I see a lot of weird people in my practice – I’ve written about them in the past and I shall write about them again. But among them all there is one set of patients which sends my heart sliding down to my boots.

That’s the kid in the dental chair.

Yes, I’m terrified of the child patient. Some of them are nice and sweet and co-operative; about one in fifteen or twenty. Some can be persuaded; and for the rest, about thirty or forty percent, oh my word, what a battle, even to get them to open their mouths.

I’ve fantasised about putting child patients in strait jackets and mouth gags more than once. Most often that's been after I've been bitten by children so hard through the latex gloves that I had to take anti-tetanus injections. I’ve been kicked, punched, vomited on, and after all that I still couldn’t treat them. I’ve had my ears assaulted by constant shrieks that would make anyone think I was cutting the kid’s throat – and yet when I gave up and let the chair down, the scream stopped like magic and the tears have disappeared like someone turned a tap off.

Back in my student days there were people who’d use “thokal anaesthesia” – threaten the child with physical violence. But that was then and I never believed in that anyway.

And mostly it’s not the child who’s really responsible. When you have parents who threaten the child with a visit to the dentist as punishment, or bribe them with promises of ice-cream (when I had to take out a tooth, for instance, and the kid began whining because it can’t have the promised ice cream at once) or say things like – in front of the child, and theatrically turning their faces away – “You treat him, doctor, I can’t bear to see this” …the child is not to blame. When parents tell their children in advance that all the dentist will be doing is just take a look in their mouths, and nothing more, the child is not to blame.

It’s just another reason why I think people need to pass qualification examinations before being allowed to become parents.

Some people just won’t be helped.

Every time I hear about a “ten kilogram tumour” being removed from some patient, I know that here’s the Syndrome in action again.

I don’t know how many times I’ve seen this happen. Assuming the individual’s financial condition is robust enough for him to be able to afford treatment, here’s what happens far too often for it to be funny. It proceeds in clearly recognisable stages:

Stage one: patient notices a spot or swelling. Pays it little or no heed, so long as it doesn’t hurt. More or less forgets about it.

Stage two: patient sees the spot or swelling still in place and increasing in size. Gets vaguely alarmed, especially since he is aware that he's in a high risk group - a smoker, say. Finally sees a doctor.

Stage three: doctor says (with a suitably grim expression in place) “You need a biopsy to see what’s wrong. It may be cancer.”

Stage four: patient flees as if all the hordes of hell were at his heels. He spends the days and nights in a state of quaking terror, far too afraid of getting himself biopsied just in case it reveals cancer. He takes whatever scraps of comfort he can find in all sorts of old wives’ tales and folk remedies. I’ve known one, whose son was a doctor, insist on getting “treated” by a tribal “massage therapist” for a bone tumour. This stage can last for years if the tumour grows slowly enough.

Stage five: the tumour grows so large that the patient’s daily life is so severely affected that he can no longer pretend to himself that it’s going to go away on its own. He then goes to a doctor for treatment. If it’s a benign tumour, he’s delivered of a ten kilo tumour or a three litre cyst. If it’s malignant, well…

Stage six: the funeral and another myth in the making of how  all cancers are incurable.

I have one of these now, a little girl with a recurring mouth tumour. The parents refuse to get it biopsied and promptly disappeared with her when I suggested it. It’s likely benign, at least for the time being, but I wouldn’t give too much for her chances if they wait for much longer.  

I’m turned off by smokers.

One of the reasons may be the fact that my dad and an uncle were both killed by cigarettes – dad by emphysema that killed him while he was on chemotherapy after intestinal cancer surgery, and uncle by lung cancer.

And equally to the point, I was mercilessly subject to second-hand smoke throughout my childhood and into my teenage from morons who had never heard of passive smoking, or if they had, didn’t give a shadow of a damn.

It isn’t too surprising, really. While most Indians are either illiterate or illiterate in English (at least functionally) the only warning on Indian cigarette packets is in thin lettering at the bottom: STATUTORY WARNING: CIGARETTE  SMOKING IS INJURIOUS TO HEALTH. It sounds like it’s meant to sound – like something meant to be disregarded, completely.

Of course, there is also the usual set of macho males who will go out of their way to do dangerous things just for the sake of doing dangerous things – but that lot will do it anyway.

I know a woman – an educated (she has a Master’s degree in English), otherwise intelligent woman, who’s a news presenter on NDTV 24X7 these days – who smokes like a chimney and claims that’s rebellion…in this day and age.

In India, cigarette smoking is banned in public places. Right…tell that to the cop with a beedi stuck behind his ear, the end still glowing.

All right, so – logically – the solution is to frighten people into giving up smoking. If nothing else works, fear might. After all, it’s worked in many countries around the globe, right?

So, in India, the health ministry has been pressing for real health warnings to be posted on cigarette packets, like a skull and crossbones, so even the illiterate would notice and understand, and in large enough sizes so that they would see. Our dear government refuses. After all, if people see those warnings, they might stop killing themselves and innocent bystanders with cigarette smoke. Think about the taxes lost from cigarette sales and all. Tobacco being an employer and stuff.

This is also an argument of the average die hard smoker, now that at least a fair segment of them can no longer deny that smoking ruins lungs: “By smoking, I’m providing employment to so many people. So many farmers and packers and retailers...”

(“Yeah,” I usually reply. “And to doctors and undertakers. You’re at liberty to poison yourself, but don’t, please, poison me too.”)  

This being India, nobody has the gumption to point out that the losses from lung cancer, emphysema, and other goodies gifted by tobacco smoke would be less damaging than the taxes lost if people bought less tobacco. And if anyone pointed it out, “electoral compulsions” would ensure he or she was ignored.

Ah – there is one way you can scare an Indian smoker into quitting. And that would be to copy the warning posted in the picture above. 

As for me, the second biggest turn off for me is a smoking habit. It ranks right after prudery and no sense of humour.

So stub that cancer stick out.

If I went out of the door with a gun (assuming I could get hold of one, this not being America) and shot two people, I’d be gunned down by the law or – if I were arrested instead of shot – I’d spend the rest of my life in prison if I didn’t get executed.

The message is that I can’t get away with murder.

Now, if I killed ten thousand people – and made money, a hell of a lot of money out of it – not only will nothing happen to me, but I’d be honoured by society for being clever enough to make a lot of money very quickly. And I could easily buy my way out of any scrapes I might get into with the law.

How do I do it?

I make fake medicines.

It’s so easy and so profitable and so unlikely that anything will ever be done to stop me that there may be more fake medicines being made than real ones.

In little hole in the corner workshops all over India to more elaborate concerns, probably hundreds of thousands of people are contributing to the national economy and earning a living churning out “antibiotics” made of glucose and “painkillers” of chalk powder, not to mention “saline” bottles containing tap water. And if they enrich themselves and their employers, that’s all quite fine. It’s the capitalist economy – where there is a way to earn money, it’s kind of immoral to stop people from earning it, am I not right?

China recently executed its drug boss for promoting fake medicines after taking bribes. Not very surprising Indian officials tacitly condemned it. People might get ideas.  

In a town in South India, a 15 year old boy - son of a couple of doctors who own a nursing home - performed, with his parents' permission, a Caesarean surgery on a pregnant woman.

The reason was his parents' desire to get him on the Guiness Book of World Records. Accordingly, they recorded the event, put it on a CD, and showed it to members of the local chapter of the Indian Medical Association (IMA).

Now, these two crooks knew perfectly well this was illegal. No one can perform a surgery unless he or she is a surgeon qualified for that purpose.

The local IMA chapter petitioned the national IMA for revocation of the couples' licences to practice. What happened? Nothing.

The national IMA said nothing could be done without a complaint from the patient. And she will not complain because she will either be threatened or bought off. Meanwhile, the CD has disappeared. Not surprising.

The IMA will do nothing, in fact is moving very, very slowly in order to ensure that it will have to do nothing. If, after all, every case of malpractice is to be punished, at least half the members of the IMA would be left jobless.

Not even the fact that the dad, who is not an anaesthesiologist, administered anaesthesia to the patient will be  punished. After all, virtually all doctors who own nursing homes do this as a matter of course, and many of them are not even surgeons.

Apart from medical malpractice, what does this tell us about the Indian penchant for getting into record books, at all costs and against all good sense? I'm sure many Indian parents will be ready to defend this duo of charlatans, as well as their son, just as they were ready to defend the exploitation of Budhia Singh.

It's a bad outlook. 

Yesterday, not far from my home, a rabid dog bit not less than fifteen people before it was shot. It also - says rumour - bit another dog, which - says rumour - instantly became rabid and yet roams the locality, biting (like the rats of Hamelin)

the babies in their cradles...

OK, now that's an urban myth. But it's only one of a bizarre coillection of myths this episode has brought floating up to the surface of a very scummy pond.

I myself have seen no trace of either dog. Nor of any dog which is acting in the least bit abnormal, but to hear people, you'd think foam flecked apparitions are roaming the streets, werewolf-like, ripping hearts out of torsos. Make that giant foam flecked apparitions.

Now rabies is a viral encephalitis. It spreads along the nerves from the point of entry into the body until it reaches the brain (always after an incubation period of days to years, but usually weeks to months) and then from the brain to the tear glands, salivary glands, and possibly to the sex secretions as well. There is nothing magical about the disease. It can be stopped. Just scrubbing the bite with soap and water can reduce your chances of getting the disease by something like 80%.

But here is what I discovered...

Prevalent Bengali belief: Rabies does not exist. Dogs have poison ducts like snakes. When they go, literally, insane, they bite and inject venom into people, who begin barking like dogs and shuffle off this mortal coil. If they've been bitten by cats, they begin mewing like cats. (Yet no one I have heard tell of this has averred that cats have poison glands too.) Anti-rabies vaccine is basically an anti-venene like snake bite vaccine.

Prevalent Khasi belief: If you get bitten by a rabid dog, you need to get some of that particular dog's hair and tie it to the wound after doing some incantations over it. 

No wonder India has a yearly death toll from rabies of anything from 10,000 to 30,000 - and that's the official toll only.

Another thing: rabies anti serum used to be given out free from the government run Pasteur Institute in this city. It has disappeared from there. They say it's in short supply, but you can buy it freely from pharmacies - at something like four hundred rupees a shot. I wonder how many of the bitten people can afford an entire course of immunisation, or will go for it even if they can afford it.

This being a part of the world where rabies is endemic, you'd think there would be some arrangement in place by now to prevent profit-gouging of desperate people. But, pharmaceutical companies have a legitimate right to make a profit, I guess. At least that's what they say.

And I'm sure the rabies virus gives a damn.

Blood is thicker than water.

Well, obviously. Even if you take water that is not thrice distilled and contains any amount of dissolved contaminants, blood, with its serum and its erythrocytes, leucocytes and thrombocytes, wins hands down when it comes to specific gravity. But that's not exactly what I am talking about.

Back in the days when I was a third year student in medical college, it was not legal for someone who had joined a private medical college to switch to a government run-or-funded one (like mine, for instance). The reason for this regulation was simple and excellent. In order to join a government college, one would have to qualify through an entrance exam, which was pretty tough (though amazing numbers of dodos ultimately got through) and highly competitive. Private colleges, on the other hand, would let in anyone able to pay the exorbitant fees. Not very surprising therefore that private colleges  don't, how should I put it, command the confidence of the average person (which is why they have difficulty even getting patients for their students to work their magic on).

But...

Teachers wanted their own children to follow in their footsteps.

I have never made a secret of the fact that I detest family traditions, especially when it involves children being given no option but to do what their father (it is never the mother, not in this country) does. But I am not talking of me.

Now some of these teacher's kids were already in the college, having qualified by the usual method, and naturally we'd grown used to them walking away with all the awards. It was totally to be expected. A simple quid pro quo, one teacher promotes another's child in the expectation of the favour being returned tomorrow. We were disgusted when we thought of it, but normally we did not think of it. Even if the "child" was an ignoramus, like Lalu Prasad's daughter Misa Bharati, he or she would get the top position. So what? In later years, it means doodly squat.

But in order to garner those awards, a teacher's child actually has to be in the college. Right?

What now, if he or she is too dumb to pass the qualifying exam? What then?

Solution: private college. Pay their way in.

Ah, but, you see, private colleges have no credibility.

Well, now, this being India and all...

What they did was transfer their kids to the second year of our college (the year junior to mine) directly from private college. There were about four or five of them that I remember, two or three teacher's children, one senior bureaucrat's daughter, and the daughter of UP's then BJP chief, Kalraj Mishra. It was illegal, but they went and did it anyway. Obviously no one from the student body would dare to protest (we would never have been able to pass their exams in that case, and we knew it all too well - we were not even allowed to have a student's union). Then they went and had it legalised somehow or other, so the law said they could transfer if they had done one year in a private college.

But by the time this rigmarole was all done, the year end exams were approaching, and none of these VIPs had the requisite attendance to appear. What to do, what to do?

I must admit it - their solution was brilliant.

They managed to "lose" the attendance records of most of the class. Not all - that would have had to draw the attention of the Lucknow University authorities, under whom the medical college then was (it is now itself a deemed university and manufactures its own rules). Just most. So most of the class would not be able to appear for the University run year end exams. A problem, don't you think? What would the logical solution be?

Yeah, you guessed it. The whole lot were allowed to appear, regardless of their attendance, including the VIPs...who naturally shared between them all the top places. Except for the bureaucrat's daughter, who was made to fail, probably as a warning to her father not to rock any political boats.

If nepotism be the food of success, lay on.