Tuesday, February 13, 2007

Notes From the Cuckoo's Nest: Part I

My blog receives periodic calls to action from Rimi, and had it not been for her gentle reminder, I wouldn't have been guilted into writing this. I'm really glad I did though, because I had promised Rimi that I would write about certain episodes from a past life of mine, which is so far removed from where I am now, that it seems quite surreal. Perhaps this is my way of reminding myself of the very real people and adventures I found myself with.

Here is how I shall proceed. This is an ongoing series, but I'm not entirely sure how many episodes I'll write. It would be interspersed with other blogposts, because the theme can get a bit depressing at times. I'm also thinking of starting another post series where I'll write my travel stories, which would run concomitantly with this series.

About 10 years ago, a combination of events in my life landed me in one of India's largest mental diseases hospitals for a year. Despite all the jibes from my friends teasing me about how much shock therapy I received daily, I was not, in fact, a patient. I was not even supposed to be in the hospital. But it so happened that the social work department where I was studying had planned to send me to a prison correction centre as an intern.

The thought of working for the prison system was for some reason rather unpalatable at the time, so I refused. The only other choice, as it turned out, was the hospital. I had recently finished reading One Flew Over the Cuckoo's Nest by Ken Kesey and The Myth of Mental Illness by Thomas Szasz, and was sufficiently interested in the workings of mental illness to look forward to the switch to working in the hospital. I was being accompanied by another intern, the very upbeat psychology nerd Ms. Phillips, who knew a lot more about diagnosis and therapies for mental illness than I did (I had never studied psychology at university). Ironically, that knowledge was completely useless in the set-up we were about to find ourselves in.

Our supervisor at the hospital was the head of the hospital social work department Mrs. SK, a powerful, though strangely, slightly repulsive person, whose views and ways were the cause of a major bout of unpleasantness later in my stint. Things started on a fairly friendly note though. Mrs. SK had three full-time social workers working for her, Mr. JJ, Mr. RR, and Mr. GG. Our duties were to assist doctors in the out patients department (OPD) with gathering case information from the relatives of patients, and examining case histories and organizing therapy sessions with patients admitted to the hospital wards. Ms. Phillips was assigned to the female wards and I was with the male patients(the wards were gender segregated). In the OPD, we worked together for the same doctor.

With this background in place, let me begin with the first of my many stories from the hospital. And tell you folks about about the person that was Dr. Dee. Many human beings manage to pack in a fair bit of contradictory, incongruent parts - manipulative but generous, chatty yet frigid, kind morphing to cruel, etc. Dr. Dee managed to stretch his contradictory ways to extremes that made him seem like an angel one moment, and an asshole the next. Let me explain.

Dr. Dee was the smartest doctor in the entire hospital. His diagnostic skills were impeccable, he always prescribed the right medicine, and his knowledge of his field was borderline genius. And yet, within the first week of working for him, I had developed a deep disgust for the man, which even my grudging respect for his talents could not overcome.........................

Day (perhaps Tuesday, or Thursday) Date - Forgot, sometime in the year 1996
Place - Dr. Dee's office, The Hospital
Time - 10: 00 a.m.

(A line of patients had formed outside the door. This is a government hospital, and in its scale, one of a kind in the entire region. We have patients and their families who have travelled overnight by bus/train and waited hours outside the hospital for the OPD to open. Most are dirt poor, and coming up with the bus or train fare must have been a struggle. They wait anxiously for their turn, with almost reverent faith in the doctor's ability to cure the malady that ailed their son/daugter/wife/husband/father/mother.)

Dr. Dee arrives and greets us. He notices the line out of the door, but also manages to catch the eye of the sales representative of a pharmaceutical company. He ignores the patients, and calls the salesperson inside. They're old acquaintances, and start chatting. About stuff. Hospital gossip. Dr. Dee trying to wheedle a medical conference invitation from the man. The salesperson dumping drug samples on Dr. Dee's desk.

One hour passes. The patients get impatient.

TM and Ms. Phillips: "Dr. Dee, won't you ask the first patient to come in?"

Dr. Dee: "Huh? They can wait. An hour is not going to make a difference."

Two hours pass.

TM and Ms. Phillips: "Dr. Dee, should we at least start doing case histories with the patients?"

Dr. Dee: "No, I need to see them first"

With this, he went back to chatting with the salesperson.

Salesperson (nervously): "Dr. Dee, why don't you see a few patients, I'll come back later"

Dr. Dee: "Oh no, no. Don't leave. The patients are in no hurry."

Middle of the third hour.......................................

I had taken to glaring at Dr. Dee intently in an effort to shame him into action, while Ms. Phillips , with a look of intense embarassment and anguish, was trying to find new spots on the walls to stare at.

Finally Dr. Dee and the salesperson run out of things to talk about, and with a supercillous wave of his hand, the doctor summons the first patient in. Once he starts seeing them, he's remarkably efficient. One case in particular stood out.

A young woman came in, accompanied by her father. She had been seen in another hospital, where she had been diagnosed with schizophrenia. The family had moved to Delhi, and she needed a fresh prescription for her medicine. Dr. Dee looked intently at her face (he hadn't seen any diagnosis reports yet), and then turned to us -

Dr. Dee: "She doesn't have schizophrenia."

TM: "But you haven't even asked her questions or looked at her previous diagnosis."

Dr. Dee: "Trust me on this. You'll see - she's not schizophrenic. She has borderline mental disability"

TM: "Umm....she doesn't look mentally disabled to me"

Dr. Dee: "Just wait."

With this he turned to the father of the girl.

Dr. Dee: "Iska kabhi koi buddhi ka test bhi karvaaya tha?" (Did you ever get her IQ tested)

Father: "Ji Dr. saab, pichhle hospital mein saare test karvaaye they" (yes doctor, in the previous hospital, they did all kinds of tests)

With this he gave Dr. Dee a copy of her IQ test. Yes, what he said. She had borderline mental disability. Then he started asking the girl questions. Trying to determine if symptoms of schizophrenia existed. None did. She had just been horribly misdiagnosed. He asked her to stop taking the schizophrenia medicine and referred her to another specialist.

When the last patient of the day was seen, he turned to us and said -

Dr. Dee: "You think I'm a slacker, but see how I saw the patients"

TM and Ms Phillips: "Yeah, spending less than 5 minutes per patient and after many had been diverted to other doctors"

Dr. Dee: "Ha ha, but I'm good at what I do. Five minutes is enough for me to diagnose."

The good doctor used to flirt non-stop with us. He was absolutely delighted to have us assisting him, unlike the glum doctor we had been assigned to before. He also flirted with every female hospital employee who was remotely good looking. Rumour had it that his marriage was in shambles, his wife, also a doctor, was working in another city, and they hadn't seen each other for ages.

Another day in the OPD...........................

Dr. Dee walks in, this time accompanied by the pharmaceutical salesperson. Much idle chat commences. A female hospital clerk walks in. She's in her mid-30s, pretty, slightly plump, and is more than little fond of Dr. Dee.

Clerk: "Dr. saab, aap ne to MBBS ki hai, yeh bataiye na meri gardan mein kya hua hai. Bahot dard hai" (Dr., you also have an MBBS, please tell me what's wrong with my neck. It hurts)

Dr. Dee: "Kal raat pati ko zyada zor se belan maara tha kya?" (Did you hurl the rolling pin with extra force at your husband last night?)

Clerk (giggling): "Kya Dr. saab, aap bhi na. Dekhiye na kya hua hai" (Oh please Dr. Dee. Why don't you see what's wrong?)

(TM and Ms. Phillips suppress a laugh)

Dr. Dee, instead of getting up to examine her neck, grasps her arm to pull her towards him.

Dr. Dee: "Kaafi solid baanh hai aapki. Bechara pati" (Your arm is a solid one, poor husband)

Much giggling ensues between the clerk, Dr. Dee and the salesperson, all the while the doctor held on to her arm, running his fingers on it. After another hour of banter between the three, the clerk and the salesperson leave.

Another two hours of OPD time gone. However, when the patients did start filing in, Dr. Dee was all attention, keen, perceptive, a sharp interpreter of symptoms, at times handing out medicine samples to patients too poor to even afford the subsidized medicine from the hospital pharmacy. When he concentrated on his work, he had no equal in the hospital.

However, his short bursts of productivity were squished into periods of indolence, indifference and plain apathy. Clearly, he did care about his skills, but at times, little about the people he practiced them on. An incident that occured towards the end of my term at the hospital pushed the doctor firmly into asshole territory for me - no amount of expertise or generosity could rescue my opinion of him.

We were sitting in Dr. Dee's office, writing down the case history of a patient, when an OPD peon walked in with a wicked grin on his face.

Peon: "WOH aayi hai, aur aapse milna chahti hai" (SHE is here, and SHE wants to see you)

Dr. Dee: "Woh kaun?" (Who?)

Peon: "Wohi, jis-se aapki ward mein anban hui thi" (The person with whom you had a tiff in the ward)

Dr. Dee's face changed. He looked grim.

Dr. Dee: "Bhejo usey" (Send her in)

A very stern woman in her late 50s walked in. She had an intent, fierce glint in her eyes that seemed to pierce through her glasses. She was agitated, but only slightly.

Woman: "Dr. saab, my work told me to get a certificate from this hospital that I'm fully recovered from my schizophrenia. Please sign a certificate for me"

Dr. Dee: "Ok. Give me the papers and wait outside. I'll call you in 10 minutes."

The woman went outside and Dr. Dee turned to us.

Dr. Dee: "Here's the deal. This woman, believe it or not, actually works in the social work department of (a major government) hospital. She's had chronic paranoid schizophrenia for the last 15 years or so with relapses from time to time. I don't know how fair it is for me to assess that she's fit to work as a hospital social worker."

Ms. Phillips: "Does she absolutely have to work?"

Dr. Dee: "She supports herself and her elderly mother with the income. She's not married, and doesn't have any other income."

Ms. Phillips: "If you think she's recovered for now, why not let her go back to work?"

Dr. Dee: "Hmm......we'll see."

He shouts to the peon to let the woman come back inside.

Dr. Dee: "I have looked at your papers, and I'm willing to sign them. However, I think you need to undergo another course of treatment before you join your work. I'm prescribing Clozapine which we recently got approved to use. It's very effective in treating your kind of cases."

Suddenly my mind went into overdrive. Clozapine...............Clozapine...............Clozapine........it's familiar...........very familiar........................in fact, I heard about it last week...................in Dr. RSP's office...........................the doctor was telling a patient's family about it......................the new effective drug................................that had a 1 in 1000 chance of killing the patient who went on it..............................the patient's family refused the treatment........................Dr. RSP was almost relieved they did.

TM (mentally): Dr. Dee, tell her about the side-effects.

Dr. Dee continues to talk about the drug's benefits.

TM (mentally): C'mon Dr. Dee, tell her it has a 1 in 1000 chance of killing her.

The doctor talks about all the chronic patients it had cured.

TM (mentally): C'mon you motherfuckin' bastard! Tell her it's dangerous!

Dr. Dee: "I really think you should go on this new drug. It would really help you"

The woman though was having none of it.

Woman: "Dr. saab, I was admitted to the hospital, and you people released me when I was cured. I'm cured now. Just sign my health certificate."

Dr. Dee: "I won't sign unless you go on the treatment."

All the muscles on the woman's face were quivering with anger. She was absolutely furious. She got up, muttering profanities under her breath and started walking to the door. On her way out, she slammed the door with all her strength, nearly shattering it, and screamed "Kuttey ka pilla!!" (son of a dog).

The doctor turned to us, his bright eyes, glinting brighter, with a slight smile curling his mouth.

Dr. Dee: "See, she's not cured at all. She's still relapsing, and she wanted me to sign that certificate."

TM: "You never told her about the side effects."

Dr. Dee: "What?"

TM: "You never told her that Clozapine has a 1 in 1000 chance of death for the patient."

Dr. Dee: "That's not a significant risk, especially for someone with chronic paranoid schizophrenia."

TM: "But you never told her about the risk."

Later, the peon told us that the woman, during her stay in the ward, had physically assaulted Dr. Dee and slapped him. He never forgave her that transgression.