Involutional Melancholia

What is the worst of woes that wait on age?

What stamps the wrinkle deeper on the brow?
To view each loved one blotted from life's page,
And be alone on earth, as I am now.


LORD BYRON, Childe Harold

Today I visited Raipur Rani, where on every Saturdays we conduct Otolaryngology clinic at a Govt School for the Hearing & speech handicapped children. Raipur Rani is an outreach village in Haryana,one hour drive from Chandigarh. Most of the patients are aged villagers who come to remove ear waxes or complain of ear discharge. We used to joke among residents saying that going to Raipur Rani without an ear probe would be futile. Village women in their typical shyness hiding their faces behind their dupattas (shawls),hands almost covered with heavy bangles, lips painted with florescent coloured lip sticks ,men with long gray moustaches, turbans on their heads and dresses stained with dust from fields were our routine visitors.


It was a light day, when an old lady came showing an outpatient card of my college. She was in her seventies and had that peculiar waddling gait typical of fat old ladies. She wore spectacles which I noticed had not been changed for years. She was already seen at our college some 2 years ago for ear drum perforation, but had not completed or followed up her treatment.. People in the villages speak a local slang of Hindi. I am usually reluctant to speak in the slang as I feel awkward in my south Indian version of Hindi. Usually people get closer when we use their language. I decided to give it a try as there was no one around. She had come with the same complaints again. My first reflex was to speak rudely as I hate non-compliant patients. I asked her why she had waited for 2 years. Usually people have all sorts of excuses to put forth ranging from servants’ marriage to grand daughter’s exams. To my surprise she burst into tears and said that her only son had met with an accident and was bedridden. He was the only earning member of the family as her husband had already expired. She told me that when she came to our college two years ago she was confused and scared seeing the crowd. She wouldn’t forget the young resident doctor who helped her that time. She had walked that day for 4 kilometers to come to the clinic. I talked to her for about half an hour. Mostly she spoke about her family problems. When she left, I could read from her face that she was happy and satisfied not for seeing the list of drugs I prescribed, but for patiently listening to her woes.


I had only one hour left in my duty when I got a call from the emergency for a neck abscess (advanced infection where pus collects). I went to see a man in his thirties with a neck swelling, unable to open his mouth or turn his head due to pain. His foul smelling mouth and toxic look pointed to the diagnosis of deep neck abscess secondary to dental infection written all over him. An immediate CT scan and surgery at the earliest was the only way to save his life. I called out for his relative to hand over the investigation form. To my dismay an old baba(elderly person) in his eighties answered my call. He was just a skeleton, with his cheeks hollowed, wrinkles playing criss-cross over his face and hair and beard as white as those of fairies in Harry Potter. I explained to him the bad condition of his son and the importance of getting him operated early. He just stood there blank and handed his BPL(below poverty Line)card to me. I understood that he was from Saharanpur, a remote village in Uttar Pradesh and realized that he understood nothing I said. I immediately took him to the RMO ,made his card free , got his CT done and took him to operation theatre with in 30 minutes. This may perhaps be the shortest time a patient is prepared for surgery on an emergency. He improved dramatically after the surgery and was discharged in a week. While leaving the baba came to see me in tears being grateful for returning his only support and hope of his old age to him.

Once during my MBBS days I was taking morning rounds in the medicine ward. I was looking at the case sheet of a 60 year old man who was admitted with coronary artery disease the previous night. He hailed from a place called Thangalpadi which was close to my village .He came in the pedigree of our Prophet and people respected such families. I always had the feeling that these people exploited ignorant people by claiming extra ordinary power and had lots of riches .I asked him why he got admitted here as our college was about 200 km from his place. He told me he was travelling by bus and developed chest pain on the way. So he got admitted at the nearest hospital. As he was alone I offered him to contact his home and inform them. To my surprise he was reluctant to give me his number. But I my doubts were cleared when I called his home. An old lady, most probably his wife answered and quite unemotionally asked me to take care of him as there was no one to come there. I was worried how to tell him the news, but to my relief and a bit of surprise he had taken voluntary discharge and left.

I always remember my rural service period  at the  primary health centre ,Edapal being my best time of professional life. The lion share of my patients was elderly people , most of them just coming to see whether I was all right and for chit-chat for some time rather than treatment their diseases An old man used to come regularly and offer me tea. A woman in her eighties once came to see me. She just sat there without saying anything. I asked her some routine questions about her problems but she would not talk. I shifted to personal questions regarding her whereabouts. But she still did not budge. I was getting frustrated as there were other patients waiting. I asked her who had accompanied her. She just broke down in front of me, told me that her son had left her ,that she was alone at home, that she had not talked to anyone for three days and that is why she came to see me . She sat there and spoke there for another 15 minutes holding my hand. I told her she could come here anytime she wanted. She left without even taking the medicine slip , but I was sure she got what she came for.


Old age is something all of us should go through. Weakness, cataracts, ailments, memory loss are our belongings on those days. But nothing is more painful than the solitude to which we are subjected. No one to turn to , no one to speak with ,no one to support in our bitter road as Mother Teresa once said ,” Loneliness and the feeling of being unwanted is the most terrible poverty”.

By the eldest son