Sunday, May 31, 2009

Just for the sake of information

Yesterday there was a lady who came for a filling, accompanied by a friend. It was a simple matter and was over in fifteen minutes. Before leaving, her friend asked,
"Doctor how long it will take to remove one tooth?"
I told her that it may take five minutes or it may take one hour and gave the explanations.
"How much you will charge?"
Again I told her that I may charge one hunded rupees or one thousand and gave explanations.
"After removing, is it necessary to fix an artificial tooth?"
and the questions continued.
"Can you fix a tooth there immediately ?"
"How long we have to wait before putting a denture?"
"How much you will charge for a replacement?"
"Can a temporary denture be made?"
"How much you will charge for a bridge? what about a denture?"
"Is plastic good or ceramic?"
"Are any cheaper varieties available?"
"Which is better? removable or fixed?"
"Which will last longer?"
"If there is no pain, why can't HE keep the decayed tooth as it is and forget about all this?"

I had spent nearly half an hour answering her questions and now it dawned on me that I have not obtained one basic information from her. I asked her whose tooth we were talking about?

"It is my husband's. He had come to you with tooth ache four years back and you had asked him to have that tooth removed and a false tooth put. Later there was no pain and he left it as it is. It is gone now. Only some pieces are there. He does not want to do anything. He only wanted to find out if the charges are same or increased!"

I have forgotten most of this very nice kannada poem. I don't even remember the title but I can reproduce part of it,

ಓಡುತ ಬಂದನು ಗೌಡರ ಸಿದ್ದನು
'ಕರಡಿ' ಸ್ಟೇಷನ್ ಬಾಗಿಲಿಗೆ
ಎದುತ ಬೆವರುತ ಮೇಷ್ಟರ ಕೇಳಿದ
"ಸ್ವಾಮೀ ಮೇಲ್ ಟ್ರೈನ್ ಏನಾಯ್ತು?"
"ಅಯ್ಯೋ ಪಾಪವೇ, ಮೇಲ್ ಟ್ರೈನ್ ಆಗಲೇ
'ಗುಬ್ಬಿ' ಸೇರಿರಬೇಕಲ್ಲೋ "
"ಹೋಗಲಿ ಬಿಡಿರಿ ಅತ್ತಿಂದ ಬರುವ
ಪ್ಯಾಸೆಂಜರ್ ಗಾಡಿಯು ಯಾವಾಗ?"
"ಅತ್ತಿಂದ ಇತ್ತಿಂದ ಎರಡು ಗಾಡಿ
ಗಳತ್ತಲು ಇತ್ತಳು ಹೋಗಾಯ್ತು"

(Sidda came running to the "Karadi" railway station
sweating and breathless, he enquired with the station master
"sir what happened to the mail train?"
"oh poor fellow, the mail has already reached the next station 'Gubbi' "
"forget it sir, when is the passenegr coming from the other direction?"
"passengers from both directions have come and gone their way" )

The poem goes on describing the villager enquiring about all the trains that pass through the station and at last, the station master very sympathetically enquires where he intends going and if there is any urgency?

"Oh, I don't intend going anywhere sir. I only have to attend a wedding on the other side of the railway track and wanted to Know if it is safe to cross it!"

Wednesday, May 20, 2009

"I look like a MONKEY"

One of my uncles lived in a small town near Bengaluru. He had a flourishing stationary business there and a coconut farm which contained a few hundred coconut trees. We spent many enjoyable holidays there. I mean it was enjoyable for us. I do not know about my uncle. His shop was on the busy market street and the house was at the back of the shop. We spent most of our time in the shop fetching and handing out various items and hindering my uncle, and felt very important collecting cash and returning change. We dashed into the house now and then to stuff ourselves with the tasty snacks my aunt prepared in honour of our visit. We pestered our uncle to take us to the farm and forced our mother and aunt to join us. We were not keen on their company but we got to ride in the bullock cart if they joined us. Otherwise we had to walk. Apart from the best tender coconuts that I have ever tasted, there were many fruit trees which we could climb and a clear water stream in which we could make a mess of ourselves. We invariably had a good time there and our mother always commented that she felt ashamed of our behaviour. Proof that we did enjoy.

I was with my uncle in the shop one day when a boy came with his father, asking for an instrument box. We called it a 'Geometry box'. Buying an instrument box for the first time is a big thing and the boy minutely examined all the boxes that were offered and selected one. Before making the payment, he subjected the contents to an even closer scrutiny and felt that the similar box which his friend had purchased had a bigger eraser. He wanted a bigger one too. My uncle tried to explain that a box of the same make can not possibly have a bigger eraser but the boy did not want a lesson in logic. He wanted a bigger eraser. Uncle searched for a bigger one but could not find any. The boy was not prepared to buy a box which contained deficient equipment.

Uncle took the box from the boy saying that he would search in the godown. I followed him like the Mary's lamb. He did not find a bigger eraser in the godown but found one of similar shape and colour but slightly smaller. He placed the SMALLER one in the instrument box, took out the one that was originally in the box, held it in his hand and came out. He opened the box in front of the boy, removed the smaller eraser that he had put in it, showed it to the boy, and replaced it with the 'bigger' one he had in his hand. The boy happily accepted the box, the father paid with pleasure appreciating his son for getting a better bargain and my uncle got his profit and another pair of satisfied customers.

It was nearly forty years later that I was doing a pair of complete dentures ( a set of false teeth) for Mrs Miranda. She had about a dozen and a half decayed and broken teeth in her mouth and wanted to have all of them removed and replaced by a set of sparkling white artificial teeth. She felt that with a new set of teeth, she had a better chance of being addressed as 'aunty' instead of 'granny', and she was right. She was very particular about the appearance and had made it clear to me that she is ready to undergo the torture of removal of all the teeth, gum corrections and all the associated inconveniences only if I guarentee that she will have a set of teeth that provide the expected results without giving themselves up.

I had finished the extractions and the minor surgical procedures to shape the gums properly and had begun the process of making the dentures. I had spent considerable time and energy in getting a suitable arrangement of teeth to fulfill Mrs M's exacting standards. I had selected the shade, size and shape of the teeth with lot of care and they had been now set in a wax base which fit the gums, awaiting trial, which I was sure, was only a formality.

The making of an artficial set of teeth involves about five stages of recording shape and size of gums and registering the position of upper and lower jaws, and the 'Trial' is the last but one. The teeth which are arranged in a wax base, are placed in the person's mouth so that the would be owner of the set knows how he/she looks with the dentures in the mouth. It enables us to check if all the work done till then are right or not. At this stage it is possible to alter the arrangement, if necessary, to suit personal requirements. If the trial is Ok, the wax base is converted to Acrylic and the dentures are ready. ( I once made the mistake of asking one of my cases to go home with the trial denture and exhibit it to all the people around for approval. She went home with the wax denture in her mouth, got the approval of all concerned, drank a cup of hot tea and came back with a warped base in her mouth and all the teeth in her hand.)

Mrs M had come with her husband and I had placed the 'trial' set in her mouth. She did look much younger. I was happy with the result and made the usual joke asking her husband to be careful lest somebody might carry away his bride. I asked Mrs M to take a look in the mirror and waited for the words of appreciation. She went to the mirror and looked at her image.

"Eeeek, what have you done doctor?"
"Why, what happened?"
"I look like a MONKEY"
"What do you mean? you look perfectly fine."
"I don't think so. It looks horrible. Look at the size of the teeth. They are so big. And they are almost jumping out of my mouth. I look absolutely like a monkey. Is it not?" she asked her husband.

Her husband was in a quandary. If he said no, he will be against his wife's opinion. If he agreed with his wife it would be worse. So he just sat with a stupid look on his face alternatively shaking and nodding his head.

I explained to her that sometimes people did feel odd with a new set of teeth in the mouth. They would have remained without teeth for many months and might have got used to that look. With a mouthfull of teeth appearing from nowhere, they do feel unnatural. I also explained to her that the dentures remain in the mouth holding on to the gums and a flange of the denture comes in between the lips and the gums. That gives a slight bulge to the lips even when the teeth are placed in perfectly normal positions. That makes a person feel as if the teeth are projecting out. She listened to whatever I said but stuck to her opinion. The teeth were big and out. She did not like them.

I suggested that Mrs M take the opinion of other close relatives, may be her daughter. Thanks to the mobile phone and the trendy two wheeler, Miss M was with us in no time. I explained why she was called and asked her opinion on her mother's appearance.

"I definitely don't think that you look like a monkey, mummy" she said, "a dracula would be more appropriate" and she started giggling. I cursed myself for inviting this giggling teenger who was not serious about anything. Luckily, Miss M stopped giggling and continued,
"No mummy, I was just joking. You look fine with the denture. In fact I can introduce you as my sister. May I go? bye, my friend is waiting" and she was off.
Giggling or not giggling, you can rely up on any teenager to have a view exactly opposite to his/ her parents and sometimes they do talk sense.

Mrs M looked at her image in the mirror for some more time. May be her eyes got used to the picture and she said,"This may be okay doctor but I would like to see how I look with the smaller teeth. You had said that you can make any changes at the trial stage is it not? please have the smaller teeth put on this denture and I will decide after seeing that" and that was final.

In my enthusiasm of explaining the procedure to patients, some times I get carried away. I had told Mrs M that I will be doing the best possible denture, and will be giving her a trial. I had said that if at all she is unhappy with what is done, I would re set the teeth, repeat the whole procedure if necessary and see that she is satisfied. Now she quoted me word to word and told me that I better stick to my words.

Those words sound nice when we are trying to convince some one. But it is not easy to put them into practice. Preperation of a pair of dentures is a painstaking and time consuming process, tolerable when doing it for the first time but to repeat the whole thing is horrible. Moreover, it is not my work alone. The lab and the technician are involved and they would grumble. Still, I would have taken the trouble of repeating everything if something was really wrong. Here, I had a perfectly satisfactory set and Mrs Miranda was insisting that I redo it. But the customer is always right and I had to accept her views.

I sat looking at the teeth set in the articulator ( the device in which we arrange the teeth) for some time. Next to that was the empty plastic strip on which the manufacturer sticks the teeth and supplies them to us. Each strip has the size and the shade number mentioned prominently at the side. We had used size 13 and shade 22 for Mrs M. As I looked at it an idea occured to me. I called the lab and asked them if they have size 14 of the same shade. They had it. I asked them to send the strip to me. I received it the next day.

I had asked Mrs Miranda to come after three days and she appeared exactly after three days . I showed her the strip containing teeth of Size 14 and told her that I have taken them out of her dentures. I showed her the empty strip of size 13 and explained that we have used teeth one size smaller on her dentures now. I asked her to try it on and said that if she felt that the bigger teeth which were used earlier as per my judgement, looked better, I do not mind repeating the whole process once again! She went to the mirror.

"Ah, thats nice." she said. " No doctor, I respect your judgement but I feel this smaller teeth look much better. The other set is very big. Now I look like myself. Please use this set and finish my dentures"
This time her husband had no hesitation in agreeing with her and I was of course happy to sacrifice my professional judgement and ego for patient's satisfaction!
My uncle's trick was effective even after forty years, on a person forty years older than the boy who came for the instrument box!
The dentures were finished and delivered. After about six months I met Mrs M in the market with her husband.
" Nice to meet you doctor", he said. " You please advice my wife to stick to your instructions and take the dentures out at night. She likes them so much that she refuses to take them out at all".

Sunday, May 17, 2009

too little and too much

I had nothing to do this evening. I spent some time clearing the unwanted growth in the garden, watered the plants, spent some time teasing the chameleon which was on the rose bush, trimmed some branches which were obstructing the path way, and still it was six thirty. Summer evenings are the worst time indoors. It was cloudy and the humidity had increased. It was better outside. There was a cool breeze. So, I just set out hoping to find some other soul with whom I could while away time, with idle chat.
I was not disappointed. First I met Mr. Dias. He was standing in his compound leaning on to the coconut tree in half pants and banian, with the banian pulled up from the stomach and bundled around the chest exposing the stomach to the breeze. ( typical summer sight in Goa). His son Nevil, has appeared for the 10th standard exam this year. I casually enquired about Nevil's performance in the exams.
" what to say doctor, I do not know how to deal with this fellow. He is not at all interested in his studies. I should be happy if he just scrapes through. If I say anything about it, he says that he will discontinue his studies and sit in the shop. How can anyone survive on this shop these days. I somehow managed. God's blessings were with me. You please advice him. May be he will listen to you. He is just fifteen years and says he has studied enough."
I sympathised with Mr Dias, Told him that it is the teenage attitude, assured him that the boy will change for the better, changed the topic to electiom results and rain, spent few more minutes and continued my walk.
I met Mr. Rao coming from the opposite direction. He is a senior officer in the mining industry. They are usually not visible. They leave when it is still dark and return only after it is dark. His son Vijay has finished his Phd and is in the UK on a fellowship. I enquired about Vijay.
" What to say doctor, he has become mad with his studies. After his graduation he wanted to do Msc, and I said Ok. I was happy that he was doing well in his studies. Then he wanted to study further. He registered for Phd and it took five years. He got his Phd. Now this three years fellow ship. He is thirty years now. He wants to apply for another fellow ship. When is he going to settle down? Is there no end to studies? He does not listen to me or his mother. He is coming on vacation next month. You please advice him to stop his studies, get a job and get married. He has lot of regards towards you. May be he will listen to you".

Friday, May 15, 2009

IPL has it's uses

Most of my patients report with severe tooth ache and apprehensions about the treatment. Many of them do have hopes of an easy way out, but after hearing the details of treatment and the costs involved, their anxieties increase. They walk out with heavy steps, holding a prescription which they know may not be of much use. It is rare to find one in a happy state either entering into or exiting from my clinic.
There was one more such case yesterday. He went out dejected as usual and I shifted my attention to the next case.
My concentration was fully on the work on hand when the half door seperating my waiting room and treatment area burst open and the man who had walked out fifteen munutes back rushed in.
He had told me that he was feeling as if some one was hitting his tooth and the jaws with a hammer and I feared that they must have shattered.
"Doctor" he shouted to draw my attention. "Mumbai indians won and Sachin hit forty two in twenty eight balls. great"
He rushed out as abruptly as he had rushed in with a broad smile on his face and bounding steps, eager to share the good news with the world, forgetting his tooth and treatment. Apparently he had stayed back to watch IPL on the TV in my waiting room after consulting me.
I had expressed my opinion of IPL in one of my earlier posts. Now, I have to agree that IPL has it's uses.

Friday, May 8, 2009


Yesterday we visited a family who were our neighbours when they were in Ponda. They did some business in transport, rubber plantation and civil construction, none of which flourished but they managed to make ends meet. Their children finished school with difficulty and started helping their father in his business. Grit and business acumen were their assets and they invested them to the full, in the iron ore transport business. Luck was on their side and they had entered the right business at the right time. The children, both boys, who were dull in studies, learnt fast the things that mattered. They concentrated on their business and lived where their business was, that is, on the roads between Hospet and Goa.
With in a few years they had their hands in all the activities involved in production and transport of iron ore. As the selling price of ore jumped from twenty dollars to two hundred dollars and transport activity multiplied, money started pouring in.
I knew they were doing well when they purchased some land and constructed their house. Then they built the first floor. Purchased the plot next to their house. Bought land in their home town and constructed a house there.
The elder of the sons had a passion for cars and the cars they processed showed their ascent much more clearly.

They began with a Maruti800 which was just enough for 3/4th of the family. A Tata Indica followed and was joined by a Tata Mobile. Now they had one each for the father and two sons. Maruti 800 was replaced by a Hundai i 10. For the elder brother’s wedding the younger brother gifted a Skoda.
Last year the elder brother purchased a Benz and the younger brother bought a Hundai Tuscon for ‘rough use’.
The latest is an Audi Q7. I believe the annual maintenance cost of this car is twice my annual income. Yesterday we were taken for a drive in their new car. Before stepping in, my children washed their feet, circumambulated the car, prostrated in front of it and applied the dust below the wheels to their foreheads. “An Audi needs to be treated with reverence”, my son explained “and don’t bang the door” he whispered “it is not your Maruti”. There was no need for his warning. You can’t bang the door. It closes on it’s own.
When accelerated, the car feels like an airplane on jet thrust rushing for take off. Only, it is much more smooth and there is no fear of the wings falling off.
After we were back, our host thanked us for joining him for the drive. Though very rich, they have remained as humble as they were earlier. I wish them well.
After I returned home I was glancing through the newspaper and saw that my star forecast for the day indicated “Rajayoga” (A King’s lifestyle). My “Rajayoga” lasted exactly 11 and 1/2 minutes. I wish the planets had taken it easy when they were traversing through my horoscope.