The Other Side of the Desk

By Dhruva Sulibhavi

A collection of short stories, “The Other Side of the Desk,” delves into how the disease affects the patient. Each story reveals how the illness, the treatment and side effects can impact patients' lives and the lives of those around them. Medicine, from the perspective of the person on the other side of the desk.

Dr. Sulibhavi draws from his decades of practicing medicine, in the field of neurology, and treating patients.

• Language: English
• Publisher: Lulu.com
• Release date: Feb 26, 2023
• ISBN: 9781312980624

Book preview

Forward

There is a difference in treating a disease and treating the person with the disease. Most of the time for practical reasons we focus on treating the disease. I want to highlight how the disease affects the patient and people and the world around him. How does the world react to the person with the disease? How do patients handle the devastating effects of the disease? What can a patient teach the doctor that the books do not teach? Should a patient and the doctor who is treating him look at each other as adversaries? What is the cure? What is an alternative treatment? What is the role of faith? What do families go through outside the bounds of the doctor’s office to find solutions to their problems? The book highlights the progression of some diseases. Disease like the death is an inevitable part of life. How to live with death?

-Dhruva Sulibhavi

The Good Son

HIV/AIDS

In the early 1980s, reports from physicians treating patients from the gay communities in New York City, San Francisco and Los Angeles reported seeing rare infections in otherwise healthy individuals. This was linked to compromised immune systems.

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system, making the body prone to infection and disease. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). When physicians began seeing patients with this disease, its origin and etymology were not yet clear.

In the beginning, AIDS was a disease looking for a name and those with the disease were often ostracized and excluded from society. Common symptoms of HIV infection include experiencing flu-like symptoms for a few days to several weeks.

There is currently no effective cure. Once people get HIV, they face a chronic situation. But with proper medical care, HIV can be controlled. People with HIV who get effective HIV treatment can live long, healthy lives.

It was some time ago; the doctor saw a young man for consultation. John Davis, 30 years old, a young man, was suffering from pain and numbness in his feet and hands. John was of medium build, had thinning hair and a pale complexion. He was suffering from deficiency of immunity in his body, in the early 80’s this disease was a new phenomenon looking for an appropriate label. This disease made John vulnerable for opportunistic infections. As a matter of fact, he was suffering from a lung infection. He was being treated with new medications to build up his immunity. His doctor wanted John to have a consultation for the pain and numbness in his hands and feet.

The doctor, after the investigations, told him, Mr. Davis you do have Neuropathy that is causing the pain and numbness. The tests do not tell nor can tell what is causing the neuropathy, whether the immune deficiency is causing it or the medicines, which are new, that are being used to boost your immunity, are causing it? It is difficult find out. As you know, the disease is new and so are the medicines.

Mr. Davis asked, Doctor, how do we find out what is causing these symptoms? Is there any treatment for this?

The doctor answered, Mr. Davis, let me add that you do not have any of the other conditions that cause neuropathy for which we have treatments. I can give you medicines to try to reduce the pain, you could have side effects, though. There is no specific medicine to treat the cause, except the medicines you are already taking. If the medicines you are taking to treat the immune deficiency are working and immunity improves, and the pain goes away, then we know the neuropathy is caused by the immune efficiency.

Mr. Davis asked, What kind of side effects doctor?

The doctor said, Mr. Davis it depends up on the medicines we use. I will use the mildest one initially, but there is no guaranty.

Mr. Davis expressed concern, Doctor, I do not know.

The doctor suggested, I understand your predicament. If the symptoms are not that bad you can wait. Later, if the symptoms get worse you can take a chance with some medicines starting with the mildest ones.

He continued, Mr. Davis the difficult problem will be if the neuropathy is caused by the medication being used to boost your immunity. The only way to find out is to stop the immune boosting medication and see if your symptoms improve, but that might put you in great danger.

Mr. Davis said, You are telling me that I am between a rock and hard place. I know in all likelihood my time is limited.

The doctor replied, Mr. Davis, as a doctor I cannot give up. I have to give you hope, but not false hope. Hope for the best but prepare for the worst. The best thing to do is to follow up with the doctor who is monitoring the antiviral medicines and keep in touch with me periodically so that we can review the latest thing that is happening with your neuropathy. Maybe the medication you are taking might start working? If you want me to give you the prescription for pain to use later if need be, I will give you one.

Mr. Davis said, If I need the prescription, I can call you doctor, I want to be cautious. He got up to leave but then he sat down and continued, Doctor, I do not have a family of my own except my mother and a half-sister who lives out of state. I am staying with my mother. I love my mother very much. I want to protect her. I do not want any harm come to her from my situation. She is a very simple person. She does not know about my lifestyle and about my condition. I know she cannot handle this information and I am not the type to insist that my mother should embrace and accept my life style. I have kept an aide to protect my mother from my condition.

The doctor responded, Very thoughtful of you. When we are ignorant about anything we have to be at least, cautious. It has personal and social implications; we have to be careful not to offend anybody or expose others to any harm. For example, in my profession, I have to protect all of my patients. Nobody likes to be examined by my unwashed hands. The precaution you have taken should be good enough.

No offence doctor, but I hope I do not need your services anymore right now. Thank you doctor, so saying Mr. Davis walked out.

A few months later…

A heavy-set woman in her early sixties walked in slowly; she carried her head as if it weighed a ton. There was no fear or anxiety there was also no hope written on her face. The doctor introduced himself and shook her hand. Her demeanor was not lost on the doctor. She had a kind face. After she sat down, the doctor asked her gently, Mrs. Davis- Johnson, what brings you here? She complained of having headaches for the first time in her life. The doctor asked her lots of questions. After examining her thoroughly he told her, My clinical examination is normal. I have to send you for some tests to be sure.

Doctor, could stress be causing these headaches? she asked.

Mrs. Davis-Johnson if you had experienced any stress, you would not have come to see me, you would have tried to resolve it yourself. Even if you had told me about the stress, I still would have prescribed these tests to make sure. Because you are having these headaches at this stage in your life it is advisable to have these tests done. You had never suffered from headaches before in your life. In the meantime, do you need any medication? asked the doctor. Over-the-counter medications seem to be working, she told the doctor. Good, said the doctor, the less medication, the better. I will see you after all these tests. If you need anything in the meantime, call me.

As Mrs. Davis-Johnson came home, her son asked her about her visit to the doctor. She told him about the tests she has to go for, including a brain scan. She saw the untouched food on the plate. Why didn’t you eat anything? Her son told her the usual story that he was not hungry. The aide cooked and left the plate near his bed after he told her that he would eat later. I will make your favorite soup. John, you have to eat something. I cannot see you keep losing weight.

The doctor told Mrs. Davis-Johnson that all the tests were normal. It was good that there was no bad news with the results. But the bad news was that she continued to have headaches and what was causing the headaches was unknown. The doctor asked her about her family and children in more detail. She had lost her first husband, Mr. Davis, in the War. She was left with a daughter and a son. She married Mr. Johnson, but kept her first husband’s name.

She lost her second husband a couple of years ago. Her daughter was married and her family lived out of state.  Her son was very bright, lived in Manhattan and had a very high paying job. My son is single and he has been home to recoup from some kind of infection. My son was always very close to me, a mama’s boy. My son has hired an aide; he does not want to trouble me. Her son insisted that Mrs. Davis-Johnson should see a doctor for her headaches. The Doctor asked Mrs. Davis-Johnson, Do you feel depressed? She had no time to cry she told the doctor. I am worried about my son. She told the doctor that she does not feel like crying. Her sleep was disturbed I never was a good sleeper. It is getting worse.

The doctor prescribed her an antidepressant. He explained to Mrs. Davis-Johnson that there would be some side effects she should be aware of and told her come back after a month. Mrs. Davis-Johnson, said the doctor, we still do not know exactly what is causing your headaches, obviously nothing bad. Sometimes the proof is in the pudding. If the headaches go away than we know what the cause was.

Mrs. Davis-Johnson came back after about a month. She was sleeping better. She was feeling much better and the headaches were less frequent. The doctor increased the dose of the antidepressant and asked Mrs. Davis-Johnson to come back after another month.

Mrs. Davis-Johnson continued to improve. Her son however was not doing well. He was getting weaker and getting more dependent on the aide. The aide cleaned his room, assisted him with bathing and feeding, even did his laundry. She carried the garbage out from his room herself.

One day he called his mother and said, Mom I want to talk to you.

John what is the matter. Is there anything the matter? she asked.

No Mom, listen. It is not easy for me, so let me say what I want to say. Mrs. Davis-Johnson waited for him say what he wanted to say, keeping his trepidation in check, I am not getting better, Mom. This is something new. The doctors do not even know what to call it. They are still figuring it out. There are no medicines to control this infection. The doctors will find a medicine, hopefully soon, but not soon enough for me. Mom, I have accepted the inevitable. I have made my peace; my mind is at peace. Mom, I love you, I have always loved you. You are taking care of me even now. It hurts me to see you suffer. This is more painful than impending death.

Do not say that, implored Mrs. Davis-Johnson, holding back tears.

Mom, I do not want to lose it before I say what I have to say. It is hard for me. So let me say it. I do not have any time left. Mom, listen, I am at peace with myself. I want you to accept it and find peace in the inevitable. That will put my mind at peace.

How can I accept it, son? It is the children who take care of their parents in the end. To lose a child is very painful, perhaps the most painful thing for a mother to experience. I do not know how to accept it, said Mrs. Davis-Johnson

Mom, death is new for me too, particularly at my age. I have crossed the phase of agony; with great difficulty I have found peace. I am ready. In one way we are even, Mom; for you losing your son as a mother and for me death at my young age. It is very painful for me to see you suffer.

Mrs. Davis-Johnson was speechless. She just nodded her head and kissed her son on his forehead. John, rest, be comfortable my son. I will see you in the morning.

Mrs. Davis-Johnson came back to see the doctor after many months. She had missed a number of appointments. She still had headaches but not as bad as before. She was not worried about the headaches. She was still on the antidepressant medication. She did not think she needed the medications any longer.

The doctor asked, if you are not worried about the headaches, it means either they are relieved or you know the cause, which is under control. Lastly, you do not care about your health. A few cautious things we can do, I can repeat the tests or I can follow you up to make sure no other cause is cropping up. Mrs. Davis-Johnson, you do not think you need the medicines, yet you come back. There must be a reason, I am glad you came back.

Mrs. Davis-Johnson took her own time and said, Doctor I made this appointment as the last patient today. You always gave me time and listened to me. Doctor, I am conflicted. You see you had asked me about myself and my family at one time before giving the medicine. I had told you about my son who was with me recouping from some infection. I had told you I was not depressed. I was really not depressed, like any mother, I was worried. Doctor, as you know, children fall sick when they are growing up, mothers worry but know that they are going to get better. Doctor, I am not an educated person. My strength was in being a mother. I thought this infection that my son was suffering from was a passing event. But I lost my son.

The doctor said, I am sorry Mrs. Davis-Johnson. It is very hard for a parent to endure the loss of a child. When did your son pass away?

Mrs. Davis-Johnson continued, "It has been almost three months since my son passed away, doctor. John, that is