December 13, 2015
The Psychiatrist looked at the door which was notorious for making a funny noise when opened. It disturbed him as he was busy reading.
Three men walked in.
"Good evening doctor," the oldest of them said.
"Don't you know that you need to knock the door before you enter? There is even a board hanging outside which tells you to do so. We hung it only a few days back," the Psychiatrist said without greeting back.
"We knocked many times. You may not have heard," replied the oldest.
"You may have knocked. I did not hear as I was very busy. Before you walk in, you need to make sure that there is no one here except me." The Psychiatrist’s anger did not subside.
"Doctor, only after making sure that you were alone, we moved in." The old man was good at arguments.
"Please do not argue. Anyone can come here, but only with an appointment."
"We phoned for appointment and there was no reply. You had a secretary here who is not seen today."
"That means you have come here before. Yes, I had a secretary who is on leave now. That’s why so much of confusion. Are you the patient?"
"Do only patients come to a Psychiatrist? I am not a patient by any means. Every time I came here I brought others. I am a Social Worker. Sometimes I sat outside. I may have come to you twice."
"You may not be a patient. But someone who comes to visit a psychiatrist is a patient in some way or the other. There should be a patient among you three. Who is that?"
"This young man," the old man said, pointing his finger at the youngest.
"So you brought him here. Why the third person?"
"He came along with us since we came from a village. This man cares about this young man and me too. How could we tell him not to accompany us? Should I send him out?"
"Absolutely, three people are not required here. And if you feel like it, you can also go out."
"I will not go. I want to follow up this young man’s case. But only if you do not mind." The oldest paused and addressed the middle aged third person. "Please go out."
The middle aged man obliged.
"What’s your problem?" The Psychiatrist spoke. "Tell me briefly. I do not like stories. I understand everything."
"Can I talk or him?" The old man intervened.
"As long as there is truth anyone can talk. But finish as soon as possible. I have other appointment."
"I will talk," Said the young man. "I know my problem better than anybody else."
"Talk...But in brief."
"Yes. I want to tell you as briefly as you wish. I have fear… Lot of fear... I experience it every now and then. I am afraid that I will collapse... And that I will vomit blood and I have chest pain every now and then."
"Tell me your family history."
"My great grandfather died at the age of hundred. Grandpa died at eighty. Then they said our family lived longer."
"Is your father alive?"
"No. he died at the age of sixty. I was thirty then. I suddenly realized that our lifespan was coming down by twenty years. Hundred, eighty, sixty, and mine forty…twenty years gap. I am nearing forty now. I did not think much about it in the last ten years. Now I feel that I may die anytime."
"You are going by mathematics. Nothing happens as you imagine. I want to know what’s happening inside your body, not only in your mind. If a man has some fear about death in his mind, that will affect his body as well. So you need to correct your mind first and look after your body. Do you have any bad habits?"
"For the first twenty years I did not have any bad habits."
"Fifteen to twenty years is the time a person embraces bad habits. Some people are exception. They start a bit late."
"I first smoked after I was twenty. My father smoked heavily. So I did not want to smoke. I hated that bad smell. But one day I thought we are blessed with long life and bad habit might not affect me. But I did not smoke much and never touched alcohol then."
"You drink now?"
"Yes, I drink everyday,"
"Cigarette and alcohol increase the cholesterol in the blood. Are you aware of that?"
"Yes I know. I read a lot. Sometimes I feel I have hypochondria."
"Hypochondria is a fear of diseases. It is the disease of the mind. I am happy to know that you have read about it. Even if you catch cold you think it can be cancer. There are thousands of diseases in the world. But symptoms are few. Ordinary person does not understand this. By talking about diseases with others, by seeing people who are dear suffering and by seeing their symptoms, we feel that we are also affected."
"Hypochondria affects not only the ordinary people, but the educated too. The more you know about some diseases and their symptoms, you are more likely to have fear… Especially doctors have this more often… That’s what I feel."
"Let’s not discuss this anymore," the Psychiatrist intervened and said, "You mean to say all doctors have it including me?" There was some anger in his tone. "You do not have hypochondria my dear young man. You are suffering from anxiety disorder which is also called agoraphobia. How is your general health?"
"Everything is fine. I have done all the tests. ECG was also taken."
"ECG tells the history. Only tread mill test can predict the future."
"I did that also."
"I will prescribe you some tablets. Take them in the morning and at night as prescribed. They are only tranquilizers. You feel dizziness for some time. Mind you these are not sleeping pills. They will bring down your anxiety. Please come back after fifteen days for review."
"So you diagnose him with anxiety disorder," the old man who was sitting without uttering a single word for a long time spoke. "I also know a bit of psychology."
The Psychiatrist got angry.
"Everybody knows a bit of psychology," the Psychiatrist said, "You cannot come to a conclusion at once while diagnosing."
"How much do we owe you?" the old man asked ignoring what the psychiatrist had said.
"I do not work only for money. I am also into social work like you, but in a different way. Two hundred rupees please."
The old man and the young man went out.
The Psychiatrist felt relieved.
The Psychiatrist had told three lies - first, that his secretary was on leave. She had left because she was always paid late and she did not like her job as it was 'boring'. Second, that he did not work only for money. As of late that was his only intention. Third, that he had another appointment. He did not have any for that evening.
At the age of thirteen, the Psychiatrist started reading the books his father had bought. He liked all the books. But he liked those on psychology and on Sigmund Freud more.
Sigmund Freud is called the ‘Father of psychoanalysis’. All his theories may not be true. But one fact which no one can deny is Sigmund Freud was the one who laid the foundation for systematic psychology.
The Psychiatrist as a boy did not understand anything about psychology. He was too young to understand these things. Yet his subconscious mind grasped many things on Freud and his psychology.
The Psychiatrist was good in studies. Though his father was not very rich he made sure his son completed his 10th standard. He used to buy many books, most of them on psychology. The young boy never knew why his father was so interested in that subject. He only read as much as he could, which his subconscious mind would store.
He took science after his 10th standard. He never thought he would become a doctor since it required a lot of money. His merit helped him to get a free government seat. He completed his MBBS. His colleagues either started practicing or went for higher studies. He wanted to pursue his higher studies only in Psychiatry. But no seat was available in any nearby medical colleges. He got a seat in the state capital city which was quiet far from his town. He was forced to go there as he did not like any other subjects.
He passed psychiatry with distinction and started working in a medical college as Professor during the day. He opened an evening clinic as most medical professors do. In the initial stage few would visit him. But later more came for consultation.
He married a dentist after a few years. The Psychiatrist did not have many ambitions in life except to make a good name in the society. His wife came from a very rich family. She started working for a dentist’s clinic. After two years of marriage she bore a girl child, after which she stopped working. But before she could join work again, she was pregnant with another girl. So there was a gap of four years in her career. The money the psychiatrist brought home was not sufficient for her.
"I have to look after two girls," she always complained.
"You are also working now... But…," The Psychiatrist would reply.
"Yes I work now, but after so many years of break. What if I was a home maker? So many doctors have home makers as their wives. And what I earn is spent on our children. I want our girls to get educated in a good school. Only because of these problems I am working part time now. As a husband it’s your duty to work hard. You should save more for your children."
The Psychiatrist would explain a few things to her as he would to his patients.
"I do not want any classes on psychology at home. I am not your patient," she would say angrily.
"We have everything. Tell me what do you miss here? I was brought up in a poor family. I am happy now. I am a content person."
"But I was not poor. We had much more than this."
"That’s why I tell you that you have enjoyed life. Don’t worry. After some days of hardship everything will be ok."
How could everything be ok? She never spent anything on household expenses except to treat her brothers and sisters. Every household expenses were paid by the Psychiatrist, be it school fees, house loan, car loan or anything. His whole salary was spent on these things.
At his clinic he would not get much. If anyone was poor he would not charge. After paying rent and electricity bills he would remain with nothing. He did not even pay his secretary on time as he always had a cash crunch.
He asked the doctor next door to help him with his secretary.
"We are always busy. Wish I could help," the busy doctor said.
Yes, the doctor next door would get hundreds of patients a day.
The psychiatrist started developing mild jealousy about other doctors. Jealousy is one of the virtues of a person well explained in psychology. It is said that saints, priests and some enlightened people overcome jealousy. But it is not necessary that a person can overcome jealousy just because he has knowledge of jealousy.
His thinking now was not different from an ordinary person.
Words like profession, clinic, patients, psychiatry, life, money, wife and death started troubling him. Why even death? Inferiority complex started invading him.
His thinking upset his mind. He would go into mild depression. If the mind is not well it affects the body. While someone has anxiety and depression for a long period, the problems turn into psychosomatic and the pain can reflect in the body. And any part of your body can ache if you feel it's aching. When you think your finger is paining, you feel it. When you think your stomach is paining, you find pain there.
He started getting acidity and headache every now and then. It’s easier to prescribe medicine to others. But not for self. He took the tablets he thought were good. Sometimes he took tranquilizers like Ativan. He would get relief after taking tablets.
"Why did I do MD in psychiatry? I could have done in ortho or any other subject," he started thinking.
But what’s the guarantee that he would have succeeded in his profession had he taken up other subjects?
The situation lasted for days without any improvement. The Psychiatrist phoned the renowned Psychiatrist of the town. He knew him very well though they hardly spoke. He asked for an appointment and requested him to keep it confidential. He managed to get the appointment the following evening at eight.
"If it was with me, he would have got an appointment immediately," he said to himself and laughed loudly.
All psychiatrists are the same. They all learn psychology. He could have gone to any psychiatrist. But he had decided to go to the renowned and number one psychiatrist.
"Yes. People do not come to me because I am not famous. And if I myself want to visit only the famous, what about ordinary patients?" He just thought about the appointment episode.
He got all the reports done during daytime itself as he was aware that he would be asked. And above all he wanted to satisfy himself with the new report.
He reached in time.
"Good evening doctor. I am afraid that the doctor is very busy. You will have to wait for another half an hour at the maximum," the secretary at the desk said.
He looked at her. It was his former secretary who left him a few days back. He recognised her.
"Doctor, I have got a better job here and I am always busy," she laughed.
'Better job' and 'always busy' hurt him a bit. But even as a psychiatrist he did not understand that she was mocking at him.
He sat on a chair in the waiting room. He found two people who he knew well. He became restless seeing them there. He tried to avoid them by holding an old magazine against his face and pretending that he was busy immersed in reading. "These people know me well. And they do not come to me," he said to himself with anger.
"How are you doctor? Why you are here?" One of them said.
"Well, I have a small discussion with this doctor," the Psychiatrist said.
The renowned psychiatrist was seeing the other person from his same profession. So he did not ask many questions. But he had to say something. So he said, "Every person on this earth including you has some fear. I have seen all your reports. So I rule out any physical problem in you. I prescribe you some medicines. You will recover."
The renowned psychiatrist did not write the prescription but only mentioned the names of medicines.
"The same stuff. Same medicines I would have given to others. Waste of time," thought the Psychiatrist.
One day while he was busy reading a book the old social worker walked in. He had come with another youngster.
"Almost like the previous case," the social worker said. The psychiatrist listened carefully to the youngster, wrote the prescription and talked: "Young man, do not even think about dying. Think positively that you will live. Try to come out of your problems. There are many ways out. If you believe in God, just pray. Spend your time with friends instead of lying around at home. Nobody can decide death. You are very young. Be positive."
The Psychiatrist remembered about the other youngster who had come last time.
"How is that young man who came here last time?" The Psychiatrist asked the social worker.
"Not bad," replied the social worker. "Now he is better. I was told he went to a psychiatrist for second opinion. I was told he was very famous in town, but I cannot recall his name."
"Why second opinion? Am I bad? Is my education wrong? Did I study at the wrong medical college? Why did you bring this man here? Just because it is cheaper here?" The Psychiatrist shouted in anger.
The old man asked the youngster to leave the room and once he left, talked slowly. "Dear Doctor... Do not get angry, please. You are a good doctor. That’s why I bring people here. Every person is not successful in his profession. I also studied a lot. See what I am doing? That too without any remuneration? But I am happy."
There was heavy fight at the Psychiatrist’s home. The problems aggravated. His wife started fighting about the future of their children. She kept on nagging about lack of resources. The Psychiatrist explained to her that she should not talk about the future as it was far from the present. She did not seem to understand him.
Yes, when mind is not well, body cannot remain fit.
He read many books on death. He knew all the reasons which led to death - smoking, diabetes, hypertension, the life without exercise, the history of the family, tension, depression, wrong life style etc. He read about the cause of death, mainly the most prevalent - heart attack.
Everything was in his favour. He did not smoke nor drink. He walked every day. He did not have hypertension or diabetes. He had a very good history. His grandfather and father were alive and healthy.
He read about the symptoms of heart attack like stomach pain, vomiting, pain on the back, pain on the chest, and many more. But sometimes there are no symptoms at all. Heart attack can be massive at times where a person may not survive. Sometimes and most of the times it can be mild and people do not die. If they take proper care they can live longer.
Once, while he was reading an article he came across a story about Sani Abacha, the former dictator of Nigeria. He read about how he died. He read his doctor's statement: "We had checked him a few hours before he died. We checked his heart also. Everything was fine. Yet he died of heart attack. We cannot predict death."
One day no patients turned up and the Psychiatrist was sitting alone in his clinic. At once he felt that something was happening within him. He started feeling pain in his chest. He took antacids thinking it’s the old acidity again which he was very much used to.
After a few minutes a thought came to him that it was a heart attack. Then he thought even if it was heart attack he could still live with an operation. Only that he had to spend some money. But he had enough insurance coverage for that. These types of thoughts had come to him earlier also.
The pain increased. Light foam started coming out from his mouth. It increased. He shouted for help, trying as best as he could. He shouted louder. Nobody heard him.
The compounder who worked at the opposite clinic after closing his doors just peeped into the Psychiatrist's clinic to see why the lights are on. Normally the psychiatrist would close his clinic much before others.
The Psychiatrist was lying on the floor. He was already dead.
Nobody knows when death comes. It shows no signs.
The doctor in charge of the hospital wrote the report 'Death on arrival. Massive heart attack' with tears in his eyes. He looked at a doctor colleague and said, "He was my class mate. He was very intelligent and a very good human being. Look how young he is... I do not know what could be the reason. God... Why is man born? Why does he live? And…and why does he die?"
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