MSM Musings

Mens Sana Monographs, III:6, IV:1-4, Mar-Dec 2006

Childhood Buddy Hangs Up

'R' really was special. Shouldered the responsibility of a business family at a tender age. Worked over inefficient estate management by elders, saw to it younger siblings were settled, sacrificed youth to bring up business and family. Enjoyed friends, drinks, driving.

We were childhood buddies from the same town.

I had met him a couple of months before the incident. It was after nearly a decade. At a chemist's shop. He was buying medicines. Antidepressants. I asked him what happened. He had tears in his eyes. There was no flicker of the customary light on his face I had known so well. The smile that usually sparkled in his eye as he met an old childhood buddy had vanished.

I could read the distress. I shook hands and told him to meet me in the clinic and we would sort it out. Depression is perfectly treatable, I said. Did you undergo psychotherapy. No, he said. Only drugs, but felt better. Some thoughts bothering you, I asked. Yes. Why not talk to your psychiatrist, I said. He thought for a moment, a long moment. I had never known 'R' to take that long to decide. Finally he said he would come and meet me in my clinic.

Suddenly 'R' was dead.

Died by hanging.

I wondered what went wrong. Would I have saved him if I had got over my professional reserve and insisted he come for treatment? Was he really taking treatment with someone, or just self-medicating himself? I know he listened to me. If I had phoned him up, or his parents, and told them: nothing doing, I want to see 'R' well. Let him come to my clinic. Would that not have given him a chance to survive? Or even if he did commit the act, it would not be from want of trying.

Some days later. As I neared his house while I was going to a neighbour's, I looked up at the forlorn structure. A grim board outside said, "Trespassers will be prosecuted".

What about the late owner, who prosecuted me since I could not trespass a professional limitation: don't solicit patients.

Ajai Singh

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Preview Of Forthcoming Musings

Footprints to follow

Some two decades ago, I was travelling in a bus for a conducted tour of some scenic spot for which organizers of annual conferences of psychiatrists used to take delegates. Sitting with me was the area manager of the pharmaceutical concern that, if my memory serves me right, had sponsored the tour. As the bus journey took some time, he got talking, and we came to the topic of doctors and rep’s visits to them.

Well, it was a chastening experience in more ways than one. Doctors always have a rather patronizing attitude towards rep’s visits, which the latter know very well. But are ready to play along, nevertheless. It’s a great ego massage for some of the docs to smile condescendingly as reps detail products, and enjoy their sense of superiority as reps play ball sportingly. The poor guys often wait hours outside non-ac waiting halls of consulting rooms/clinics, uncomfortable behind tie scratchy stiff colors, but still manage the easy smile when their turn comes to enter the clinic. And play ball even if some doctors call in three at a time, and talk to the other two while the third is detailing his product. There are some who expect reps to come by 9 pm but they can meet the doctor only after 12 midnight, after he has finished all his patients. And one of them tells them to continue detailing his product, as he is busy counting his day’s cash collection. As he finishes, the rep is supposed to quietly leave his samples, gifts etc on the table. And his departure is greeted with a gruff ‘huh’, the only concession the doctor gives to any presence beyond the important task of cash counting at hand. For the cash has to tally, and the pretty receptionist has to leave, since it’s already so late. And her smile as she leaves is more important than the smiling rep’s detailing, samples, gifts etc. For they are to come on the table, anyway. And his smile is unconditional, hers isn’t.

What struck the young consultant in me, then, was that it’s not that reps don’t understand our patronizing behaviour. But they are trained (or have learnt) to ignore it as they have a job at hand. What also struck me was the fact that doctors’ idiosyncrasies, their unrealistic demands for gifts and sponsorships are tolerated but discussed in the medical rep community with open glee. Something the docs don’t probably know, since the reps are always properly respectful to them. So I decided to behave myself with them always, something that reps who know me will vouch for.

Something else struck me too. As my friend talked about the funny things that docs do, he came to one of them. His voice mellowed with respect, his face was suffused with almost a reverence. I can still remember the expression on his face as he talked about him words to this effect. But there is one doctor who never behaves badly with us. He takes no gifts or samples or sponsorships. He talks caringly with us, even sometimes asks about our welfare and if all is fine in the family. All of us in the rep world know how good he is, and we all respect him. And there is only one of this kind in the whole of Bombay.

I remembered the big stock of samples lying unused in my clinic, which I had a problem accommodating but could not also throw away. I remembered the glossy calendars that adorned the walls of my home and clinic, courtesy the same pharmaceutical of which he was the area manager. I remembered the gifts of bags, pens, clocks, wallets, ties, display items, bric-a-brac, which occupied my table, and my house. I remembered the joy with which I would look as the med rep plunged into his bag after he had detailed his product and placed his samples on the table. For that last plunge meant he had something extra to offer. The magician conjuring the candy to please the child doc.

One doc had none of this.

He had said there was only one of this kind in Bombay.

Well, there was a second that moment onwards.

Ajai Singh

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Psychiatry And Its Critics

There is something about Psychiatry that attracts the most vehement protests. No other branch of medicine sees such vilification heaped on it.

And yet, those who are in the system know they are doing the best thing possible for their patients/clients. And it is the one system that is most open in discussing what needs to be improved about it. While most other systems of medicine would dismiss most protests with a shrug, psychiatry is one branch that considers ethical issues, sometimes almost to the point of becoming paralysed for action.

Every psychiatrist knows the benefits of ECT in selected patients. Every psychiatrist knows how psychopharmacology has revolutionised patient care. The grateful patient who has been saved from suicide, who has got rid of his delusions/ anxieties/phobias to lead a productive life is so very well known in psychiatric practice. The whole problem is patients who get well do not talk. They go on with leading their lives, and often want to hide their psychiatric history for fear of stigma.

It’s a rare instance that a man would speak as eloquently about his psychosis and how he got rid of it, as he would about his recent bypass, or appendectomy, or whatever.

It’s not that treatment failures do not occur in other branches. But they are accepted as part of the process. No one wants them. But no one dies a thousand deaths over them. However, in psychiatry, its opponents trumpet every treatment failure so loud as to scare so many more who would greatly benefit by it.

What do we do? Nothing, maybe. Or, go on doing our bit to the best of our ability. And think of the grateful faces of those helped. And wait for saner counsel to prevail in the less charitably disposed.

Maybe it is also time for those who have been helped by psychiatry to speak up.

Ajai Singh

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