Tag Archives: addiction

A Living Death

A Living Death
© Dr. Rajas Deshpande
“Please allow my son to drink, Doctor! He has to drink minimum 4 pegs otherwise he becomes horrible. He suffers and then he troubles us all” said the desperate mother.
The patient, a 35 years old man, could barely get up from the examination bed. His 60 year old mother supported him with his wife. He was obese, unkempt, shabby, with unclean eyes. He had almost green teeth, and stunk. His clothes were crumpled, and he had dried blood upon lips, and a few abrasions. He had had a convulsion / fit that morning while driving his car.
“But I had specifically told you that he is not allowed to drive” I asked his mother.
“What can I do doctor? He doesn’t listen” she said, this time tears in her eyes.
Patient’s wife sat there upon another chair, face down. Very beautiful and highly educated, she held her 5 year old daughter to her bosom. She avoided looking up, she was beyond tears.
They were a super-rich family, now headed by this senior lady, who herself has diabetes, heart disease and blood pressure. Her husband (patient’s father) had epilepsy. Although his fits were controlled well, he had passed away with alcoholic liver disease. He had himself introduced and encouraged his teenager son to drinking, thanks to a common notion that it was a sign of modernity. © Dr. Rajas Deshpande
Now the son had uncontrolled fits, was highly addicted to alcohol and smoking.
Needless to say, they had very high reach. The son had given up on education after school as they had a flourishing business. He was married (arranged) to a postgraduate, meritorious distant cousin, who had herself had convulsions / fits in her childhood. Their five year old daughter also had convulsions, well controlled now.
They had tried many doctors and rehabilitation centers prior, but his addiction was resistant. I made changes to his prescription, and explained once more why he should not drink, why his mom should take a tough stand rather than falling prey to his tantrums, and even made an emotional appeal to the patient to give up alcohol for the sake of his cute daughter.
Blankly, with some guilt, but with also a resolve, he replied “ I can’t give up alcohol, doctor”. Sadly, I knew he was speaking the truth! Alcohol and many other addictions are proven in many cases to have a genetic tendency, and an addiction prone person is unable to overcome it unless serious efforts are made early in the course of an addiction. That goes with smoking too. The patient may seriously want to quit (as against the notion that they have a “weak” will power), but cannot.
It is easy to blame and advise the patient, but is impossibly difficult to accept, understand and forgive. A doctor has no other choice than to be compassionate, keeping aside personal opinions. He smiled at me as he left, and also shook hands to thank me. © Dr. Rajas Deshpande
Next day, his wife returned alone. “Doctor, I am leaving” she said, and broke down.
“I have had enough now. I do not deserve this life. I was educated to be very proud and although I am from a very rich and cultured family, all my education was merit based. I am fed up with him now. We have no family life. We cannot connect at all, we never did. I was told that he was a ‘social drinker’ and his fits were well controlled, I didn’t approve of even that, but ours is a closed community. I had no choice to marry against my parents wish. Now I have only two options: I can kill myself or leave him and grow up my daughter under a better roof”.
“I never told you till now: that my husband goes completely berserk once drunk, uses the foulest language, beats up his mom and me too. I have often had to lock up my daughter in a room to protect from him. My parents ask me to ‘adjust’, but I cannot. I am 30, I want to live some life. I have told this to my mom in law. She understands, but begs me to stay. I don’t know what to do. I want your suggestion. I have some questions for you: Will he ever be normal again? Will he quit alcohol ever? Will he learn to care for me and his daughter? Will he be able to regain his sexual efficiency? Will I get some life with him in future, Doc?”
Many a “NO” formed a queue in my mind, but I had to choose words carefully. “We can make an effort. We will try and find him better counsellors and rehab centers. There is a chance that he may improve, but his mother has to avoid weakening and accept some more effort rather than giving up. I am willing to help you all with all that I can, but it is not my place to advise you about the separation”.
I could not be partial to my patient, but I also could not be partial to his wife. A Typical Doctor’s Dilemma. © Dr. Rajas Deshpande
So many, especially the youth, encourage each other to “Just have a taste, just one for the road, just give company”, little knowing that they may be initiating inflicting a mayhem upon someone’s life. So many thousands die every year due to alcohol. However, the glamour associated with alcohol, the profits involved, and the “acceptance” by governments makes it appear as a “social, cultural choice”.
To every male patient who has told me that “stress” was the reason for their alcohol intake or smoking, I have asked “so your wife never had stress in life? Be a man, quit”.
There is no good use of alcohol. I often wonder why someone should be ashamed of being their normal selves, that they need to hide behind alcohol to forget things rather than face them, or to gather courage to speak what they want to. If a glass of wine or a peg is enjoyable and relaxing for someone, they may make their choice, but inviting others and forcing someone to “try” alcohol or “have more” is medically as criminal as a murder.
The patient’s wife came back after two days again.
“I have made a decision, Sir. I am leaving, with my daughter.. I will come to follow up with you for her. I have nothing to do with that family now. I will also not go to my parents, I am upset with them. I have found a job. Please consider me your sister and stand by me” she said, sobbing. I knew how she felt, I reassured her.
Who should we curse: The makers, the sellers, the advertisers,or the tax collectors of alcohol? The fathers who initiate their children to alcohol? The mothers who provide it out of love? The friends who encourage the ‘First Peg’ or “One more”? The parents who marry off their daughter to “social drinkers” without scrutiny? The proponents of weekend compulsory parties?
Some “HE MEN” who boast about their alcohol capacity for years come clean, forget all the filmy dialogues and sher-o-shayari and quit once they develop heart attacks, strokes, fits or liver disease. But by then they have caused enough damage to themselves and others.
While illiterate women in rural India have taken a dashing stand and made many a villages and husbands “Alcohol Free”, the educated community is yet to wake up.
It takes immense courage to open eyes and see the naked truth.
The patient’s mother passed away few months ago. His alcohol intake has multiplied.
I see him and his daughter both at different times, but each time I meet any of them, I end up having a very sad day.
Sorry, but with alcohol, there is seldom a happy ending.
© Dr. Rajas Deshpande

Food, Sex, Addictions and Privacy: Seriously!

Food, Sex, Addictions and Privacy: Seriously!
© Dr. Rajas Deshpande

An old man of 82 was admitted in London ON once with stroke during his “regular” morning lovemaking with his contemporary wife. An accurate history and onset time is necessary so we can use a clot buster injection within 4 hours of onset. He qualified and eventually recovered too.

I was amazed at the calm, expressionless responses but courteous attitude with which everyone in the staff treated him there, the couple was never embarrassed by any of the staff or doctors. Upon discharge, the patient asked Dr. H, an authority in the world of stroke, with a cute wink if he could continue his “Morning routine”.

A smiling and about twenty years younger Dr. H replied he could, so long as he took the prescribed medicines, and joked with a return wink that he (Dr. H) envied the patient, making the patient smile!

A twenty two year old unmarried female student came for suspected Multiple Sclerosis once. “I smoke grass (marijuana) for recreation, doc. I also take oral contraceptives often. Does this affect my illness?”. Both her parents sat there without any change of expression, and did not interfere at all with any part of the consult. I couldn’t help remembering the contrast panic and beating up by parents in some of my Indian college mates I knew, whose only fault was stealing a cigarette from their Father’s pack! Also the whole-family-humiliation-screw meeting in which the traditional family-nerds irritatingly shine!

In India, people seldom relate correct history for the shame attached to it. I have witnessed some very embarrassing moments, when doctors (especially junior) openly, loudly ask sexual / urinary history or addiction details to the awkward patient, while their colleagues exchange blushed, meaningful and pregnant glances. This is an obvious turn-off, and whether it is sex, sphincters, alcohol or smoking, no patient likes “Open Questioning” about this without adequate privacy. Then too, people talk only if respectful dignity is offered by the doctor. One must ensure such privacy, but never miss to address this issue out of shame or embarrassment. A history of STD or HIV risk must be asked where important, with relevant but properly formed questions, without a condescending tone. Many doctors half the age of patients actually humiliate the patient in a hope to make him / her quit alcohol / tobacco / smoking. Such patients are irreversibly hurt by open humiliation, and this should best be left to professional / experienced counselors.

This is also why many patients (especially the older, less educated, depressed) who have had heart attacks, spinal cord problems, accidents, strokes etc. hesitate to ask a “Loud Doctor in Hurry” about physical relations and addictions. Some refrain from normal life out of unnecessary fear, which may contribute to their depression. If the patient feels embarrassed or awkward, it is the doctor’s job to reassure and address these issues. A pre-discharge counselling meeting is essential. Fortunately the younger and educated generations even in India are now quite open and frankly ask their doubts without feeling “unnecessarily” guilty.

Actually, every patient, rich or poor, deserves privacy for any health discussion. It is a sick scene to see patients in a queue in most govt. / municipal hospitals having to openly answer such questions in absence of proper space. Overworked and authorityless doctors are helpless here.
My internship days.
A civil surgeon (administrative post) took what we call “Babaji Rounds”: smiling, hand-waving rounds just to ‘show’ the patients that “I am the boss”, talking sweet to every patient and firing everyone among staff. Administrative rounds like these are medically useless, but some depressed patients feel good, and some good administrators correct the service deficiencies.

One thin built religious leader was admitted with acute shutdown/ failure of kidneys. No urine output. Blood pressure very high, we struggled to control it. When the CS came to his bed, the worried wife asked: “Sir, what should I give him to eat?
The CS beamed a big angelic laugh, patted on the back of patient and said aloud “Anything he wants.. icecream, fruit juices, milkshakes..”.
“Samosa?” asked the lady..
“Yes sure”, said the CS and told the patient: “Eat more if you want to get better soon”.
The patient touched his feet and said “You are like God Doctorsaab, my illness is half better just by seeing you”.

That diet would have killed that patient, had not our fuming medicine professor (after a caste based solid expletive for the CS) asked me to rush back and stop the excited wife from feeding all that to the patient!

The CS didn’t even know the condition, diagnosis, or other details. He never wrote anything on paper (Capital or Small in verbal instructions??), but could have severely damaged patient’s health, just by his careless advice under pretension of knowing what he didn’t.

Point:
Many unqualified people / quacks/ and some qualified doctors too advise via verbal instructions trivially. Patients blindly follow these instructions. Right from “Shudh Desi Ghee (Clarified Butter)” to herbals!
This is equally or far more dangerous than bad handwriting of a good doctor.

Advice about food, exercise, sex, work, posture, sleep, physiotherapy and lifestyle are all parts of the consult, equally important as the medicines. A good doctor’s routine will include this advice for every patient. Patients should also consult a specialist for their illness at least once in the initial stage, so he / she can plan out long term holistic plan and the regular general / family practitioner can follow it up.

Some patients take advantage and ask the same things repeatedly. In a busy clinic, a personalised printed advice can be given. In a crowded OPD, as in charity and govt. hospitals, a “general instructions for a disease” booklet will go a long way, or special group counselling can be advised.

Things are changing. Many newer generation doctors are making good friends with patients especially from their own age groups. Fortunately, even the youngest doctors still do not use colloquial phrases like “Aish Karo” (Enjoy to the hilt), otherwise some perfectionist patients may really follow it to the core!

Because “Chalte- Chalte” / hurried advice, however trivial, may prove dangerous.

© Dr. Rajas Deshpande