Mid April is the time of year when pleasant fragrance of spring starts to fade away and painful pangs of summer come knocking at Delhi’s door. It is the time of the year when schools reopen and children start exhibiting the excitement of new class , new bag and new books , mothers on the other hand begin Tiffin and bus anxiety .
Mid April is a season when the dull slag of ” Holi ” recedes and the doctor community awaits the increased patient foot fall . “This year is going to be better , lord mosquitoes may grant us our wishes” . Medical representatives enter the doctor’s cabin with broadened business smile and the doctors receive them with calculative eagerness .
Mid April is harvest time in Dadri when every single villager works over time to save his crop from any possible unexpected , early downpour .
Mid April is also the season when Dadri witness the epidemic of a very peculiar disease , affecting mainly the female population of its villages .
Leaving behind the high end expectations of life that I was catering to , especially after having spent good part of my life in Delhi and Bombay and leaving behind the modernized sophisticated resource based medical practice of Bombay , my ego had started to settle in the rural life , trying to learn the ordinary. There was so much to learn , medicine and otherwise . Dadri , such a Mecca of medicine that it was , never failed in this of objective . There were teachers every where . Brijesh was one such teacher .
Two ‘o’clock in the night she was brought bundled into the folded arms of her husband and a bunch of ladies with anxious looking faces following the carriage . I was inform of her arrival over phone .
“Sir , there is a patient . Admit karna hai ‘
Oh don’t be surprised , I know admitting a patient comes under the domain of doctor . It is the doctor , who advises the admission , that too after a thorough examination . But in Dadri things are different , a patient coming in the middle of night with bag and baggage , quilts and bed sheets , has to be admitted unless he is from some outer galaxy or you know nothing about medicine .
There she was laid on the examination table , slender body , teeth clenched , body stiff with over used muscles and saliva frothing out of her mouth .
“oh what the heck , she is convulsing , somebody put her on oxygen ,get the suction and load midazolam ,common fast ” , I shouted .
As things were being carried out, with the reluctant unease of night shift staff, of course , the group of ladies started settling down in the foyer , smoking ‘ beedis ‘, I kept myself busy with medical management. After a while, I spoke to the mother in law, who had come along with the atient .
Married for the past two years , Brijesh had no kids ,h ad one or two similar episodes in the past, though milder, I was told.
“Looks like epilepsy, will investigate in the morning since there is no night time diagnostic facilities in Dadri “, I explained.
After completing the formalities I went back at four thirty to have some sleep, only to be woken again. Brijesh had one more episode and the apprehensive relatives are pressing for an explanation.
There in the ward beside the bed on which Brijesh was lying, with apparently altered sensorium, were standing two elderly looking men . The taller ,heavily built , wearing white khadi kurta -pajama, over grown but well-groomed beard and slightly impervious facial grimace , was in conversation with a thinner companion. As I arrived at the scene, he asked
“Dogtor kya ho raha hai chori nu” (what’s happening to the girl )
“Ise daure par rahe hain , janch ke baad malum parega”
(she is convulsing, the cause we will come to know after the investigation)
“To karo janch , wo kya kahve hain , han ! rangeen x-ra karvao chori ka ,
pata padni chahiye jane kauan si bimari pal rakhhi laundiya ne”
( then do the test, do what you call, yes! , do color X- ray, we should know what disease she is harboring )
then looking at the thinner man, he said in an authoritative manner.
“Dekh Jagbeer , kharcha to taine karna parega , chori thari hai ”
( look Jagbeer , you will have to spend money as she is your daughter ) then turning towards me, he continued
‘Dogtor sare test karvao , je Brijesh ka baap hai , je paise devega” ( get all the investigation done , Brijesh’s father will pay for it )
“Laundiya theek honi chahiye” ( the girl should recover ) , he told me, in a stern voice, sending ripples in my stomach
After both of them left, I decided to look at Brijesh once again, for any more clues, there were none. She lay there in the same, clenched teeth, posture.
Let’s wait for the scan I thought.
After a lot more persuasion and after having eaten up most of my morning time the father finally agreed for the C T scan , I took a sigh of relief , at least for another few hours I won’t be disturbed.
C T report came in the afternoon, only to make matters worse. I was summoned again by the father.
( Oh yes in case you are not aware, in Dadri instead of waiting for the doctor, it is they who summon us at their own sweet will)
Upon arrival into the ward, I was handed over a piece of paper, the provisional report, it was bang normal.
“Report kya khave hai ” ( what does the report say )
“Normal hai ” I replied
“Phir” (meaning )
“Matlab under koyi ganth nahi hai , mirgi hi hogi ” ( that means there is no space occupying lesion in brain , could be epilepsy )
“Mirgi par report to normal batave hai ” ( Epilepsy , but report is normal )
“Han mirgi mein C T normal ho sakta hai ” ( yes in epilepsy C T scan can be normal)
“Matlab jab taine pata tha , to karvaya hi kyon “, he said in demanding or rather questioning manner .
(When you knew it could be normal , why have you ordered it )
I stood their , in front of the father , like an accused standing in front of the judge , I had committed a crime by ordering an investigation which came out to be normal . It was criminal waste of money .
Anguished by his lame logic , I decided to turn my attention towards Brijesh .
I thought she was teasing me and I grinned with anger . She didn’t seem to like my grinning , as at that very moment , she twisted again , swinging her body in air accompanied with a coarse mourning cry , articulated from the base of her throat .
“Dogtor , chori to phir akad rahi hai ” ( Doctor the girl is throwing fits again )
“Thari samajh kuch aa raha hain, ki nahi ” ( are you able to figure out anything 0
Without giving any heed to his babbling , I indicated him to go out and ordered the nurse to sedate Brijesh once again .
I knew this won’t last long . I had to come out with a solid explanation soon . Referring her to a bigger facility wasn’t a good idea ,
case bigaad kar bhej diya ( referring the case only after spoiling it)
I had to do some thing fast .Under pressure of , providing an explanation for mysterious twitching of Brijesh and under pressure , to establish my reputation or perhaps save my neck , my wit and patience both had started caving in .
At this juncture , as a last ditch effort , I decided to phone a friend and dialled Dr Piyush’s number.
Dr Piyush is a fellow physician , a close friend and most importantly , he had the experience of working in Dadri .
After briefing him hurriedly , about the case , I waited for the reply . Piyush on the other hand had picked up the diagnosis , from the word go , but decided to test my nerves , like a teacher testing his disciple
“You have taken the history properly ” , he asked
“Yes ” , I replied
“She belongs to Tilapta you said ”
“Yes “, I said
“Married for two years and no kids “, he inquired
“Yes but what’s the point ” , I was getting impatient
“What time of the year it is ” , without bothering to notice my impatience , he continued
“Mid April “, I said
“You know she belongs to a community….. ….”, he continued and the diagnosis provided , brought the winning smile back on my face .
Re energised , this time , I sent for the father.
“Pradhan ji ” I said ,”
“ maine phir se case study kiya hai, theek ho jayegi “,( I have re studied the case , she will be alright )
I said in a bolder , more confident fashion and staring at Brijesh , I continued ,
” theek ho jayegi par , wakt lagega , kareeb 6 ya 7 din ” ( she will recover but it will take time , at least six or seven days )
“Din chahe bees lag jaye , din ki chinta na hai ” ( even if takes twenty days , he is not worried )
“To teekh hai aap aram karo ,” I said , ( you take rest )
” main ilaj shuru karta hoon” (I will start the treatment )
And ordered the nurse , to give injection ,the one told by Dr Piyush .
As sister was giving injection to Brijesh , behind the flicker of her eyelashes and clenched teeth , I could see a hidden smile .
A smile of consent , consent to diagnosis and to treatment offered ,
A smile teaching me , that there is a world beyond medicine .
Relieved , I walked out of the room .
Piyush’s words still ringing in my years
“She belongs to a community where females have a very hard life , to get up at three o clock in the morning an d feed cattle’s, do daily chores , prepare food , is no mean task and to add to their agony ,they have additional responsibility of harvesting the fields in April . Men , on the other hand , have no work , except smoking ‘ hookah’ .
So , she has come here to rest , my dear , how much is enough , she will decide . Keep giving her distil water as placebo ,