The Red Badge of Bravery (1)



In a life time of medical practice, a physician has many ups and downs some of which he forgets with the passage of years. However, certain people and circumstances are forever remembered because of their powerful impact on the mind. I wish to relate some of them.

I started my medical career way back in 1956. Proud of having acquired a thorough "text-book” knowledge, it was with contempt that I regarded my seniors. I was the know-all, I thought, the smartest. There was even a tendency to look down upon the patients. Their ignorance which I then equated with stupidity was, I now realise, in fact their naivete. In the Out Patients Department after examining them cursorily, I would prescribe unnecessary vitamins, tonics and other drugs of dubious therapeutic value. It was during this period that I came across some senior doctors who were kindness personified-a scarce commodity when dealing with the poor who throng our public hospitals. These doctors, my teachers, have left an indelible mark on my psyche. I gradually freed myself from my own conceited and supercilious notions. I have tried my best to emulate my worthy seniors and am still trying to come up to their standard.

I remember one incident vividly. When I was a senior medical officer, a lad of about twenty years, came to the O.P.D. complaining of a severe backache. His relatives told me that he literally cried and doubled up in pain. I examined him "thoroughly" and declared that the boy was a hoax. I even went to the extent of declaring that perhaps he had been bitten by the 'love bug' and thus may have neglected his studies and was now putting on a show. I refused him admission in my general ward saying that it was overcrowded. Being middle class people, I thought the young man's relatives could not afford a semi-private or private ward and I would get rid of the malingerer. But the relatives were insistent and I had to admit him in the paying ward. I planned to discharge him after a couple of days. The relatives now approached the Superintendent of the hospital. He was a kind and genial man. He ordered that an X-ray of lumbar spine be taken. It was only when the young man developed urinary retention (inability to pass urine) that we realised the gravity of the situation. He had by then developed weakness of his lower extremities. The X-ray of his spine and lumbar myelogram revealed a tumour that was compressing the nerves necessitating an urgent operation for its removal. To our horror and to misfortune, the tumour turned out to be a malignant one. Whenever he suffered from pain, he would hide his face in the pillow in order that others did not see the tears rolling down his cheeks. At other times he would offer words of courage and reassurance to the other patients in his ward Whenever his college friends came to greet him, he did not discuss his ordeal with them. He enquired after their welfare and made them laugh still remember his smiling face and I am filled with remorse. I learnt a lot from this episode - if, after the preliminary examination one cannot arrive at a diagnosis, one should call the patient again for a follow-up, observe him, take a detailed history once again and re-examine and investigate him thoroughly. If necessary, without any ego hassle, request a senior colleague for his opinion and advice, for one is after all dealing with another human being, not an inanimate object. Knowledge acquired from textbooks is not enough to become a doctor — a good doctor at that. Practical experience is of paramount importance. The operation was uneventful. However the patient died some six years later of secondaries, namely, distant spread of the malignancy.