I have discovered something about writing. It has whims and fancies of its own. When you are in the practice of writing most days, the words flow easily, your thinking does not falter and sentences form fast,fluent and effortless. But when you have stopped for a while, for reasons beyond your control, it acts like a spoilt tantrum throwing brat. You have to really scratch your brain about that particular flash of inspiration which occurred yesterday, right in the middle of a busy opd, which evaporated miraculously like the whiff of an agarbatti smoke. It is as if your writing has gone into a huff, for not giving it enough time!

This is the state I found myself in last month. A month of busy, busy work days, the responsibilities that go with being an exam mother (by which I mean revising with your kid, subjects which you tried hard to avoid studying into adulthood), trying to teach my younger one to read by herself and the general business of keeping house – all of which allowed absolutely no vigour or brain space to open my laptop.

At the end of the day, the only energy I had was enough to flip the pages on my kindle, and so, that’s what I did. I read some amazing books- those that made me happy, sad, upset and in awe of things they spoke about.

The oneswhichhad adirect impact were Em and the Big Hoom by Jerry Pinto and the Book of Light.

On a day to day basis, I see a range of emotions (from anger to over protectiveness) shown by the relatives of my patients. Some are shocked to realize that their relatives are mentally ill, some refuse to acknowledge it and some firmly believe that their son or daughter is showing symptoms to cop out of some responsibility. When I am talking to the family about the actual nature of the illness which their closest of kin are suffering from, I usually discuss it with the adults, and the children are generally playing around in my consulting room. I surprisingly realized that I have never ever discussed the illness from the child’s point of view. A vibrant impressionable mind, which is in confusion about why their favorite adult is behaving somewhat differently and unpredictably from the rest.

Which is why I found Em and the Big Hoom a very interesting read. How would a child feel, when a parent is mentally ill? When the caretaking becomes a child’s responsibility instead of the other way round. When it is difficult to expect your parent to attend your school functions or pta meetings for the fear that he/she may do something embarrassing.

The story revolves around the author’s family whose the mother suffers from bipolar disorder.  The book is written from a child’s point of view, and tries to address the concerns which are unique to such families. Have they inherited the illness? Will they become mentally ill like their parent? Or will it skip a generation and affect their children? Or are they, at the other end of the spectrum,  accepting the adults as they are and ignoring the quirks?

Going through the book, gave me insight about a huge chunk of responsibility I was ignoring! As for many other mental health professionals, though time is tight, I promised myself that I would spend some time for these children henceforth.

Going on, I read another book, written on the same lines. The Book of Light, which is a collection of stories written by the relatives of the mentally ill about their experiences in life. There are very few books written about mental illness in the Indian context, and hence this book gives an idea as to how the people from different sections of society deal with the illness and the adjustments that go along with it.

If anything, I felt the need to do more, work harder. Not only to help those who are overtly ill, but also those who are silently suffering on the side.Or confused. Or slowly slipping into an illness themselves.

Only if there were more than twenty four hours in a day! (and no math exams!)

 There are many cliches associated with being doctors. The near dictum that doctors are next to Gods. That practicing medicine is a noble, respectable, ideal profession. In the nineties, most children in India, I would safely say, grew up with an idea that their life would be made if they became doctors, or engineers. It was the rare parent that would allow his child to choose a profession apart from these two.

According to a recent study by the WHO, despite medical schools mushrooming all over India, we still are short of doctors.  The state of a patient in rural India, who needs some form of emergency medicine is still abysmally bad. So,yes,we do need doctors.

But suddenly, it almost feels like doctors are everyone’s favorite punching bag. It is as if we are a group of individuals with dubious reputations, unscrupulous, unethical and those trying to make a buck out of the poor patient’s pocket.

It is therefore probably the right time to remind ourselves that medicine is, basically, just another profession. Yes, compassion is important, as well as a sense of responsibility. But then, those with an aptitude for both should not have difficulty in finding their way into this field, just as someone with good computing skills takes up computer engineering. To deglamorise, doctors study five and a half years for a degree which tells them how tackle certain ills in a scientific manner. We do not claim to be Gods, nor are we the devil reincarnate.

I do agree that there is a lot going wrong with the practice of medicine in India. But these wrongs mainly stem from a flawed, aged, system rather than the individual doctor.

Children as young as seventeen, I believe, rarely have the maturity to realize the seriousness of a profession like medicine. In the west, medical school would be an option to only those with an undergraduate degree under their belt. I personally know of kids who take up medicine because of the glamour associated with it or because of parental pressure. When you choose a profession for the wrong reasons, the outcome seems near obviously bad.

The presence of corruption in a system which deals with life itself. In conversation with one of vice chancellors of a medical school, I get to understand that the seat matrix in any medical school across India is decided by how many palms are greased rather than, how good the patient student ratio in the teaching hospital is. We see around us a number of med schools where professors exist only on office papers, and the teaching hospital needs to be filled with fake patients who are hired during MCI inspections. We PRACTICE MEDICINE. And where the practice of teaching is poor, the confidence of a doctor to handle a patient is obviously poor.

The weird attitude that once we choose to become doctors, we, as individuals, need to give up on material gains. The salaries of doctors in rural service is pathetically low for the amount of risk that they take. To quote Atul Gawande in his book, “Better” ,doctors in rural India are the most innovative and efficient. They need to work with patchy electricity, minus specialist help, have to work against unhealthy  but traditional practices to the convince the family to get the patient treated. Hence, they learn to work with enormous amount of common sense. But, the rewards materialistically or otherwise are poor. They have poor roads, horrible infrastructure, no legal aid, their children have no good schools, due to which they would have to be sent away for their education. All the while, when media glaringly shows them, that their counterparts, with half the years of education, are earning fat sums, driving the newest eye candy, spending time in malls, living in penthouses, working in centrally air conditioned offices and sending their children to international schools. Who in their right mind would choose rural service?

As doctors we ultimately deal with lives. And people. And people with a million different personalities. And these personalities, when they are under stress of illness. But nowhere in medical schools are we taught the importance of good communication, on dealing with grief, on being calm during periods of stress or emergency. It is as if we are expected to magically source this information from some place in the universe and imbibe it. The art of counseling, is not hereditary. It needs to be taught. And as my dean in med school, Prof. Dr.B.M.Hegde would quote, doctors, needed to be trained to “cure rarely, care often and comfort always”. Poor counseling skills, automatically translates to poor patient care.

Law concerning self protection, medical insurance and negligence are alien subjects when we study medicine. We only get to hear these terms when we land, slap bang in the middle of a controversy. We do make mistakes. We are human. But, mostly the health of our egos and our bank balance depend on the good health of our patients. The pleasure we get when we see a critically ill patient walk back home with a smile on his face, is probably what keeps most of my fellow doctors in the profession, despite the grueling hours and non existant social life. Hence, if we were to be taught what to do when we err, we would definitely tread with more caution, rather be caught on tv appearing like a petty criminal.

If we are a society concerned with health, then we have to understand that we have an individual responsibility towards our health. Poor lifestyle habits, not following the doctor’s advice and skipping doses, and then blaming the doctor for poor health despite taking expensive medicines is simply playing the blame game. Not acceptable.

To summarize, we need a multi pronged approach to start a change in most of these areas. Able law makers,thinkers, senior doctors and the public at large who should first understand the flawed but totteringly functional system completely. And then attempt change. Only then, we can hope for the health of the country as well as its doctors.  Till then, still happy to be a doctor and enjoying it despite the hurdles!