Though the English left India 70 years ago, their language and its symbolization as superior and powerful has continued. It is a rare parent who does not beam with joy when his child speaks some English. Parents make sure they scrape their hard earned money to put their child through an English medium (which means elite in other words) school. Schools charge their students a fine if they are caught speaking their mother tongue on campus. Even parents of special children who come to my consultation room, coax their kids to “Say” in English, the answer to any question that I ask in kannada.
A knowledge of English is seen somewhat as a sign of superiority, a matter of pride and a way out of future poverty. Phew! So much burden for one language to carry! And I am sure that if English were a person, she would have crumbled under this intense pressure (which is probably more than what P.V.Sindhu faced on the eve of her final match at Rio) of millions of Indian parents for long long years. She would have probably scooted the country far before the British did. But she did not. And here we are –grappling with realities.
I love the fact that we live in a country with so many languages. Each language with its own flavor and essence. English, I love –because I studied in it for most part and knowing it, helped me expand my horizons. Kannada because it is the language of my land. I enjoy the strangeness of my mother tongue Konkani. I love the way Tamil and Marathi sound. Hindi seems to me, a way to understand tv, my North Indian patients and our prime minister’s ‘Man ki baat’! Though I worry about landing with a twisted tongue, I did learn quite a few sentences of Malayalam! I love the fact that we are a language potpourri. English words which have been Indianised and used ever so casually with an air of ownership. My daughter and son believe that “bussu”, “caru”, “traffic jamu” “hotelu” are essentially kannada!
So, it is not that I have anything against the language. I am not a language fanatic nor a grammar nazi. Nor am I a snob who believes that people who speak english incorrectly are imbeciles. I understand that it comes from learning with limited means and lack of practice. But I believe in people knowing their limitations. That they are fluent in a few languages and have to treat the others with caution. Or if they did want to use it conversationally, it would happen with hard work rather than over confidence.
Well, that does not seem to be the case with our poor English. Apart from being put on the podium as a status symbol, she is also tortured continuously and most times hilariously. A lot of it which I get to see in my hospital.
Starting from my internship. Along with my co intern, I had spent the night filling in patient information into files, when the hospital attendant announced that the head nurse wanted the “cassettes”. We looked back blank. “Which cassettes?”. “The ones you are filling.” Realization dawned. He meant the “case sheets”.
Or when the duty nurse sent me a note from the far flung recesses of the TB ward. The note read “Doctor, the patient in ward 9 has not passed urine or stools since two days. Please come and pass it”.
When in my residency, we were posted in a Government hospital whose cassette, sorry case sheet carried a mandatory question of finding out why the patient had landed in that particular hospital for treatment. Most patients would reply that they had come over for free “statement”-meaning “treatment”. “Please give my son good statement”, they would ask of us. And after the free statement was given, they would profusely say “TANK you” and leave us sufficiently tanked in their wake!
Once I started my practice, I realized the all encompassing power of the word “aunty”. There was once this eighty year old man who called me ‘aunty’ at the end of Each. And. Every. Sentence. Which was promptly followed up by his obedient wife, who was almost seventy and had only one single tobacco stained tooth in her mouth. The auntying got so severe that I caught myself unconsciously smoothing my hair to cover my grey strands for the next one hour!
The best was yet to come. There was once a concerned husband who hovered around after I finished counselling his wife. He then came over and whispered conspirationally, “Madam, can my wife try property?”.
I thought that he wanted to be sure that his depressed wife was lucid enough to make decisions about her finances and real estate.”Sure, no harm”, I replied. “She is smart enough to handle and plan her finances”.
He did not seem convinced. “But property?”, he insisted.
Now, this instantly made me suspicious. I wondered whether he was planning to cheat her and do away with her money.
“Why exactly are you asking me this?”, I queried.
He must have caught my tone of irritation.”Madam, I care about my wife and her health. We wanted to be sure to have a gap of three years between our kids”.
Now, I was confused. Family planning and real estate. No bells rang. I finally asked him to explain what exactly he meant.
He looked at me rather pityingly, at my lack of common medical knowledge. “Madam, you know that thing they use nowadays to prevent pregnancy-they insert it into the uterus- it is called property. Never mind. I will ask my wife’s gynecologist about it”
Turns out he meant “copper T”.
I rest my case.
We doctors, are suspended in a strange state of limbo. Gone are the days when consultants treated patients like minions who had to accept their judgment without questions. Also are bygone the days, when concoctions from bottles of various sizes were mixed together and passed on as panaceas for all ailments. The compounder who would dutifully carry the doctor’s bag and keep the clinic running like clockwork is also, now an extinct species.
We are now in an era where hospitals are treated like business with business models, plans, huge glassed buildings and air conditioned offices. The targets they have to meet to get such a huge gargantuan venture going, loom large in front of the doctors.
The reason we are in a limbo is probably this- that at heart we are still pompous old world people who believe in our skills and dealing with a patient who does not believe in it brings us crashing down to reality!
A lot of patients now behave as though they have come to a hospital for a business transaction. They give us money and we give them health. When the deal works well, everything is hunky dory, but when things go awry, the doctor bears the brunt of it. And how. He is beaten up, the hospital is ransacked and the staff are manhandled, before the good old police finally reach the scene.
In such a scenario, it is not strange that doctors develop a defensive attitude of not accepting our mistakes. And mistakes do happen. After all we are humans. Only, we deal with other humans!
Though treatment procedures have been standardized for years, first in the lab, then on hapless animals and then tried on humans to prevent any mishaps, we know that patients react differently to different drugs. At least 1 in 10 patients and their illness does not behave as obediently as we expect. According to a study in Australia, about 18000 deaths occur in a year due to medical errors! A lot of times the body plays tricks on us. Placing red herrings, leading us on a merry path to a destination, which is exactly at the opposite end of where we want to be. We have to start afresh then. Slightly more cautious and worried. And rarely, it does happen that we mess up bad. And it does end in the patient’s demise. A valuable but a very sad lesson.
Unfortunately, in our profession, accepting our mistake is taken as a sure fire sign of guilt. We only have the freedom to accept our mistakes when we are doing our residency, when the worst we have to face for this is the wrath of our teacher.
Therefore, when I read “Do No Harm”, by Henry Marsh, a neuro surgeon from Britain, I enjoyed it immensely.
First, because it acknowledges that we as doctors are human and need to get it into our head that failures do happen. He has portrayed himself as genuinely as possible. That, at times, he is guilty of losing his temper, sometimes his decisions have been made by how tired he was or how the weather was behaving! This admission according to me, was extraordinarily brave. l have made some purely selfish decisions, but till date ,have great difficulty in acknowledging it! It is always easier to defend myself. And hence, the greatness of this man, who has actually put it on paper.
Secondly, the book also gives us examples of the times when things do not go as expected. The moral being- catharte, accept, console, move on- but do not forget for next time!
Thirdly, that vice versa can also happen. Those whom we expect the worst to happen, go on to outlive their children and we end up being at the end of condescending glares and living room gossip. So to learn to communicate the truth, but not to give out ultimatums. Instead, to be gentle and as hopeful as possible.
Lastly, but most importantly, the book gives us insights about knowing when to stop our work and accept that nature has to take its course. As doctors we sometimes get carried away by the drama of keeping the patient alive by all means. But the consequences of such survival may be more of a burden than help. Like when the operation is a success, but the patient ends up in coma for years. The relatives are at a loss financially, emotionally and unable to take a decision about the future!
Do no harm is a book which deals with such difficult questions and circumstances which every doctor faces but is unable to voice out. It is honest, upsetting sometimes, but definitely re assuring for two reasons.
One because, it gives a sense of solace that the dilemmas shared by doctors all over, are not unique.
Two, because come what may, being honest with the patient and family, brings alive a bond akin to what was present eons ago- a sense of understanding, and a trust level which allows for acceptance even if we inadvertently harm their dear ones.
How I wish this book was a part of my medical school reading!
