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!

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