The Doctor Is In

In Neyyarinkara, people did not usually fall ill. If they did fall sick, they went to the village vaidyan. The vaidyan is an ayurvedic practitioner. Govindan was the village vaidyan in Neyyarinkara. He was in his eighties. Traditionally Ayurvedic vaidyan’ s asked a lot of questions. From the minute the patient would arrive till the time they left, it would be series of questions. What did you have for breakfast? How was your sleep? Are you motions regular?  Yes… the questions could get personal. Govindan Vaidyan was an exception. He rarely asked questions. He had served three generations of the villagers. He knew the medical history of each family in the village. His consultation rules were simple. You went to him and told him the problem.  Govindan would then disappear into the inner rooms of his hut. After a few minutes he would return with a medicine. His hut was full of strange smelling herbs and decoctions. The older generation in the village had absolute faith in his healing powers. In the village they said that if you died in spite of Govindan’s medicines, well, that was just bad karma. The present generation of inhabitants in the village did not agree with this view point. They preferred Allopathic doctors and medicines. They preferred travelling twenty kilometers to Trivandrum to get healed.

The scarcely populated medical fraternity of Neyyarinkara received a boost with the arrival of its first Allopathic Doctor – Dr. Shivaraman. Technically he did not come to the village as a doctor. He came along with his daughter Rukmini. Rukmini or Rukmini teacher as the villager called her, was posted as a Malayalam teacher at the Neyyarinkara Village School. The school admitted both boys and girls. It offered classes from first to tenth standard. Neyyarinkara did not have a college. If you survived your tenth exams, you had to trvel by bus to join the colleges in Trivandrum. A bus would take an hour to make the journey. Few students from the village needed to take the bus. On paper, Rukmini was assigned to teach the students of fourth and fifth standard. As there was no other Malayalam teacher in the school, she ended up teaching all the classes.

Rukmini’s mother died years ago. Her father Dr. Shivaraman was a retired professor of the Government Medical college. After his wife’s death his dominating sister stepped in. At first, his sister tried to get him to remarry. He refused. Then his sister told him to marry off his daughter the day she turned eighteen. Again Dr. Shivaraman refused. He wanted her to be financially independent. He had hoped she would become a doctor like him. Rukmini rejected that idea. She wanted to become a school teacher. She got a job as a government school teacher. Shivaraman’ s pension was far more than what his daughter earned as her salary. He was not going to let her stay alone in some far away village. He came to Neyyarinkara along with his daughter. Dr. Shivaraman planned on spending his free time reading. He came to Neyyarinkara, armed with a truck load of reading material – old newspapers, novels and magazines. He had collected them over decades. Dr. Shivaraman had another talent a more practical talent. He was an excellent cook. In their house he would cook while Rukmini did the dishes and washed the clothes. That was the arrangement between father and daughter. Dr. Shivaraman did not believe in engaging maids and cooks. He believed in the dignity of labor. He was a socialist at heart and a follower of Gandhi.

“Rukmini how are you finding life here in Neyyarinkara?” said Raman Kutty, Head Master of the Neyyarinkara Village School. It was a month since she had joined and the school.

“Sir! The students are bright, hard-working and eager to learn. There are a few who are weak in their studies but that is because they have no one at home to guide them. This is my second posting and I am really happy I have got an opportunity to work here.”

“I am happy you feel that way. Where are you staying?”

“I have rented a house on the corner of East Street. My father lives with me.”

“Oh! that is good. Is he working or was he working before?”

“He is a retired Professor of the Medical College. Now he spends his day reading books.”

“He was a Professor in the medical college at Trivandrum?”

“Yes Sir! he retired five years back.”

“That means he is a doctor.”

“Yes Sir. He was a doctor.”

“Once a doctor always a doctor.”

A week passed since Rukmini had the conversation with the headmaster. It was ten in the morning and Dr. Sivaraman was sitting in the verandah reading a science fiction novel. In the novel the aliens had landed and were slowly making their way towards the cities. That was when the doorbell rang. Dr. Sivaraman hated it when he was interrupted while reading. All through his career he never got the time to read anything. He intended to catch up on all the lost time. He continued reading. The door-bell rang again.

“Must be supporters of some political party on a campaign to collect funds,” he said muttering to himself.

At the door he found a man standing with a young boy.

“Doctor Sivaraman?” the man said.

“Yes! What can I do for you?”

“This is my son. He has a fever. Please can you have a look at him.”

“What? No! I am not a doctor. I mean I do not practice.”

“You were a professor at the Medical College, Right Sir?”

“Yes, I was but I was the administrative head of the college and have not practiced medicine in years. Also, I am retired now.”

“I understand all that Sir. Please help us. We do not want to go to the vaidyan. He is in his eighties. He can hardly see and has trouble hearing. I do not mean any disrespect to him but I do not feel confident going to him.”

“I… I … do not have any medicines.”

“Please can you look at my son and tell us what to do. It will take an hour to reach Trivandrum by bus. I do not want to take him there in this condition.”

Dr. Sivaraman sighed and said, “Ok come in.”

He did not have a stethoscope to check the heartbeat nor did he have a thermometer to measure the temperature. Instead he used his watch to time the pulse. his palm placed on the boy’s head told him the severity of the fever. Luckily the boy had a slight fever and Dr. Sivaraman prescribed some rest and analgesics. He did not have the medicines, nor did the shops in the village stock the medicines he had prescribed. That did not matter as the boy’s father was not planning on purchasing the medicines anyway. He had come to meet a doctor. He wanted the doctor to reassure him that the boy would be fine. The boy’s grateful father told his wife she spread the word around. Within a week of the incident, Dr. Shivaram was in business. It was as if the flood gate of disease and ill health had been opened in Neyyarinkara.

Sharath Achari was one of the richest people in the village. He owned a string of jewelry shops in the village. He was thirty-eight years old and weighed a hundred kilos. He sat in the main office. Every day he would be at work by eight in the morning. He would be there till eleven at night. His job was such that he never got to leave his shop. He had a car and a driver to drive him around. It was his wife who was the patient. Compared to his wife Sharath was thin. Shalini had trouble climbing the three steps of the house and collapsed on the chair in the hall. One look at her and Dr. Shivaram knew what the problem was. Still he let his patients do the talking. Sharath’s wife Shalini was a graduate. She was the daughter of a rich business man from Trivandrum. She hated Neyyarinkara. The couple did not have any friends and hardly if ever spoke to their neighbors.

“Doctor, I cannot walk. I cannot sleep.  My knees hurt. I do not feel hungry. Please help me I think I am going to die,” said Shalini. She had to stop talking as she was having problem breathing.

Dr. Shivaram let her regain her breath.

“So why do you think that you would die?”

“Doctor, as I told you I feel uneasy. I cannot sleep at night and have to sleep during the day.  Please help me Doctor.”

“Pardon me for asking do you have any children?” said Dr. Shivaraman.

“No Doctor. I do not like children.”

“So, explain to me how your day goes by.”

“Doctor, my servant girl comes by seven in the morning…”

“You have a servant?”

“We have three. One girl sweeps the house and cleans the bathrooms, another one does the cooking and washes the clothes. There is a man who help with the purchases- vegetables and groceries.”

“Three servants and how many people are there in your house?”

“Two of us. Me and my husband. They stay with us so are available the whole day.” She said pointing at Sarath sitting next to her. Sarath smiled at the doctor and wiped the sweat from his brows.

“This is what I want you to do. To start with I want you to send your servants home by lunch every day.”

“What about the work to be done?” said Shalini.

“You can start doing some of the work at home. The problem you have is that your body does not have any exercise.”

Sharath was looking at his wife and smiling at the doctor’s comments.

“I meant both of you. You can start by reducing the working hours of your driver. There are a lot of places in the village where you can walk and reach. You do not need to travel everywhere by car.”

Now Shalini was also smiling.

Dr. Shivaraman had an unconventional way of treating his patients. He reduced the dependence on medicines and advocated more exercise and a healthy diet.

“This is the impact of modernization that people in a small village like Neyyarinkara are being affected by obesity and blood pressure.”

“Father, you always needed a place to implement your idea. Now you have got your lab and your test subjects.”

Dr. Shivaraman smiled, “After all it is for their own benefit.”

Every day of the week Rukmini would return from the school by one forty. The house was a ten-minute walk from the school. She would reach home, have a bath and then father and daughter would sit down for lunch. With Dr. Shivaraman ‘s ‘practice’ now flourishing that schedule looked difficult to maintain. There would be people standing outside the house when she would return. She would lay the food out on the table but the chances of Dr. Shivaraman coming to eat it was remote.

“Father are you planning on continuing the practice.”

“Do I have an option here. The people are just not ready to listen to my excuses. It has been years since I practiced medicine. At the hospital I was managing the staff, setting up the duty roster and granting leaves. That type of work done over years dims the mind. I have forgotten the names of most of the medicines! What I am doing is ethically wrong. I tried explaining all this to the villagers but they just do not seem to understand. For them I am a doctor – an allopathic doctor and that is all that matters.”

Somebody was knocking at the door.

“I am coming. Just having my lunch,” said Dr. Shivaraman shouting. He was chewing at that time and ending up coughing.

“Father you will have to set up proper consultation timings. Read up on your medicines and yes most important of all buy some basic doctor equipment – a Stethoscope, a thermometer and that thing which is used to measure blood pressure,” said Rukmini.

“Sphygmomanometer,” said Dr. Shivaraman.

“Yes, that too,” said Rukmini.

Dr. Shivaraman finished his lunch, washed his hands and came out and saw a young man waiting for him.

“Sorry Doctor. My name is Balan, I am a medical representative. Please can I have ten minutes of your time?”

Inside the hastily converted consultation room of Dr. Shivaraman the young man spread out the medicines from his bag on the table.

“Sir, this is my card. This is the list of medicines manufactured by the India Medical Pharmaceuticals company. We offer a commission of …”

After half an hour later when the young man left another man came barging in.

“Sorry sir! I need two minutes of your time. I am from Relief Pharmaceuticals. I am their area manager for sales. This is my card. When you recommend my companies medicines you get a commission of ….”

That evening the last patient left by about eight. Dr. Shivaram had a supply of medicines on his desk. He had cards, calendars, brochures and stickers from various medical companies.

“This profession has become a business,” said Dr. Shivaraman as Rukmini washed the dishes in the kitchen.

“Father does that surprise you?”

“I know, I know child but this is no way to work in the medical profession.”

“So, what are you planning to do about it?”

“I am yet to decide what needs to be done.”

Balakrishnan Pillai was the Panchayat President. The Panchayat was the local government body. He was in his sixties and had been a member of the village panchayat since his twenties. As he climbed up the steps of Rukmini’s house, she was rushing out.

“Are you late for school, teacher?” said Pillai.

“No, I have asked a few students to come early. We have organized special classes for them. Some of us teachers will be taking special classes for students who scored poorly in the last exam.”

“That is a good initiative. Please convey my regards to Raman Kutty, your head master.”

Rukmini smiled, nodded her head and ran out.

“Your daughter is hard working and sincere. Raman tells me so,” said Pillai.

Shivaraman beamed with pride. He said, “I know. So, what does the Panchayat want from me.”

“Ah yes! Let me explain why I have come here this morning,” said Pillai as he settled down in a chair in the Doctor’s room.

“Doctor! First of all, on behalf of the villagers I would like to thank you for starting your practice. Govindan Vaidyan is getting old and half the time is not very coherent. The people you have been treating have been talking and they are recommending you to their friends and family members. Now the panchayat has decided to submit a proposal to the government to start a full-fledged hospital in the village. It may not be big but about ten beds to start with but it will be a start.”

“That is a good idea. Let me know how I can help?”

“Ah yes there is something you can do. You were a professor at the Medical College. You are practicing as a Doctor. You can help us draft the letter to the government. We will need your help to come out with the proposal.”

“Definitely, I am at your service.”

With the state elections due in a year’s time, the proposal as drafted by Pillai with inputs from Dr. Shivaraman was approved. Funds released and work started on the construction of a hospital. It took two months to be completed. The local member of the legislative assembly the M.L.A was called to inaugurate the hospital. The hospital had a full time doctor a few nurses and some basic medical equipment to help with the treatment of patients. People flocked to the inauguration function. Post the function most of the villagers lined up for a checkup. Work at the hospital began in earnest.  That same week Govindan Vaidyan the village Ayurveda expert passed away. Among the few people at his funeral were Dr. Shivaraman and Rukmini.

After the start of the clinic, the people coming to visit Dr. Shivaraman reduced drastically. Not that he minded it. The few who came included Sharath and Shalini. The couple had taken the doctors advise seriously.

“Doctor, we have started going on a morning walk,” said Shalini. She had lost a lot of weight but was still way above the acceptable body weight.

“Sharath you have lost some weight. So how does it feel?” said Dr. Shivaraman.

“I feel lighter doctor! Every morning we walk for about a kilometer. It is not easy but we try.”

“That is good. Being healthy is a state of mind. You do not have to take medicines to feel better. Do you still hold me responsible for reducing your driver’s duty hours?”

Both husband and wife laughed.

“Doctor, I promise you in a year’s time we will walk up to your house. That will be two and a half kilometers either way from our house, but we will do it.”

“I will be waiting at the gate to receive you.”

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