Complicate and treat?

“Naa re shaanya (no, no, dear) doctor is not giving you any injection. No. he will not remove your tooth. He will just see it and give you some sweet medicine. Or, he will put some medicine in your tooth and the pain will go away”.
I could hear Mr. Patil trying his best to coax his son Akhil, into the clinic and knew that I was in for trouble.

Patil had called me earlier, saying that the boy was complaining of tooth ache, and had taken an appointment. I knew that I will have to do at least a ‘pulpotomy’ (removing part of the soft tissue in side the tooth- which also contains the nerves) or even an extraction. I had told Patil, very clearly, to inform the boy, what to expect. I had suggested that he explain to the child, as sweetly as possible, that whatever is to be done to cure the toothache, will be done and if necessary, I may give an injection or even remove the tooth. I had told him to prepare the boy for treatment by stressing on the fact that while there may be a wee bit of pain, none of it is going to hurt much. And I had specifically asked him to abstain from telling ‘sweet lies’.
Now I was hearing exactly the opposite. To make his job of depositing the boy in my chair, easy, Patil was putting forward an imaginary and strawberry flavoured dental treatment, which always made my unpleasant task doubly difficult.
From the Sanskrit saying “satyam brooyaat- priyam brooyaat- na brooyaat satyamapriyam” (tell the truth- tell what one loves to hear- don’t tell the truth if it is not liked.) the parents always select the later two, and the inconvenient one – to tell the truth (and work it) - is left for me to handle!

I like children, their innocent ways, and their curious questions. I like to listen to their un inhibited talk and see their pranks. But I declare that, as patients they are a pain and apart from the un explicable fears of childhood, what makes my job worse is the fears and mistrust a child develops because of the wrong attitude of the parents towards our profession and overt expression of false fears and anxieties.
Even though I hate to have children in the chair, I do attend to their needs and have been reasonably successful in getting the expected results in majority of the cases. But I always have to brace myself and offer a silent prayer before starting on a child patient.

I began with the text book suggestion of putting the correct picture before Akhil. I took time to explain to him why his tooth was paining and what needs to be done. I showed him the instruments and explained their use. I smilingly pricked my finger with a needle, to demonstrate that it does not hurt much. He appeared to understand and subjected himself to treatment. Initially he was quite co operative. He sat through the first few minutes when I was working near the surface of the tooth and as I moved deeper, he started squirming in the chair. It was obvious that the ‘truth’ was being felt. I still had a long way to go, and it was time for injecting a local anaesthetic. I applied a bit of ointment to make the surface of the gums numb and surreptitiously injected some local anaesthetic. I was hoping that the injection would be fully effective but my luck was not agreeing with my hope. Few more millimeters in to the tooth and he was not comfortable any more. He started shaking his head and wriggling his body. The injection was only partly effective. I tried other tricks to make the tooth numb and failed. Now the only option was to give what we call a ‘nerve block’, a deeper injection, which can be made ‘almost painles’ if we have full co operation of the patient. Even as I was explaining this to his father, Akhil covered his mouth tight with his hands indicating that no co operation is forthcoming. When his father very sportingly but foolishly offered to hold his son’s hands and legs tight and restrain him, Akhil just jumped out of the chair and ran out. All our single and joint efforts involving all sorts of explanations, coaxing, rewards and threats failed to bring him back. He steadfastly refused to come in and be treated. In the end, I had to go out of the clinic with both my hands raised, holding only a bit of cotton as a white flag and a sign of surrender, and convince the boy to come near me and just allow me to pack his cavity with cotton.

I dispatched them, offered a prayer and kept my fingers crossed hoping for some miracle to ‘make the pain go away’ or at least not to make things worse. But my prayers were just as effective as my treatment. After three days Mr. Patil called to say that a painful swelling has developed over the jaw. The situation had got worse. From a deep cavity with an inflamed pulp (nerves) it was now an abscess (pus in and around the roots of the tooth). Almost in all cases, an untreated infected tooth, naturally leads to an abscess, but in the present instance after my meddling with the tooth, the accusing finger was fixed firmly in my direction even though not mentioned.

I told Mr Patil that there is nothing much I could do other than removing the tooth under general anaesthesia. But something had to be done immediately to reduce the suffering of the boy. I asked him to bring his son again to the clinic.
I swore on all the known gods that I will not be giving an injection and convinced the boy to occupy the chair. Now, the child was more concerned with the swelling and pain on the jaw and allowed me to touch the tooth. I thought that I would at least wash the cavity with an antiseptic and gingerly tried to remove the cotton dressing that I had placed. The child was calm. There was no pain. I probed a bit deeper. Still no pain. I used the air drill to clean the cavity further. Fine. I went deeper and deeper and almost reached the roots. There was no sign of any distress!
Another millimeter and I had drilled through. I could see a drop of pus seeping into the cavity from the roots. Once the pus was drained out, the boy felt much better and allowed me to proceed with the RCT (root canal treatment) and the rest of the treatment went like a dream. Two more sittings and the procedure had been completed to everybody’s satisfaction.

When I had tried to work on the tooth the first time, the nerves were inflamed and extra sensitive. In the later stage they were fully infected, ‘dead’ and degenerated. So there was no sensation at all!
I failed miserably trying to treat pulpitis (initial inflammation of the soft tissue present in side the tooth) but could successfully treat an abscess, which is a complication arising out of untreated pupitis!!

I had read this joke long back and had thought it was a joke. Not any more!

ಬಹಳ ನೆಗಡಿ ಡಾಕ್ಟರೆ ( I have severe cold, doctor)
ದಿನಾ ನಾಕು ಸರ್ತಿ ತಣ್ಣೀರು ಸ್ನಾನ ಮಾಡಿ ಎದೆ ಮೇಲೆ ಒದ್ದೆ ಬಟ್ಟೆ ಹಾಕಿಕೊಂಡು ನೆಲದಮೇಲೆ ಮಲಗಿಕೊಳ್ಳಿ. (Have a cold water bath four times a day, spread a wet cloth on your chest and lie on the floor.)
ಅಯ್ಯೋ ನೆಗಡಿ ಹೆಚ್ಚಾಗಿ ನ್ಯುಮೋನಿಯಾ ಆಗಲ್ವಾ ಡಾಕ್ಟರೆ ? (won't my cold turn into pneumonia?)
ಅದಕ್ಕೆರೀ ಹೇಳ್ತಾ ಇರೋದು . ನನಗೆ ನ್ಯುಮೊನಿಯಾಗೆ ಔಷಧಿ ಗೊತ್ತು. ನೆಗಡಿಗೆ ಗೊತ್ತಿಲ್ಲ. (That’s why I told you that. I know to treat pneaumonia. Not common cold! )

just a short post

Made a short visit to Bengaluru.
Graced a ‘Upanayanam’ ceremony.
Renewed contacts with a group of relatives.
Was glad to know that I can still find my way in the by lanes of the city.
Realised that I can also weave in and out around cars and auto rikshaws on a two wheeler and reach my destination with my limbs intact.
Was surprised to note that my lungs are able to get oxygen out of carbon monoxide.
Learnt (the hard way) that sitting astride a two wheeler when the vehicle is stationary in a ‘No-Parking’ zone, amounts to ‘parking’. (a policeman taught me this and collected a ‘gurudakshina’ of rupees one hundred only)
Felt sad to find that the famous ‘Nanda talkies road’ and part of Lalbagh will be shorn off their tree cover to help constructions of the Bengaluru metro.
Returned yesterday and discharged my duty as a citizen of India, by voting a new candidate who is sure to loose.
I am not guilty of evading my duty as a citizen and will not feel guilty of making one of the known dacoits our MP.

My son finished his BDS scoring enough to secure admission to MDS in the normal course. Some well connected people tried to alter the normal course to suit their requirements and because of that, there was apprehension that the path to MDS admission for these ‘normal course’ students may not be easy. The college authorities did not budge under political pressure. Whoever was interested in changing things were not ready to give up and tried their luck in the high court in the form of a writ petition. We had to intervene. All the parents had to meet, engage a lawyer, work out strategies and in general had to keep fingers crossed and sit in the court with butterflies in our stomach. There was no need for us to hire a lawyer. To our pleasant surprise, the judge almost argued out the case on our behalf, refused to grant a stay on admissions, and went as far as indirectly advising the petitioner to withdraw!

The admissions went along the normal course. To day the admission process was over and my son has enrolled for MDS. Will the MDS qualification make such a big difference in his life? Would he not have had a good life with out it? God knows. But if it was denied- for whatever reason- it would have been a terrible disappointment for him and for all of us. Still, to what extent one needs to involve himself/herself in matters concerning the children? Do we need to actively involve ourselves to see that our children have a good life?

I remember one of the poems in Mankutimmana kagga, which says,
ಮಕ್ಕಳ ಭವಿಷ್ಯಕ್ಕೆ ಕಕ್ಕುಲಿತೆ ಗೊಳಬೇಡ
ಪಕ್ಕಾಗುವುದು ಭಾಗ್ಯ ಎಂತೆನ್ತೋ ಜಗದಿ
ದಕ್ಕಿತೇ ಕುರು ಪಾಂಡು ತನಯರ್ಗೆ ರಾಜ್ಯಸುಖ
ದಿಕ್ಕವರಿಗವರವರೆ ಮಂಕುತಿಮ್ಮ

The literal translation would be,
Do not get perturbed and worry about your children’s future
Everyone’s luck matures in it’s own way in this world.
Could any one ensure the pleasure of ruling the kingdom for Kauravas and Pandavas?
Each one is on his own.

Now, what is Sri DVG trying to say here? Does he mean that one need not bother about what happens to one’s children? It is futile trying to do anything for them? Everything goes according to their destiny and we only need to watch? If interested. I don’t think he means so. Sri DVG was well aware of the compulsions of ‘attachment’ or ‘maaye’. My meaning for the verse would be,

One needs to do his/her duty. Do your duty towards your children. Provide whatever is expected of you and try to put them on the right path. Anything with in reasonable limits. IF for whatever reason things do not go right, there is no need to worry your head off. “ಮಕ್ಕಳ ಭವಿಷ್ಯಕ್ಕೆ ಕಕ್ಕುಲಿತೆ ಗೊಳಬೇಡ , ಪಕ್ಕಾಗುವುದು ಭಾಗ್ಯ ಎನ್ತೆನ್ತೋ ಜಗದಿ".
Do not go against expected norms or ‘dharma’ to secure your wards future at the cost of others. That was what Dhritaraashtra did. But “ದಕ್ಕಿತೇ ಕುರು ಪಾಂಡು ತನಯರ್ಗೆ ರಾಜ್ಯಸುಖ ?". So many people did so many things both 'dharma' and 'adharma' to ensure that kauravas and pandavas rule their kingdom with peace. But their destiny was not in agreement.
Ultimately it is "ದಿಕ್ಕವರಿಗವರವರೆ". each one on his own.
The earlier I fully attain this attitude, the better it will be.

Ganesha's curse

Lord Ganesh came to earth, got himself worshipped, stuffed himself to the bursting point with sweets offered by his devotees, and was riding back home on his mouse. It was dark, there were not many on the road and the mouse faltered on carrying the heavy burden. The moon saw the dozing Ganesh on the tiny mouse, thought that it was a funny sight but managed to hold back his laughter. All of a sudden a snake came across the road. The mouse got scared and it shivered with fear.
Lord Ganesh, who was half asleep, lost his balance and tumbled down bursting his stomach and spilling the contents. But he collected his wits fast, collected the spilled sweets faster and stuffed them back in to whatever had remained of his stomach. Being the god of intelligence it was a moment’s job for him to solve the zigsaw puzzle of his stomach pieces and place them back in their right places. Now, he looked around for something to tie his stomach securely, saw the snake that was still there looking at the havoc that it had caused, snatched it and tied it around his stomach. He got on to the mouse again and the mouse started tumbling along carrying the additional weight of the snake. The moon could not restrain him self any more and laughed aloud.
Lord Ganesh was very angry and wanted to hurl a stone at the moon. Since he could not risk bending to pick up a stone, he broke a piece of his tusk off and hit the moon with it. Not being satisfied with the physical damage done, he cursed the moon pronouncing that who ever saw the moon on Bhadrapada shuddha chaturti, ( according to lunar calendar) will be falsely implicated in a crime or wrong doing. I think that his idea was to prevent people looking at the moon, there by making the moon feel neglected.

It was about two weeks after the Ganesha chaturti festival. One early morning I was trying out some Yoga and Pranayaama instead of my usual walk. My wife, who can not bear the sight of me trying to tie myself into knots and suffocating, went out for a walk. I sat in ‘Yogamudra’ and was in the middle of a cycle of -breath in - hold - breath out - hold - procedure, counting seconds, when my wife barged in and broke my concentration making me gasp and loose rhythm.
“Look at you sitting like a Buddha when your patients are getting heart attacks and dying. Do you know what happened?”
I did not, and shook my head to indicate that, trying unsuccessfully to get back the rhythm of breathing.
“You removed Rodrigues’s tooth is it not? Poor fellow it seems was bleeding the whole night, had a heart attack because of that and is dying in ICU. And you are sitting here with your eyes closed. You and your yoga. Open your eyes and see what is happening around.”
When it came to holding my breath, I could barely manage few seconds with out ever reaching the optimal 4:8:4:8. But, on hearing this news, my breath got stuck and I was going in for a record holding time. It was no time for creating records and so with an effort I managed to get it unstuck and regained my breath. I asked my wife where she got the news?

On her walk she had met Mrs. Dessai.
D: Good morning. Came alone ?
W: Yes. My husband did not come today.
D: Good thing. Every body will be asking the same thing no? difficult to answer.
W: What same thing? what difficulty? I did not get you.
D: You don’t know?
W: Don’t know what?
D: Doctor removed Rodrigues’s tooth no? Poor man, it seems he bled the whole day and got a heart attack. He is in the ICU at Margao. Must be struggling for life. Everybody feels doctor should have been more careful. What else will happen if you remove tooth when blood pressure is so high? My husband had told Rodrigues not to have his tooth removed. Or at least consult Dr. Fernandes. He is specialist it seems. MDS. Doctor Raghunandan has experience but what is the use now? Ok. I am going. Have to prepare breakfast for children. They will be late for school.

My wife had cut her walk short and rushed home. On her way back she had met Mrs Naik and Mrs Mascerenhas both of whom endorsed Mrs Dessai’s news and views. My wife was furious.
What ever my faults are, she does not tolerate any one crticising me and casting aspersions. It is entirely her prerogative. So, she had taken over.

The news did worry me. I was anxious about Rodrigues, one of the few sensible people around and also, such news is not good for practice. I realized why Mr. Naik wanted to cancel the appointment for extraction that day. I had to continue to live and practice in the same neighbourhood. I pulled on my clothes and ran to Rodrigues’s house. I wanted to get first hand information and was hoping that some one will be there.

I rang the bell. No response. I waited for some time and rang again. No response. I decided to get the name of the hospital from Mr. Naik, Rodrigues’s neighbour, and go there. I was climbing down the steps when I heard the sound of door latch. I turned around and could not believe myself. Rodrigues was standing there! I first looked at his feet. The toes and heels were in order. So it was not his ghost. I had read that a ghost can make itself resemble a human perfectly but will always get the feet wrong. The toes face back and the heels in front. That was not the case. It was Rodrigues alright. I asked him what is he doing at home? He had no business there. He ought to be lying in a coffin or at least in the ICU on his way to one.

“So, you heard the rumours already? I am sure you are disturbed. I am sorry. I have been telling all these people who came to see me that my extraction had nothing to do with my condition but they won’t listen. They insist that it was because of getting my tooth removed. Idiots. Sorry again doctor. I was about to call you and tell about it. I came back from the hospital late last night. Come in and have a cup of tea and I will explain.”

Rodrigues had come to my clinic about three days back. He had severe pain in one of his teeth and wanted it removed. I knew that he was hypertensive and asked him to get his pressure checked. He said that he has had it checked just the day before and that he is fine. He had already taken his tablets that morning and insisted that I remove his tooth. He knew from experience that pain killers are not of much use and did no intend bearing with it another day. Since I endorse that view and since I had extracted three of his teeth earlier, without trouble, I removed his tooth and with in ten minutes he was out.
Late that evening he had felt some discomfort in the chest and went to see a cardiologist. The ECG looked a bit doubtful and to be on the safer side, the cardiologist had injected an anticoagulant or a ‘blood thinner’. He was kept in the hospital for observation. His family fussed over him and wanted him to have absolute rest. One of them was feeding him with a spoon at night and while doing so, disturbed the blood clot that had formed at the site where the tooth had been removed. It started bleeding again and since a strong anticoagulant had been injected, the bleeding did not stop. Still, the bleeding was not very heavy and they were able to manage that with packing the wound repeatedly through the night. Since he was not allowed to get up and use the wash basin he had to spit out into a jar and more than a litre of a red mixture of spit, blood and water collected in the jar. The sight of a ‘gallon’ of blood, complaint of chest pain and history of extraction was enough to get the tongues wagging and trample my reputation into dust.

As I have said earlier, Rodrigues is one of the sensible people around and he remained sane and helped in containing the damage.

I knew the story of lord Ganesh and the moon from my childhood days and on chaturti day we used to keep our heads down if at all we went out. Even if we just imagined having seen the moon, we used to rush home and read ‘Syamantakopaakhyaana’, the story of Lord Krishna getting in to trouble because of seeing the moon on chaturthi, which is supposed to be an antidote for the curse.

This year, I did see the moon on Ganesha chaturthi day but thought that the curse had lost it’s validity after passing through ‘Tretayug’ and ‘Dwaparayug’. The ‘Kaliyug’ does not care for these things. But I did not realise that Lord Ganesh has given it a very long expiry date and that it is in force even now.
I purchased a copy of ‘Syamantakopaakhyaana’ to have it handy just in case!

my computer

Our computer was suffering from bouts of fainting. A well meaning well wisher offered to cure it. After his treatment it does not faint anymore. Because it is yet to regain consciousness. He has admitted it into his hospital. He has been good enough to provide me with an alternate CPU and I am on line again. This CPU I believe, was employed in a religious organisation and is supposed to be ‘SATVIK’ in nature. I hope that I can get along with it till my ‘TAMASIK’ CPU is back.

i am a stupid fool ??

“Dr. Raghunandan? I am very sorry doctor, calling you at the last minute. I could not fix an appointment earlier. I am a stupid fool and am in a big soup because of my stupidity. I should have listened to your advice and got that tooth removed. I do not deserve any sympathy but this pain is killing me since the last three days. Will you be kind enough to allow me inside your clinic and have a look?”
It was typical of Mr. Shenoy. It was closing time. Our compressor had been switched off and drained. Drills had already been cleaned and oiled for overnight lubrication. Instruments were either in the sterilizer or immersed in the disinfectant for overnight disinfection. We were about to call it a day.
Any one calling me at that time with a three days old tooth ache, would have got the following response from me.
“If you have such severe pain since three days, what have you been doing all this time?”
“I purchased four types of pain killers from the pharmacy doctor. I have swallowed more than a dozen. But the pain is not going completely. The pharmacy fellow says go see a dentist.” (usual reply)
“See if any more pain killers are left in the pharmacy, swallow them to night and see me tomorrow morning. It is too late for me to do anything worthwhile now.” And so on.
But it was not possible to be blunt with Mr. Shenoy. The way he spoke, and his very personality, made it impossible for me to give a harsh or sarcastic answer. I always gave in to his request.

Mr. Shenoy walked in after fifteen minutes. He went to the wash basin, rinsed his mouth and came in. He apologized profusely for inconveniencing me at closing time and added “this mining job is horrible doctor. I can think of my tooth only when it starts bothering me more than my boss. I can not return from work early because we work in godforsaken places and are at the mercy of the company vehicles to bring us back to civilisation. I could have come half an hour before if I had come here directly from work, but I can not bring myself to enter your beautiful clinic in my working cloths, carrying half a ton of iron ore on my person. I had to have a bath and change. Kindly bear with me.”

I heard myself saying “Oh, its alright Mr Shenoy. Do not bother. You are welcome any time. What is the trouble?”

He took out a tooth pick from his pocket, put it in his mouth and searched for the offending cavity. He located it and held the tooth pick there for my benefit.
“You see this tooth doctor, you have told me any number of times that I have to get it extracted. Being a fool, I have ignored your kind advice. You had said that it should not be filled. As I was unable to get it removed due to my heart condition, and since that is the only tooth with which I can eat, I had requested for a filling and you had filled it with some medicated cement. As you had rightly said, it keeps troubling me now and then but generally I am OK. That filling came out last week and since three days the pain is severe. Please forgive me for going against your judgment and suggesting my foolish remedies. But I feel better with the filling there. Will you please do a filling once more?”

So, Mr Shenoy, not only decided the time of treatment but also decided the treatment procedure too. And he did it in such an appealing way, that I could not refuse. Once again I found myself doing the filling that should not have been done!

“I would like to make a payment doctor. You have been very kind and I am very grateful for your service. You have such a smooth hand. I did not feel anything at all. I was expecting to be kicked out of the clinic but you have treated me so well. Now regarding your charges, please do not spare me. I request you to charge me heavily so that I learn a lesson and do not trouble you like this again and again”

Usually I have a lot of hesitation with my charges when I know that what I have done is not right or not up to mark. But some times I do act mean and charge a bit more for people who do not listen to my advice and bother me unnecessarily. I thought that I should do so now and said,
“Let it be Mr. Shenoy, please do not bother. I have not done anything worthwhile anyway. I will surely accept my fee when I do something useful.”