The other day, we had municipal elections in our town. The town wore a festive look.Huge, colorful hoardings came up overnight on the roads. Banners of various candidates appeared over roof-tops and shops vying for the passer-bys attention. Each candidate had his or her own agenda for winning.I have this unsightly, overflowing garbage bin  just some distance away from my clinic. There is a sweets shop just adjacent to the bin. The ‘halwai’ sits on a huge concrete slab in front of his shop and fries his ‘jalebis’ and ‘samosas’ in a huge vessel quite oblivious to the fact that the bin is teeming with flies and the occasional cow and dog.A BJP member had been elected from this area. It so happens that the Congress candidate who had lost runs a wedding point nearby. He was very keen to win back this seat . What better time than this to put forward my plea for shifting the garbage bin to another place ? So when the Congress candidate came calling, that is exactly what I did. I told him he will have my vote if he could get the ghastly eyesore removed from where it was.Little did I realize what this simple request would lead to!     The next morning, I saw one of those huge yellow cranes come to a rumbling halt in front of my clinic. The driver lowered the hook and picked up the bin, garbage and all and whisked it away to an unknown destination.Boy, was I glad to see it go! I rang up the Congress nominee and thanked him profusely for his quick action.You would think that would be the end to the story? Wrong! This was only the beginning……When I came to work the next day, I saw a huge crowd gathered in front of a house just a short distance from the clinic.The mob was looking very agitated and I could see some of them carrying sticks and clubs in their hands. I stopped my car and asked one of the onlookers as to what was going on. Apparently, a BJP candidate lived there and he had taken out his weapon and fired some shots in the air. The reason? A garbage bin next to his house! He was threatening to shoot the cleaners if they didn’t remove the bin at once. I looked towards the bin in question. Any guesses as to which bin it was? You are right! It was the one which was next to the sweets shop .  The police had to be called in to disperse the mob.Tempers were really frayed for a while. The inspector had solved the problem. He had called in a crane post haste and had the bin in question removed.I am waiting for the next elections to come by while I sit and stare at the abominable mess of a garbage bin opposite the road, next to the sweets shop!  

LINK TO part one : Stairway to Heaven 

 I stepped into the bedroom to find the old lady lying flat on her back in the middle of the bed. She had a huge,protuberant abdomen.She was looking weary and frustrated.Her brow was bathed in sweat.As I neared the bed,I could get the smell of urine.Her embarrasment became clear to me.She had wet herself and was feeling a little ashamed of the fact.
At first sight,I estimated her weight to be around 200 pounds.She was barely in a position to even turn to one side.Her weight had shot up rapidly in a few months.Despite being very regular with her medicines and her diet,she was unable to stop her weight gain.
Her husband told me that she had not stepped down since the last one month!
Even though diabetics and patients with thyroid problems are known to gain weight,this particular case didn’t fit the bill.She was grotesquely huge.Her blood sugar levels and thyroid hormone levels were well in control.What could have caused this sudden gain in weight?
Further investigations were required,most importantly an ultrasound of the abdomen.
That of course,was easier said than done!The staircase was just wide enough to accommodate a person of average weight.The steps were barely eigteen inches broad.She had not got off the bed in a long while.And no radiologist would be wlling enough to get the equipment to the patient’s flat.Oh boy !
A glance around the room showed one large grilled window overlooking the street.Apart from that,there was one narrow door leading to the bathroom and the other one was where I had entered from.There was no way she was going to fit through either door.The only option which remained was …….you guessed it,the grilled window!
This called for a meeting with the entire family.Would they be willing to lower her to the street from the window ? The husband readily agreed.The children appeared to be more worried about what ‘people will say’ rather than anything else.Fortunately,good sense prevailed at last.
A carpenter was called in to remove the grill.The husband ‘knew’ someone in the electricity department.The service of a crane which is normally used to repair street lamps was called in.The lady in question was shifted towards the window,still on the bed.The window was large enough for her ample frame.Once  she was in the crane,lowering her to ground level and a waiting ambulance was a cinch.
She had another unpleasant surprise waiting for her at the radiologist’s chamber.. Various imaging studies were performed including a pelvic ultrasound, which identified an 18.9 cm × 10.4cm × 15.6 cm cystic lesion that extended into the abdomen to about the level of the navel. Two MRI studies were ordered which identified a large cystic structure that appeared to suggest an ovarian tumour.These tumours can occupy the entire abdomen and weigh in excess of 100 kg.This accounted for her sudden gain in weight.
She was admitted for surgery.The tumour was removed en masse and weighed a whopping 37 kg!Luckily for her,it was non-cancerous.
She had an uneventful recovery in the hospital.When she was discharged,her family was there to receive her.
As for me,I preferred to wait for her on the steps leading to her flat.I can’t explain the pleasure I felt as I watched her amble up the stairs (oh,those narrow stairs!) to the place she called heaven….her home.

They were married at a time when one of the worst human convulsions in history,the partition of India into two countries was taking place.Within the space of two months in 1947 more than twelve million people were displaced. A million died.Countless children disappeared. Homes, villages, communities, families, and relationships were destroyed.
They lived through this holocaust of 1947.They preferred to come to India being Hindus.
As refugees with not much to survive on,he eked out a living as a street peddler.As time went by,he began to prosper.From being a street peddler,he graduated to owning his own little kiosk selling newspapers and magazines.
Meanwhile,his wife supported him wholeheartedly through all the troubled times.Theirs was an ‘arranged’ marriage.The first time they set eyes on each other was on their wedding night!He told me it was love at first sight.In 1947,he was a strapping lad with the handsome features of his forefathers from  West Punjab.She was short,slim and demure.
They must have made a striking couple.
When I first met them,they had been married for forty years.They had a large family comprising two girls and four boys.All happily married.
Now, the handsome couple of yesteryears was but a shadow of their former selves.
He still walked tall but his face was withered and showed the strains  of life’s hardships.She was no longer slim and demure.In fact,she was very obese.Which is why they came to me in the first place.
Despite having given birth to so many children and looking after them single-handedly while doing all the household chores this lady had bloated to outsized proportions.The husband was worried.So was she.When I first weighed her,the scales showed her to be 93 kilos.When you are not very tall like her,it can really show.
They lived on the second floor of a very old ramshackle building.The stairs leading to the floor were steep,narrow and slippery.It took all her effort now to reach her home.By the time she reached her landing,she would be huffing, quite out of breath.
You can understand why they were worried.
Laboratory investigations revealed that she was suffering from diabetes (high blood sugar levels) as also  hyperthyroidism (a metabolic disorder of the thyroid gland which can cause tremendous weight gain ).But that was not all.The sugar levels had affected her kidneys and one of them was not functioning properly.The prognosis was far from good.
Kidney failure is a dreaded complication of diabetes and many patients ultimately need to undergo dialysis .This is an expensive procedure and sometimes the monthly expenses can be more debilitating than the disease itself !
To be honest,I have never really been fond of giving the ‘bad news’ to a patient.This was no exception.I must say they took it quite well.Perhaps the many hardships of the past had steeled them to face all sorts of calamities. 
I had to call  in a nephrologist to manage the kidney problems while I handled the sugar and thyroid problems.
Fortunately,she responded well and her blood sugar levels came down to normal in a month or so.But,what about her weight ? Two months later,she weighed in at 101 kilos!
And to top it all,her knees had also started giving in and climbing the stairs had now become a very arduous task.She was now very depressed and frustrated with herself.
Even though she kept a brave front,I could see she was very worked up about her situation.For someone who had been very active,being almost bedridden is very,very depressing.
Time went by.One day,I got a frantic call from the husband.
"Doctor,please come soon,my wife has fever,he said.
"Why don’t you bring her over,I’ll check her first,I said.
"No,you don’t understand,please come",he sounded worried.
I agreed to visit her in the afternoon.
This was the first time I was visiting their home.The stairway was very steep and narrow,so narrow one had to walk almost sideways up the stairs!When I reached the second floor and looked into their bedroom,I could see her lying there.She had become huge.It had been a while since I had seen her.Almost six months,I think.The nephrologist
had been treating her.I had not expected her to be so large.
"Doctor,now you can understand why I wanted you to come?",he said.
Of course I could.The lady was so big,she couldn’t fit in the stairway!
to be continued……

After a quick general examination of the patient’s condition,I was relieved to learn that his heart was ticking the way it should and his breathing was even and regular.
I pulled a sheet from the bed and covered him up.
Meanwhile,the hotel staff were getting an earful from the other two outside.I heard them mention the word ‘doctor’ again and again.One of them suddenly rushed into the
room and began yelling at me and grabbed hold of my collar and pulled me away from the floor.I tried to calm him down as best as I could.I’m afraid my best wasn’t good enough !Again a burly waiter had to drag him away.The manager was beginning to panic as all this commotion had attracted the attention of the other hotel guests and people had begun milling around.I had earlier asked him to call in and ambulance.
As I mentioned earlier,I could see no signs of any alcohol or drug ingestion.Why was this guy drenched from head to toe ?And why were all of them in the nude ? The room had snug wall-to-wall carpeting and I could see a wet trail leading from the guy on the floor towards the bathroom which was shut. I headed for the bathroom door.When I opened it,the first thing that hit me was steam.Loads of it.The kind of steam you see in a sauna.
But that was not all.There was another overpowering smell.If you’ve ever sat in a car which is run on LPG gas,you will know what I’m talking about.It has that peculiar sweet sickly smell.The steam in the bath had a similar smell. Further investigation revealed that this hotel used gas cylinder powered boilers in the bathroom.
I could now begin to understand what had happened.The man on the floor had fainted because of an overdose of LPG gas and steam.The bath had one tiny ventilator and no exhaust.He must have apparently decided to have a really hot water bath.The leaking gas mixed with the steam had worked as a dangerous cocktail.
The ambulance arrived and whisked all of them away to the hospital.After the gentleman was put on oxygen,he revived without any complications.
What about the other two ?Why were they nude ?Apparently what happened was when the unconscious guy didn’t respond to their calls,they felt something was wrong.They managed to open the bathroom door.When they saw the room filled with steam,they first removed their clothes before entering the bath to rescue their friend!You may well ask how I managed to gather this last bit of information ? I remembered there was a Language Institute nearby and one of the staff was a multi-linguist.We used his services the next day as an interpreter !Ciao for now.

My clinic is situated in the heart of town in a commercial area.There are several hotels too. Once in a while,some hotel guest gets seriously ill and the hotel owner asks me to make a
‘hotel’ call.
I remember once when I had to attend to an acute emergency during my clinic hours. It was summer time and the hotels were full.The vacations has just begun and the usual horde of tourists had descended on the town.There was a new hotel nearby.
One morning,a profusely sweating,agitated waiter came running into my chamber from this new hotel.His demeanour was such that I instinctively knew there was something very seriously wrong.
"Doctor,please hurry,one of our guests has fainted !",he said.
"Alright,I’m on my way",I said.This of course,meant leaving my waiting patients fuming. But what to do ? An emergency gets priority.
I got into my car and quickly drove across to the hotel.The guard recognised me from earlier visits .Without wasting any time,he caught hold of my bag and directed me to the room where the guest had fainted.
When I entered the room,the sight that greeted me was to say the least,rather peculiar.
There were three young foreign tourists in the room,all in their twenties.One of them was lying spread-eagled on the floor with his eyes shut.The other two were by his side.
You know what made the sight peculiar ? They were all in the nude !Now,I’m no prude but the sight did distract me for a while.After all,it’s not everyday you walk into a room with three nude adults !
Anyway,the sight notwithstanding,I quickly got down to the job I had come for which was to revive the unconscious hotel guest.And then my troubles began.
These guests didn’t know a word of English or any language I could understand.Moreover,they were screaming incessantly.Try as I might,I could not quieten them down.Can you imagine the scene ? Two nude guys,flailing their arms wildly,gesticulating and making incoherent noises while I tried to examine the third lying flat on his back,also nude.Oh boy,what had I got myself into ?
With great difficulty and with the help of two burly waiters,I was  able to have the two escorted out of the room.Finally,with peace descending,I could get down to the business of attending to the third one on the floor.
The first thing I noticed was that he was drenched from head to toe.Fortunately,he was breathing evenly and appeared to be in some sort of deep slumber.Which,of course,led me to think about a narcotic overdose.There was no smell of alcohol on his breath and his pupils appeared normal.I could not see any injection marks,new or old,anywhere on his body.I pinched his arm and pressed my thumbs into his eyeball sockets.There was no response.
With no means of getting any history from the other two,my task had become even more difficult.Something had to be done.And quickly…..
to be continued

This case goes back seventeen years.I was (in fact,I still am) the family doctor of a very large joint family.They have four generations living in a sprawling ‘haveli’.The grandmother is ninety-six !She’s a frail old lady with wrinkled skin and twinkling eyes,with the kind of face that probably lights up many a  grand-child’s day.There are four brothers,all married.The children come in all shapes and sizes.The family business ? A very successful sweets shop in the heart of town.
The case I’m going to share with you relates to the middle brother.A portly gentleman with sausage-shaped fingers adorned with rings of all kinds.Deeply religious in nature,he told me he had visited Vaishno Devi in Jammu and Kashmir every year since the last twelve years.When I first met him he had  two daughters aged six and four .His wife adored him and would go into a panic even if he sneezed just once!All in all,a nice happy family.
That is, till Mr Ahuja’s wife got pregnant.
As days went by,I could see that the lady was becoming more and  more distraught.Instead of putting on weight,she began to lose it.She became withdrawn and depressed.The elders in the family (the ones ‘in the know’) passed it off as depression due to the first trimester of pregnancy.
But somehow,that argument wasn’t very convincing.Mrs Ahuja had borne her previous pregnancies with great aplomb.She had no early morning sickness or depression or…anything then.Something was amiss.
Then one day I had an afternoon visit from Mr Ahuja to my clinic.He was holding a sheaf of papers in his podgy hands and looked very restless.Despite his uneasiness,he kept waiting for the last patient to leave before he came in.
He began talking to me in what can only be described as a whisper.
"You can speak louder,there is no one else here,"I said.
The gentleman cleared his throat and began his sordid tale.It didn’t last very long.
But it was enough to leave me speechless and seething with anger.
As I had mentioned earlier,he had two sweet little daughters.The bottom line was,he was craving for a son!Apparently,he had told his loving wife that she "better give him a son or else".
In addition,he had visited an ultrasonologist along with his wife on the pretext of ’seeing whether everyhing is ok’ and got an ultrasound performed.The rules for sex determination had not yet been made and the doctor had unwittingly congratulated them about their baby girl-to-be !
This of couse,explained his wife’s behaviour.But what had angered me was his suggestion to ‘do something’ about the baby.
Here,I would like to explain a few things about who determines the sex of a child.Women have a set of XX chromosomes, and men have a set of XY chromosomes. Not XX and XY just XY. Women will of course release an X because that is all the woman has. Men will either release an X or a Y. If they release an X the baby will be a girl (XX), if the male releases a Y the baby will be a boy (XY). In other words,it is the MAN who is responsible for determining the sex of a child.
And here was this Mr Ahuja not only asking me to do something about the baby but also threatening his wife with…..I don’t know what.Wasn’t this reason enough to be angry ?
I calmed my nerves with all the strength I could muster and told him in no uncertain terms about what he could do with himself.After that,I tried to explain all about chromosomes and who was responsible in the first place.
Needless to say,I did not comply with Mr Ahuja’s instructions and ‘do something’.
And I prayed that he doesn’t find a willing doctor.
Five months passed by.I had not heard from Mr Ahuja since our last meeting in unsavoury circumstances.
Apparently,my prayers had been answered.Mrs Ahuja delivered a fine baby girl.
But what of Mr Ahuja ?He refused to speak to his wife or see the baby girl for three months!
And then came Holi,the festival of colors.I am told that Mr Ahuja relented and visited the mother and the baby.He relented even further when the darling little girl smiled from her crib and curled her tiny little fingers around her father’s podgy index finger.
She is sixteen and a half now.Her father’s favourite’little girl’.
Did I tell you she has twinkling eyes like her grandmother’s?

P.S. Last heard of,Ali was visiting a sufi saint in Saharanpur.He still can’t walk.

The case of Durga losing the use of her lower limbs had me perplexed for some time. What could possibly have caused this young,spritely girl to become bedridden? The case was a challenging one and I wasn’t about to give up easily.For Durga’s sake, I had to get to the bottom of this. And fast.
Her father told me that she had been running a low grade fever for a while  and had lost her appetite as well.They thought of it as a seasonal ‘flu and ignored it.But when she suddenly fell while playing and refused to get up,her father panicked and rushed her to my clinic.
I have had the good fortune of interning with some of the best physicians during my medical school days.One of the dictums I remember from those days was taught to me by the Head of Medicine at Bowring Hospital,Bangalore.What he often told his young doctors then has helped me arrive at a  correct diagnosis many a time now.What he said was,
"Think of the common ailments first and you will be commonly correct.Think of the rare ones and you will be rarely correct".I thank him for teaching us this simplistic approach
to diagnosing an ailment.
So it was that in Durga’s case I applied the aforesaid dictum as taught to me by Dr K C Das.What is the common cause of low grade fever and loss of appetite in our country ?
What could cause paralysis of the lower limbs in a six year old?
Keeping that in mind,I turned Durga to one side and began examining her spine.As I was pressing along the lower spine,she suddenly winced in pain.I felt a lumpy swelling along the side of her lower back and left buttock.
Now this may sound callous to the layman,but doctors do get very excited when they discover a ‘clue’ to the cause of an ailment.And the patient’s attendant may stare at you aghast when he sees your face lighting up with a smile.This is exactly what happened to me.I was excited with my finding,for now I knew I could help my sweet little Durga.
I ordered the necessary blood tests and X-Rays (we had no CT scans then). The next morning,the parents were waiting with bated breaths outside my chamber.Durga was resting at home.The X-ray confirmed my suspicions.There was a large  loculated soft tissue shadow by the side of the lower spine.The blood counts were high as well.
She had,what is commonly called a ‘cold abscess’.But the presentation was very unusual. This is usually found in the neck region.Durga’s was in the buttock.
The cause of a cold abcess,you may well ask?
Tuberculosis.TB of the spine is most common in children.The clinical manifestations of Pott’s (as it is called) spine are protean.The prevalence of tuberculosis is around 30 million globally and approximately one-third of the cases are found in India!Sad,really.
Because of the subtle nature of the symptoms, diagnosis is often missed until the disease is advanced. Delay in diagnosis can be catastrophic in vertebral tuberculosis.
She was put on antitubercular treatment, and she showed significant improvement at 2 month’s follow-up.By the time six months had gone by,Durga was her usual playful self.
Sixteen years had passed by.Durga and her siblings had returned to their native land.
The other day one pretty young Nepali woman with a three month old infant in her arms walked into my chamber.She looked very familiar.She had a twinkle in her eyes which reminded me of someone I had treated years ago.
"Hello,uncle",she said.
And I knew it was Durga!
What had brought her back to India?You guessed it.She had married a person working here as a guard !

She was only three when I first saw her.A tiny wisp of a girl.Frail,fair complexioned with freckles.She had two more siblings, a brother aged two and a sister who was still a baby.The father was from Nepal and had come across
the border looking for greener pastures.Like many before him,he earned his living as a ‘chowkidar’.His meagre income wasn’t enough to sustain his family.But he was
a responsible man and always made sure that his children were brought for immediate treatment of any ailments they might suffer from.
I was their ‘family doctor’.This means that whatever I told them was GOD’S own truth. And let me tell you,I take this very seriously.The last thing I ever like to do is to mislead
a patient.If it is within my means to treat the person I do so,otherwise I prefer to tell them the truth and refer them to the concerned specialist.YOU MUST NOT SHAKE THEIR
FAITH IN YOU.
Coming back to my frail little patient.Her name was Durga.A very befitting name as I was to learn later.Durga was prone to catching a chill almost every month and by the time
she was six ,you can imagine the number of times she had stepped into my chamber.
She was growing up into a nice little bubbly girl,full of cheer with a twinkle in her eyes. I always began my examination of her with some light banter and she was always quick to reply.
I remember it was a cold winter evening.I did not have many patients waiting outside.
Suddenly,I was disturbed by loud sobbing outside my door.
"Doctor saab,meri beti ko bacha lo !"(Doctor,save my daughter).
In rushed a wailing man with a limp bundle in his arms.His face was streaked with tears and there was a kind of helplessness in his demeanour.It was the chowkidar.
The limp bundle was Durga.
I asked him to put her on the examination table.A quick examination revealed that Durga was unconscious but breathing evenly.I heaved a sigh of relief and turned around
to the father.
"What happened?",I asked.
"I don’t know.She was playing in the yard when she suddenly swooned and fell.
I picked her up in my arms and ran.Doctor saab,please do something.",he sobbed.
Meanwhile,I heard some moaning behind me.Durga was regaining consciousness.
Thank God!
"Hello Durga,wake up,I’ve got something for you,"I said.
The brave little girl opened her eyes and smiled up at me.
"Hello uncle (she called me that).
"Ok,don’t scare your father.Get up now",I said.
And then the horrible truth struck her and me at the same time
Durga couldn’t move her legs!
to be continued ………

Generally,most of us  seek pleasure rather  than happiness.So what is the big difference? Actually,there is a huge difference between the two. That momentary feeling of joy which one gets from enjoying a favourite game  or watching  a favourite TV soap-that is pleasure.Watching your shares moving up in the stock market-that is pleasure.Have you noticed how pleasure is dependant on some external event? Have you also noticed how it does not last very long? We get addicted to these short-lived experiences of happiness,needing more and more of the same.Something akin to a high a drug addict
gets.But is this really,truly long lasting happiness?
Inner happiness doesn’t come from the outside.Inner happiness is something that we can all experience - if we are willing to be with ourselves and give up our self-hatred,I guess!
C.P. Snow said,"The pursuit of happiness is a most ridiculous phrase: if you pursue happiness you’ll never find it."How true.Our happiness, ultimately, is our own responsibility and not someone else’s.
The happiness I get when a patient comes back and tells me he’s doing fine is definitely not momentary.The joy of watching my kids grow and sharing their experiences gives me immense, everlasting happiness.Something which will bring a smile on my face in my old age (provided of course,Alzheimer’s hasn’t got to me first!).When happiness happens, you want it to happen again and again. Things that bring happiness bring happiness everytime.
Not so with pleasure,I’m afraid.
Give me happiness.Anytime.