Shrink's Views

ramblings of an unknown psychiatrist

Archive for the ‘children’ Category

New View, New Hope & New Life: a story

Posted by Dheeraj Kattula on January 9, 2011

“It was wonderful, Harsha. Your drives have improved a lot”, I said. I doubt if he heard it. He was running around with joy. Why not? He was the man of the match in his school cricket. I realized that it was this day five years ago, Savithri left this earth for me to live on alone. We had been together for more than 30 years. It had been tough for me. With both my sons being well settled abroad, I had no reason to live without Savithri.

It was then an accident happened. My friend Chakri, his wife Hamsa and his son Raman died in a bus accident. They had gone to attend a wedding in the neighbouring town. The bus collided head-on with another bus on the bridge and fell into the river. I was wallowing in my own grief after Savithri’s loss till the death of Chakri and his family shook me awake to reality of sufferings of many others.

Raman’s widow Sukku is young, beautiful and not so educated. How would she survive in this dirty world? After the funeral I invited her to bring her son and live in my home as my daughter. I suggested that she could give their home on rent to someone so that she could have some money for herself. She agreed. Some relatives did not like it. Is it not surprising that many invisible uncles and aunties become visible, when a dad or mom is found!

Harsha is Raman’s son. I teach him everything be it shlokas, cricket, school subjects or moral values. Being a retired civil engineer, I can handle many subjects. Harsha is from a good family though not an accomplished one. Chakri was not a great student. He dropped out from our school in class X. He became a watch-repair man. He was skilled in that trade. Raman too was not very good in studies. He too joined the trade and later found a job in HMT Company as a technician. They might not have been brilliant but they were always upright. One could always trust the work and word of Chakri and Raman. It is not difficult to bring up Harsha, in whose veins flows such good blood.

I have never felt as depressed after Sukku and Harsha joined me in my home. Good things cannot be limited or contained. They will find a way out to influence and affect others. About a year after Harsha and Sukku joined me at our home, I happened to visit Choklingam at his home. It was being moved. His son had sold the house. He needed capital for investment in Australia. So thought it was better to move his retired father and mother to a rented apartment and sell of the house. It was a decision worth praise in economic terms.

Chokli was a surgeon employed with the state Government. He had spent all his evenings in a busy private practice to make money to guarantee a good future for his children. His day began very early as he completed his operations of private practice before he reported for work in the Government Hospital. He sent his kids to the best tuitions available. His children studied well. He afforded post graduate education in engineering for one son, who is now in the US. He gave his daughter in marriage to an NRI based in UK. The youngest son, who had done an American MBA was setting up a business in Australia. It was he who decided to sell of the property of the father. I am glad I did not give away my property to my children before my time is done. Chokli is now dependent! He is the man who made most money among all friends.

I have seen him move from a palatial bungalow to a place which was more like a dungeon. I visited him about three months after the move. I was aghast when I found Chokli and his wife in an unconscious state. I called for an ambulance and got both of them admitted in a hospital. His wife had been having memory problems for few months now. She was diagnosed as having Dementia. Chokli had diabetes and hypertension which had led to a stroke. His children never came when told of that the parents were serious. They did give me all the possible contact numbers just in case the one I was contacting them with did not work. It was as if they did not want to miss the news of death of their parents.

Chokli improved with treatment. He still has some weakness of his left side. We were told that his wife will become dependent in the future, but her general condition improved with treatment too. Where could I leave them? Leaving them in that dirty dungeon, without anyone to care for them would be cruel. I though I could take them into my custody. I asked Sukku about it. I honestly do not know what she thought. She did not refuse. Chokli and his wife moved into our home. Sukku had to cook for more people. Our expenses increased. I started giving consultations for the local builders. Chokli joined a private medical college nearby as a faculty. The college arranged him to be picked and dropped. Sukku managed the kitchen and helped care for Chokli’s wife.

Six months ago I went to the village we all hailed from. I had some land which I had given on lease. Usually the produce of land was sold and shared between the farmer and us. I did not want rice to be sold now. I thought we could consume part of it ourselves. It would cut our costs. It had also been long since I smelt our village. I needed a break badly too. As I was walking from the bus stand to the interior of the village, I wanted to drop into a shop for a cool drink. As I bowed down to clear my get my head through the thatched roof of the shop, I saw Lakshmi. I froze for a second.

Lakshmi was one of the brightest students in my class. She was the only daughter of a small farmer. Her mother died while giving birth to her. A rare man that he was, her father did not marry again. He took good care of Lakshmi. When we were in 8th standard, she had to drop out of school. Her father had taken a loan and was not able to repay. The Zamindar wanted to marry Lakshmi in return for the waiving off the loan. Lakshmi’s father had no choice. It was everyone’s knowledge that Lakshmi was abused badly by Zamindar. He father could not tolerate the pain of his daughter and committed suicide.

Lakshmi gave birth to a baby boy. She was of course never given the status of a wife in Zamindar’s household. She was like a slave in his haveli. Her social links were all cut off. Her world revolved around her son, Rajesh. As her son grew up, he was not unlike his father. He was impulsive, irritable and hot blooded. There was a feud in their home regarding property when Rajesh claimed a share equal to Zamindar’s other sons. There was an exchange of blows. In a fit of rage Rajesh stabbed his father to death. He realized his folly and surrendered to the police. The other sons of Zamindar got Rajesh killed in Police custody. Later the police showed it as suicide.

Lakshmi lost everything. She had lost her education, her father, her son, her so-called husband, her lands, her residence and livelihood. I knew she moved out of the haveli, but I did not know what she was doing for a living.

We recognized each other in an instant. I asked her, “How are you?” “Life is going on”, she said “I make pickles and sell them in few villages nearby. I sleep in the village school. I use space near the temple for making pickles. No one says anything. I am able to make ends meet.”

Then the shopkeeper said, “Sir, she makes excellent pickles. We have stopped the bottled pickles from the town. Everyone is buying her pickles only.” I wished her luck as she picked her bags to leave to the next village. I had my cool drink and then caught up with her when she was alone.

“Lakshmi!”, I cried and added “Why don’t you come to the town and make pickles on large scale? God has given you skills and you should use it appropriately. I always knew you were capable of great things. Life treats some of us very badly. Bad times need not last a life time. We all live in the same home- Chokli, his wife, Chakri’s daughter-in-law and grandson Harsha. Do you remember Chokli and Chakri? You could join us Lakshmi. It would be great. You would be an asset to our home. You will have a room to rest. More importantly, you will have fellowship and friendship. Come and see.”

Lakshmi thought for a while as she stared into the blue sky and smiled. I took her bags full of pickles and walked back to the bus stop. Lakshmi now lives with us in our home. She has started supplying pickles to few malls here. ‘Lakshmi pickles’ has become a local brand now. She does not think of expanding now as she is also helping Sukku in taking care of Chokli’s wife.

I am wondering how much life has changed since I stopped looking at myself and my own problems and looked at others and their problems. It is not that difficulties have all disappeared but we find strength from each other as we care for one another. We are quite like firewood in a stove. When removed from others our fire dies out. When we are in touch with one another despite the weak flame, we all keep burning.

I have toyed with the idea of marrying Lakshmi. If things had gone the way I desired as a teenager, I would have married her in my youth. Things did not go that way. This was my opportunity. She was never loved in the real sense. She was always betrayed. I know she respects me. There is no reason why she should reject me. At the same time, I also think of Sukku. She is young. She has a son. If I were to think of companionship at my age, how much should she be concerned of her own needs? If she were to think of her own life, what would happen to Harsha. But anyway, her problem is different from mine. In fact if she were to get a decent young man who would accept her as she is and also the responsibilities that come with marrying her, we would be happy to get her married again. Isn’t it? So it is not wrong for me to consider marrying Lakshmi.

I mustered courage and went to Lakshmi’s room yesterday evening. I called, “Lakshmi, Do you have a minute?” Lakshmi came out and asked with a gentle smile, ‘What is the matter?” I swallowed saliva from my parched throat and said, “Nothing…nothing special…just that your pickles are very nice.”

Shloka: Verses in Sanskrit

Zamindar: Landlord

Haveli: Private Mansion

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Posted in children, fiction, indian society, love, marriage, social | 1 Comment »

Bollywood, Brothel and Being Born Again: a story

Posted by Dheeraj Kattula on September 25, 2010

This is a sequel to the story ‘A Dirty Job’ that I had written a couple of weeks ago. You can read it by clicking this.

It was the story of a girl who had very traumatic childhood. She landed in a brothel at an early age. She was rescued from there. She was given therapy to overcome her problems. She was also trained to live a decent life. She chased a dream to dance on film sets after she gained majority. She ended up having an affair and mothered a girl child. Hunger and desperation pushed her to the streets to solicit men.

The story was harshly realistic, reflecting lives of scores of women who land in brothels having chased a Bollywood dream. Is life over for them or is there any other way? Please read on…This story reflects a hope that I believe in.

Bollywood, Brothel and Being Born Again

Bollywood dream is over. I was not getting chances as expected. I made a new choice- to do the dirty job. I had detested it. I always had maintained that I would never do it. I was warned of this by few people. I wonder how they saw this possibility. I do not even want to think about where I went wrong. I always had prided in living in the present. No one knows what the future holds and no one can change the past. So why bother about these things which are not in one’s control. This is how I always thought. The doctor I had met used to advise me of being mindful, but my mind was full of ‘never mind’ philosophy. I think when one crosses boundaries and chooses to go far away from the previously set boundaries; it becomes easier as one moves along.

Having slept with a man once again to satisfy my hunger pangs, I was willing to continue this to sustain myself and my child decently. I went to Kamathipura and joined a brothel. I was given a small room. There were four others with me sharing the room. There were times when two of us were servicing our clients with only a cloth separating us. In the beginning I was a bit disturbed when I used to hear my daughter cry when I was engaged at work. I could see her through the diaphanous cloth which was to shield my shame. I have since gotten used to it. It is all right for a child to cry once in a while, especially if the tummy is getting filled thrice in a day.

I do not know why, but many of my clients come back to me for more. I had a record for this in our brothel. Mohammad Altaf was a local goonda who used to come for me frequently. He looked terrifying. He always carried his revolver with him. Another such regular client was Inspector Chogle. Chogle used to even bring biscuits and milk for my kid. Chogle had apparently recommended one of his bosses an IPS officer Mr Tripathi. He too came regularly. My status in brothel increased. I was given some freedom of movement. Moreover, I was voluntary here. Other girls who were trafficked from Nepal and Andhra had no contact with outside world except the clients.

One day Chogle came and told me to dress well for an outside engagement. He took me in a taxi to Bombay Orchid Hotel. He told me that it was one of the best hotels in India. The hotel looked astounding. He took me to a room more luxurious than the hotel. It did not require me to be an intelligence officer to know that I might have to service a big-shot.

I was shocked to see him. He was a minister. Everyone in the country knew him. Xavier Francis was his name. I had seen him debate on TV on issues of women like rights, dignity and self- reliance. He always wears Khadhi and speaks desi stuff. This is his real face- sleeping with young women in star hotels. After the job was done, he threw two bundles of Rs 100/- notes. I had earned Rs 20,000/- in one hour! I was thrilled. Suddenly he asked me to return the money. As I was giving him back, he tore few pages from a book that was placed near the table lamp. He wrapped the money in those papers. He then secured them with my rubber hair bands that I had left on the table and gave back the money to me with a smile. I liked his gesture.

When I went back to my brothel, I unwrapped the covers to take the money out. I was about to throw the papers, I thought I could as well read them. It was long since I read something in English. I might forget it fully if I did not read on and off. One sheet was the first page of a book. It had a seal stating ‘placed by Gideons International’. The other sheet had a story.

It went like this,

“But Jesus went to the Mount of Olives. At dawn he appeared again in the temple courts, where all the people gathered around him, and he sat down to teach them. The teachers of the law and the Pharisees brought in a woman caught in adultery. They made her stand before the group and said to Jesus, “Teacher, this woman was caught in the act of adultery. In the Law Moses commanded us to stone such women. Now what do you say?” They were using this question as a trap, in order to have a basis for accusing him.

But Jesus bent down and started to write on the ground with his finger. When they kept on questioning him, he straightened up and said to them, “If any one of you is without sin, let him be the first to throw a stone at her.” Again he stooped down and wrote on the ground.

At this, those who heard began to go away one at a time, the older ones first, until only Jesus was left, with the woman still standing there. Jesus straightened up and asked her, “Woman, where are they? Has no one condemned you?”

“No one, sir,” she said. “Then neither do I condemn you,” Jesus declared. “Go now and leave your life of sin.””

I got shocked. There were many things that I did not understand in the story like what are olives, who was Moses, what is this trap thing for this man Jesus etc but I did understand one thing. I am like that woman. I could be caught by police and tried according to the law. This would not happen as people like Chogle sleep with me. This man Jesus was different. He could have condemned that woman but he did not do that. He did not use this position in any other way too. He just told her to go and leave the life of sin. “Go now and leave your life of sin”- that statement rang in my ears for few minutes. I was so lost in these thoughts that I did not even notice that brothel keeper and my co-workers came and took away my money.

When I came to senses, I did not even feel the loss of money. I was awakened. Something was new in me. May be like a sapling. It was alive and growing. I was beginning to see things a bit differently. I do not know how to explain this. I could no longer enjoy the services I rendered. I was lost in some other world. My regulars also noticed a difference. Many of them asked me if I was not well. In fact I was feeling more than well. I realized that there is a thirst in me that needed to be quenched.

A few days later I was on my way to a beauty parlour. I was on an over-bridge near railway tracks. A drunkard walking with a cup of tea on the bridge spilt some tea on my shoe. I looked around for some waste paper. I saw an old man stand in a corner of the over-bridge giving away some booklets. I took one and tore a sheet from it to wipe my shoes and threw the rest of the booklet away.  Just as I was about to throw the sheet off, I realized I could read some English like I did on and off.

The passage went like this:

“Now he had to go through Samaria. So he came to a town in Samaria called Sychar, near the plot of ground Jacob had given to his son Joseph. Jacob’s well was there, and Jesus, tired as he was from the journey, sat down by the well. It was about the sixth hour.

When a Samaritan woman came to draw water, Jesus said to her, “Will you give me a drink?” (His disciples had gone into the town to buy food.)

The Samaritan woman said to him, “You are a Jew and I am a Samaritan woman. How can you ask me for a drink?” (For Jews do not associate with Samaritans.)

Jesus answered her, “If you knew the gift of God and who it is that asks you for a drink, you would have asked him and he would have given you living water.”

“Sir,” the woman said, “you have nothing to draw with and the well is deep. Where can you get this living water? Are you greater than our father Jacob, who gave us the well and drank from it himself, as did also his sons and his flocks and herds?”

Jesus answered, “Everyone who drinks this water will be thirsty again, but whoever drinks the water I give him will never thirst. Indeed, the water I give him will become in him a spring of water welling up to eternal life.”

The woman said to him, “Sir, give me this water so that I won’t get thirsty and have to keep coming here to draw water.”

He told her, “Go, call your husband and come back.”

“I have no husband,” she replied.

Jesus said to her, “You are right when you say you have no husband. The fact is, you have had five husbands, and the man you now have is not your husband. What you have just said is quite true.”

“Sir,” the woman said, “I can see that you are a prophet. Our fathers worshiped on this mountain, but you Jews claim that the place where we must worship is in Jerusalem.”

Jesus declared, “Believe me, woman, a time is coming when you will worship the Father neither on this mountain nor in Jerusalem. You Samaritans worship what you do not know; we worship what we do know, for salvation is from the Jews. Yet a time is coming and has now come when the true worshipers will worship the Father in spirit and truth, for they are the kind of worshipers the Father seeks. God is spirit, and his worshipers must worship in spirit and in truth.”

The woman said, “I know that Messiah” (called Christ) “is coming. When he comes, he will explain everything to us.”

Then Jesus declared, “I who speak to you am he.”

I got excited as I read this. This is the same man Jesus. I had difficulties in understanding everything. Of course I was reading a passage out of a story book and I cannot get an understanding reading a small portion. I asked the man distributing for another copy. He gave piercing looks and looked at the booklet I had thrown away. It had landed open and face down on the railway tracks. I knew what I had to do. I ran as fast as I could and got there before a train came and destroyed it. I sat in the platform and read through this booklet. It was called ‘Gospel of John’. It was about Jesus. It says a lot of things about love.

It said that “God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. For God did not send his Son into the world to condemn the world, but to save the world through him.”  It also said, “Light has come into the world, but men loved darkness instead of light because their deeds were evil. Everyone who does evil hates the light, and will not come into the light for fear that his deeds will be exposed. But whoever lives by the truth comes into the light, so that it may be seen plainly that what he has done has been done through God.”

What I had read earlier was also in this booklet. I realized that I was living in dark. In reality brothels are dark places. Many of our clients want their visits to Kamathipura to be kept in dark. I was living in dark and I was doing evil. Do I have a choice? Can I make a living for my child and me in a way that is not evil? Even if it were to be possible, was I willing to come into the light?

I realized that if I could do it, it would mean plainly that I have done this through God. I prayed to God to help me know the right thing and do the right thing. I went back to my brothel. Life was never the same. I could not enjoy my work at all. It was seen by my clients and soon my brothel keeper would know it. I could fake being happy, but I could not bring myself to do it. There was a discomfort welling within me about being untruthful. I could not even fake it for my survival. I was happy acting in line with my feelings.

I decided I must leave this brothel and this life style. I can work as a maid servant and life a truthful life. I should not let my daughter enter this dirty world if I really love her. Usually the brothel keeper never lets me out with my daughter alone. I had to find the right reason to take her out. That very week Chogle gave two passes for an amusement park nearby. One was for an adult and one was for a child. I had the right reason to go with my daughter and no one else would be with us.

Where would I go with my kid in Mumbai? Whom could I trust? I just wondered. I remembered that things are possible with God. I phoned Mohammad Altaf from a phone booth. I knew Altaf was a goonda and was a ‘bad guy’. Anyway, I decided to trust him, as he was on the wrong side of the law and was faithful to people on the wrong side. Chogle, Tripathi, Xavier etc appear to be on the right side of the law and are unfaithful to the ones on their own side.

Altaf came in about 15 minutes. I told him, “Altaf, I want to leave this trade. I need money to leave this place. I know that you are a tough guy, but I also know you are a good guy. So I have trusted you. Please help me. I want to do the right thing.”

“Laila. Come let us go to ATM…How much do you want?” he asked. “How much ever you can offer”, I answered. He gave me Rs 10,000/- and said, “Leave Mumbai. It is not safe here. They will be able to get to you. Wait for a minute… I will buy you a burqa from the shop near the mosque. You can cover your face.”

He came within five minutes and gave me a burqua. He told me to go behind the pan shop to wear it. In the meantime he took my daughter behind a barber’s shop and cut off the hair of my daughter and dressed her up like a boy. I was so happy for his resourcefulness. We had a chance to escape in nice disguise. As we were about to leave, he got emotional, “Laila, I wish I was a good guy. I would have given you a new life. My life has no future and so I can never commit. I would always love you.”

I always had this intuition that Altaf was a good guy at core but had life had built this tough shell around him. What else can you expect? His mother was also a worker like me, who died of HIV few years ago. He never knew who his father was. I was glad at least he realized there is something called love. I prayed that he too understands God’s love and power to change our lives.

I took a train to the place where I was treated as a teen-ager. I still remember the doctor who cared so much for me and gave me so much of advice. I hoped that he was still there. The hospital had not changed much. Extensions had been made in existing buildings. I went to the room where he used to meet me. I peeped in. He was there. His hairs have greyed a bit and he has put in few kilos of weight. His assistant wanted me to show the appointment card, which I did not have. All of a sudden the doctor came out, probably to grab a cup of tea in between few sessions. I called out for him. He took a couple of seconds, but he recognized me by my name. I was so happy. I was Laila, Lovely or Darling to many men according to their choice, but to the doctor I was, who I really was. He told me to wait till he finished his appointments. He asked me if I had eaten before he went in and resumed his work. I knew I reached a place which had some concern for me.

The wait felt very short. I told my whole story to him. He was not amused. He took it in as if he knew it all. He made some phone calls and then told his assistant to take me to the destitute home. He told me this was a short term arrangement till we could work out a long term plan. The home had 20 destitute women who were old and infirm. They had been deserted by their families. I enjoyed work in the home. Those ladies took good care of my daughter as well. I began to learn their language. There was a nurse who visited us twice in a week. She used to sing songs of Jesus at the beginning and at the end of her work. I shared with her my story. She got excited. She started praying with me for future of me and my child. I began to realize that this place was not my long term home. I wanted to move back to the brothels and help rescue many little girls and young women who are forced in to this trade.

I discussed this with the doctor. He bore the same expression he had when I had shared about wanting to be a dancer in Bollywood. He was true in believing that sparks should be kept far away from fuels. He thought it was intrinsically risky with the promise of earning powerful enemies. There was also the risk of me falling back into the trade. He encouraged me to stay at destitute home to help in the daily chores. He also encouraged me to complete my schooling.

I found a new love for books. They told me about how the world operated, a world created by God. This love made me learn with enthusiasm unlike the way I studied earlier. In a couple of years, I finished my XII standard. I even appeared for the Nursing School Admission test in the hospital where I had got treated. I got selected. My doctor and his friends supported me by paying my fees. They were also supporting my daughter’s school education.

In five years I completed my Nursing course and accumulated two years of experience. My daughter finished her VIII standard. It was an easy choice for me to wait for four more years till my daughter finished her XII standard and secured a seat in Nursing School. I continued to feel the pull to go and rescue girls who were caught in the dirt of flesh trade. I discussed with my doctor. He felt I was a mature woman now. He had developed links with NGOs who are trying to rescue girls and women who were trafficked. He said he would put me in touch with one of those NGOs. I put my daughter in hostel attached to our destitute home. My daughter knew the importance of my work. She was glad to release me. There was a mobile in the home. I could contact her anytime in the evenings.

In the first one month of my job, we were off on a raid. My job was to provide support to the rescued girls. We had social workers, volunteers and police in the raid team. The vehicle’s windows were covered. When the door opened and we alighted, it was like a déjà vu for me. The scent was familiar, the landscape, the building…everything. In fact it was not a déjà vu-It was all real. We had come to the place where it whole thing had begun for me about 20 years ago.

We rescued 15 girls that day. On our way back, I had tears in my eyes. I too had been rescued once, but I had fallen back. I needed a saviour. I knew these girls need a lot of love and a lot of grace to make this rescue meaningful. In our journey back, I prayed for each of these girls as they slept around me in the van. Maybe I lacked someone’s prayers and therefore I got back into the mess. I would not let that happen to these children. I have received love and it is time I share it.

Epilogue:

I became 50 years old few weeks ago. My daughter has become a nurse. She is a nursing tutor in the hospital that took care of us. Her husband is a Physiotherapist. They have a beautiful daughter Raksha.

I chose not to marry again though I had few proposals. I dedicated my life to a mission to rescue girls and I did not want any other engagement in my mind.

I have had my own share of problems too. I have been assaulted numerous times during the raids. I have had fractures a couple of times. Once I had a gunshot wound in my thigh and I lost a lot of blood. I was reminded of my saviours shed blood for me. Without sacrifice of some body, no good would come to this world.

I have been part of numerous rescue operations. Hundreds of girls have got rescued under my eyes. I do not know what has happened to each. I am sure there may be quite a few who have gotten back to the trade. I also know of numerous examples of those who get a new life after a rescue. I have seen them marry and establish homes and families. It is such stories which keep me moving forward. God has been faithful. He always gave me the needed strength. I would carry this on till my death. That is what I am called for.

******

Goonda- Ruffian/ Hooligan

Khadi- Indian fabric usually made employing rural populace

Desi-Refers to people, cultures and products of Indian subcontinent

Burqa- is an enveloping outer garment worn by women in some Islamic traditions to cover their bodies in public places which includes woman’s loose body-covering, head-covering and the face-veil.

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“He will get bed sores and die in about three months. Take care of him. Feed him with what he likes.”: Medical Model VS Family Practice Model

Posted by Dheeraj Kattula on June 29, 2010

He was discussing about his experiences after he came down from the mountains. He was doctor doing medical work in the communities based in nearby hills. He was posted there by our hospital for a couple of months. Of the many things he told that day, I remember this story clearly.

He had seen a 74 year old man with a fracture in his femur in a hilly village. He asked me what he would have done. It was a simple answer for me. I said, “You would have told them to bring him down to the hospital. We could give some charity, even if they cannot pay fully. The bones can be fixed.” There were five competent orthopaedic surgeons in our hospital at that time. He smiled sarcastically. He wanted to make a point, but what he said shocked me.

He had said, “I told them, that he might not live very long. He cannot move here and there because of his broken hip. He will get bed sores and die in about three months. Take care of him. Feed him with what he likes. Let him enjoy the time he has.”

I was filled with malaise. What?!!! How can a doctor say this kind of stuff? I couldn’t control myself. I asked him, “Wasn’t it inhuman? Fractures are treatable. Isn’t it? Then why not offer it. How can we give a death sentence for a treatable condition?”

He laughed at me as if I was talking rubbish. I heard his argument keenly. Probably, it was to rubbish his argument to boost my egoistic ethical pride. He said, “Listen, this old man has a son who is the only bread winner. His daughter-in-law is a house wife. His grandson is now in standard 10. His grand-daughter is in standard 8. It costs about Rs 5000/- to bring him down from the hills in a vehicle. The cost of treatment in the hospital would at least be Rs 30,000/-. They do not have that much of money. If I do send them down, they will have to bring him back after a discussion with a orthopaedic surgeon. In the bargain they would have spent off large amount of money. Just in case they go ahead and treat him, they will have to sell off their house. If they sell it off, then they will have to live in the street.”

I was listening. He went on, “If they spend all that they have, the grandson may not pursue education beyond high school. The grand-daughter would have to discontinue school to add to family income. All this might add one or two more years to a 74 year old man. Is adding a couple of years to such a man worth losing the future of a whole generation?”

It was a tough call. I was a new graduate then. I was trained in the medical model. I was supposed to tell the best medical treatment available to the patients and let them decide what they wanted. I realized this model absolves me of any feeling of guilt. The truth is I do have in my mind what is better, but still I would have done what is ‘right’. My friend’s argument did not convince me.

After about 6 years of that incident I am wondering if that ‘right’ that I would have done is really right?  What would I do if I were in that old man’s position? I am absolutely sure I would rather wish a better future for my grandchild than live a few extra years. I have heard grandparents in India bless their grand children, “Let my years be added to you.” Of course that does not mean that one can assume this sentiment in every case?

The point is that my friend is a family physician. His expertise is not only in managing health problems at a primary level but also in understanding clinical problems and treatment options in the light of socio-economic conditions and the values of the family. His model makes people happier and fulfilled more than the medical model which has the appearance of being more scientific. May be it is time the specialists learn to use the broader model. This can be done when; in addition to eliciting clinical histories clinicians spend some more time with patients in understanding their and their family context and expectations.

PS: This event happened about 6 years ago. Today, thanks to Chief Minister’s insurance scheme and 108 ambulance services, patients like the one described can get free treatment in our hospital.

Posted in challenge, children, Diagnosis, distress, economics, education, ethics, indian society, medicine, philosophy, social | Tagged: , , , , , , , , | 3 Comments »

“There is a limit to suffering one can take. I have to poison her before she brings disgrace.”

Posted by Dheeraj Kattula on April 5, 2010

She had an innocent smile of a child on her face. It was the first time I was seeing her. She was of dusky complexion, cute looks and shy behaviour. She had been on low dose anti-psychotics for few weeks. Her mother complained of her missed periods. Every day, we reassure a lot of people regarding menstrual abnormalities secondary to anti-psychotic use. As I reassured them, I could see that her mother was not satisfied. She complained of swelling in her lower abdomen. I smiled sarcastically at her ignorance. I felt she was worried thinking of menstrual blood getting accumulated down there.

Ignorance is fought with education. A couple of minutes of psycho-education could let them cool down, I thought. As I reassured them again, I noticed a smile of the patient. It was not the usual smile. It had a touch of mental retardation. I became serious. I knew she is a likely victim of sexual abuse. She was single, female, poor, beautiful and mentally disabled. I looked at her parents again. They obviously knew better than me of the possibilities. That was why they looked so distressed. They were afraid of the worst possibility- PREGNANCY.

The elderly couple also have a son. He has chronic Schizophrenia. He is dependent on them. The patient in front of me was dependent too. The grown up children cannot do any meaningful labour in the marketplace. Their mother is the bread winner. Their father is unable to work anymore because of old age. He minds the kids at home. The old lady was already in tears. I told her that she was not alone and such suffering is not uncommon. I realize these words are empty. Suffering hurts most when it hurts you.

She wiped her tears with the free end of her saree. She said “There is a limit to suffering one can take”, as she blew her nose she added, “I will have to poison her sometime, before she brings any disgrace to us.” I could understand her pain. I was shocked to see her daughter smile innocently as she heard this. I knew why this ghastly filicide had not happened till now. It is not tough to kill someone who would submit to you with a smile. It is impossible. Her mother loved her much. She just did not know how to handle her situation,  if at all there is a right way to handle it.

I wanted to send the patient for a pregnancy test. I also wanted to treat her with dignity as an individual with some ‘capacity’. So I asked her if ‘any man had come close’ to her. She agreed with a shy smile. My heart sank. Her mother nearly fainted. She reached out to the nearest bench that was available. I told them not to worry. We could find out if she is truly pregnant in the first place. Her missed periods could be due to medicine itself.

 Her parents did not want the test!!! Why?? I was shocked. They should be asking for it not me! They told me that a test would take time and if they do not go back in time, their schizophrenic son might wander away. Our OP assistant gave them an idea. Her father could return home and mother could take the patient back after the tests are over.

After a couple of hours, I saw them again. The pregnancy test was NEGATIVE. I sighed with relief. I am pro-life. I cannot think of recommending an abortion. We don’t do it in our hospital either. In fact if she was positive, I really do not know what I would/ should have done. Thank God! The old couple would not get another dependent into their family. They also did not have to kill a weak and helpless unborn child.

I told the mother to teach her to keep a distance from unknown men. Of course I know the ones who abuse are usually the known men. But here it was the case of an unknown man. Her mother told me that she had beaten her number of times to teach her that lesson. I wondered why she had to beat her daughter before an act was done! She knows her daughter and their situations better. I better not theorize how to handle these at this stage.  Anyway, now that the patient has experienced a ‘reward’ for the act, I predict she would continue to seek it. This is not my guess .It is the law of effect in maintaining behaviours called ‘operant conditioning’. I suspect that the mother understands this risk. She can never be in peace.

They left, temporarily relieved. I know God does not test us beyond what we can stand. I hope and pray they do not fail the test. We can imagine but we would never know tough it is. How could one help the patient live in safety? What should this mother do now, to prevent such happenings? What are her options given that are such daughters have right to liberty granted to them by International law like Convention on Rights of People with Disability? Where do local laws/ policies stand in situations like this?

Do comment and help me write the responses to the questions stated above in my future posts.

Posted in behavioral therapy, challenge, children, distress, ethics, law, love, mental retardation, schizophrenia, stigma, women's issues | Tagged: , , , , , , , , | 11 Comments »

The Woman in Your Life

Posted by Dheeraj Kattula on January 11, 2010

Dr Dheeraj MD (Makes Dishes)

A very good friend of mine forwarded me an email titled “The Woman in Your Life”, which goes like this:-  (I have deleted all the beautiful photographs that the email had.)

To all the guys who read this…..please read fully and understand………….. 

To all the girls who read this……….. An excellent forward……please read fully….. and forward to the boys you know……….

This is a beautiful article:
The woman in your life…very well expressed…

Tomorrow you may get a working woman, but you should marry her with these facts as well.

Here is a girl, who is as much educated as you are;  who is earning almost as much as you do;

One, who has dreams and aspirations just as you have because she is as human as you are;

One, who has never entered the kitchen in her life just like you or your sister haven’t, as she was busy in studies and competing in a system that gives no special concession to girls for their culinary achievements

One, who has lived and loved her parents and brothers and sisters, almost as much as you do for 20-25 years of her life;

One, who has bravely agreed to leave behind all that, her home, people who love her, to adopt your home, your family, your ways and even your family name…

One, who is somehow expected to be a master-chef from day one, while you sleep oblivious to her predicament in her new circumstances, environment and that kitchen

One, who is expected to make the tea, first thing in the morning and cook food at the end of the day, even if she is as tired as you are, maybe more, and yet never ever expected to complain; to be a servant, a cook, a mother,
a wife, even if she doesn’t want to; and is learning just like you are as to what you want from her; and is clumsy and sloppy at times and knows that you won’t like it if she is too demanding, or if she learns faster than you;

One, who has her own set of friends, and that includes boys and even men at her workplace too, those, who she knows from school days and yet is willing to put all that on the back-burners to avoid your irrational jealousy, unnecessary competition and your inherent insecurities;

Yes, she can drink and dance just as well as you can, but won’t, simply because you won’t like it, even though you say otherwise

One, who can be late from work once in a while when deadlines, just like yours, are to be met;

One, who is doing her level best and wants to make this most important, relationship in her entire life a grand success, if you just help her some and trust her;

One, who just wants one thing from you, as you are the only one she knows in your entire house – your unstinted support, your sensitivities and most importantly – your understanding, or love, if you may call it.

But not many guys understand this……

Please appreciate “HER”

I liked the stuff.In fact I felt if this was the ideal that people are looking for, then maybe I am one of the most eligible batchelors around 🙂 I have added my take on each of the points made.

Tomorrow you may get a working woman, but you should marry her with these facts as well.Here is a girl, who is as much educated as you are;  who is earning almost as much as you do;

Of course I might marry an equally educated girl, who earns as much.(Preferably more.) 🙂 What should be the problem if all the money anyway comes to the home kitty?

One, who has dreams and aspirations just as you have because she is as human as you are;

Of course, she should dream (preferably of me 🙂 ) and have aspirations (to balance work and life).

One, who has never entered the kitchen in her life just like you or your sister haven’t, as she was busy in studies and competing in a system that gives no special concession to girls for their culinary achievements.

Thank God my sister and I did well in the kitchen, just as we did in studies. Problem is nowadays people are not giving weightage to culinary achievements in marriage market!

One, who has lived and loved her parents and brothers and sisters, almost as much as you do for 20-25 years of her life; One, who has bravely agreed to leave behind all that, her home, people who love her, to adopt your home, your family, your ways and even your family name…

She could maintain her relationships with all her brothers, sisters, cousins and parents just as I am sure to maintain mine. Only that it would be great if she could incorporate my circle into hers.I would try my best to incorporate hers into mine.I can only hope she does not come from a family which she was glad to leave! Of course she is welcome start a family with me. She and I would be the family. Together we would relate with others as individuals and families. She is welcome to continue to keep her family name also. She is expected to just add mine like Aishwarya Rai Bacchan.

One, who is somehow expected to be a master-chef from day one, while you sleep oblivious to her predicament in her new circumstances, environment and that kitchen.

I could give my spouse free tutorials in cooking till she overtakes me in all the culinary skills. I would profusely appreciate when she becomes better than me.If you don’t believe that I could cook look at the pic in this post.(Don’t I look like the master chef 🙂 )

One, who is expected to make the tea, first thing in the morning and cook food at the end of the day, even if she is as tired as you are, maybe more, and yet never ever expected to complain;

She better make the tea and coffee and not complain. That is something I would expect :-/ She should understand that I am dependent on Caffeine. She should help me in the withdrawal phase. If she does not, then she would see the symptoms of withdrawal i.e. irritability, anger outbursts etc. Of course, I would make these if she were tired. I can very well understand that if I did’nt then I might have to see signs of her tiredness i.e. irritability, anger outbursts and throwing things!

to be a servant, a cook, a mother, a wife, even if she doesn’t want to;

We could conseider, employing a servant (depending on our finanaces). She cannot stop being a woman if she wanted to. She would stay a mother and a wife whatever be her choice. Do I have a choice to not be a dad and a hubby in a marriage with children?

and is learning just like you are as to what you want from her;

I hope that learning is continuous as we have Continuing Medical Education (CME).This could be called Continuing Marital Education. 

and is clumsy and sloppy at times and knows that you won’t like it if she is too demanding, or if she learns faster than you;

If she is clumsy and sloppy, she is welcome to my gang. If she demands anything, she will get it.(Anything = Nothing). I know demanding would die out without reinforcement. Learnt it in college.It is called behavioral therapy. If she learns faster than me.I ll be proud of her and would transfer some of my assignments to her and tell her to teach me. I am a better auditory learner. In that bargain, she might win some rewards for helping me 🙂

One, who has her own set of friends, and that includes boys and even men at her workplace too, those, who she knows from school days and yet is willing to put all that on the back-burners to avoid your irrational jealousy, unnecessary competition and your inherent insecurities;

Oh Please spare me of that.Let her have all those friends as I would have mine. I hope because of her jealousy I might not have to delete my ancient friends recently found on orkut and facebook. If possible, her friends could be our family friends. If not, they would remain hers. Why should I be jealous of her friends? They may be better looking, better earning, more successful etc. So,what? I am a happy man. I would not trade my happiness for money, success or looks. That is why I prefer to eat than to excercise, learn rather than earn, be with people rather than papers. Cool.

Yes, she can drink and dance just as well as you can, but won’t, simply because you won’t like it, even though you say otherwise

If she drank, you think she could become my wife? :-/ If she dances, then that will keep her in shape 🙂 I would appreciate that.I might join her and get back in shape!

One, who can be late from work once in a while when deadlines, just like yours, are to be met;

No problem.I could enjoy an extra hour of solitude or time with my kids. I could surprise her by cooking a new recipe 🙂

One, who is doing her level best and wants to make this most important, relationship in her entire life a grand success, if you just help her some and trust her;

Of course I would. The same applies to me too .Is it not?

One, who just wants one thing from you, as you are the only one she knows in your entire house – your unstinted support, your sensitivities and most importantly – your understanding, or love, if you may call it.

I would not only love her, I would also pity her. She would have to bear with me much more than I might bear with her ! 🙂 ( This is secret.Shhh…)

But not many guys understand this…

Do you still think so? !

Please appreciate “HER”

She would get lots of this. This is a lot cheaper than buying gifts 🙂

Now, what is your take ?

Posted in children, education, gender, humour, love, marriage | Tagged: , , , , , | 18 Comments »

Moulding Behaviour: An Experience

Posted by Dheeraj Kattula on June 13, 2009

I have studied Behavioral Therapy in my college years. Practiced a couple of techniques in life, but I always preferred the genuine spontaneous response to a predetermined measured response. I succeeded in changing a person’s behavior using behavioral therapy techniques. I see her as not my subject but as my teacher.

Aastha Advent Bara

Aastha Advent Bara

Aastha, a two year old sweet kid, my next door neighbour, daughter of Biji didi (sister), one of our hospital’s nursing sisters, is the one I am talking about.

Aastha is a smart kid. By the age of one year she could indicate if she wanted to see (pass urine) or gugu (pass stools).

Then, her brother Aashish was born. She regressed. She passed urine in the corridors and walked over it and soiled the whole place. She also started throwing tantrums. All this was normal, but I thought it was desirable to change her to the same sweet kid that she was. At least I could try.

I must confess the first time I tried, it was not planned. It was rather a reaction to the irritation caused because of her behavior. I picked Aastha and told her to stop crying. She did not. I told her that I would put her in a bath-room if she did not stop. She cried louder. I put her in a bathroom and closed the door in such a manner (95%) that she could not close it from inside but I could always open it from out side.

I looked at the clock and mentally set the time as 0 min. 1 min later I opened the door and asked Aastha if she wanted to stop crying and come out and play. She increased her volume of cries. But she started playing with the water we store in the bucket. I regretted using this bathroom. It is theoretically unsound to allow substitute pleasures during a time-out.

Now that Aastha rejected my offer at min 1, I left her alone for two minutes and offered her to come and play if she stops crying at min 3.She refused. I gradually increased the duration after which I would make her the offer. She refused at min 8, min 15, min 30, and at min 50. Initially, she was increasing volume of her cries and later she refused to come out by being silent.

At 85 minutes, she reluctantly offered her hand and came out. I picked her in my arms and kissed her. I told her that she should not cry unnecessarily. I told her now that she has stopped crying and has become friends again, she deserves claps and kisses. Our many nursing sisters and other hospital staff kissed her. Aastha became very happy. She began clapping for herself. 🙂

So far so good. But, within a week or so, she threw a tantrum again. The treatment process followed. Only difference is that she came out in 30 minutes. Next time it happened she came out in 15, then 8, then 3, then 1.

After this whenever I saw her throw a tantrum, I picked her in a typical way as if I were to take her for her time out. She started to stop crying immediately and also began to smile!!!. She also clapped and showed as if she wanted kisses. She got her rewards but much later, that too after a lecture about why she should behave well etc.

Since then she requires only the mention of ‘Dhee Mamu’ (Dheeraj Uncle in short) to stop crying. One day Biji didi pulled Aastha by her forearm and inadvertently injured her elbow. This required a plaster of paris cast for few days. We can be pretty sure it would have been a painful state for Aastha.

Before they went to Orthopedic surgeon they showed her to me. Aastha was in tears, but she gave my typical smile. The smiled she gives when I picked her for her ‘time out’. I was shocked at how powerful this had become. I wonder what that smile meant. I felt it was ‘pick me and kiss me’, but I could well be ‘Mamu, please do not put me in the bathroom.’

I  realize that the ‘behavioral smile’ with a desire to avoid discomfort is different from the ’emotional smile’ of joy of being loved.

But whatever, Aastha is a lovely kid today. She does not throw tantrums. She has good bowel and bladder control. Bladder control was obtained by making her clean with a small mop. She loves to imitate house hold works. She loves the kisses she gets when the work is done. How good it is to have a child who loves rewards which you can provide easily! One could mould them to be wonderful.

Guess who gets on my nerves now…Aashish. Aastha’s one year old brother. I do not think Biji didi would allow me to treat her son the way I treated Aastha at age one. I tell her that she has got Maleomania. She just smiles.

Aashish Arul Bara

Aashish Arul Bara

The pitch his cry has precipitated a couple of headaches for me. AASHISH, Watch out…I am coming…

—————————–

P.S. ( for those to whom confidentiality and anonymity are important)

I have taken permission of Biji didi to publish these photographs and the story.

Posted in behavioral therapy, children, emotion, parenting, psychiatry | 4 Comments »