It was summer time, when the out-patient department gets dry just like the weather. We joke that the extreme weather saves us from frivolous patients who love doctor shopping. Only genuine patients who are really in need would dare the extreme weather. My patients got over by 1 am, which was very unusual even under these circumstances. I visited my colleague’s room to see if he was free for a much wanted break.
His last patient was a middle aged villager who had taken his place on the revolving tripod in front of my friend. He wore the typical white turban covering his head. He had a big mustache, its tip was sharp and pointed upwards. I could imagine years of effort behind his achievement. He sharpened his mustache frequently while he talked. This was the mark of his manhood and he took pride in it. He spoke in his typical colloquial Hindi which carried a tone of spontaneous innocence . His white clothes had stains of dirt on it as if he was just coming from his paddy field . Surprisingly, the two youngsters who accompanied him wore jeans and T shirts exhibiting an educated background. He was skinny and his face had many wrinkles which bore the reminders of his life’s struggle. But he had a beautiful smile to his advantage and spoke in a jovial tone. His smile made his mustache arch upward and produced dimples (which any other woman would love to have) in between the crisscrosses on his face. He smiled exposing his misaligned and tar coated teeth.
He came to us with vague complains. He said he has a neck swelling which is there for the last 12 years and some minor throat discomfort for the last few days. My friend tried to argue with him saying that the swelling could in no way be there for the last 12 years. Swelling that remains for 12 years and does not rob the life of the patients are limited in number and his swelling was definitely not looking like one which could have spared him. He smiled and said,” Doctor Saab, Apko jyada patha he. Tho do saal karlo”( Doctor , you know better than me, so make it 2 years). When asked about the throat discomfort he had , he said it was just mild and occasional. Then my friend started cross questioning him and he answered every time with the typical smile sometimes looking at my friend and sometimes at me. Any Cough? Sometimes .(Though he was constantly coughing in between his words). Any difficulty in swallowing or breathing? Negative. though his breathing was labored even while sitting. Do you smoke? No .Actually, that was the wrong question. I don’t ask it that way. I ask them how many years have you been smoking? What he meant by saying no was that , he didn't smoke in front of us. I asked him in my way and he said that he smoked 2 bundles of bidi per day for the last 30 years and stopped 5 days ago. No one likes to admit that he smokes , especially to the doctor. Alcoholism? Occasionally, which means on all occasions. Well , occasions occur every day, isn't it? . I asked him how much a pack of bidi costs? He replied that it cost merely 5 rupees. I told him that it meant 10 rupees per day and Rs 3600 per year. So he had spent nearly 1 lakh rupees on smoking. Babuji ,aap lakhpathi ho.( Uncle ,you are a millionaire). For a moment he got shocked which I thought was due to his realization that he had wasted so much money only to get this disease. But , after a while he smiled at me a said ,doctor Saab, ye tho aapne bahuth badiya baath booli (doctor, you have said the most wonderful thing to me). In fact , this person who might not have held a 1000 rupee note in his hand was cherishing the fact that he owned 1 lakh. He was really enjoying it.
I looked at my friend and said that if only he could knew what was going to happen to him in the next few months. He had a cancer in his throat which had spread to his neck lymph nodes , which we usually designate as an advanced stage disease with a very poor prognosis. We could only offer him palliative radiotherapy. By the first few days of starting his treatment , his beautiful moustache which his cherishes so much along with his facial hairs would fall off. Skin changes would appear making his entire skin of the radiated area hard , thick and dry making his wrinkles dissappear. He would have a mask like facies wiping off his innocent smile. His mouth would become dry devoid of saliva and he will never have a tasty meal again in his life. He will have frequent episodes of shooting neck pain which even the strongest pain killers are yet to control. After all this , his chances of surviving 5 years are just 40 percentage. Many of them would rather hope to die rather than living like this. Here he is sitting front of us in mirth and merriment ,ignorant of all this. My friend rightly sent him outside the room , not telling him anything. Instead his relatives were informed of the condition. Atleast he would spend some more time in his wonderland where he is a millionaire on his own