DENGUE TIME

“1962. I was epidemic officer in the Calcutta Corporation. Salary: one hundred and seventy five rupees. To supplement my income, I worked as an assistant to Dr. Davis, the legendary psychiatrist. He gave me eighty rupees every month. Alongside, I was trying to build up my own practice in the evening. On most days, I had no patients and returned home empty-handed. I had five members to feed…

The young doctor in the rear of the Tata Sumo was tipsy, and had so long been busy blathering with an equally tipsy cardiologist. He tried to find out who was talking. It was dengue time in the city. And an ex-epidemic officer in their midst! But the speaker was seated in the front with a colleague on his right, face not visible but the baldness of his head was glistening in the light of the car. Of course, a senior guy. But how old was he?

What was your fee at that time? The young doctor blurted out. And he felt very smart asking this. Lime-laced Vodka was kicking in his head.

There was actually no fee at the time. The doctors would then give different mixtures for various ailments, and some sulfa drugs, and would charge a price for them. But occasionally one would come across a sophisticated patient who would offer the fee. And it was just two rupees.

How long have you been in the business?

Forty-two years.

The speaker was answering the young doctor without looking at him.

A long innings, the young doctor commented somewhat frivolously. He looked very satisfied by the comment he made.

Do I look unnatural? The cardiologist now asked him.

Yes, you do. Your face is flushing, and you have slurred speech.

But I feel normal. He dangled a silly smile over his face.

Well, it’s okay as long as you feel normal.

Just consider this, what’s the point of it if you attend these CMEs and don’t drink?

Hmm.

Do you agree with me or not? It can’t be that these guys will get us to write their drugs for free.

I saw you were taking red wine.

Yes, why not? And I had taken plenty of it. They had arranged specially for me. Do you know this car to and from Park Hotel is solely for me?

I never knew it. They said it was for me.

During those days we had just one antibiotic – penicillin. And the doctors used it for almost every ailment. I don’t know of any other drug so grossly abused. Some patients may have benefited from this drug, but a lot more have died due to shock and other complications. Then came tetracycline. The same history of use and abuse! But I was personally thrilled with the advent of amoxycillin.

Is he taking a class on the history of medicine, the cardiologist ranted in a low-key, grumpy voice. Are we his students? Ask him to stop.

The young doctor did not respond. He was now listening to the speaker with interest.

Do any of you write amoxycillin these days? It’s there in the market, but no longer as effective. That’s about the life of a drug. Effective once, useless now. I’ve always been fascinated by this rise and fall of a drug.

How boring! The cardiologist whispered. What’s there to be fascinated about a drug? Nonsense!

Do you prescribe amoxycillin?

Why should I? There’re lots of new antibiotics in the market.

But you’ve to write penicillin in rheumatic fever.

I never prescribe penicillin.

Newer antibiotics have flooded the market. But are they worth it? I have my doubts. They come amidst marketing hoopla, and we are driven to prescribe them like crazy. And before we have them tested thoroughly, another bunch of antibiotics hit the market. Can you name a single antibiotic worth its name in the last ten years?

How boring! The cardiologist muttered. My headache gets worse.

The rule of the game has changed. It’s business 24-hour 7-days and without a care about its fallout. Do we know exactly how many people died by taking rofecoxib?

The young doctor jumped up on his seat hearing about roficoxib. Did you prescribe roficoxib?

Never really. Personally, I don’t trust any pharmaceutical house. I would do a lot of reading and surfing in the Internet before I settle for a drug. Coxib never figured in my to-write list.

I need to piss. I have a full bladder. The cardiologist suddenly announced.

The young doctor also felt the same urge.

They ordered the driver to stop the car and got out of their seats. It was the fringe of Kolkata still possessing some patches of green. The silence in the threshold of midnight was kind of eerie for a landscape bathed in mercury vapor. There was too much light. Or that was what seemed to the young doctor How come the dengue was revisiting the city in spite of so much development? Many had died of it already.

Why don’t you refer patients to me?

The young doctor simply ignored the question.

They were both relieving themselves in the open.

The old fart is really boring. He gets on my nerves.

But he’s an experienced guy.

A burnout case, I bet.

How do you know it?

He thinks too much. Guys of this kind can never make it.

Back to the seats. The car started.

The old guy was still talking. But the subject had now changed.

The problem with today’s doctor is, he wants to earn the big money without investing time to build up his practice. And they write too many investigations these days just for their own interest. But for the diagnostic labs, some of them would surely starve.

The cardiologist suddenly felt flustered. He thought he would protest it right away. But the red wine had just now touched his brain and gave him a sudden kick.

Why don’t you send me patients? I have good sops for those who refer patients to me.

The young doctor did not answer him.

Hey, I’m losing orientation of time and place. You must help me when my house comes. Do you know it?

Yes, I’ve seen it from outside.

What do you think about my house?

Great. Cool.

My colleagues envy my house. But that’s what I really want. And I had it in just ten years.

These days they take the patient for a ride, and extort them to the hilt. What a sea change in attitude! Did anybody ever think of a doctor as an extortionist?

Stop it. Please stop. The cardiologist suddenly shrieked. I’m sure you’re at me. Why are you so jealous? It’s not my fault that I’m successful at an early age.

The interior atmosphere of the car suddenly changed. The doctors in the car looked at one another. The speaker, for the first time, craned his neck back to take a full view of the young doctor and the cardiologist. He looked shocked.

What’s up? I don’t really know you.

Why do you insinuate?

You need not take it personally unless you identify yourself with those doctors I talk of.

You’re attacking me personally, assaulting me.

Why the hell should I be attacking someone who I don’t know about?

The cardiologist fumbled for words.

The young doctor felt miffed, and tried to stem the spat.

What I mean is that our profession is no longer the same noble one, and it’s sinking daily as its members get more and more unscrupulous.

My foot! Do you live in this time or what?

I do live, and in a more involved way than you do.

The cardiologist laughed without an answer.

He was fast sinking in a stupor. Suddenly, he went limp.

Do you know him?

The young doctor nodded affirmation.

Where does he practice?

The young doctor looked at the cardiologist to assess his level of consciousness. Empowered by vodka by now, he thought he would spill the beans.

He practices in my locality and has actually few local patients. But he lives just fine with his brand new car, his big house and all that.

Interesting!

We’ve always wondered how he does it. But he is a great performer. He operates through agents. Agents procure patients for him from various localities. He has got a wide network.

I see.

He has a glib tongue. Once he gets hold of some patient, he would take him in his car to some lab for exhaustive investigations.

I’ve heard about such doctors.

He does not care about treatment. Once he goes through his way, he loses interest in the patient. No patient visits him a second time, and he’s a hate figure in the locality.

But how is he doing it for so many years? There should have been a public outrage by this time.

Recently, there was a furore when the local cable exposed his link with a diagnostic lab. He got a female patient to undergo the same USG twice in one week.

At this point, the cardiologist tried to wake up from his drunken state. Do you know the cable TV censored my point of view? Bastards! It’s a conspiracy against me.

He had a staccato voice, and fell asleep once again.

He’s just unstoppable, the young doctor said as closing remark.

He’s out, someone said.

The speaker sighed and got back to his earlier position.

How are you dealing with your dengue patients? I’ve yet to see a dengue patient in my clinic.

The speaker was in no mood to talk. But he held forth after some silence.

Oh, I’m getting them by dozens. It invokes me the memories of the 60’s. Dengue, malaria, kalaazar, and hundreds of people dying.

What drugs did you use at that time?

The same penicillin. There was, of course, quinine for malaria. And thanks to Upen Brahmachari, we had ureastibamine for kalaazar.

I did never see any kalaazar patient during my training. Nor any dengue case, for that matter.

That’s why you’re not getting any dengue patient in your clinic. What your mind does not know, your eyes do not see. You must have got dengue patient and treated him successfully. If I’m right, you’re not the kind of doctor who sends every case of fever for expensive Mac Elisa test.

I’m kind of scared about dengue.

Nothing to be scared about. Most cases are benign, and need just symptomatic treatment. Only one or two cases get incapacitating. They have severe muscle and joint pain. Do you know this is also called break bone fever?

Have you seen any case of dengue shock syndrome?

A lot in those days. I’ve got a personal memory. In 1964, my newly married wife was diagnosed to be suffering from the syndrome. She survived miraculously.

How is she now?

She has been dead for about eight years now, but not of dengue. A street accident.

Oh, so sad. What about your children?

My son lives in Australia and is a virology professor. My daughter is a pathologist and is married to a heart surgeon in Delhi.

So, you ‘re alone?

Yes, alone with my patients. I never feel it. Life is still a learning place for me. Do you see that diseases like dengue, malaria and kalaazar are all coming back? I wonder why. Can you corroborate it with our development?

The young doctor could not respond.

I’m sure the small pox also will return.

The young doctor had goose bumps all over his body. He had never seen a case of small pox in his life, but read about its terrible effects.

Stop here. I’ve to get out.

The car stopped. The speaker exited. An erect, solid figure. All of six feet.

He faced the doctors and looked apologetically.

Sorry, friends, for the spat. This is dengue time, you know, and you can’t help being dragged into such things. Anyway, you must be on your guard.