DharmasankaTa In Dentistry

 I do not know if there is an equivalent in English for the Kannada word ‘DharmasankaTa’. It is difficult to explain the meaning of the word. It is a sort of dilemma. May be an ‘Ethical dilemma’. I am not sure.  It is actually a situation you find yourself in. You are required or compelled to do something or act in a particular way. While it is not wrong doing it, it is not exactly right/moral/ethical either. You experience ‘SankaTa’(suffering?) because what you are required to do may not exactly be ‘Dharma’. Pricks your conscience, so to say.  I do not know if I am talking sense but this is the best I can do to explain ‘DharamasankaTa’, assuming that I have understood the term in the first place.

I found myself  in DharmasankaTa recently. In my practice. Nothing serious, just concerning a decision whether or not to squeeze out my fee from one of my patients.

Dhaku Gaonkar came to the clinic holding a broken denture in hand. He said that I had made the denture about a year back or may be two years at the most, and it broke.

 “It was very good. Was fitting very well and I could eat everything with it. It was just about a year old and it broke. Do dentures break like that?”

Usually they don’t. I asked him if he tried to bite something very hard? (Some people get carried away with their new found ability to chew up things and end up with a broken denture).

He looked a bit sheepish. “I was washing it after dinner when it slipped and fell down. Before I could pick it up, my wife stepped on it.”

So, I was off the hook. Relieved, I went over his record. I have the bad habit of writing down everything that I do for my patients in a card and preserving it. (Why I call it a bad habit - I will explain some other time)  Going over his record, I found that his had been a particularly troublesome case and that I had to put in considerable efforts to overcome the difficulties and prepare a set of dentures for him. He had mentioned about some financial difficulties and had requested me to allow him to pay my fee in installments. I had not only agreed to his request but had also charged much less than usual. I had paid for the services of a specialist and the lab, from my pocket. He had paid a little more than a quarter of my fees and had taken the dentures. That was ten years ago and he had never come back!

I was annoyed but one cannot openly express annoyance (shout at a patient I mean) in the clinic. I expressed my displeasure at what he had done and he gave the usual explanations and vague reasons for the lapse on his part. “I did come to pay your fees but your clinic was closed” and “someone in the family fell ill and had to be taken to Bombay for treatment” etc etc.  I have heard these umpteen number of times in my profession and am used to my door being closed, somebody being ill, a lady being pregnant and a student having exams for years together. 

Anyway, his broken denture had brought him back to my clinic. Having got used to his dentures over a decade he was unable to eat anything without them. It had to be repaired or new dentures made. A god given chance to recover my fees. That was my first thought.  But  when I saw the fellow sitting in front of me, forlorn, holding his broken dentures in his hand, I realised that it was not going to be easy.

He was employed in mining, some small job, and with the mines closed down, even that had gone. He was old and weak. And with his dentures broken, not able to eat properly. He knew that he had cheated me and that I was not kind towards him but now, he had to seek help from me again. He was in a pitiable condition. I could force him to pay my fee but he being in that condition and the dentures now broken - making  whatever service I had rendered meaningless - was it right on my part doing so?  

At the same time, I could not forego the fee for a service for which I had not only put in considerable efforts but had actually spent quite an amount from my pocket. I run a practice, not a charity establishment. What the fellow had done was in fact cheating. He had used the dentures and had obtained all the pleasure out of my work for ten years.  And he had not paid me in spite of the concessions given to him.  I should actually demand my fee with interest.

Should I or should I not? That was my ‘DharmasankaTa’.

After a bit of thought I decided up on a compromise. I decided to forego a major part of what he owed me, charge him just a little more than what I had actually spent from my pocket, and repair his denture free.

Bad for the business but good for the conscience.