Cancer tales 6: The cocktail of delay

© Dr. Sujeet Kumar

How many times I need to tell you to call the doctor, yelled the mother.

Father reluctantly picked up his bicycle from the front yard of his semi-pucca house and paddled it to another part of the village and stopped in front of a house. The house was a double-story designer house with high fencing and iron gate – only one such in the village.

He banged the Iron Gate somewhat loudly. Realizing the loud thud of iron he toned down his next two knocks on the door. After every knock, he peeped through the grilled upper part of the Iron Gate.

The village doctor came up to the gate – a 40-year-old man dressed in a shiny white vest and chequered blue lungi. He said, Ramveer what happened? Why are you so tensed?

Sahib, my child has got a fever again and he is crying in pain. I would be grateful if you accompany me and see him once. He needs some medication.

He got a fever again! Had seen him playing two days back. Ok, you cycle your way back home. I will get dressed and come to your home in ten minutes on my motorbike. Doctor Sahib went to his room, put his shirt and pants on, picked up his black suitcase, and came out to his garage. It had a cycle, a motorbike with “Rajdoot” printed on the oil tank, and a brand new car called Maruti Zen – all three shiny and dust-free as if washed more frequently than used.

He tied the black suitcase on the back seat of his rajdoot with elastic rope and kick-started it. The bike had a typical roaring sound, more coarse than modern-day motorbikes but less than that of a Royal Enfield. This “roar” was familiar to villagers and it was synonymous with – someone in the village is sick. Louder the roar, sicker the patient.

Mother ran to her door hearing the approaching roar of rajdoot. She said hurriedly to the doctor before he could untie his suitcase from the back seat – doctor Sahib, please do something so that my child gets rid of this disease completely. The fever is coming back again and again – it has come back three times in the last two months.

Father takes the suitcase in his hand and all three enter the house. A small child covered in three layers of the blanket was lying on a cot. The mother removed the blanket partly to uncover a child’s head and chest. He was drenched in sweat and wincing in pain. The mother immediately wiped out the sweat from the child’s forehead and said to the doctor – make him pain-free and make him disease-free sahib.

The doctor opens the suitcase and takes out three glass vials and loads the contents of each in a syringe and prepares to inject into the child. The observant mother interrupts him and says – sahib last time also you had given three drugs but the disease came back, are these drugs different from last time.

The “Doctor” now keeps the loaded injection down and says – Let me tell you clearly, the injections I am giving will reduce his pain and make him fever-free. I don’t know what your child has but looks like some serious disease. You need to take him to a doctor in the city.

The father interrupts ‘Sorry sahib’ you are our only doctor and we trust you. For generations, your family members have only been the savior of this village. I am sorry on behalf of my wife – she asks a lot of questions (frowns at his wife).

No! You need to visit a doctor in the city, his disease is now out of my hands and expertise – said the doctor. He picks up the loaded syringe and says, till you visit the city this injection will make your child comfortable. As he picks himself and his suitcase up, he utters – you really need to hurry to the city doctor.

The child got immediate relief from pain and this brought some smiles to the face of parents. But buried deep to the smile was worry imparted by the doctor’s words “he might have some serious disease”. The father assures the mother that tomorrow morning they will head towards the nearest city called hazipur – 50 km away from the village.

Hazipur is a small city and nearest medical hub of that area – a hub accessible to poor patients – a hub where the rickshaw puller decides which doctor you visit – a hub were pathology labs are run by only technicians – a hub where every lab report is given but not all tests are done. It is just a stopover to the next big city – the capital town “Patna”. However, only a few of these poor patients are left with money and will power enough to reach Patna after this stopover.

The father with bag hanged by his shoulder and the mother with child rested on her right shoulder came out of the bus at the bus stop. The family steered across the swarm of rickshaw pullers only to be poached by one of them. As the trio was getting seated on the rickshaw the father said – take us to some good child doctor.

The rickshaw puller took them to a doctor’s chamber and introduced them to the reception. He charged 20 rupees from the father for transport and asked the father to go back to the rickshaw and unload it. While the father moved across towards the rickshaw to bring his wife, child, and bag the rickshaw puller moved across to the reception again.

This is the 10th patient that I have brought to this clinic this week and you are stuck with the same old 50 rupees per patient payment – the rickshaw puller argued with the receptionist. Others are paying 75 rupees per patient and if you don’t make it comparable then I will be forced to fall for a better deal. The loss will be yours – warned the rickshaw puller. Ok, we will increase it from the next patient – replied the receptionist. The rickshaw puller left the counter.

The child was admitted to the hospital there and after 5 days of treatment and investigations, he was referred to a tertiary hospital in Lucknow. The doctor had informed the father that child has blood cancer which can only be treated at that center in Lucknow. The family somehow gathered money and courage for the next stopover and after 10 days of struggle got an appointment in that Lucknow hospital where they first encountered Dr. Ankit in OPD.

Save this child sir – said a 40-year-old well-dressed man who had a couple standing behind him with a child rested on mother’s shoulder. Ankit looked at them as they entered the room and approached him. The stark difference in man’s attire and overall appearance from the rest three was distinctive.

Sir this child has blood cancer and hence he has been referred here. They are the parents – he said pointing towards the other two. The child had a recurrent fever for the last two months and now he has become weak also. The blood reports say that he has blood cancer.

By now Ankit knew that the man describing the child’s condition has some medical knowledge and he didn’t belong to the family so he interrupted – But who are you?

I am an allopathic practitioner and practice in their village. I came with them to accompany and help them as a fellow villager.

So you are an allopathic doctor?

No, I am an allopathic practitioner and practice in the village. I am not a doctor – the man said with hesitation.

The child’s parents were surprised and their eyes had astonishment – the father wanted to interrupt the conversation but kept himself silent. He wanted to say– he is the only doctor to help us in emergencies and he is the only one for at least 20 such villages in that area. He is our doctor and he is our village savior.

So you are not a registered medical practitioner?

No, I was a compounder in my 20s and gradually learned to manage some of the common emergencies and then started practicing in my village. I know it’s wrong but what else the people in that area do. The nearest doctor they would get is 20-25 km away. I know some common drugs and they work well in common emergencies. I call them – the cocktail.

He went on to explain in detail – the cocktail consists of diclofenac, paracetamol, Phenergan, and finally a steroid. The combination works in most cases and when it doesn’t, I refer the patients towards the city. Even if doesn’t work, it gives some sort of relief and time so that patient can go to a city hospital.

But why did you accompany this child?

The man then turned back and looked into the eyes of the parents and made some gesture – the parents immediately left the OPD room with the child.

The man continued, sir frankly speaking I think the child’s diagnosis was delayed because of me and if I had not accompanied to help them – I would have lived in guilt. I might be indulged in the unlawful practice of medicine but I don’t consider my practice immoral – after all, it helps villagers and it works most of the time. If an RMP would have been there – I would not have been there. Sir, you must agree – Some medical care is better than no medical care.

The argument put forward by “allopathic practitioner” was something which couldn’t be brushed aside and hence Ankit focused on Childs diagnosis – after all, there was a long queue of patients waiting to be seen.

So this child has received your cocktail?

Yes sir, 2 times in the last 2 months.

Do you know why the child responded to your cocktail in spite of having blood cancer?

No sir

Steroid my friend – steroids, you need to be careful with these drugs – these work partially on blood cancers and make the patients feel better and so they delay the diagnosis which actually is harmful to these patients.

Sorry sir, but I hope the matter is still within control for this child – I have promised his father financial help and I will bear his initial treatment cost. After all, he is from our village and his child is my child.

After consultation when they were leaving the OPD room – Ankit said to the “allopathic practitioner” –  “Some medical care is definitely better than no medical care”. Ankit had many things to say to the “allopathic practitioner” but he held himself back for the fact that – who in this world goes on to help even after realizing the mistake?

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