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The lost goat and one ophthalmologist

Dr. Jyotirmay Biswas

After joining the medical profession, almost all doctors came to know that apart from treating a patient, he has to give sympathetic answers to all the queries that arise deep down in the hearts of the patients.  These questions according to cricket terminology, come to you as “good length” or “too wide”.  You have to listen carefully, patiently, and answer.  After finishing the questionnaire, he can ask the same question once again.  Don’t feel bad about that.   After the patient has finished asking questions, the patient’s wife will again ask the same questions separately, then the patient’s uncle and then the patient’s cousin, who had come with him but was all along standing outside puffing at a cigarette or had gone out to have tea, will come back and ask the same questions.  After that, the patient will find out somebody, who is known to the doctor and through him will ask the same questions about a week later.  He may ask the same questions while having ice-cream together with you having been invited to the same wedding party.  That’s also no problem for you.  At least don’t make the patient understand that you are ill at ease.  But the problem is different - most of the time that relative or friend cannot remember the good name of the patient.  You have seen Sandipan Mukherjee or Malabika Gupta, but the patient’s relative knows him or her by the name Bubun or Tumpa.  This is also natural.  Because these days you have to be so busy with yourself that you cannot afford to remember the good names of all, and your distant relations.  A patient will obviously have questions, because he is not well.  Doctors also do the same things when they fall ill and go to other doctors.  And in fact ask much more than the laymen.  So it is the duty of all doctors to free the patient as soon as he has diagnosed the illness, from the net a claustrophobic atmosphere of all those unanswered questions into the fresh air of  transparent idea about his disease.  It is quite possible also.  But some of them again want to go back and wrap themselves with the net of the same ignorant questions over and over again.  Some call them, “Doubting toms!”  Tagore himself had written “It is possible to understand only half of what we call love, only half of what goes on deep down in the heart of a human mind, who on earth has understood the whole of it ever ?”.  Tagore knew about that, farsighted great soul that he was !  But you, ya you, have to make the patient understand everything, everything about diabetes mellitus from your medicine textbooks, which took you seven years to understand.  Actually some of them do go through books like “easy allopathic treatment” and then their sole aim is to findout whether what you are telling is tallying with what they have read or not !

 

The patients first question invariably is “why am I having it ?” that ‘why” for which you to even if you don’t have an answer, the patient will obviously have an answer to it.  Naturally he will try his best to help you out regarding this.  Whether you want it or not is immaterial.  Actually hidden inside every patient there is a doctor.  Even if he does not know whether the liver is in the right or left side of his body, he can with conviction tell you that the disease is from the liver only.  Because his uncle also had the same liver problem and ended up with a lot of trouble, and this even the big and famous doctors also could not diagnose.  That’s why all patients become very happy  when asked to describe the lusting and even try to explain their hearts out.  Yes, one person I do remember, he had told me “What, sir, if I myself tell you everything, why have I paid you the consultation fee for ?”.  Ofcourse, I refused to see him, and told him to pardon me as ‘I’m not a veternary doctor’.  I had asked another ophthalmic patient whether he had any systemic problems, to which he had answered “no, no nothing much ...... just a little but sugar, for that I take insulin twice a day, and two years back I had a bypass surgery done, ya ...... kidneys sometimes do give a little trouble, and at times I cannot pass urine for loms, and as you can understand, as people age, indigestion and all will obviously be there and ..... “  I stopped him in the middle of the sentence and told him “OK, that’s enough, no need of any more ‘ands’ !”.  Later, I learnt that “and” was that he had a right paraplegia one year back.

That the patient’s history is very important, is very clearly mentioned in Hutchinson, the ‘Gita’ of clinical medicine.  But what Dr. Hatchuson has not written is the history of Bengali patients.  And if that Bengali patient, after coming to the South, happens to meet a Bengali doctor, then god save the doctor !.  They will start with “good, you are a Bengali, I’ll be able to explain things better in mother tongue”.  That time outside, I know, patients are keeping vigil at the waiting hall, and silently using some of their chaoicest words to abuse me.  And if this waiting period extends about an hour more then those abusive words will  not be lettered so silently....  I hope you understand what I mean. 

 

Bengalies are very very history-conscious.  Any other patient can be oblivous or a little negligent about its history, but a Bengali NEVER!  He’ll surely try to give you a clue, and some among them can any time put Doyley’s Sherlock Holmes or Agatha Chirste’s Hercule parot to shame.  Let me give you an example.  He had told me “you know ..... one Maruti care ... red in colour ... suddenly the headlight glare fell directly on my eyes ... and that’s it .... I lost my vision” obviously I did not ask him the registration number of that car, because he had infection in the retina, which is never possible to come from a care headlight.  Bengali patients explain their history with a lot of colour and introduction and preface.  I remember one elderly gentleman - a simpleton, he had started like this “Last year, it was Mahastami, the date being twenty first of Ashwin (Bengali month) (sitting on Chennai, I grouped for Ashwin and Mahastami, you know, you cannot keep a ‘Panjika’ in your out patient department ! keeping Ayudha Puja in mind, I understood it probably be mid October).  I told him “OK then ....”.  Happy that I’ve understood, he continued “That day was Ashtami, I have read the Chandi in the morning (a religious text depicting goddess Durga) ...... daughter and son -in-law are both at home ..... after having a little Hilsa (a form of river water fish - a hot favourite among Bongs) and sweets and I just sat down to read the Kathamrita (biography of Sri Ramakrishna Paramahamsa) suddenly I found my vision in the right eye has become very hazy.    I called out to my son-in-law “Subodh (son-in-law’s name is Subodh) my child, I cannot see anything  with my right eye.  They were viewing the T.V. then.  My son-in-law told, “Oh, that’s nothing, you have gastric trouble, that’s why .... take a little bit of Digene gel, you’ll be alright”, ofcourse, it was not all right, otherwise, why will he come for treatment in Chennai with retinal vein occlusion ?  I said to myself, “Really, you are very lucky to have such a wonderful son-in-law”.

Patients have many types of (myriad) questions.  It is really of no use for doctors to loose patience on this account.  I always try to answer as patiently as possible and correctly too.  For example, someone had asked, “OK, but, will I be able to watch T.V ?”  “yes, of course !”  “colour T.V.?” “yes, yes !” “Diet ? food habits ?” “If you are offered take it ” “No what I mean to say, there is no restriction, no ?” “No !!” “Can I travel by bus ?”  “yes, you can” “If the bus jumps a lot ?” “no problem !” “Can I climb onto a running bus ?” “Difficult questions. I told” Wait, wait, why on earth will you climb a running bus ?”  “No, no if required at times .... “  I replied “OK, then you can climb, ‘at times’.  He was about to ask me another question but I stopped him halfway because I know he is invariable going to ask “...... but if I cannot climb ?”.  Then my only answer left would be “then you’ll have to walk”.  These questions are sometimes more difficult than these asked in as interviews.  Someone might ask “my eyes become red if I wash my face with soap”  I told “mine also gussed, it’s not unusual!”.  I was about to tell “all people in the world have the same problem, their eyes also become red when they take bath with soaps”.  One elderly lady had asked me “you know, whenever, I sit down to correct my students exam papers (she was a teacher), my eyes become so heavy”.  I told, “may be you are a bit tired, you can rest or sleep for some time”.  “No, no even if I get up from sleep, my eyes become heavy the moment I sit down to check these papers.  Hardly, I can see one or two .... after that eyes become so heavy, so heavy I can’t explain ....”  I also could not explain.  My medical science knowledge does not have an answer to that.  I really don’t know how that lady is still checking papers with heavy eyes what numbers or marks she is to the paper, she is examining’.

 

I was not able to reply to one more patient - he was a gentleman from Midnapore district and had haemorrhage in the retina.  After answering all the questions related to treatment, he suddenly asked, “can I climb onto the lamp-post ?”  Before I could think what to answer pat came the second question which was even more dangerous - “can I climb without ladder ?.  I got flabbergasted and exclaimed, “wait, wait ! why on earth would you climb on to a lamp post without ladder ?”  He got a little ashamed and replied “no, actually I work in West Bengal Electricity Board, I repair the lamps on the road.  So, I have to climb a lamp post ....”  I exclaimed, “But  without ladder ?”  He replied, “Actually, sir, there are only two ladders in our whole block and both are broken.  In spite of repeated petitions, the Government is not providing a new one, since last 6 months. If I don’t repair the lights on the main road, the local people will beat us up”.  I managed to reply “why don’t you tell your colleagues to climb up ?”  Remember, you have undergone photocoagulation a few days back.  Otherwise, while climbing to repair the road lights, you may lose the light of your own eye ultimately “there are various problems.  Like that day, someone was asking me, “Dada (elder brother), please do something for me, do something so that I can see better”.  I replied, “you have mild cataract in your eyes.  You do not require surgery right now.  Do come after 6 months.”  Almost on the verge of breaking down he replied “Dada, please do the operation before the football season comes.”  I exclaimed, “Why football season ?”  He replied ... “No, actually I give running commentary of the football matches in Akashbani (All India Radio). I only know how I managed in the last rainy season,.  And gone are the days when Chuni means Mohun Began and Balaram means East Bengal.  Now the time has come when players are changing teams every year and to top it all, all those Nigerian black players have come to play in Calcutta.  In the rainy season when they all are smeared with mud it is impossible to recognise who are Chima (One Nijiman player) and who is “Kima” (“Kima” in Bengali means meat chopped into fine pieces).  I somehow survived as it was on radio ..... Had it been T.V,  I would have been beaten up by the mob by now”.  Let me assure you that his cataract operation has been done.  The people of West Bengal can hear his football relay in the coming season.

Problems are so many and strange too.  One patient asked me “When I eat my eyes water ?”  I thought that his wife was not cooking properly or regularly trying new recipes (from the radio) on him.  As most people say “The recipes told in radio are normally tastes not so nice as is told or may be, be has to eat regularly the soup of “Neem-brinjal” or Thankuni ( a very bitter) leaf.  When I was a child, my mother made these two a compulsory part of our menu, whenever there was an attack of chickenpox in our locality.  When I hinted at all these possibilities he answered “no-no-not like that ! during having food only my right eye is watering”.  I failed to answer his question and after searching many books on ophthalmology, I came to the conclusion that it remotely resembles something called “crocodile tears syndrome” - very rare disease !!

Basically the Bengali have eternal gest for questions.   When I joined this eye hospital in Madras, within very few days I got the instances.  For example, as a doctor on duty, during preoperative instructions I had to tell all patients to wash the face nicely with soap on the morning of operation.  Patients from other provinces did not raise any questions about it, but 90% of the Bengali patients would immediately ask me one question “Can you guess the question ?” .... Yes, that is it ... “Which brand of soap should we use ?”  This is the typical Bengali.  If you plant them in Haldia, they will grow in Sunderbans (Haldia and Sunderbans are two corners of Bengal).

Sometimes a Bengali patient gives you the history tinged with enigma.  For instance, I have one patient who underwent cataract surgery outside long back and after surgery the vision has not improved.  I asked him, “Have you got any report of previous surgery ?”  He replied “No, sir, the doctor committed suicide 2 days after the operation .... “Suddenly I experienced a chilly sensation down my spine but he assured me immediately, “No, no ...... not for feeling guilty of doing my surgery wrong he had a longstanding problem with his wife ..... that’s why he committed suicide”. 

Once I saw an 18-year-old boy who came to me for a chronic infection in the left eye.  During examination, I discovered to my surprise that he had no vision in the right eye and the eye was small and shrunken.  Naturally, I asked him “What happened to your right eye ?”  He boldly replied “Forget about the right eye, It is lost totally.  In my childhood I had some disease in that eye - my father knows it.  You don’t think about the right eye - it is out of syllabus now”.  I thought I would ask “Whose syllabus - mine or yours ?”.

Not only are they smart in giving history or asking questions.  Sometimes they are very kindhearted and do a lot for their friends also.  I can vividly remember one person.  He made an STD call from Shantinekatan for his friend’s son.  The conversation goes as follows:

- “Are you Dr. Biswas ?”
- “Yes”
- “How are you ?”
- “I am OK .... What is the matter ?”  I was eager to answer as it was an STD call and every moment costs.
- “You may not recognise me, but I know you.  My friend’s son had a bad accident in his eye yesterday night.
- “What happened” I exclaimed
- “Actually, while he was bursting a cracker on the day of Diwali a fragment went inside the eye”
- I queried “Have you shown him to any local doctor ?”
-  “Yes, but he told me to go to Madras immediately”.
-  “Then tell them to come immediately.  Emergency service is 24 hours open.”
- “Will you be there ?” he asked
- “There is no need for me to be there, emergency doctor will take care.  There will be no problem”
- “No, actually it will be good for us if you are there, Are you going for a holiday ?”
- “No” I answered in monosyllable.

He then told “You know, actually last time I had sent a patient also referring your name, but he came back and told me that you were on leave.  This time I thought I will check”

 

“May god give me patience” I murmured
Next question came.
“How shall they reach your hospital from Station ?”
“Auto” I replied.
“Taxi not available” he asked.
“Oh ! God!” I muttered under by breath again for making the conversation long.
“Where is the emergency section of your hospital actually ?”.
I leached my teeth an answered - “After entering through the main gate right there is a tamarind tree - after that the front gate is the emergency.
“Thank you” he replied.
Again he asked “so they will get you there or not ?”
I thought I would answer “I will be there whole of my life for your friends son only.”  But did not, instead I asked him, “I have a little question ..... you are on STD line for such a long time ..... you have to pay a good amount for it, is it not ?”

He was a little taken aback and answered “No actually, no actually, I am working here in Telephone Exchange ... doing this much for my friend’s son ....”

But not only these bitter incidents, I have some sweet memories also.  And for these reasons sometimes it seems that life is really worth living.  I will tell two incidences, and the memory remains fresh always.  It makes me remember Tagore’s words “Loosing faith on mankind is sin”.

First one is as follows.  This poor gentleman came to me from Begampur (Howarh district) and one of my senior college mate, now a doctor in that Public Health Centre, had sent him to me with a letter.  I had helped him a bit and then completely forgot about the incident.  After a day long O.P.D. when I was rushing towards the ward.  This man came to me and said, “Sir, I want to give you some oil” “Oil ?” I was flabbergasted.  “No, actually, I want to give you mustard oil”.  I thought he is mad.  Then he told “Actually sir, I have my own oil making machine in my home .... it is fresh and pure, sir, nice taste ... if you mix with moori (puffed rice) and eat, you will like the taste. Is Moori available in Madras.  He took out one tinned pack of mustard oil from his bag and gave it to me.  According to the hospital rule, I deposited the cost of the oil in the employee’s common welfare fund and took it to my home and really enjoyed the taste of the oil with  “moori”.  How the general manager of our hospital, assess the cost of the oil much less. I know it is foolish to evaluate the cost of the oil in terms of money.  And one can never, never evaluate the simplicity, love, and gratitude that came with this small gift from a poor villager.
And the second one is a letter which is one of the most valuable letters to me (ofcourse otherthan my wife’s letter).  The letter was not written to me.  It was written by the Headmaster of Numul Huda village to his friend Nur Mohammed.  Nur Mohammed came to S.N with his small daughter who  was suffering from a complicated eye disease and this letter.  The letter is as follows (without my editing).

“Dear Nur Mohammad,

With love and prayers.  Today, morning I came to know from the head-master of Junka that there is a doctor called Jyotirmay Biswas in Sankara Nethralaya.  He is known as Dr. JB there and he is from our district Nadia.  You tell him my name and also tell him that the head-master of his village has requested him to take care of your daughter.  He will make necessary arrangement.  What more ?.  The special news is that we have found our lost goat.

Yours,

Abu Bashar.

I do not know Abu Bashar.  But it does not matter. There were two important points in that letter - first, ofcouse me from I his own mother district - definitely, he has some right over me as a headmaster in a school of that village.  And second one is that lost goat .. I am also born and brought up in a village.  I know when someone goes to a new place from a village how comfortable and confident he feels when he find some person from his own village there !.  And ofcourse it is equally important for a villager to find out his lost goat.  Yes, I helped Nur Mohammed upto my highest capacity.  But I have conficated his letter.  The letter to me is an ultimate testament of man’s simplicity and will remain a  treasure to me and gives me the utmost satisfaction as a doctor.  I hope you also do agree with me.

 

 

JB

 

Dr. Biswas is a reknowned uvea specialist & Ocular Pathologist. He is currently working as director of department of Uveitis and Ophthalmic Pathology in Sankara Nethralaya, Chennai