectic in the recent few weeks and so we made no attempts to pacify or mollify him. He left the clinic shouting, yelling, badmouthing me loudly, a completely dissatisfied and annoyed patient.


I am writing this story to reflect on my feelings and my reactions to this man’s demeanour. My initial feelings were hurt, insult and anger. This man challenged my clinical decision. He was exerting the supremacy of his knowledge and awareness about his own body. He was dismissing my clinical skill. He was not only rejecting my clinical diagnosis; he was insulting me by giving me those nasty looks and passing those dismissive comments. Both these hurt me bad and I got angry with him. But the more I think about it, I realize that it is true that he is the best judge of what has happened to his body. If I had a fall and felt a bone crack, I would know my bone has cracked. If I had not fallen, and probably just had a sharp object shear away part of my skin, then I would know that nothing has cracked and only the skin was torn. These are things that one can make out with just common sense. The crepitus was probably just air trapped in the bleeding that was accumulated under the skin. So maybe I should have respected what he said and listened to him more patiently. Despite 20 plus years of medical practice, I realized that I am still vulnerable to my clinical ego being touched and hurt. I realized that I need to work harder on having an open mind and respecting patients as equal partners in care.


Another very interesting and completely opposite event happened today. Having run a very hectic clinic and finishing it almost 2 hours past its routine closing time, I literally sneaked out of the back door of the clinic as I was exhausted to see any more patients. Fortunately, no one else was waiting to see me. As I walked out of the clinic, a share-auto came by and I showed my hand and stopped it. It was empty and the man driving it stopped for me. I stepped in and took my seat next to the driver. It is not actually a seat. We just share the driver’s seat so that other passengers may climb on to the back of the vehicle. In the share-auto trip from the village to the nearest town, the charge is Rs. 15 per passenger. So, the greater number of passengers the driver can gather, the more he earns per trip. All the young men in the village drive the share-auto for some time to make a quick buck. Every household has a young man who has at some point driven a share-auto. So, everyone works towards optimizing the earning of the young share-auto driver. That is why sometimes as many as 14 people travel in that small share-auto which is supposed to carry just 4. Sitting in the driver’s seat and sharing it with him is a show of solidarity, in which we say “brother, I am in this with you. I will help you make more bucks for the trip”.


The driver was a nice chatty guy. He started a small conversation as we started moving towards the town. “I have heard there is an excellent doctor in this clinic. His name is some Raja…something….do you know him?”

“There is no Raja in this clinic brother. I don’t know whom you are referring to.” I said.

“That is strange. How come you don’t know the most famous doctor in this area? You seem to be working in this clinic. I see you often. But you don’t know that doctor?”

“I really don’t know whom you are talking about. Tell me why you asked?”

He then started describing that he has been having bleeding from his rectum for the past 1 month. Whenever he eats meat, which is approximately once a week, he develops this bleeding. By the way, all this conversation is happening in the share auto as we are travelling to the town.

“Brother, looks like you might have piles. I can help you with this. Why don’t you come by the clinic next Sunday? I will come next Sunday.” I said.

The driver guy went quiet for some time. He did not understand why I was asking him to come to see me next week. “But Raja sir wont come is it? I want to see only Raja sir. Everyone asked me to see him”

“I don’t know who is Raja sir. I am a doctor and I work in the clinic. I can help you if you want and my name is Vijay” I replied.

He went quiet for a full minute. I was sitting facing outside the share auto and I could see his facial expression on the rear-view mirror. He was biting his tongue and had his free hand on his forehead.

“I never took you to be the doctor. Thank you for talking to me Sir. I will surely come and see you next week” he said and at the same moment, we reached the town bus stand. I got down and handed over the Rs. 15 to him. He refused to accept it. He said, “let it be sir. I will not take money from you.” I had to then insist and convince him for the next 5 minutes before he accepted the money from me.

I had a very warm and nice feeling after this memorable 10-minute auto ride. It is always a nice feeling to be acknowledged for your work. The man got my name wrong. There was a sweet innocence in the way he spoke the wrong name, argued that there must be something wrong with me for not knowing the ‘great doctor’ and finally showed his respects by refusing to take his auto fare for the ride. This episode helped me see the power that doctors wield in the community and the amount of respect that we command. It is a humbling lesson for all of us to be worthy of this amount of respect.


The clinic today was a roller coaster ride, on one extreme a bitter and hurtful episode and on the other an ego-boosting and warm one. Whatever the experience, there is always so much to learn each day.