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All in a busy day at the clinic

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As current affairs play out in the background, dealing with a microcosm of the population

“All you need to know about Nirav Modi and the $1.77-billion PNB fraud”, said the newspaper headline. Television channels vie with one another to report the breaking news. After an unending assault on my ears and eyes, I brace myself for another day in the clinic with a heavy heart.

My brain goes into a spin, posing unending questions. What are the implications in day-to-day life for an ordinary citizen?

I see my first patient of the day, a portly woman in a tattered sari, a thread (not diamonds) adorning her neck. She is accompanied by her weathered yet sprightly husband. I had planted a stent in her following a heart attack six months back thanks to a government-sponsored insurance scheme.

They have a tale to tell. Hailing from a village 100 km away, their threadbare existence was strained to breakpoint by her illness. She now has recurrence of symptoms.

They look at me with hope written all over their faces. I scrutinise her records and scan the recording of her procedure, which seems perfect. Is it restenosis, a complication that occurs in 5% of patients following an angioplasty? Another thought interrupts my stream. With the recent price cap on stents, are companies maintaining regulatory standards? Overburdened as it is and constrained by time, do drug inspectors have the wherewithal to check quality? I shove away the thought and reassure her I will try my best to find the cause and fix it. They prostrate before me with gratitude as I pull away and promise myself I have to help her, come what may.

My next patient comes from 300 km away. I am happy he is doing well after a procedure six years ago. I proudly write his prescription and wave him away with a perfunctory glance. He barges into my chamber again, much to my chagrin. Curbing my irritation, I look up. He has a tale to tell too. The price of the medication he usually purchases for three months has gone up by nearly 30%. I explained to him that I did not alter any medication. He confronts the pharmacist, who attributes it to GST. I make a mental note to ask my friend to check why the costs have gone up, as I ask him to purchase generic medicines. He is worried about quality but I reassure him.

A news channel on TV is blaring outside about the nexus between doctors and pharmaceutical companies Unpleasant thoughts again: are the drug inspectors alert and uncorrupt. Why doesn’t the journalist stop Nirav Modi from looting us? Why can’t he sit in my chamber and answer my patients. I summon my patience as I whisk away my thoughts and focus on patients again.

I brace myself to face my next patient, a self-styled businessman who wants me to order CT coronary angiogram that could show any blocks in the arteries. I explain to him he does not need it. He is adamant on getting it done and I give up and fix an appointment. Thoughts intrude again. Am I guilty of agreeing to the patient’s whims and fancies and writing out an unnecessary investigation?

A dark-complexioned, malnourished lady staggers into my room, her body wracked by rheumatic heart disease, a scourge eliminated in the west but still thriving in India. She reminds me of my country wrecked by scams, trying to break free from clutches of poverty.

Deferred surgery

She had been advised surgery five years back during her pregnancy, which the family, with an extra mouth to feed, deferred — although a government scheme pays for the surgery. Nobody is willing to operate on her given her nutritional status. The cost to the family, which leads a hand-to-mouth existence, is enormous. For the husband there is also loss of workdays during the period of hospitalisation.

The unaccounted burden of disease extends beyond the obvious. I brush away my thoughts as I devise a low-cost food plan for her along with medication to manage her heart failure before we subject her to surgery.

Visitors to my clinic on a typical day represent a microcosm of society. They go through the motions of existence and are oblivious to the fact of who looted the country.

Another headline, “Humanoid Sophia steals the show”, grabs my attention. Will Sophia take my place one day in the future? Will she go through the business of seeing patients with no intruding thoughts, nor emotions? Will she be more efficient, I ask myself.

As I retire for the day, Scarlett O Hara’s words echo in my mind: “After all tomorrow is another day.”

sujasri@icloud.com

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Printable version | Jan 21, 2020 1:56:33 PM | https://www.thehindu.com/opinion/open-page/all-in-a-busy-day-at-the-clinic/article22919391.ece

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