To the fresh, eager young faces who were beginning their journey as doctors, my focus this year was to make a distinction between a dream and an aspiration, between the joy of perception and the burden of chasing a market-driven ambition.
This thought stemmed from a post I had put up some time ago on Facebook:
Whatever you choose to become tomorrow- a parent, a practitioner, a teacher, a writer, your ultimate objective of that role should be to bring about a transformation in the lives and minds of the people you touch- your children, patients, students or your readers. I say this because profits, expansion, competition– these are the words that govern the modern world. Aspirations are built on the foundation of these words. Do not fall prey to these. True happiness comes only from a positive transformation of the world in which you live. Touch lives and live on in the minds of the people you have touched. There is no greater joy than that!
To which one of my students asked:
‘But what should a doctor dream about? For instance, I am the first in my family to have taken up this profession. I am now already in my second year, but I do not know what I must focus on. Should I just focus on studying and building concepts? How do I plan my future? What defines a dream? If I wish to set up a hospital, would that be a dream?‘
This question, I realized, was the question of the hour- the unasked question that nevertheless hung heavy in the minds of all the young people in the profession. While a large segment of society believes that the problem lies with the students who make an entry into this field by paying a huge capitation fee while they are not suited for the profession, my experience with them has been different. Like the student who asked me this question, there are many who are here to explore and to learn. In fact, entrance toppers have often been a disappointment in this regard because more often than not, they are good performers and not true learners. Many are only masters of a formula that works when it comes to delivering in Indian entrance exams- an evaluation pattern that seldom assesses the creative application of the knowledge acquired.
So what must a doctor dream about?
When I worked in the Medicine Department, we had a doctor by name Rosamma. Rosamma ma’m was a middle aged lady, and she only had an MBBS degree. My room was adjacent to hers and I could hear her conversation with her patients. On many occasions, I have wished I could work as an apprentice under her.
She talked to her patients–
About their illness, about medicines, and about numerous other things that no doctor would bother to explain. I remember her telling her diabetic patients:
‘You can eat just the same. Fill up your plate, but reduce the quantity of rice to a cup, and increase the vegetables. That way, your stomach is full, but your calories are low. You could perhaps divide your meals into six small meals, instead of three large meals. You could substitute your snacks with salads and fruits. It is alright for a diabetic to eat a little fruit. Go down on the rice and the starch, but increase your dals and fish, so that you are not hungry. Steam or bake your fish, instead of frying it. Most importantly, keep giving yourself a change of menu so that you are not bored of the same diet. Once in a while, after your blood test, if your glucose is normal, you can treat yourself to a sweet.‘
She maintained a holistic approach to all kinds of illness. She had these little non-drug prescriptions for all kinds of illness- common cold, asthma, abscesses, diabetes, hypertension, heart disease.
‘Instead of jogging, you could do gardening. Since you enjoy gardening, you would be more motivated to pursue it, as opposed to jogging or other physical exercise‘, she would tell some of her obese patients.
Rosamma ma’m was very particular about the follow-up of her patients. She would ask relevant questions on follow-up and listen attentively as her patients let out details of progression or regression of the disease, and I realized that she had acquired most of her wisdom from such attentive follow-up. There were many occasions where she was able to identify things that many specialists missed. Some were simple things. For instance, an infection that failed to abate because her patient had stopped the medication midway- a fact that the patient considered irrelevant to mention. Or self-medication with antihistamines that suppressed a throat infection. She had also learnt to differentiate between brands of a medicine; she was aware of which brands were cost-effective and patient-compliant. When prescribing a new brand, she always made it a point to check with the patient if the patient had experienced any particular difficulty.
In effect, Rosamma ma’m was a very happy and content person, unlike all the specialists in that department. She had built a patient clientele, and had gained their confidence. She demonstrated a deep involvement with them, and that was the reason for her ‘success’. This deep involvement was possible only because she kept her clientele limited. At the time, she had no private practice unlike the specialists who filled up all their time with practice.
Her calm, content face was a striking contrast to the frustrated faces in the department.
Rosamma ma’m quit this hospital a few years ago. She is now happily settled in a little village called Kelakam where she runs a clinic and enjoys the simplicity of rural life. She has a beautiful house with abundant garden space, and she enjoys tending to her garden. She grows her own vegetables and rears a couple of hens on her farm.
I think a dream is defined by breathing life into what has touched us. I am sure we all have our stories of encounter with disease and of how it has touched us. In the dark alleys of disease, one often discovers the most powerful stories of human life.
Perhaps it is these stories that the young doctors have to search, within themselves. It is in these stories that they shall discover their dreams- the dreams that define their role as a doctor.
(to be continued….)