House of doctors

Prologue Chronicles of a Gynaecologist had been out for more than a year now and I was basking in the success of becoming a doctor-author. My first book focussed on two sections of society I fought passionately for, women and doctors. The book was about the gynaecologist and her patient. But, what made a doctor, and particularly a gynaecologist? ‘You want to become a doctor?’ I remembered my relatives looking shocked! A thin, small-built girl, who easily got scared by just about everything, no one believed I had it in me to become a doctor. ‘I wouldn’t be touching lizards and cockroaches.’ I would defend. ‘You will need to do surgery, deal with blood.’ Their eyes widened as they recalled my histrionics during vaccinations. My immature mind got influenced by the doctors I came across. Their world seemed so glamorous. I gave up on my dreams to become an engineer and my father gave up on his of seeing me as a bureaucrat, at least temporarily. But then the next few years took me on a fascinating, whirlwind of a journey. And, every other ambition of mine got trampled on this rollercoaster ride. I wanted the world to know the metamorphosis and soon started writing my next manuscript, Anecdotes of a Medico. I wanted to share all that went behind making a doctor. From working with cadavers to real patients, from overbearing seniors to those who shaped your career, I wanted to deliver the truths that breathed behind the closed, sanitised walls of a hospital, exposing the sad realities that plague our society. These were troubled times, where so much was being said everywhere that ‘truth’ became a myth. The book would give a broad perspective of the factors that interplay in the making of a doctor. Above all, I wanted this book to be a bridge between the medical and the non-medical world. And, then one day I was invited by my alma mater, the Gajra Raja Medical College, Gwalior, to give a talk on my first book. I was overjoyed. It was a feeling of déjà vu, to take my book to where it all started, sharing with those who had been my co-passengers in this enlightening journey. I met my head of department, my teachers and my seniors. The department of obstetrics and gynaecology! It was nostalgic. I was standing at that phase of life where I had left them years ago. I understood them more! My juniors had flourished over the years. So many memories came gushing. So many untold stories came rushing into my mind. And, the old hospital building… it stared at me! I was transported back. This place had single-handedly taken me away from everything safe and secure, everything I once believed in and sucked me like a tornado into a new world. A world infested with pain, suffering and disease; blood, gore and disbelief, a world inhabited by patients and doctors, nurses and staff. A world that made you its backbone, a world that clung on your shaky shoulders. A world that challenged you as you struggled with stereotypes and misogyny. It frustrated as much with prejudices and the social bigotry as the fury wrecked by anaemia, haemorrhage, eclampsia and unsafe abortions. The pain of seeing young lives lost to preventable diseases left deep scars. The septic labour room and the eclampsia room still formed my worst nightmares! No wonder they keep cropping up prominently in my narratives. Now, years later, after having moved to Delhi, whenever I see the same diseases surrendering in front of advancements in medicine and technology, better blood products and better intensive care, I get gripped with regret and an intense sense of loss. And, I missed my emergency duties. The times when we were the unquestionable boss. There was something so comforting about seeing the hospitals at night, swathed in yellow light, minus the hustle bustle of the day. With relatives gone home and most patients sleeping; the emergency staff beating their biological clock and still looking energetic, the building looked almost inviting. At times the peace and serenity belied the tensions underneath as if the hospital wanted to forget its turbulent activities and sleep over its daylong turmoil. And, as one welcomed ‘life’ in the early hours after the night had ‘laboured’ long enough, nothing could beat the morning cup of tea! The aroma of fresh tea intermingled with the flavour of duty of the past 24 hours, as we residents from different departments sneaked out to the tea stall just opposite the hospital gate, lingered in my memories. With every nerve of the body crying ‘go to sleep’, barely after a two-hour break, we dragged our sleep-deprived yet widely awake minds to our assigned wards. Yet, nothing could measure up to the sense of accomplishment that an emergency duty imbibed. The frequent tiffs with the administration still bring an indulgent smile on my face. Our blood boiled at the slightest provocation yet cooled down with just an affectionate pat. Always in the line of fire from seniors, teachers, administrators and patients, yet we laughed freely and fought back fiercely. ‘Aap duty pe sone ke liye aate hai (Do you come to sleep at work)?’ An elderly man in a cream kurta-pajama had once sneered down at our fellow resident. Tired after being on toes for more than 16 hours, he had decided to stretch his neck muscles at around 2 am. He had hardly rested his head on the desk when a bright light dazzled his tired eyes. He flushed guiltily. Just his luck that a new, overzealous minister was on his nocturnal, surprise tour of the hospital. What better way to gain public mileage than by snooping on a doctor! It made great news for the next few weeks. The poor doctor was suspended. The residents who were the backbone of the hospitals were ridiculed and made scapegoats by the spineless politicians and an insensitive media. What followed was a strike down by the RDA (Resident Doctors’ Association) till the suspension was cancelled and the doctor reinstated. The medicos were notorious for getting into a broil with just about anyone, the bureaucrats, the police or even the goons. We feared none! This was, after all, the land of the Chambal. And it gave back so much more. It gave me the passion to stick to my conviction, the compassion to deal with disease and infirmities, the zeal to fight the Almighty, the steel to take on my destiny, the mettle to override my fears and insecurities, the nerve to hold back my tears and bid goodbye. This place also gave me love, my life and friends for a lifetime. Post-graduation was a time of building relationships. I watched the corridors with awe. I had matched steps with Sameer, sneaked into his ward, held his hands and looked into his eyes with a promise. Dousing hopes of my parents to find a bureaucrat match for their daughter, I was rewriting my destiny on a blank sheet. And I had laughed here with my friends—Kavya, Raj, Varun, Ranjan, Meera and Parul amongst many others! The silly banter, the juicy gossip, rushing off from the hospital to watch the first day-first show at the movies, sitting in the first row! I had evolved with them, cried out my disappointments over their shoulders, clasped their hand to tide over many a crisis. We had worked together as if driven, pitched against odds that tested every fibre of our body and had emerged victorious. Between ignorant, innocent patients to the vindictive ones, between crumbling health infrastructure, dwindling resources to the tenacious, budding doctors, between bullying seniors to those who held your hands and taught, between friends and family who got sidelined to the ones who stood by you even in your worst ‘complications’; between the samosa and tea breaks to the forgotten lunches, between sleep-deprived nights to an all-time high of saving lives, between forgotten marriages to love blossoming in the wards… there was something that broke through. The first cry of ‘life’ as it opened its beautiful eyes! And as we took our baby steps, the ‘hospital’ watched patiently and heralded the birth of a new being. A gynaecologist! These were my most cherished memories, my most prized possession. So, Anecdotes of a Medico took a backseat. This story had to be told first. My brush with this institution, the Kamla Raja Hospital and the department of obstetrics and gynaecology! I entered again, the ‘house of doctors’. Introduction My earliest memory of the department of obstetrics and gynaecology is not a particular patient or a particular doctor but a strong smell and a mad commotion. The smell still stays and sometimes when I visit a government hospital, it takes me on a memory trail. I cannot pinpoint for sure what the smell was about. May be the red, overused Mackintosh that lay on the beds or the sweaty sheets and clothes in which the patient travelled miles before reaching the hospitals. It could also be about the amniotic fluid swarming the labour room or even the stinking bathrooms. It remained buried deep in my mind. Our senses adapted to it, to the extent that we looked with disdain at others trying to cover their nose in the hospital. And the commotion! Be it at the gate of the Kamla Raja Hospital, the entry to the labour room, outside the operation theatre or within the wards. The expressions were almost universal—anxiety, apprehension, restlessness giving rise to sometimes relief and sadly sometimes to grief and a sense of loss. The department was unique. Here, majority of the patients were suffering not from a pathology, but an altered physiology. Those pacing outside the labour wards and operation theatres were the ones waiting for some ‘good news’. Yet, there were dangers lurking round the corner. Obstetrics remained an unpredictable branch. It didn’t take much for things to change dramatically catching even the doctor unawares. However, it was a dynamic department, the only fast-paced place in a hospital. And the only place where people celebrated, the arrival of life! People distributed sweets here and carried memories of having first held in their arms, a gift from God, a token of their love. Hospitals were also a striking proof of the fast growing population of this country. They were also proof of our aptitude to gossip endlessly. In India, talking is the strongest antidote to most sufferings, much stronger than any medicine. You could easily spot them neck-deep into it, sharing their grievances which could range from their mothers-in-law, their medical problems to their misgivings about the care being given, the doctors, the hospitals and yes, the food. It was hilarious that even a couple of days in the hospital equipped them with enough knowledge to give a medical advice. One pregnancy made you an obstetrician, one baby a paediatrician and one visit to the hospital an ‘all-round’ physician for a lifetime. The free advices, especially the medical ones, although unasked for, were usually looked at with more respect and trust than even a paid medical advice. These were also the places where doctors were graded, the best ones decided, swapped and the referrals done. People travelled from places not just with their patients but also with their stoves and grocery, despite repeated warnings by the security staff. The aroma of fresh food being cooked in the hospital corridors whetted everyone’s appetites. The bias that people carried about hospital food was clearly evident in the leftovers ravaged by the dogs and cats that were the permanent residents of the hospitals. There was one thing the cats loved more than food. But I will come to that later for I don’t want to offend the senses of my readers in the beginning. Moreover, it was much later that I discovered it. The beautiful doctors were, however, the brightest aspect of this department. The elegant doctors were known not just for style, fashion and glamour but also for ‘substance’. The zeal with which they rushed about invoked respect. I envied their energy. You could easily spot in the department a harassed-looking girl, sprinting past, with her hair flying everywhere, patience snapping from the lack of sleep the night before yet trying to keep up with the pace of the day. She would be seen trying to match the steps of the doctor on rounds, clutching a bundle of papers as they fell around, jotting down the flurry of advice from her senior to sometimes silently looking around for that ‘forever’ and miraculously disappearing pen. And once the rounds were over you could also catch her giggling over a cup of tea and a hot samosa with her friends. These were the brief interludes in the life of a resident doctor. There was another ‘trademark’ of a gynaecology resident—a tote, almost the size of a travelling bag, which they fancifully called a kit. It contained all the stuff you would need for an emergency surgery or an emergency delivery. From stationary like blank papers, requisition forms to intravenous sets, Foley’s catheters and sutures, it had everything. A smart resident came with a smart, well-equipped kit. Not everything was available in the hospital and neither every patient who walked in could afford all the items. A lot of times, this kit was the sole saving grace in acute emergencies and life-threatening situations. The kit also taught the finer nuances of management. When a patient of normal delivery was asked to buy a Foley’s catheter that she would not need instead of the more expensive suture given free you knew it was the ‘kit’ calling. Most of the attendants were not literate enough to understand this ‘barter’ in its most enterprising form. It was a patient paying for another patient. The chances of your senior bashing for that absent Foley’s catheter in your kit was more worrisome than an attendant complaining. The idea was to keep the kit surplus and to replace what was disappearing, irrespective of the cost. That was the need of the hour and the insight of the resident. Needless to say, the kit was the most precious commodity in the hospital. Patients owed much more to the smart kit and a resourceful resident than to the hospital and the government. Those were blessed times. The media stayed where it belonged, in the newsrooms. People thronged the hospitals with trust. And for the doctors, the concerns of their patients were paramount. *** Our first exposure to the gynaecology wards was during the third-year clinical postings in the department. Conventionally, the second-year post-graduates took our classes during the afternoon posting. Post-graduation in the obstetrics and gynaecology department was of three years. The first-year PG was called a House Surgeon, second-year the Junior RSO (Resident Surgical Officer) and the third-year PG was called the Senior RSO. There was much more to learn from these wards and the hospital in general for the discerning eye but most of the times the students were busy in themselves, gossiping just as much as the attendants whom they pushed as they made their way past, unmindful of their glares. In my final year, where it was a main subject, I would return to the department again for a longer time. I would need to grasp it better for I would need to clear the subject in my final professional exams. Later in my internship, I would come here again, hopefully to have some hands on experience but most of the times for the much pricey attendance. My post-graduation would take me on an undefined journey, where there would be no rules but new boundaries. My rendezvous with this branch would threaten to redefine my life. No wonder it is the longest and the deepest section of this book. I will have to delve deep because only then will I come up with this gem, my most treasured belonging—MS (Obstetrics & Gynaecology); my identity henceforth. But all this would come later. For now it was the ‘hospital’ calling the third years. Third Year ‘Every physician must be rich in knowledge, and not only of that which is written in books; his patients should be his book, they will never mislead him.’ –Paracelsus ‘Sister, where would the labour ward be?’ He stopped in front of us and asked, a little unsure. The harassed-looking man was trying to locate his patient. Kavya looked offended while the boys laughed. Our white aprons made us stand out, but clearly not enough! ‘I am not sister!’ She replied pointedly and walked away. This was one line that would be repeated over and over again and we had yet to perfect the act of ignoring it. The poor guy had no clue about the offence he had committed. ‘Bhaiyya, let me explain this to you.’ Taking pity on him Raj started giving him with the directions. Before he could complete a loud scream broke through the corridor. The visitor didn’t need the directions anymore. It was coming right from the labour room itself. We rushed towards the source of the noise. The entry was clogged. We peered through the crowd. Our white coats helped us make our way through. ‘Stay away from me.’ A woman was standing on the labour table. Her intravenous (IV) set dangled from her hand and the IV stand was about to fall when the ward bai lunged forward. By then the IV line had been disconnected. ‘Oh my god!’ The doctor stared at the blood that started oozing from the intravenous set. The labour-room nurse leapt to hold her wrist, another two people, probably her relatives, grabbed her before the venflon could be closed to stop the gushing blood. ‘Let me go!’ Unmindful of everyone the woman shrieked. The poor doctor was out of her wits. I had been warned by almost everyone right from my seniors to friends and family about the labour room. Seriously, I didn’t know that it would be so dramatic. But what exactly was going on here? ‘She had a normal delivery. There is a vaginal tear that needs to be stitched but she wants to go home, unstitched,’ the labour-room doctor informed us. We looked at her surprised. ‘Can’t we do it under anaesthesia? Why strain her if she is so reluctant?’ I asked. ‘She needs to come down, even for that.’ The nurse chipped in. ‘Listen, your stitches will get infected and will never heal.’ The doctor tried to reason out with her. ‘Aadmi paas nahi ayega (Your man will not come near you).’ The ward bai added. We looked at each other. This was crude. ‘I don’t care.’ She shouted. Meanwhile, her husband and mother-in-law were called in. From cajoling to threatening they tried out everything but in vain. She refused to budge. ‘It’s all because of you!’ She started abusing them and fed up, they went out. Her hair flew around her face wildly and her clothes were still scattered around her body but she was unabashed and looked possessed. ‘I think she’s hysterical.’ Raj whispered ‘Maybe she’s burnt out by the pain.’ The doctor was still sympathetic. The woman, meanwhile, stared mutinously even as she chose to finally sit down on the labour table. ‘Husband se milti ho to dard nahi hota (Doesn’t it pain when you have sex with your husband)?’ We gasped at another profanity from the ward bai. Was this what everyone warned us about? ‘You shall learn the basics from the labour room.’ Our seniors had told us. ‘You are not even allowed to be embarrassed. There are male doctors there, too. But you can’t protest.’ I remembered my mother telling me her scary story. Was it really ‘a house of horror’? And the patient clearly had had enough. She wanted to go home. ‘You will have to sign this before you go.’ She readily signed on the paper that she was refusing all treatment and was going home on her own wish. This was called LAMA, left against medical advice. A little bemused, we started ascending the stairs towards the lecture theatre. The aroma of freshly brewed coffee from the office of the head of the department welcomed us as we made our way to the lecture hall. The official rooms of the consultants lay adjacent to the lecture hall. By now we were adept at picking up the fragrance coming from the rooms and identifying the consultant. Dr Sarika entered the classroom. ‘Good afternoon.’ She greeted cheerfully. Taking out a chalk from the pocket of her apron she wrote: Obstetrics & Gynaecology. ‘Not again.’ The girls groaned. This was the third class where the definitions were going to be taught. Dr Sarika pretended to have not heard our reaction. She turned around and pointed to one of the boys. ‘Define obstetrics.’ He stared at her while rest of the boys laughed. ‘Alright, gynaecology?’ Dr Sarika asked, seeing his blank face. He fumbled and looked around for support. The exasperated teacher asked the next boy. ‘You?’ He looked back so stupidly that everyone burst out laughing. ‘Keep quiet, everyone.’ Dr Sarika was clearly getting impatient. She then pointed to Kavya sitting on the front bench. ‘Ma’am, obstetrics is the branch of medicine that deals with pregnancy and childbirth.’ She answered confidently. ‘Gynaecology?’ ‘It is the branch of medicine that deals with the problems of the female genital tract.’ ‘That was pretty simple, wasn’t it? Why don’t you boys listen?’ Dr Sarika said. They were still not listening. ‘Ma’am, we are not going to take up this branch.’ They grinned shamelessly. The gender bias was obvious. Out of the many subjects taught as undergraduates one would pursue only one as a postgraduate. Yet, the way boys treated gynaecology was so uniformly similar that it became pathetic. ‘Aren’t you supposed to clear the subject in your undergraduate exams?’ Dr Sarika asked. The boys looked away. It was an undisputed fact that the boys were treated leniently in the department. Most of them were here for the sake of attendance and to have some fun. Even then it was clear where their priorities lay, definitely not in the subject but always in the petite doctors. They had been very well tuned by their seniors on how to behave here. If any boy showed interest in the subject, he was immediately labelled ‘sissy’ and was much ridiculed later in the hostel. Not every girl dreamt of becoming a gynaecologist and there were quite a handful who believed that their interests lay beyond the functioning of the female genital tract. It was definitely not their cup of tea. But there was another universal truth. A woman could take up any speciality but to the public she would always be a ‘lady doctor’ and that meant an obstetrician by default. Invariably, most female doctors, whatever branch they opted for, were forced to practice gynaecology especially in the smaller cities. It became easier for them to establish their practice. But, times were changing. Obstetrics was tough, demanding and a very challenging branch fraught with litigations. There was money but it came at a cost. Most gynaecologists paid it with their time. No wonder many young doctors were now opting for safer pastures which gave them a better quality of life. Besides, medical colleges reeked of gender discrimination. Girls couldn’t dream of entering the male domain of general surgery, medicine, orthopaedics amongst many others. Most of the branches barring obstetrics and gynaecology were male-centric. Acceptance by the general public was also very poor. A male surgeon always carried more weight than a female one. People didn’t trust females in any branch besides obstetrics and gynaecology, more so as surgeons. A female doctor was called ‘sister’ but a male doctor was always doctor sahib. Even his wife was doctorni. Dr Sarika, meanwhile, had moved on to the next question. ‘What is gravida and what is para?’ She looked around questioning Again, this was the third class that we were discussing it. Would we ever move to anything else? ‘Ma’am, can’t we go and see some patients? We have already been through this so many times.’ One of the girls asked. ‘Then answer my question fast and we will,’ Dr Sarika said. ‘Gravida (G) refers to the number of conceptions and para (P) to the number of deliveries. So a first-time pregnant woman would be G1P0.’ The girls were in no mood to let the boys stall the class again. ‘So, a pregnant woman with one previous abortion and no live issue is G2P0A1.’ Dr Sarika went on elaborating. ‘It looks more like some coded message.’ Sameer rued. Clinical history taking was much different in gynaecology. Here, one had to go in details into obstetric and menstrual history. The issue of gravida and para was closed for the time being. It would come to haunt us again in our final year in medical college. But, right now we wanted to see a ‘real’ patient. We had enough of theory classes. Looking at the excited faces, Dr Sarika took us to the antenatal wards. They generally kept the patients with complicated pregnancy here. The ‘patient’ came to sit before the students reluctantly. It was one thing being doctor in the eyes of the neighbours and relatives but it was something else commanding respect in the eyes of these patients. They knew better, the worth of young medicos. Predictably, this one carried a bored expression. ‘I was going to rest.’ She lamented. ‘I hope you had your lunch.’ Dr Sarika spoke indulgently. ‘The food was not even good today.’ She continued to crib. ‘My mother is going to come today with some home-cooked food. My son will come along too. Please allow them to meet me.’ The deal was sealed. She knew the ball was in her court. The art of ‘bartering’ was not lost to the patients either. She was an experienced patient, one who knew her answers well. She informed us that she was about 36 weeks pregnant. Calculating the gestation in months was taboo. Conventionally, the expected due date (EDD) was derived by adding nine months and seven days to the last menstrual period (LMP). Sounds simple, doesn’t it? ‘The examiner will flunk you if you calculate her period of gestation in months.’ Dr Sarika warned. ‘Why make everything so complicated? What difference would that make, anyway?’ whispered an aggrieved voice. ‘So how many weeks would be if she has completed nine months?’ Dr Sarika was looking pointedly at Sameer. ‘Thirty-six weeks.’ Sameer was quick to reply. ‘Really? Every month has only four weeks?’ ‘Of course!’ Dr Sarika raised an eyebrow. Sameer flushed. ‘Err.’ ‘It is four weeks and three or two days.’ Sameer lowered his eyes ‘So, now you know. On your due date you complete almost 40 weeks.’ A lesson one was never likely to forget. Dr Sarika went on to demonstrate the four obstetric grips to explain to us the position and presentation of the baby which was now called foetus. The top fundal grip to feel the head, lateral (side) grips to feel the back, the pelvic (lower) grips to feel the head which was the presenting part (the part that comes out first) in the majority of cases. As she made us do those grips, we almost felt like a real doctor, the difference being that we hardly understood much but well, the patient wouldn’t know that. Or would she? One could just marvel at the difference this touch of a patient brought to the budding doctors. While most of us were trying our best to absorb this clinical acumen and waited excitedly for our turn, Raj looked a little hesitant. It started with the first grip but as he reached the lower pelvic grip, his discomfort became almost visible. ‘What’s wrong with you?’ Kavya looked at him with curiosity. ‘How can you girls be so insensitive?’ He looked concerned. ‘I could almost feel that I had gripped the baby’s neck in the pelvic grip. What if we really strangulated it? I have such strong hands.’ He was deeply worried. This had never crossed anybody’s mind. Dr Sarika burst out laughing. ‘Don’t worry. Maybe now I need to prove that you have not harmed the baby.’ She brought the stethoscope on the patient’s abdomen and made us listen. A sound which was almost like a horse galloping filled the room. So fast and so rhythmic! Everyone took turns and listened, completely enthralled. A sense of peace and contentment enveloped all faces. It was strange; this effect a foetal heartbeat could have on, not just the mother but everyone, even the errant boys. It was almost as if it was reassuring that the human species was growing, safe and protected. ‘The baby can communicate with the external world through this single sound. It can convey that it is distressed and needs to be taken out fast,’ Dr Sarika said. ‘And also the havoc it creates in the lives of not just the patient but the doctor too when it goes missing.’ She warned. Third-year clinics were only about basics. It was more about getting familiar with the subject. History taking, routine obstetric examination, mechanism of normal labour and some important medical conditions complicating pregnancy like anaemia and high blood pressure. But yes, one just couldn’t escape abortion and contraception. It was taught in almost every year of medicine in some way or other. This was probably to reinforce the young minds with what they would soon realise was the ‘felt need’ of India. *** The clinic was a place where one could really comprehend what ailed one half of the population. Most women were obsessed with one organ of their body—the mysterious womb or the uterus! From something as vague as a simple backache, to something as weird as mood changes, everything they suffered was somehow related to it. And then there were milestones. ‘My backache started after my son was born.’ The problems could be traced back to their pregnancy period. And the most common grievance was undisputedly the shortcomings of their ‘in laws’ and husband during that period. ‘Never got to rest and nobody took care of me.’ Not that they were always wrong. But most women had been there and done that. The easy familiarity with the condition often made them casual to other women. It often masked an attitude to neglect. However, it was also here that one met the most sacrificing, most loving specie that God ever made, women! My friend Kavya and I made our way with difficulty through the noisy corridors lined with women waiting for their turn. It was always very difficult to control women deep in gossip, engrossed as they were in more pertinent issues. Like the saree they bought, the recipe they had tried, the hundred ways to make a simple dal, the saas-bahu soap operas, the men in their lives to the common ogre in all women’s lives, their mothers-in-law. The older ones generally looked with disdain at the young doctors. ‘Inko kya samajh mein ayega (What will they understand)!’ In crisp, white aprons with a stethoscope hanging proudly around our neck, we settled down in the outdoor clinic. Our senior, a house surgeon briefed us. Armed with our theoretical knowledge we set on our maiden mission. ‘Prabhadevi, how old are you?’ Age was very important in the medical history. It was seemingly a simple question, but then was it really easy? ‘Must be 30–32 years.’ She definitely looked much more than that. The house surgeon interrupted. ‘How many children?’ ‘Four, Sir.’ ‘Sir’ was often gender neutral in hospitals. It was better than being called sister. ‘How old is the eldest?’ ‘Twenty-five years.’ There, she couldn’t be five years old when she had her first baby! Some fast calculations, the age of her marriage and the ages of all her children it was reasonably deduced that she had to be at least 45. To the lady it hardly mattered. Age was probably just a number. ‘So what are your complains?’ The doctor asked. She looked around, covering her head with her saree’s pallu a little more securely. She was looking for some support. Her husband stood at the door. It was better to ignore him, rather prudent to elicit history from the patient herself. That would be the real test to what we were learning, the art of taking medical history! ‘If you can’t tell us we will send you out again.’ The house surgeon spoke a little firmly. She looked outside, hesitated and began reluctantly. ‘Aadmi se baat karne mein taklif hoti hai (It pains to talk to my man).’ Now, what kind of problem was this? Were we supposed to solve their domestic problems as well? ‘Listen, medical problem batao.’ ‘Madam, bas yahi hai.’ She covered her face some more and fixed her gaze on the floor. ‘Arrey, then stop talking to him na.’ That was easy enough. ‘Madam, woh manta nahi hai. Bolta hai bahar chala jaunga (He doesn’t listen. Says he will move out).’ This was getting weird. Suddenly someone nudged and the outdoor slip was pulled away by the house surgeon. ‘Kabse hai (Since when)?’ She asked. ‘For more than a year.’ She replied without lifting her gaze. ‘Painful coitus for one year.’ The senior deftly wrote on the outdoor slip.

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