Sunday, November 24, 2013

hyderabad deccan chronicle 10K 2013

Hyderabad Deccan Chronicle 10 K 2013
I almost thought the Hyderabad 10K on 24/11/2013 would be cancelled. What with the inclement weather and cyclone Helen! Fortunately it did start albeit a few minutes late. There was no sunshine (nice) the aid stations and medical stations were adequate and well manned. Really good organization!
Most of the Hyderabad runners were in the “elite category” and the “rest” of us ran with the “jungle” (did I hear the compere right?”) crowd.
There was no Zorro but an “Anna Hazare” made his appearance shouting “Jai Mathaji Ki!” I thought he said “Jai Mathaiji” so I smiled and took a photo with him before I realized my mistake!


Saturday, November 16, 2013

making a doctor

Making of a Doctor

The nephrology and urology departments were housed in the basement. The nephrology part was not so bad; It housed a heterogeneous collection of enormous (swollen with fluid) patients of both sexes.  Most of them had chronic renal failure for varying reasons. The ones who had acute renal failure either died or recovered quickly with dialysis. The chronic cases  were given  medications as they awaited kidney transplant. Those were early days, relatives were coerced into donating kidneys, there were no “rackets” and the success rate was low. Steroids were the mainstay of therapy, and across the board (male, female, young ,old) they were moon faced and hairy.
The other section was filled with men, most of them old with prostrate problems. Some came with acute retention of urine, crying as their bladders painfully filled up with urine they could not void. The whole place smelled like some one had emptied a can of urine on the floor.  Most of the girls did not enjoy their posting there. Personally if I was not obsessive- compulsive about attendance, I would have gladly have cut the posting altogether.
The urologists, (almost universally male), were want to crack jokes which were so far below the belt that they were practically on the floor.
“Why do antibiotics not work for vesicovaginal fistula?”
(Women sometimes unfortunately developed this injury in childbirth. A communication developed between the vagina and the bladder and they dribbled urine all the time. They also developed frequent urinary tract infections. This had to be repaired surgically. The success rate was low and repeated surgery was often required.)
The correct answer to the question was “Because there is a tigress living there (resistant bacteria).”
“Why did it rain in the circus tent? Because the trapeze artist had a watering can perineum.” (A urethra with multiple perforations)
Why  is the prostrate enlarged? Not getting enough sex!”
We were also forced to watch a torturous procedure called “trans urethral resection of the prostrate (TURP). It was done through the penis, no one except the surgeon knew what is happening, but we had to stand around in the air-conditioned, anaesthesia gas leaking theatre for hours on end. It made me sleepy and sometimes I wheezed. A few of my class mates ran away to the “surgeons lounge” and slept there. Some ran away altogether and indulged in caroms and cards in the rest rooms.
Anyway we survived. Since it was not a separate subject in MBBS examinations (it was a part of surgery), a rudimentary knowledge was enough. Or so I thought ( a big mistake!)
When  I reached internship, we were posted in a surgical unit with a deaf, misogynist bachelor, a frustrated urologist. He insisted that every male patient admitted for any surgical procedure have an evaluation of his post-void urine volume and then a phenol injection into his prostrate through the perineum if the volume was more than 100 ml. The whole procedure was disgusting to say the least. The patients were not subsequently followed up, so no one really knew if they recovered, developed atrophied prostrates, cancer or died from the sheer pain of the injection.
“We are doing a service to mankind”, he explained, “these people will not develop benign prostatic hypertrophy (BPH) as they age. They will not need surgery in the urology department later in life. (That seemed to be a major incentive.)
This was before the time of proper medical studies double blind with 10-15 year followup. He was a famous surgeon and  his word was law. None of us questioned his logic. We did not read up about it either. There was no internet. Questioning his order meant a long trek to the library, a request to the librarian for journals, a few days wait and then reading relevant or irrelevant data. After which, the lion had to be faced in his den.
Many years later I did look it up.  Apparently, it affects 90% of men by the time they are eighty. The risk increased with obesity, diabetes and decreased physical activity.  The risk factors seem to describe most of the  middle aged men in India, so perhaps the injections were a good thing.  Maybe there really was a dip in the surgery rate for BPH for the next 10 years and now that no one is going around injecting prostrates, there is a resurgence?
The rest of the posting involved mundane procedures like surgical repairs of hernia and hydrocele. There was also the occasional adult male circumcision. (The children went to paediatric surgery). We were allowed to do these procedures as they were considered “minor,” and they were sent home within a day. There is nothing really minor about any surgical procedure. Also, no one really told us how much skin is cut off during a circumcision.  The ones my batch did showed varying grades. (Some had no skin a left at all, others had plenty). An enthusiastic classmate even nicked off a bit of the tip of the penis. The patient returned after surgery to enquire about this, and was told that that was what the surgery was meant to be!
We got away with many things, but I guess “hands on” is the  only way to learn!

Dr. Gita Mathai
The writer is a paediatrician with a family practice at Vellore.
If you have any questions on health issues please write to




Monday, November 4, 2013

frog tales

Frog stories
I have always hated frogs, they are slimy and look disgusting. They have enormous eyes which rotate in all directions. Above all, they have no fear of the human race, they tend to run straight at you instead of away. (What if God forbid one jumped up my clothes)? If they get into the house they hop into cupboards and sit there waiting to jump out and give you a fright!
I had a distant relative, a very bad tempered old man, who lived by himself in an enormous house in Kerala. His wife had died many years ago, and his children lived abroad. One or the other sporadically went to visit him. His sister lived fairly close by and she dropped in about once a month to make sure he was not dead. He lived a lonely life for which he blamed everyone else.
My mother insisted on visiting him when we went to Kerala, so I was deputed to escort her there.
The garden was gloomy and dark, the sunlight completely excluded by tall trees. Even though it was midday, there were frogs everywhere. I developed a paranoid fear that they were going to climb up my leg. Just near the door of the  house was a grinding stone. A snake slithered out of that,  grabbed a frog and proceeded to swallow it whole. This was too much for me. “Lets go” I said to my mother, “this place is creepy.”
The door opened abruptly and an enormous shapeless blob of flesh with warts all over appeared with an iron rod. He beat the snake mercilessly till it died. “bloody monster” he said, “eating my frogs.”
He caught sight of us and said ,”come in, chechi, I didn’t see you.”
The last thing I wanted to so was go inside. He filled the dark damp hallway and eventually led us to a musty drawing room. The chairs looked mouldy so I sat gingerly at the edge of a bench. My mother  had astigmatism and cataract in both eyes. The lighting was ideal for her. The place looked dim and clean to her.
“Would you like some tea?” He asked and then added “I have to make tea, but there is brandy in the cupboard.”
We politely declined. My mother softly, me vehemently. “I only came to see you” said my mother “we don’t want anything”.
“Then you won’t mind if I have a brandy.”
It was only 6 pm but I made a polite grunting noise. I was trying to keep the frogs at bay. I was holding both my legs about a foot off the ground. My hips were beginning to pain and my thighs were going into spasm. I just wanted to leave before the next snake made its appearance.
He brought out a brandy glass and poured an inch of brandy in it. Then he placed a saucer on the ground and poured a little brandy into that.
“Who is that for?’’ I enquired.
“David.”
There seemed to be no one else there, but after a few minutes of hoarsely saying “David,” an enormous toad came out from the crevice behind the cupboard. It went to the saucer and flicked out its tongue. “He loves brandy,” said the old man. “After that I give him raw chopped chicken liver.”
They looked eerily alike, size, skin, eyes, demeanor, posture, warty skin  and pitch of voice. “Lets go, “ I said to my mother. By then she also wanted to leave.  It  was along walk to the gate and the car. God only knew what creatures we would encounter along the way!
“Do you think it is cruelty to animals?” She asked.
“What is cruelty?” I said.
“Feeding those frogs brandy, encouraging then to take over his house, giving them chicken, aren’t they supposed to eat live flies and mosquitoes?”
We never went back there. I was not really surprised that his children didn’t go either. Finally a few years ago I heard that he had been admitted in an old age home. He had developed dementia, probably worsened by the fact that the home did not allow consumption of alcohol in any form! He was heartbroken because they would not allow David to come with him. Apparently he wandered around searching for David saying “he never leaves me , where has he gone?” 
Dr. Gita Mathai
The writer is a paediatrician with a family practice at Vellore.
If you have any questions on health issues please write to