27 November 2011

Destiny


There are times I wonder why some people are born with all the luck and for some everything that can go wrong, does.

Grudgingly I then begin to accept the orthodoxy of destiny.

The youngest of four siblings Parul was born to a low income upper caste family earning their livelihood out of a tiny grocery shop situated in the urban slum on the outskirt of north Delhi. While her older siblings merged in the crowd of underprivileged children living in the ghetto, she stood out as someone who didn’t belong there. Parul was unusually pretty. Her grandmother called her Bhuri as she had fair skin, light eyes and hair with golden hue. The origin of her looks was traced to her great grandmother who hailed from a particular clan of Mewat region with similar aesthetics.

The family was poor. The resources were meager.  The children were undernourished .Their upper caste tag blocked their chances of availing much of the benefit offered to backward section with the purpose of bringing them in the mainstream. The family represented prototype of the marginalized group living in the throes of society. The upper cast urban poor were the new unfortunate segment.

Fully aware of her daughters charms Parul’s mother decided to exploit it.

The deficient resources available to her large family served as compulsive reason for her to do so.

A month after clearing class VIII exam, fifteen year old Parul was married to a wealthy, middle age, fruit wholesaler, who was twice married before. The trader knew the deal was good and the family was well compensated. As the adolescent wondered how could she be married ahead of her older siblings she was told she was lucky to get a marriage proposal from a rich man who owned two flats , a warehouse  and a tempo.

The marriage was illegal as the man was not divorced from his second wife. He didn’t have a single child from either of his marriages. He was alcoholic and suffered from liver derangement.

Replete with inconsistencies and illegalities the marriage was solemnized in a hushed up manner and the couple was relocated to different part of the city.

The part where I live and practice.

Three months into marriage and a visit to Vaishno Devi later, the girl was brought to me in a state that could put mankind to shame. An alcoholic, hypersexed and inconsiderate beast of a husband had forced upon the defenseless child bride who was ready for the act neither in body nor in mind. She was subjected to physical abuse when she resisted. Before she could realize the full impact of the injustice done to her by her own people she was expected to be a willful recipient to the lust from her perverted husband. She was clueless both to the situation and to the act. The kid was traumatized repeatedly as the marital rape continued unabated. Her immature mind had gone numb much earlier as her body continued to cope up with the onslaught for a while longer and then gave up.

The day she was brought to SMC she ran high fever. Her vaginal laceration and bleeding required urgent attention. An orthopedic referral was required for the dislocated wrist. She needed to be put on antibiotics for severe urinary tract infection she suffered from. She hadn’t slept or eaten properly for days on account of pain she suffered. She was in a pathetic state and needed to be admitted in the hospital.

The husband failing to gauze the gravity of situation refused admission .There wasn’t anyone else to look after the ailing girl as he hadn’t informed her family

As we proceeded with the investigations, another revelation marked further complexity in her case.

She had missed her cycles.

The underage ailing minor was two months pregnant. The marital rape had facilitated fertilization as no contraception was practiced.

There was no way she could cope up with the phenomenal stress of pregnancy at this stage.  She was sick. 

She was too small. She was just a child.

We suggested termination of pregnancy after stabilizing her condition. For that we required consent of her husband as she was a minor. The husband wouldn’t ever agree for such a thing as he was childless from previous two marriages and was desperate to have one.

There are times when one wants to scream in sheer desperation. This was one such for us.

Blissful ignorance is a luxury that is ruthlessly denied to us doctors. Our job makes us envisage more than we want to but eventually have to.

Resigned to the situation we tried to do everything possible to help her regain her health if not life.

Under the care of a team of specialist the girl improved gradually yet remained underweight and anemic throughout her confinement.

Teenage pregnancy can be a harrowing experience not just for the patient but also for her doctor.

There is difference between an average normal pregnancy and pregnancy in a child. The text books do not say the entire thing. Her cravings and mood swings were more intense than usual. Normally women crave for pickles and imli while this one would ask for lays and momos. She vomited multiple times and happily ate food after each regurgitation. She wasn’t bothered about stretch marks or disfigurement. Her figure wasn’t fully developed.  She felt fetal movement much later than expected. she slept like a log and got up only when she felt hungry. She had a springy walk and didn’t suffer from backache. She was mortified of injection and behaved like a brat after each such attempt .We pacified her with candies kept at the counter for pesky uncooperative kids accompanying their mothers.

As a life grew within her she grew in life. The girl metamorphosed into a woman in the span of nine months. 

Walking with gravid uterus in the later months of pregnancy the adolescent looked twice her age. She mellowed down quite a bit and prepared for the forthcoming ordeal. The fellow pregnant women in the antenatal OPD gasped at the site of juvenile expectant and empathized with her in a way no one else could.

Five weeks before the expected date of delivery Parul went in to spontaneous labor and after 6 hours of excruciating agony she got completely exhausted.

A human body can endure only as much as 47 dol units of pain. During childbirth a woman experiences 58 units of pain which is 11 units higher than the average tolerance limit .The pain is as much in intensity as generated when twenty bones are simultaneously fractured in an individual. 

That is a lot of pain. Every other kind of pain seems insignificant in comparison.

The kid couldn’t bear with so much pain and soon lost patience.

A caesarian section was performed in the wee hours of a cold night and a preterm, underweight baby was born to Parul.

The child became a mother overnight.

It was a girl. She named her Aishwarya.

Parul was discharged a week later and didn’t report for a follow up. The baby too wasn’t brought for periodic vaccination.

Life moved on and two years passed. There wasn’t any news from her.

Once while on morning rounds in the hospital I saw her husband standing in the queue for OPD registration. The man looked as if he had been through a protracted illness. I wanted to ask him about Parul but he looked away as if he hadn’t recognized me. I wondered why.

Few months later we had a visitor from the local police station .I knew the police officer as her wife was under my care. He was conducting an enquiry about a woman who had run away from home with her paramour. She had been a regular patient with us and her husband hoped the doctors could have a clue to her whereabouts.

As the inspector disclosed the name, I found it hard to express appropriate reaction to the revelation.

I was least surprised to learn Parul escaped from the jail her husband called home. In fact I was amused and inquisitive that she could find an opportunity to do so.

The girl had some guts.

Parul’s elopement remained a mystery for everyone at SMC till the missing link to the saga was provided by her next door neighbor who frequented SMC for her dental treatment.

She said Parul was subjected to extreme physical torture by her husband. Her baby too was treated shabbily. The man was abusive, volatile and compulsively possessive. Every night he returned home drunk and hit both the females. Once he even threw the baby from the cot. He wanted a son and blamed Parul for bearing him a daughter.

The long standing alcohol abuse took a toll on him and he developed liver cirrhosis. He was admitted in the hospital for two months. All this while Samar Khan, his assistant in whole sale business looked after him. Samar was a hardworking young man who had learnt the traits of business from his mentor. 

Samar hailed from Mujjafarpur in Bihar and had no immediate family in Delhi. Parul and Samar developed instant liking for each other. Samar took care of Parul’s baby like baby’s ‘father never did. Parul found a soul mate in Samar and confided all the miseries and hardship she has been through. Samar cared for her and wanted her to be happy. 

They fell in love and as it blossomed they decided to run away.

Parul used to meet samar on the pretext of coming to SMC for checkups. That is what made her husband think I could have a clue to their whereabouts.

There are certain situations that appear hopelessly irredeemable at one point and then as if with a magic stroke things begin to fall in place.

It was a day with heavy rush of patients since the clinic had opened after three consecutive holidays. I was delayed for hospital rounds and was rushing out in hurry when the front desk called. There was a couple wanting to see me urgently. On days as these you don’t want a visitor or medical representatives to rob you of precious time reserved for vital issues. I was tempted to ask them to take next day’s appointment but later changed my mind and called them inside.

The tall man and his burqa clad wife sat in silence. I was low on patience and energy. There was no recollection of seeing the man before. After much hesitation he spoke and made an unusual request. He asked if his wife could be admitted in the hospital for a couple of days without any indication for such a thing.

I heard myself saying an emphatic No and begin to walk away with my bag and car keys when I caught a glimpse of the woman who by now had lifted her veil.

Parul had grown much beyond the three years since I last saw her. She had not just grown but had changed drastically. She was married to a Muslim and looked like one. Parizad as parul was now called looked every bit a confident woman. She showed me the scars of the plastic surgery she got done to erase the massive tattoo on her left forearm. This  was her  possessive former  husband’s idea to  secure his claim on the unlawfully wedded child bride. I remember seeing the tattoo which read ‘ Mahesh’

The scar of tattoo looked every bit ghastly like the man whose name it was supposed to reaffirm.

What about Aishwarya, I asked.  Guriya lives in Mujjafarpur with my parents and goes to school , replied Samar like a proud adoptive father .Oh !  So you mean you took the girl with you when you left “ Yes, Samar wouldn’t allow me to leave her behind as under the influence of alcohol Mahesh used to do all wrong things to the little girl, his own flesh and blood.

I felt goose bumps as she narrated the gory details of how the beast abused them both. It was like the proverbial rebirth for the girl who was still under twenty. At the age when most other girls of her age were still getting pampered by their parents she was through an abusive marriage, sexual slavery, forced motherhood and an elopement followed by change of religion and a second marriage.

But the girl was strong. She now had a life. She had someone who loved her deeply and cared for her and her child.

She had to adapt to a great extent to be with Samar and she did so willingly. The previous marriage was illegal as Mahesh was married before. There wasn’t any legal binding on her.

On expected line Mahesh proved to be bad looser. He got after their lives and wanted her back. They were on the run and lived in rented accommodation in different locations for small duration. He registered a case in local police station omitting the crucial fact about invalidity of their marriage.

Samar was looking for a foothold outside Delhi. He managed to secure a job with the help of a relative in Amritsar fruit mandi. They would soon leave Delhi and had no plans to come back. One week was all that remained in their way to freedom. They needed to hide during that time.

What made them think I would help them? Did they know cops were looking for them? A phone call to the police station and their lives and plans go up in the fire.  I wondered as I caught the glimpse of absolute trust and unflinching hope within those large moistened hazel color eyes looking towards me with such gratitude.

Mind takes all the time to decide upon a complexity while the heart does so in a fraction. That day I relied on the latter.

Parul was kept in the hospital with a vague diagnosis. The visitor’s entry to her room was disallowed on medical grounds. She was discharged after four days. An ambulance was arranged to drop her to the interstate bus stop. The hospital bill was heavily subsidized and attending doctor’s fee was waived.

As they parted, Parul hugged and cried. This was unusual for both of us. She never cried before this and I never saw my patients off.

Her parting look was eloquent enough to say she may not come back to see me ever again. I looked back to convey she didn’t have to.

With all my genuineness I wished them a happy life here on.

After she sat in the ambulance, Samar got down and requested with folded hands to make sure no one finds out where they are. I smiled and asked him to stay assured.

It has been six months ever since. Mahesh continues to look for them. The case he registered in the police station is not yet closed. I can play an important role in solving it but I don’t wish to.

The family has no clue. They seem disinterested to know.

Her neighbor misses her but prays to God they never find her.

I too hope that.

If a life is resurrected by an act of willful omission, I am willing to be part of such a conspiracy not once but many times over.

13 August 2011

Diary Of A Lady Doctor

The chamber of a gynecologist is a strange place to be in. Seated outside in the waiting lounge exposed to commotion characteristic of a medical establishment one can hardly get an idea of what transpires within the secure confines of these 10 ft by 10 ft chambers.Inside as a woman is sealed from the world with in its four walls she is split wide open to a single person who has her permission to enter her  body and sometimes her mind too.

 The need to visit such a facility and open up to a consultant occupying authority arises out of certain vital biological functions carried out during the course of a life born as female. The dialogue conducted within the confines of these holed up clinical places are reflective of turmoil of an average woman’s life and that itself makes the whole place anything but ordinary. 

The sheer volume of work and consequent exhaustion at times might have compelled the slogger in me to label the routine as mundane, repetitive and insipid but the observer in me has painstakingly been taking cognizance of pathos that surround my subjects. My expertise as gynecologist makes me deal with human body born with genetic equation of 44XX therefore programmed to go through the ordeal of menstrual cycle, Puberty Pregnancy, and menopause but that is a miniscule part of the entire spectrum of purpose I serve to my clients.

During the course of their seeking my counsel I end up entering their lives. 

I end up taking their decisions. I end up knowing more than I should.

Every subject is Distinct. Every situation is different. Every story is unique.

Some have solutions, others are simply irredeemable.

The boundary between professional and humanitarian duties is blurred so often that at times one has to make efforts to stay detached at the cost of being labeled insensitive.

The lives are born, terminated, curtailed and at times ruined by advice emanating from such chambers. The vitality of nature of our work domain makes it a significant place not just for the visitor but also for those within her sphere of influence. The atypia interspersed with the typicality of my work as a ‘woman’s doctor’ serves me well. It keeps me hooked to the otherwise demanding profession. It allows me to stay human with a requisite dose of humility. It also makes me see the world from a perspective other than that of arrogance-ridden world of healers I belong to.

 

And if you thought the counsel between the clinician and the client is designed for the benefit of the latter you couldn’t be farther from truth. It is as much for the person occupying the other side of examination table.


I deal with women in age group which spans from very young to very old. However majority of my clients belong to fertile age group. That incidentally is the cluster where all the action lies. A woman is a powerhouse of energy  is a fact known to everyone but a woman is epitome  of  adaptability and acceptance of the weirdest of things happening with her or through her was something I learnt during my dealing with them . And like a true character of my own script I adapted and accepted.

Every subject had something sensitive, poignant or secret in nature to share. How many secrets can one hold? I had no idea till I joined private practice. I learnt as women are assured of patient hearing in a non judgmental manner they acquire an inane sense of confidence. The interactive Sessions then acquire the relevance of therapy sessions. The healing process takes off from long before they pop a prescribed pill or are wheeled in to procedure area. Whatever field of specialization counseling remains single most important aspect of our role as a healer.  I cannot say how many of us take cognizance of the fact. 

I am glad I did.


A Gynecologist is not trained to a sexologist and can’t therefore be expected to function as one. It, like any other field of medicine has a demarcated area of expertise with specifications and limitations. But often this premise is overlooked. It is particularly breached in our field which deals with the business of making babies. The biological functions lying in the ambit of the subject are so intricately fused with the function of conjugality and sexual activity that the line between the two forever remains blurred.   


In this blog I plan to jot down interesting case history of certain atypical cases I came across during my course as practicing doctor.The stories have been heavily modified to safeguard privacy. These could have been stories of real individuals with real situations but I am bound by professional ethics and therefore can’t disclose anything which even remotely resembles a person or her situation. Each story has components derived from a couple of others with similar profile. I have utmost regards for those who choose me to be their savior in times when they needed one. The sanctity of my commitment towards my clients thus remains unchallenged. Any resemblance to characters or situations is incidental.


On the other hand if these stories remain untold some of us will remain oblivious of trials n tribulations; Strength and courage; conviction and sincerity apart from connivance and manipulation pathgnomic of the world of fair maiden.



The stories may not be real but my experiences most definitely are.


I will be posting one story each week.


Watch out for this space.