Approximately 10-15% of the patients who come to NIMHANS are Tamil speaking. So there were days when I would see exclusively Tamil patients. From this cohort of people, there are a few that stick out in my mind.
One was a young man with a genetically transmitted neurological disease which causes progressive physical disability without affecting the mental faculties. His father and uncle had the same disease and had died as relatively young men. He had known since adolescence that he was heading down a similar path but didnt seek medical attention until recently, when he didnt have the strength to carry on with his job. This man highlighted the financial realities of life in India. He adjusted as best he could with disabilities until he was physically unable to work and then his brother probably had to incur debt to be able to bring him to Bangalore to see a neurologist. In his case unfortunately, there is no effective treatment. In Australia, we would treat a patient like this with physiotherapy to maintain some minimal level of strength and orthotics- devices designed to assist the function of movable parts of the body. But this would be ridiculously expensive in India and there was no way this guy could afford it. So he was sent home with vitamin pills.....
Then there was the guy who was roughly my age who came with some sort of wierd seizures, which happened to occur in really dangerous places- when he was standing on a train all three times. So he had basically nearly died 3 times!! Those of you who have travelled on Indian trains will know why (of course, if its a packed Chennai or Mumbai train then its a bit safer). This was a middle class man, so he was actually better off compared to most of the people one sees in public hospitals in India. But i remember him because it could so easily have been one of my cousins, or even me!! I feel a stange kinship when i see people my age in hospitals, whether in India or Australia. Its because of the underlying feeling that people my age dont belong in hospital. So its daunting to think "what if that was me??".
The alcoholics are also an odd bunch. There are SO many alcoholics in India, particularly Tamil Nadu. In NIMHANS I just saw the neurological consequences of alcohol abuse, but in the General Hospital in Chennai, I saw the whole range of disease caused by alcohol. There is so much end stage liver disease and liver cancer in India, it is mind-boggling. And most of this happens in young men, 30-40 years of age. The youngest man i saw with liver cancer was 23!! He obviously had factors other than alcohol contributing to his problems, but still........
Perhaps even sadder than the alcoholics is the mess they leave behind when they die. There was no end to the women i saw, widows of alcoholics, who would come with various illnesses, and their children who suffered from psychiatric-type illnesses. And they all have the same story. Husband was an alcoholic, spent everything on drinking, left them with nothing, they struggled for years, and they get sick. Their kids changed the day their husbands died and developed all sorts of mental health issues, which often manifest as "pseudo-neurological" symptoms. What do you say to these people?? I had no idea. I dont know exactly what i said, it cant have made too much sense, but these people wait on every one of your words and thank you for whatever you do or offer.........
Then of course, there was the young girl who was a mystery to us all. She had some strange disease which nobody had ever seen before. Everyone of course, had their own opinion, but no one actually knew what was going on. The funny thing with her was that because she was a muslim, everyone assumed she could speak urdu, and hence understand hindi. But muslims from Tamil Nadu arent all urdu-speakers, infact, many of them speak only tamil. There were lots of confused faces when she said she couldnt understand hindi!! But she had a brother who was fairly well educated- he spoke english, making it easier for the majority of the doctors who spoke kannada and hindi, the (other) official languges at NIMHANS.
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