Meeting old friends is always a pleasure and meeting Shailendra and his wife Kiran and their two lovely young children was indeed something more than this. I have known Shailendra for more than 26 years now and have always found him vibrant, filled with ideas and constantly challenging himself and those around him with many new concepts. He is very well read and is one of those few physicians who passionately believe in primary care and the value of family practice. I was in Minneapolis to run a leadership workshop at the University of Minnesota and was staying with him. We enjoy conversing with each other and our conversations gradually drifted to the days of Brahmagiri and the joy, excitement and pain of building SVYM. We had just built the Kenchanahalli hospital and Seetharam had left to do his masters at Chandigarh. Shailendra had just then graduated and joined the Kenchanahalli hospital to serve as its Chief Medical Officer. Those were the days when I used to constantly travel, trying to seek support from all those I could meet to keep the hospital and the organization alive. Vivek was holding fort on the administrative side and Shailendra had the mandate of being the clinician.
Being young and inexperienced were the only assets that we had and this gave us the courage and confidence to face any challenge. Shailendra was in the outpatient that day when Kariya walked in with his two-year old child crying with pain. Kariya was a Jenukuruba from Hosahalli tribal colony and was employed with the forest department as a guard. Being one of those privileged few who could boast of a steady monthly income, Kariya had taken to alcohol and could be found drunk most of the time. His child had developed severe abdominal pain and Kariya decided that he needed to see a doctor when things did not improve with his traditional remedies. Shailendra examined the child and found a wiry mass in the abdomen. Considering the little resources that we had, he hoped that his diagnosis of worm infestation was correct. He tried to give the baby anti-helminthics to drink, only to find it throwing up everything he gave. Running out of ideas, he did the unthinkable. He crushed a few tablets into a fine powder and gave it as an enema. Being yet unsure of his diagnosis, he urged Kariya to stay back with the child till the evening at the hospital itself. After an hour or so, the drama began. The baby started to throw up and started bringing out foot-long worms. Shailendra counted more than 30 of them and he found the mass in the abdomen gradually disappearing. With each spurt of vomiting, he found the child becoming better and better and it was music to one’s ears when the child felt hungry and asked for some food. The child recovered fully within the next few hours and started to play. To Kariya, all this was an extraordinary drama. He had consulted Masthi, the chieftain of his tribe earlier in the day and had been told that his child was doomed to die. Having run out of options, he had come to our hospital as a last resort. He now returned home joyously to his people to share the good news. Masthi warned him not to feel exhilarated as he felt that the doctors could go wrong but not the spirits who had spoken.
What happened next may not have a rational explanation. One could insist that the worms dying in such large numbers could have released toxins that killed the baby. Or one could stop exploring and reconcile oneself with the explanation that the science we knew could never explain the definiteness of Masthi’s conviction. For just as he had predicted, Kariya’s child never woke up the next morning. He had quietly slipped away in his sleep.
Looking back, one feels helpless that our competence, knowledge and training made no difference to this young life. Coming to terms with our own irrelevance and incompetence can be painful, but then we need to understand that we cannot change what is destined and some things are beyond the ambit of our limited understanding of science. Masthi had his own simplistic view – the child coming to the hospital was as pre-destined as its death. What we needed was the perspective to come to terms with what we can and cannot change, and live with the fact that we are mere instruments in the grand drama called life.
– Balu
