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  COUNSELING
 
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  In the age of iDoctors  
  An old-world cardiologist  
   
  A FEW months ago, an itching sensation developed on the small toe of my right leg. A day or two later, I was shocked to find that the smooth skin between the toes had turned whitish and infected. I was worried whether it was the beginning of what is called the diabetic foot, a condition that calls for amputation of the affected toes.

I rushed to a private medical practitioner, who has such a roaring practice that he has built a large, four-storied hospital in a few years. I had a sigh of relief when he ruled out the possibility that it had anything to do with diabetics. However, he did not explain how it was caused.

I paid his consultation fee and, as suggested, bought all the medicines from his own medical shop, located in the same premises. It made me poorer by about Rs 1,000. Given the costly antibiotics, I presumed I would get instant relief. On the contrary, the problem got aggravated with itching sensation all over the body. With each passing hour, the condition became unbearable.

Finally, my wife and daughter-in-law persuaded me to go back to the same doctor. He changed some of the medicines. The second visit and the new medicines cost me another Rs 800. Alas, there was no relief. I had nail marks all over my body because of itching. Worse, I had difficulty in reading, writing and teaching which is what I do for a living.

Reluctantly, I called our family doctor and friend, Dr K.K. Mathew at Kayamkulam, on phone. As usual, he listened carefully and asked me some questions, mainly about the chemical names of the drugs the Delhi doctor had prescribed. He told me not to worry as it was a simple case of medical reaction. He discovered that my body was allergic to any drug that contained ampicillin.

He asked me to stop all the medicines, including the antibiotics. Instead, I was asked to take a new medicine that cost me Rs 72 and apply Lacto-calamine, wherever I felt like itching. Within two-three days of taking the new medicine, I had complete relief. Now, how could a doctor, living 3,000 kms away, treat me without even seeing me, while a doctor who saw me and heard me two times could only complicate my problem?

Before that, a word about Dr Mathew would be in order. He is a well-known cardiologist and alumni of Maulana Azad Medical College, named after the first education minister of India, in New Delhi. He did not have to be taught how crippling a disease like Polio could be because he himself was a victim. It was his steely determination, rather than his bodily strength, that emboldened him to take up medicine as a profession.

At a time when he could have earned a fabulous salary in a city like New Delhi, he preferred to go to Onattukara, a principality of ancient Kerala where Buddhist civilization and culture flourished till they were wiped out by Hindu revivalism, attributed to the advent of Aadi Sankara in the 8th century AD. The "palli" in place names like Karunagapalli, Karthikapalli, Pallickal, Pallippuram and Puthupalli is believed to have been derived from Pali, the language in which Buddhist texts were written.

But when Dr Mathew chose Onattukara that includes the taluks of Kayamkulam, Mavelikkara and Haripad as his 'karmabhoomi', it was known as a land of pests and pestilence. In the hinterlands of Onattukara, a majority of the people were poor, with little access to proper healthcare facilities. The setting up of a mission hospital at Kattanam, with emphasis on affordable treatment, turned out to be a boon for them.

With nothing but a desire to serve the needy, he joined the hospital. Soon his fame as a "doctor who cares" spread far and wide. That was the time when death due to sudden cardiac arrest, known as heart attack, was known to be the handiwork of "Maadan", another name for "Kalan", the God of Death, whose mother is "Ayyo" to whom every Malayali -- Hindu, Christian or Muslim -- cries out when they have terrible pain.

It is an unconscious appeal to Kalan's mother to ask her son the one who moves on a buffalo -- not to take the supplicant away. For once, the poor people began to learn that with timely medical intervention, heart attacks could be controlled. He established a cardiac care unit, the first in the region, and the patients now knew that heart attack did not happen when Maadan gave a body blow to the patient. Rather, it happened because of blocks in the arteries that prevented smooth flow of blood to the heart. Countless are the ones whom he saved from the clutches of Kalan or Yama.

Dr Mathew's tenure was a "golden period" in the annals of the mission hospital as Rev Ninan Varghese, who served as its manager for seven-long years, once told me. Personal reasons compelled him to build a house with the unusual name "Prateeksha", which means "hope" or "waiting for", off Kayamkulam-Punalur road and settle down for good. It stands out in sharp contrast to signboards like "Be careful, dogs inside" (it could be the two-legged variety!), "Beggars, salespersons not welcome", "Enter at your risk" etc. that many posh houses "proudly" display.
"Knock and the door shall open" is a Biblical verse which is literally true in the case of "Prateeksha". Dr Mathew's clinic is as simple as the doctor. The only gadgets I found there were an old-fashioned stethoscope and a conventional pressure-gauge equipment. If patients like to pay some money, they can deposit whatever they like in a translucent jar. The poor need not even say, "thank you, doctor" to avail of his services.

He is in many respects like Dr Abraham Varghese, one of those legendary doctors who combines extraordinary humanity with very refined medical skill who also happens to be an excellent writer.
I am yet to read his latest book "Cutting for Stone" which has already sold one million copies and has remained for 52 weeks on the New York Times bestseller list. His first book "The Tennis Partner: The Story of A Friendship" tackles complex, emotionally loaded subjects -- addiction and recovery, sexual compulsion, friendship and intimacy, the elusive nature of change -- in a manner that is understated and admirably free of psychobabble. Dr Mathew, too, is a prolific writer, who has a large number of books -- novels, essays, short stories and poems -- to his credit.

Unfortunately, Dr Mathew does not follow the regimen of a good writer, who believes that the essence of writing is rewriting. His writing is straight from the heart and is, therefore, devoid of all embellishment. His first draft is usually his last draft. He probably does not have the patience of the late O.V. Vijayan, who took 14 long years to write Khazakkinte Itihasam (The Saga of Khazak), a classic in Malayalam literature.

Dr Mathew shares with the American writer-doctor a worldview that separates the duo from the run-of-the-mill doctors. He believes a stethoscope is good enough to treat most patients. By merely looking at the patient, a doctor can judge how serious the patient is. For instance, a lady with fresh make-up and a clean-shaven man, who smells cologne, cannot be a serious patient.

Some fifty years ago when I had swelling all over the body, my father took me to Thiruvananthapuram to consult Dr K. Narayana Pai, who was the Principal of the Medical College there. By the time my turn came, night had fallen but that did not prevent him from spending nearly 20 minutes to examine me and to conclude that I no longer needed any medication and we should treat the disease as a bad dream.

Today I can say his diagnosis was perfect, for I was never troubled again by the disease, caused by a temporary malfunctioning of the kidney. What I remember most about Dr Pai is his roundish, angelic face and the compassion with which he examined me. As a tribute to that great doctor I still preserve, along with my school and college certificates, the tiny paper on which he wrote his prescription. The paper has turned yellow and brittle but his memory is still as fresh as ever.

When Dr Mathew prescribes a laboratory test, it is more to confirm his diagnosis than to help him diagnose. Once when he sent a patient for a whole-body scan, he received the next day a small packet of currency notes -- his commission -- which he politely but firmly returned to the diagnostic centre. Today if he prescribes such a test, his patient is the beneficiary of the "commission" for he has to pay less.

As doctors depend more and more on a variety of pathological tests, x-rays and scans, they increasingly lose their ability to diagnose. Medical students are taught how to do a complete exam of the body's systems --circulatory, respiratory, musculoskeletal and the rest. But when they begin their practice, they learn from their seniors to prescribe test after test, rather than use their own faculties.

In a recent article in The New York Times (Feb 26, 2011) entitled "Treat the patient, not the CT scan", which every doctor should read, Dr Abraham Varghese points out how doctors in America have lost their ability to diagnose. There, the doctors rely on computers and sophisticated technological gadgets to treat patients and with what result? Let me quote the author:
"Just a few weeks ago, I heard of a patient who arrived in an E.R. in extremis with seizures and breathing difficulties. After being stabilized and put on a breathing machine, she was taken for a CT scan of the chest, to rule out blood clots to the lung; but when the radiologist looked at the results, she turned out to have tumours in both breasts, along with the secondary spread of cancer all over the body.

"In retrospect, though, her cancer should have been discovered long before the radiologist found it; before the emergency, the patient had been seen several times and at different places, for symptoms that were probably related to the cancer. I got to see the CT scan: the tumour masses in each breast were likely visible to the naked eye -- and certainly to the hand. Yet, they had never been noted." Why, because the doctors did not examine her.

About a year ago when my friend, Kunju (Mathew) who was earlier with Madura Bank and later with World Vision, Kayamkulam, consulted Dr Mathew for what he thought was a minor ailment, all that the learned doctor needed was a confirmation that he was in an advanced stage of cancer. Much against his wish, the test proved positive.

Dr Mathew could have referred him to a cancer centre. Instead, he explained to Kunju and his wife that they had the option of spending a fortune on his treatment in which case he would live for a maximum of six months or spend the rest of his life in the comforts of his home without the debilitating effects of radiation. He opted for the latter and the family saved itself from pauperisation.

My mother, who has a crippled heart, owes her life to Dr Mathew, who has been treating her for the last quarter century. For once, she surprised the doctor, when after two strokes that immobilised the left portion of her body and incapacitated her throat, she miraculously bounced back to life. Today, her face radiates with joy when she calls Dr Mathew her "visible god".

However, he credits all his achievements to the Good Doctor, whose worldly accomplishments included curing the "leper", the blind, the bleeding woman and the woman with a bent. Dr Mathew believes that healing of the soul is more important than healing of the body, because many diseases have their roots in sin. He draws upon Hindu puranic traditions, still practised by rishis living in the upper reaches of the Himalayas, to argue that a body that does not crave for worldly pleasures lives longer and stronger.

A resourceful group of Catholics, inspired by a feature Shalom Television once did on him, has roped the doctor into a project to set up the multi-billion 300-bedded (first phase) "International Chaavara Cancer Research Institute" at Nedumangadi near Thiruvananthapuram. As mentor of the project, Dr K.K. Mathew hopes to have his ideas of holistic treatment translated into a reality that would also perpetuate the memory of Blessed Chavara Kuriakose Elias.
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The writer can be reached at ajphilip@gmail.com
 
  By  A.J. Philip  
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