Wednesday, January 5, 2022


A routine episode in the life of a dermatologist

So, I have a teen with a bit of acne. Yes, most teens do have acne. No big deal you would think. But this particular teen has a dermatologist for a dad and a sharp tongue (chronologically in that order, but in terms of effectiveness the sharp tongue is scores way above the dad).

“You see this one here?” she was ranting, pointing to a small bump on her left cheek  “It’s huge…bigger than your big paunch”

I looked at my paunch and then the zit on her face. I was pretty certain the paunch was bigger, but well…

My wife who was eyeing the interactions on the sidelines was about to grab the opportunity to join the conversation and steer it towards the more sensitive issue of her husband’s paunch (paunch= laziness X (no diet control+ no exercise)……blah blah blahn…..hence proved). So, I deftly shifted the focus back to the core, national emergency of unresolved acne

““Did you try the gel I gave you?”

“That doesn’t work” At least no one can accuse her of being vague or ambiguous.

“It usually takes a bit of time to work” I said, rolling my eyes

“Well, I was kind of hoping to get rid of acne before I get my senior citizen pension” Sarcasm. Scathing, acidic sarcasm. Wonder where she gets it from. I glared at my wife, she glared back. I looked down. She won. Life as usual.

“OK, I’ll give you another cream, let’s try with that”

She, suddenly rushed to a mirror and started looking at her own face with a wicked smile. Maybe she realized that the acne was not so bad after all. Then she shifts the direction of her wicked smile to me “Nothing, was just checking if I look like a guinea pig. Apparently, the mirror does not think so”

I looked at my bitter half pleadingly for help, assuming that after being married so long she would get the message via telepathy. Didn’t work. No telepathy and not an iota of sympathy for the beleaguered ‘pathy’. The wife on the sideline was  actually smiling wickedly too. Some kind of highly transmissible mutant grin.

Before I could add anything in my defense the bitter half jumped in “Completely agree with her. I have been asking you for a good sunscreen for ages, and everything you give me ends up making my skin all oily and looking worse…. sometimes I think you do it on purpose!”

The thought of messing up her skin purposely did induce the beginning of a wicked smile in my mind too, but considering the volatility of the situation and the  raving lunatic banshees involved, I suppressed my smile.

“Ok, I’ll give you another sunscreen, let’s try with that”

Family déjà vu time

There was a brief moment of silence.

“Maybe it’s not the cream, but the dermatologist that we need to change” Says the mother in a deadpan tone, followed by mutually addressed guffawing between mother and daughter


PS: The most challenging patients for a dermatologist are probably the one’s in their immediate family, especially if they have something on the face. These characters are the ultimate double edged advertising board for a dermatologist. Quite a few of us have a tendency to underplay skin issues of our immediate family, and that is something we should consciously avoid doing. So, I guess, just as charity begins at home, good dermatology care also begins at home!

Monday, November 8, 2021

A guide to dealing effectively with teenagers and other such impossible things

So, the byproduct of my marriage turned teen a couple of years back. This is about the time when you realize why children are also called ‘issues’ (although generally spouses are  bigger ‘issues’!) However, in my extensive experience of about 100 weeks+,  I have garnered some absolutely fool-proof tips to ensure peace and harmony in a house with a teen

Washroom policies - If you take 10 minutes for the shower + dump combo, you are wasting yours and others valuable time, but if your teen takes 2 hours for the same, it’s totally OK because the washroom is one of their thinking spaces. So, if they take extra time there, it is quite possible that they will come out with a solution to this climate change thing. If you interrogate them about shower times, it can and will contribute to global warming. So let them be.   Incidentally never ask your teen the dreaded “Did you do potty today?” question -  directly or indirectly….absolutely unacceptable…...and if you do ask that in public, in the presence of other living humans, then that’s like the end of normal life as you know it…

Public appearances - You are not supposed to accompany them anywhere outside your house and if you do, you are not supposed to be seen and if you are seen you are supposed to act like you are just a stranger who happened to be there. They are not supposed to accompany you to any of your events, simply because neither you, nor your pre-historic dinosaur friends are cool enough for them

Entertainment policies - The TV is one thing you need to be really firm about. You paid for the TV.The TV is yours. Period. Just give the remote control to them. And all will be well. Mobile phones and time spent on social media are also really important and you need to enforce a really balanced approach here. So, if you buy them the latest smart phone, just to balance things, you yourself will need to go for one of those cheaper button phones (on the bright side you can play ‘snake’ whenever you are bored or throw it on stray dog chasing you). If they spent too much time on social media, you need to give up FB and twitter for a few weeks to balance things. ..and oh, anyway insta is not for you don’t even go there…like literally don’t… and if u do, please don’t follow their accounts and embarrass them.

Dress codes - They choose their dresses. You don’t get to comment. They can comment on whatever you wear…and they will comment viciously (and if your teen is of the female kind, a point regarding colors. You think of colors as light and dark, while they have a couple of dozen sub-shades in between for each color. Don’t argue. So, if they say blue is teal,turquoise and some kinda word u haven’t even heard of, they are probably right)

General behavior - Dad jokes, burps, farts – absolute no-nos. If you do lose control with any of these, please follow it up with a ‘I am sorry’, even if you obviously are not. 

Finally, language and gestures- you need to understand their lingo to communicate effectively (at least act like you understand  A detailed exposition is beyond the scope of this write up, but a few important aspects are 

Barely audible grunts – can signify a half-hearted yes, an expression of boredom, hunger or contempt. Work it out according to the context. If in doubt go for contempt. Statistically more likely

‘Duh’  - it basically means –‘you low IQ dad/mom /creature/twit, don’t you know this much?’ 

‘Wassup ol’man’ -  no don’t look if you have messages on whatsapp and don’t look at the sky. If directed  to you, just smile. A ‘I’m good’ can be an acceptable response.

“Chill dude”  no it’s not cold. Basically teenese for ‘shut up’ old man

 Never reply with the words like ‘cool’, ‘chill’ or  ‘dude’ even unknowingly. It would sound really odd coming from your old mouth…something like putting premium petrol in your nano.

Eye rolls- no they are not looking at a lizard on the ceiling. You did/said something stupid. If it can be undone, do it. If not apologize. Eyeroll with sighing and disgusted head shakes – apologize quicker.

Smiles + extremely lovey dovey behavior + actually talking more than 2 syllables – time to check their progress report, dig into your wallet, or both.

No communicative sounds at all for long durations– generally normal behavior. If they open their mouths for food, things are OK. If they don’t,check if the food is good (ordering pizza  often solves the issue)

So, hope that these simple hacks will show them who is the boss.

All the best!

Wednesday, September 29, 2021

Mind your language!

More often than not when you send a manuscript to an American or European journal, and the editor realizes that the corresponding author is desi….a standard comment packed in with the rest of the sophisticated abuse is  something on the lines of ‘The language needs significant revision/ please get it checked by a native English speaker’. So it was interesting when recently we got the same comment, when we actually had a full blooded Britisher as a co-author….I mean, how much more ‘native’ can you get?:)

The material was not really Nobel prize worthy anyway, so we had more or less assumed that the paper would be rejected anyway, but we still swallowed our pride and made some cosmetic changes and resubmitted. The honorable editor did not disappoint a bit. The submission was flushed down the electronic drain promptly.

 Sometimes I really wish I could indulge in a little light hearted banter with the editor in these situations, just for ‘time-pass’.  I would probably incorporate some solid Tharoorism combined with equally solid mallu engleeshu. Things would probably look something like:

“Extremely respected excellency editor saar,

I yam the sworry that my engleeshu not that adipoli. I studied in engleeshu school only, but very humbil and simble school only. So some some  engleeshu and all knowing, but not lot lot. U get point elle? You said to check with the native engleeshu speaker, but regret to inform you that in my native place, all same engleeshu level only. What to do? Sad only. Tharoor saar, u know? He very good engleeshu….much the better than the u england people and americakaaru. Big, big engleeshu (farrago and all….not simbil rodomontade words),but  he native of Trivandrum, myself Kochi. Wife Trivandrum native…but wife not author in this the paper…and wife also same engleesh like me only…maybe little less only (PS : please don’t tell her…if she read this she give me slow death, like the kuzhimandi chor making thing you know) . Manasillayo saar? But u know what the thing saar, one of the co-authors…..he sayippu only, like the you, same native place in the Elizabeth Rani’s place…and very white skin and all. Then how his engleeshu not good. Tell tell. I know that there is engleesh correcting DTP service and all for your journal (we also have same…Akshaya center you know aa?)….but big moneys asking. We simbil people from the Kerala. No moneys….we pay big money for puravastu (antique) u know. Our Monson sir having everything from Judas paisa to rocket fuel.....but we simbil people have  no money for normal fuel only (petrol daily daily jumping like the kangaroo). Sad only. So, like your Shakespeare chettan say, please don’t make the much ado about the nothing and all. Little problems in the writing and just you close eyes and all is the well that ends in the well.

Nanni, namaskaram

Your fatefully

Dr Feroze Kaliyadan


Monday, September 4, 2017

In the long run everyone 'dyes'

Nobody likes looking older than they are and most of us probably don’t like looking their actual age too for that matter. It’s also very difficult to really know when you  have crossed the very important ageing milestone between youth and ‘middle-age’. Sometimes people around you make it easy for you though…..
So, a few moons ago, while on vacation back home in Kochi, I was getting something from one of the local supermarkets. The person at the billing there was a 20 something petite female with a permanent toothy smile and little bit of a squint. As I was about to leave the store, the lady calls out to me in a screechy voice “Ungil, you forgot your umbrella!”
For those not familiar with mallu tongue ‘Ungil’ is basically ‘uncle’ and ‘uncle’ in general, in Indianese refers to any guy somewhere around your father’s age (it may be rarely used for actual genetically related uncles too). If you have not yet reached that tipping age for ‘ungil’,  then you would be referred to  as ‘chetta’ in malluland, which basically is something like an older brother (very important note – the emphasis is on the ‘e’ in ‘chetta’,  an emphasis on the ‘tt’ implies a not so politically correct term).
My vanity was obviously dented. ‘Saar’ (sir) was acceptable, ‘Chetta’ was good….'ungil’ was a bit depressing, to put it mildly. I did do a desperate  360 degree look around me to see if there was some other ‘ungil’ around me…but alas, no…the toothy smile and squinty eyes  were both unwaveringly  focussed on me. No other ‘ungil’. Simble.
I returned home in a huff and made a beeline to the bathroom mirror. My wife as usual noticed the beelining and gave her usual, trained “ Is your stomach upset?” line.
“But, I didn’t try your cooking today darling” Don’t underestimate the meanness of an angry Indian husband.
“Hmmpph” Smart-wife switches into ‘flight’ mode.
I take a deep breath and facing the mirror, try a self  pre-botox/filler evaluation session,  making all sorts of frowning, smiling and sad expressions to see the state of my static and dynamic wrinkles…more of frowning though, considering the not so ebullient frame of mind I was in.
My wife lifts her head buried into her phone, gives me a cursory glance and some vague kind of disgusted snort before going back to her very important WhatsApping session. My crazy 10 year old daughter also passes by curiously, a couple of times, before she  finally stands behind me on her toes and peers into the mirror.
 “What do you think you’re doing” I shot at her
“Nothing papa…with all the frowning I was wondering if mama was in the mirror” with a wicked grin she saunters off. Wiseasses….whole house is infested with them.
It didn’t take too much of mirror gazing and playing ‘who’s the fairest of them all’ to reach a final diagnosis. The hair was the issue…fair and square…fair hair. To put the state of my scalp in parliamentary terms, the whites were not yet in majority, but with a few more defections from the traitorous blacks they would easily form the government in a few years (I wonder if I could keep the black hairs locked down in some resort to prevent them turning black). The whites were making slow but steady inroads down south too, to my moustache and beard areas.
“I will have to dye” I announce to the two other insensitive creatures around.
“Are you playing ‘blue whale’ papa?” The upside is that the young lady obviously does not need a paternity test…all my scratchy genes have been passed down as such in an autosomal dominant manner.
“You should have started long time ago” This “vishesh tippani” from Rajmata Sivagami devi (the Mrs.)
Now that was other irritating thing. The bitter-half has virtually no greys. Expected, you would say, because I hardly give her any stress and the vice-versa is another story….but unfair all the same. It’s classical 3 idiots wisdom - You’re sad if your wife looks old…but you are sadder if you look older than your wife.
Now I had a teeny-weeny ethical dilemma. You see, I am ‘that’ guy who normally takes the moral high horse and preaches to patients about avoiding hair color because of allergic reactions and stuff and generally not hiding your age…grey makes you look distinguished and all that crap…but I guess viewpoints are allowed to take sharp hypocritical, U-turns when people start ‘ungling’ you.  So I take a cue from Trump and set about to ‘make my hair great again’.
I went out and bought some hair color. There was a ‘buy 2 get one free’ offer so I ended up with more than I needed (and just to spite the ‘ungling’ jackass I got it from the store opposite hers….inflicting a major business loss for the moron).
Since I didn’t want to shock the world around with a sudden color shift I opted for a more subdued and subtle looking brown-black thingy. After half an hour of meticulous painting on the beautiful canvas on my head, I go back to playing ‘mirror mirror’ on the wall. This time the face in the mirror smiles back. The hairs are lovely, dark and neat…. I may not have promises to keep but I have at least a few weeks to go before I again start seeing those 50 shades of grey.
The younger lady of the house meanwhile looks up from the newspaper she is reading, seriousness writ large on her face “Papa, do you have any black money?”
“Huh”? I didn’t have too much of any money, black or white “No, obviously not, I am an honest citizen” I assure her ( For a change I am proud of her showing an interest in things like black money and demonetization instead of those distorted, monstrous faces and voices in Shin-Chan)
She gives me the upturned left eyebrow ‘you are one of those middle class- suckers’ look and then sarcastically announces to the mother hen “Papa has no black money and no black hair either” Both mother and daughter bond over a guffawing session at my expense.
Armed with my new black mop, the next day I go back confidently to the shop and stare confidently at the obviously visually and mentally challenged idiot who had ‘ungled’ me. Just to be on the safe side I left my umbrella at home (for us mallus, two things we always keep on us are our lungis and umbrellas, irrespective of weather conditions…and you can’t keep your lungi at home for obvious reasons). I am about to leave the shop after paying the bill (the one with 2 GSTs added for good measure  and paid with good old cash….no paytm or atm for old ungils after all), when she shouts from behind….
Ungil, you didn’t take your change”…… Normally I am kinda good with sharp and quick repartees. Right not the only thing which came to my mind was something on the lines of ‘※∅☠’(now go try google translate on that!)
Anyway, apparently once an ‘ungil’ always an ‘ungil’.
The same day the remaining bottles of hair color were flushed down my toilet.
To conclude (and to make a mess of the classical quote recently made famous by our former PM – Dr Manmohan Singh)  - In the long run we all dye………and then we realize that it doesn’t make a damn difference…so we stop dyeing and start living!

Wednesday, May 20, 2015

Career choices - doctor or pole dancer?

“Papa what’s a pole dancer?”
I choke on my cup of coffee and take a full minute to compose myself before intelligently replying with my trademark “Duh?!” accompanied with a couple of raised eyebrows.
I hear the sounds of plates falling on the kitchen floor. Apparently my wife has heard the interesting question too.
“You and mama were talking something about it yesterday” The young lady clarifies.
Oh that. The latest ‘viral’ thing going about in the circle of Indian doctors these days is a lovely piece written by Dr Roshan Radhakrishnan….all about why he would never allow his child to become a doctor. He even goes on to mention that he wouldn’t mind her being a pole-dancer, but never a doctor (with the little qualifier –‘in India’)
“It’s like a dancer who uses sticks” I fudge, like you normally would to an 8 year old. By now reinforcement arrives in the form of my bitter-half, who changes the channel on the ever-running TV in the background to cartoon network (from Arnab going red in the face demanding ‘India wants to know’ something as usual) to distract my daughter’s attention.
“Oh…I thought it was one of those ‘badly’ dressed ‘aunties’ dancing around a pole” She innocently returns to the more serious business of watching Oggy and the cockroaches (with Oggy doing that irritating Shahrukh Khan accent as usual).
Both me and my wife remain in suspended animation, mouths half  open for a minute.
OK. The point is kids these days are much smarter than we ever were. You really don’t need (or can) tell them what to do with their life. If they are really in the mood they may just indeed become a pole-dancer, a dacoit, a politician (in increasing order of notoriety I guess)……or even a doctor. And you never know, 20 years down the lane that idiot Aamir Khan might come back in Satyameva Jayate season 23 claiming that pole-dancers are the biggest scourge affecting the balanced growth of the nation. What is important I guess is to try to give a balanced opinion regarding your kid’s career choice…but let them decide things ultimately…and once they do, just support them wholeheartedly.
I return to my coffee and my wife get ready to return to the kitchen to her ‘weapons of meat destruction’ (the menu - ‘chicken-something-something ’ apparently is something outsourced from a Whatsapp group of her friends from medical school days who very humbly call themselves ‘masterchefs’.....that’s a story for another day though)
“So you guys earn less that these pole-dancer guys?” return of the motor-mouth.
Technically I suppose that should be pole-dancer girls, but in these days of gender equality....
Wife parks herself back into the sofa with a helpless look, I choke again on the coffee.
“Um, depends” I say ““Most doctors make more money than most pole-dancers I think”.
The way starting salaries are going for junior doctors in India I might have to revise that comment though. I’d like to ask my wife how much a good pole-dancer makes, but I suppose I would get bludgeoned on my head with a pole, so I drop the idea.
Doctors do have a tough life….especially in the period right after their graduation. There is a lot of work, a lot of insecurity regarding the future and very little money. This is the period when a good percentage of doctors start wondering why the hell they are doing what they are doing.  When I was doing my internship (where you 48 hour shifts were quite common)  I had to survive on a monthly stipend of around 2000 bucks… friends in engineering were by now into five figure salaries. The 2000 bucks of course would last about half a month, after which it was something on the lines of ‘Papa..pyaar ke naam pe kuch de de papa’ or ‘Mama, pyaar ke naam pe kuch de de mama’…..and usually mama or papa did respond favourably to the undisguised begging ….not so much because of the ‘pyaar’ thing, but because they wanted to get this irritating ‘pyaar ki nishaani’ of theirs out of their hair. Pretty much the same during the residency too….salaries were in the range of 4000 to 5000 Rs, which could just about make ends meet (ends of course including the mandatory weekly dinners and  first day-first shows )….and it continues even after the residency till a couple of years at least when you finally settle down in a good hospital or get a stable private practice going or end up in the ‘gelf’ to make money in Riyals or Dirhams (the last one especially if you are a mallu).
“Is it easier to be a pole-dancer or a doctor?” She seemed possessed by Arnab’s spirit.
“Every job needs a lot of training” I answer philosophically “Doctors need to train longer and much harder though” . Wifey seems to have a strange expression on her face. The “I’ve given up on both of you” kind....which is quite usual in our house anyway.
But pole-dancing I suppose does not require an entrance test at every level where hundreds of rats compete in a rat-kill-rat free for all. And when you do get through you have to face a hundred assorted exams, a equal number of thick text-books and  crazy examiners (exposing you to an incredibly delightful variety of sado-masochism....the only thing common being that you are the passive partner). At the end of all this you can’t really blame doctors for kind of hoping to be treated with a bit more respect and of course being paid  a bit is strange how people would not mind dishing out a few thousand bucks to service their car, but an extra hundred on the doctor’s bill is met with all kinds of nasty remarks about the ‘greedy doctor’.  Incidentally defensive medicine is the in-thing mainly because no doctor wants to labelled as the guy who missed a diagnosis. So they end up ordering all kinds of tests just to get things documented....something which would normally not have been done a few years back when patients simply trusted their doctors much more.

“So who is happier finally? The pole-dancer or the doctor?” Seems like the lady was into her concluding argument
“Hmmmmmm” Now that was the most difficult question of the lot.
Happiness is quite relative (basically I am happy even if I am in deep shit as long as the ‘other guy’ is in deeper shit)
I finished my MBBS in the year 2000 and in our batch of around 200 students I would say that more than 90% are pretty happy with where they’ve reached and what they’re doing – both in terms of professional satisfaction and financial security (at least going by the Jaguars and Audis on display in our last reunion) and honestly as far as job satisfaction is concerned I guess being a doctor out-scores most other jobs (even more so if you are into teaching I guess).So yes, most doctors are happy and most doctors do have some regrets....which is pretty much what you get in any other profession too.
And of course you have a higher chance of being sued, beaten up or both if you are a doctor. I mean theoretically it would be a bit difficult to sue a pole-dancer for negligence I guess. The beating up part is getting quite common in India these days. I sincerely feel that martial arts should be one of the compulsory subjects in the medical curriculum......along with communication skills. Most ‘beating up’ incidences are usually traced to poor communication skills...but if things get bad anyway the martial arts should come in handy. Jokes apart, doctors are human beings and they can make mistakes. If they work under fear getting man-handled for every mistake, quality of medical care will naturally suffer. It’s like trying to talk to a pretty girl with your wife watching. You would never do it properly and would anyway get a dose from your wife at the end. Doctors need to work under better security and it is really important the ‘doctor beaters’ are dealt with promptly and properly. We are almost scaring our next generation into not choosing medicine even if they have a passion for it......
Actually any wannabe doctor I suppose is quite aware of all the problems associated with choosing a medical career. More so now, with the net and networking savvy present generation. So in spite of all these negatives  if my daughter still wants to be a doctor, so be it …and I’ll support her in anyway I can. Besides getting into medicine is not really like the Mumbai underworld where once you’re ‘in’ you simply cannot leave. I have quite a few friends who finished their graduation in medicine and then moved to totally unrelated fields like business management and even software engineering (Maybe easier said than done but basically isn’t this what most engineers these days do?….they muddle their brain  4 years studying core engineering concepts and then end up writing code or doing business administration).
All said and done, we doctors will always be under a bit of extra scrutiny because ultimately we deal with human beings...not machines, but then that is exactly why each day in medicine is an interesting adventure in itself...because human beings have so much of variety unlike machines.
One lil piece of advice I would like to give to wannabe doctor is to choose your specialty wisely. Many young doctors get that extra bit frustrated because after all this trouble they go into a specialization without being really sure if they have an aptitude or a passion  for it and later find that they just can’t handle things. So basically do what you have a passion for. An old friend used to tell me that it doesn’t matter whether you are a space scientist or  a sweeper…what is important is how well you do your job. Another thing is always make time for your family, friends and of course yourself. Keep a hobby for stress relief, take a  vacation once in a while, read normal books too once a while...and generally try to smile a few times each day.
I always tell my students that being a doctor is never going to be easy……it wasn’t meant to be…you will always have unsatisfied patients, scratchy colleagues, irritable bosses and Aamir Khans……but somehow every grateful patient that you treat makes up for all these negatives. So be proud of the fact that you are a  doctor…. keep healing and keep smiling (and keep ignoring the Aamir KhansJ..they’re simply not worth it!)

Thursday, January 29, 2015

Is there a doctor on board?

Few days back I was returning home from  a short trip abroad. I had just settled in to watch Kate Winslett heroically battle cute viruses in ‘Contagion’, when the PA system announces the “Is there a doctor on board thing”. My split personality starts getting active…the ‘good doctor’ in me wants to rush across the aisles to the patient in distress and execute a dramatic recovery act, but the more practical shady side (the usually dominating one) wants to dig the ear phones deeper into my ears to block out any further announcements, hoping that some other quixotic idiot will take the call. After 30 secs the announcement comes up again. The ‘good doctor’  wins for a change and I hesitantly remove my seat belt and my earphones, say  a heavy goodbye to Kate Winslett and the viruses and head towards the back of the plane where some kind of hectic activity is going on. In the back of my mind I try to revisit  the revised steps of CPR (incidentally now after years they suddenly realize that getting the circulation thing going is more important than the airway…so the classical ABC –airway, breathing,  circulation is now CAB).  Thing is I am not too much into emergency medicine, unless you count sudden and severe itching as an emergency. Besides if I really wanted to handle such life threatening situations I wouldn’t have opted for dermatology, I would have probably chosen surgery… or a second wife. In fact it’s at deep moments like this I sometime reflect on my career choice –
(Here are some of  the most important reasons I could recollect.
1.       I  was/am/will be lazy
2.       I hate getting disturbed in the middle of my sleep – afternoon or night (I don’t mind disturbing others though….my snore-storm  affected nuclear family will attest to that)
3.       I  was/am/will be lazy
4.       I love my thick skin (some unmentionable roles in some unmentionable college skits will attest to this)
5.       I  was/am/will be lazy
6.       I wanted to work with charity foundations to eradicate all  the suffering in the world  due to itching
7.       I  was/am/will be lazy
8.       I like getting under other’s skin (Who doesn’t?)
9.       I  was/am/will be lazy…………..)

As I reach the   empty space towards the end of the cabin I see a small crowd of stewards and stewardesses mulling around the patient. One of the stewards eyes me curiously and almost accusingly says “Yes?”
The shady part of me wants to say “Nothing…where’s the loo?”  and go to the loo, back to my seat and Kate, in that order.
Anyway the ‘good doctor’ wins again surprisingly “I’ m a…doctor” says me….I myself am not too convinced.
“Oh…”  a look over and again a very expressive  “Oh!”
The steward,  apparently still not very convinced, hesitantly clears the crowd to direct me to the patient. The patient surprisingly turns out to be a stewardess….and her face is contorted with a mixture of pain and anguish as if she just  had an extra helping of  Arnab Goswami  and his “the nation wants to know”.
Anyway the good thing is she seems too young to have a cardiac arrest. I put on my best  false smile and my best false serious voice and ask her what the problem is. The patient doesn’t speak. Reminds me of our honorable  ex PM –MMS, in a time of crisis (or for that matter even in normal times).
The lady just points over  various parts of her body. Maybe she’s not happy with her body image…the dysmorphophobia thing….I want to tell her that I have the same problem,  but that you get used to it as you grow older. Anyway when she continues to point her index finger all over her body I take a closer look and notice the reddish raised skin lesions.
Aha, voila!…..urticaria…a dermatological emergency!!!….so now I smile even more broadly and take charge (incidentally also mentioning very loudly and explicitly at least twice that I happen to be a dermatologist). I take a quick history  - when, how, where, why , why not…..a little poor joke to lighten the atmosphere..and then a detailed examination followed by  a quick counseling session.
“ Don’t worry, it’s just an allergic reaction……I’ll just give you a little  injection and you’ll  be back in action in no time”
The ‘injection’ bit makes the lady go a bit pale, but I insist. Anyway, injection given (incidentally the first aid kits in commercial aircraft seem to be pretty well stocked), I get ready to go back to my cramped cattle class seat. I was hoping that the airlines staff would give me a free upgrade to business class considering my invaluable skin-saving act and significantly contributing to the health of its staff.
“Excuse me doc” a sweet voice calls out from the back.  I turn to find another petite stewardess with a pretty smile. OK, free upgrade here I come.
And then she starts frowning. Now I am confused… I hope I didn’t mess up the injection. The sweet lady holds her frown …actually frowns a little bit harder now. I look for the parachute hold.
“Doc, do you think I need to go for botox?”
Oh. That. The frown was apparently to help me assess her botox needs.
Now this is the other thing with dermatology nowadays…..either you are supposed to be an ‘itch doctor’ treating all kinds of assorted lovely itches on all sorts of assorted body parts…..or you are supposed to be a ‘witch doctor’  busy converting ugly ducklings into beautiful swans with a simple swish of a wand…and it happens to be one specialty where you are often asked to randomly opine on, diagnose and treat just about anyone and just about anywhere….a blurred ‘What’sapped  image’, facebook,  weddings,  mid-air………… .but what the heck, why bitch about it as long as the itch/witch makes you rich?!
I do the botox consult….and a couple of other similar cosmetic consults, everything is hunky dory and I turn around  ready to go back to my seat and Kate…..and of course there’s no free upgrade….maybe a little extra smiles when I exit the airlines……..but then, maybe that’s worth it too?!:)

On a more serious note, it feels nice to know that the popularity of Dermatology as a specialty choice continues to grow the world over. The little concern is that many opt for dermatology purely for the cosmetic part. While cosmetic dermatology is an interesting and satisfying part of practicing dermatology, I personally feel that it should not come at the expense of good ol’ clinical dermatology….but then to each his/her  own!

Wednesday, July 16, 2014

Reunion diaries 2 – What do you want to become when you grow up?

 “What do you want to become when you grow up?” I remember Ms Jayalekshmy , my 3rd grade mathematics teacher asking this deeply philosophical  question in our class almost three decades ago.

“Doctor”, “Engineer”, “Cricketer”,“Engineer”, “rich”,“Bigger” (!),“astronaut”, “cosmonaut” (The cold war was very much on those days)“Fire-engine driver”, “Policeman” (I suppose that should be ‘police-person’ in this age of gender equality, but in those uncomplicated days none of the girl students were particularly  interested in this particular profession anyway)……..more or less standard answers you would expect from any bunch of eight year olds, even now.

I believe that when it comes to the ‘“What do you want to become when you grow up?”most  of us grow up with vague, very attractive,  mostly unachievable dreams of being some kind of celebrity in the future –  successful film star, captain of the Indian cricket team who is part-time captain of the football team, who is part-time boyfriend to the latest pretty young thing in Bollywood  also, prime minister of a non-coalition government,  etc. etc….simple and clear concepts.  Later at a certain age when your abstract thinking skills are more developed (i.e ‘you see the light’) you bring down your expectations and start thinking more realistically. This is the first ‘eureka’ moment .Now you start thinking on the lines of the standard job-sets – doctor ,engineer ,lawyer etc. etc. You gradually realize that you (or your parents J) have a preference for one of these standard job types and you work towards ‘becoming’ a doctor or engineer or whatever…..

If you are really lucky  sometimes you have that  second ‘eureka’ moment in life, when you realize what is that you have a  real passion for. It might come before or after you venture into one of the more mundane ‘standard’ jobs .Unfortunately  out of the lucky few who experience this great moment, fewer still have the guts to throw caution to the winds and take flight with  their dreams.

Now if you’re thinking you’re in for a bit of the Arindam Chaudury-  ‘discover the diamond in you’ thing  or some similar  crazy pep psychology thing.....don’t worry…the idea was only to get it across to you that I too had at least one of these ‘eureka’ moments’. The defining moment was   around the tenth grade when I had to reluctantly visit a dermatologist for a very neglected , very scratchy ,very ugly  fungal infection in an unmentionable area. I had to wait a couple of hours  before I could meet a certain Dr B . I being me, divided the time judiciously  to ogle  at 1) The sleak and shiny Mercedes idling away in the garage of his palatial  home cum consulting space 2) More importantly at the impressive line of not –so-bad looking female patients waiting in the reception area. Finally when my turn came, the good doctor took 2 minutes and 200 bucks , gave me a list of medicines, and asked me to come  back after two  weeks ( I assume with another 200 bucks, though it was not mentioned explicitly in his prescription).Anyhow I luckily got better much before the 2 weeks periods, and so skipped a review. However now I knew what to do with my life  - Merc + 200bucks for a 2 minute consult + loads of female patients (many of them pimply maybe, but female all the same) + (best part) I  get  to treat my own ugly  fungal infections by myself –Eureka!!! I wanted to be  a dermatologist – the  small problem was that  apparently you needed  to graduate in medicine before you get to specialize in dermatology……………..and with that  began a rather interesting journey which saw me catapulted into the hallowed hallways of the Government Medical College , Trivandrum.

I was recently going through an old poll – year 2000 vintage on our batch e-groups site, which was basically something vaguely  on the lines of ‘which specialty would you opt for’. We were of course freshly out of our internship ….full time into what we medicos label adoringly as ‘entrance thoyilalism’ (for non-doctors and non-mallus: ‘Thoyilali’ means ‘worker’ or ‘employee’ in Malayalam. This wonderful period entails full time employment involving extensive ‘re-roting’ of all the bulky, highly detested text-books right from day 1 of medical school. The objective is to score well enough in the post-graduate entrance exams so that in time you can get some kind of specialization and add the hallowed MD/MS suffix somewhere behind the not so much hallowed MBBS alone thing)

 Interestingly about 50% of the responders to this pre-historic poll actually did end up doing what they wanted to do……at least in terms of choosing their specialty. Some of them did absolutely fantastic U-turns though…..I know one guy who insisted that he would never be a surgeon coz of some vague tremor while holding surgical instruments. The guy is now a hot-shot  surgeon. Another close friend changed courses around four times to finally reach a stage where he is one of the best in his field.

However when it comes to having long term, specific goals, I can think of two extreme cases in our class.

The first guy happened to be sitting right next to me on the first day of our MBBS course. That was when the deceivingly maternal looking Dr Glorine Gnanathankam, HOD, Physiology entered the classroom flashing a disarming smile  (the ‘maternal’ image got pretty well shredded after our first couple of exams when a lot of  us were initiated into one of the fundamentals of medical education…no study, no marks!) The good lady asked the eager crowd of freshers the ‘what do you want to be in the future’ thing. I was  actually expecting people to come up with  stupid Ms World kinda answers – “Start a charity hospital”, “Serve rural India”….and other such obvious hogwash. All of a sudden the spectacled, moustached, fidgety, Tam- Bram guy next to me jumps up over eagerly and shouts “Neurosurgeon!!”

Duh?! Dude…first day of class and you’ve managed to  award yourself ‘overeager nerd of the year’. I was trying to pull him down so that the damage could be controlled, but if I remember right he also simply had to explain the why’s and the wherefore’s about his ambitions too. Anyway I think  not many believed him of course at that time, but 20 years down the line Dr Gopalakrishan CV happens to be a proud and successful neurosurgeon…… present in Canada for some kind of hi-fi post-doc fellowship.

At the other extreme is a guy who I believe spent a lot of time getting confused (and successfully  confusing others too!) over the broader question of whether to go for a medical specialty or a surgical specialty (He was confused about a lot of things in general I suppose…right from girlfriends to specialties)…and finally at the end of it all the guy ends up as one of the CAT toppers and goes into IIM Ahmedabad. The last time I met him he was not talking in English or Malayalam, but pure  unadulterated ‘Financialese’…….all about stock options, recession-proofing, fiscal deficits and what not. I obviously didn’t understand the language, but what I did understand that in the near future when we poor souls who stayed on with the Hippocratic oath thing, will be thinking about upgrading our old cars, he is going to be thinking of upgrading his private yacht. Hari G at present happens to be minting money at a very senior post in a famous multinational private equity company.

On the whole I suppose most of us ended up kind of happy, doing what we wanted to do. I don’t have a specific count but I think there are virtually all clinical and non-clinical specialties represented in our batch and almost everybody seems to be doing quite well in his/her chosen field. Basically it means that during the upcoming reunion any medical problem cropping up should not be an issue – whether it is itchy rashes or hemorrhoids. So ultimately as goes the famous statement –“If  people could make penicillin out of stale bread, we could surely make something out of ourselves”