Mr Virani owns
a small industrial unit in our city. He manufactures metal furniture. He has a
number of people working for him and I often receive calls from him requesting
favour of ‘instant treatment - without appointment’ for his workers. He
seems to be a nice man no doubt, but this request is not an indication of his
concern towards the well being of his employees. It is because he does not want
them to avoid work giving the reason of a tooth ache. Anyway, I am not here to
analyse Mr Virani’s attitude towards his employees. My job is to treat the
patients and I try to do my best. And the employees get the benefit of getting
Mr Virani’s vehicle for the trip to my clinic and the visit is considered ‘on
duty’.
Yesterday I
received a call from him and within half an hour one of his workers was in the
clinic. Mr Virani firmly believes that
if a tooth is causing pain, the best thing to do is to pull it out. No
medications, temporary fillings, RCTs and such other nonsense for him. Go to
the dentist, wait for an hour if necessary, get the tooth out and get back to
work. That is what he wants for himself as well as his employees. “Doctor saab
daat dard kar raha hai. Abhi aataa hoon. Nikaal dena.” And “Doctor saab unko
phirse mat bulao. Abhi daat nikaalke bhejo” (Doctor, tooth is paining. I am
coming now. Please remove it” And “Doctor, don’t call him again and again. Pull
out his tooth right now and send him back"). What is good for him must be good
for his employees too. It is not always possible to oblige Mr Virani and help
him maintain his production schedule. I go by my assessment of the case and not
by Mr Virani’s insistence. But sometimes I can oblige him. This seemed to be
one such. The fellow who was in the clinic, said that one of his teeth was
shaking and was very painful.
I put him on the chair and examined him. The tooth was mobile
and tender ( Patients complaint - in our language). The best thing would be to
remove it then and there and he would not even need a pain killer. Two minutes
flat. Thirty seconds for the injection, one minute for the injection to take
effect. Thirty seconds to pull the tooth out. Over. All
are happy. Patient, because the pain is gone like magic. Virani, because his
worker is back to work in fifteen minutes flat. And me, because my appointment
schedule is not at all affected and I get a bit of extra money without any
effort. But it was not like that. There was something disturbing here. Take a
look at the picture.
The fellow is
little over twenty years in age and already has a shaky tooth. Not good. I am
sure you can guess which is the tooth I am talking about. Yes, the third grinder
from the back. You can see something black below the tooth. That is the root of
the tooth, which, in normal case should not be exposed. And it is black. The result
of the tooth being in constant contact with tobacco. A wad of ‘Ghutka’ to be
precise. Ghutka has not just destroyed his gums, it has affected the inside ‘skin’
of his cheek. What we call as the 'buccal mucous membrane'. It is not difficult
to notice a sort of elevated or thickened, off white or yellowish patch next to
the tooth, easily differentiated from the pink mucous membrane around. That patch
is a ‘precancerous lesion’. Meaning something that has the potential to turn
into full blown oral cancer. At an age little over twenty.
I see many
‘Ghutka’ chewers in my clinic, who mostly visit me to have their tobacco
stained teeth cleaned. I hate that job but cannot evade it. More than my hatred
towards this cleaning job is my hatred towards these tobacco chewers in
general. Every nerve end in my body burns with irritation when I see these
people spitting tobacco juice everywhere - once every minute - without any
concern, as if they own the world. I can’t do anything and I just allow my
stomach lining to get burnt. But when they are in the chair it is a different
situation. I treat them alright but I also deliver a sermon which lasts through
the session. And sometimes it will be quite a fiery one. I also try to put all
sorts of fears, real of course - though a bit exaggerated, in their mind to
make them give up ‘Ghutka’. I know it is not of much use but I try.
As I
injected, I started my sermon for the benefit of the fellow who was in the
chair. I told him that his case was much more serious than the ones that I
usually see and if he persists with the addiction he may end up with cancer. I
gave him five years, ten at the most. I finished the extraction asking him what
prevents him from giving up this dirty habit? I put a pack in his mouth and sent
him off. He went out sheepishly.
After I finished the next case he entered
again and stood silently in a corner. I asked him what was the matter
“You see Doctor saab” he said (in hindi) “I
don’t like to chew this stuff all the time but I need it to carry me through
the day. I work for nearly ten hours at a stretch with a break of half an hour
and it is an exacting job. To do this work for ten hours, I need to eat a lot. But
the salary I get is barely enough for two meals and if I don’t work I do not
get even that. I am always hungry. A cup of tea costs five
rupees and it is almost water. If I put one packet of Ghutka in my mouth it kills my hunger and I can
easily carry on for two to three hours.Three packets of Ghutka costing six
rupees see me through the day. You say that I will not live more than ten years if I keep eating Ghutka. If I don't, I will die of hunger, much earlier. How am I going to manage if I stop chewing Ghutka?”
I did not
know what to say. Look at the fellow, observe his cloths and you can appreciate
his words better. Now what am I going to do? Ask his employer to raise his salary?
Provide him other employment which is more paying? Suggest that he find an
easier job? Suggest him any other remedy?
Write to the labour department?
I do
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