Knotty Affairs

by Chirag Bagadia

  Aakash was still looking at the x-rays that he had taken at his clinic. He cleared his throat and said, ‘Yes, sir, that looks like a broken file in the apical region of the distal root,’ he said and immediately forwarded his clinic x-ray, ‘That is the last x-ray I took to mark the accurate length of the canal. It does not show the file breakage. You can see that. After taking this x-ray, I had filed all the canals till the desired length with the larger file instruments.’

  Kothawade’s tone had now turned serious, ‘Aakash beta, before coming here, I had a word with three of my dentist acquaintances. Firstly, in case of a broken instrument, you are ethically inclined to inform the patient about it. Now, your statement says that you yourself are not aware of the breakage. You, young dentists, pass out from private colleges with inadequate inexperience and it shows clearly in your daily practice. This is an act of utter negligence and ignorance.’

  Aakash breathed heavily, ‘Sir, in a case such as this one, when a broken instrument is detected, an attempt is certainly made to retrieve it. If it fails, the attending dentist is obliged to inform the patient of the complication.’

  Kothawade laughed, ‘Doctor saab, asa kasan chaalnaar…aapko to pata hi nahi chala ki kuch gadbad hua hai,’ he looked at Aneri and Bharat. Then, looking at Bharat, he resumed, ‘Sirjee, I had a detailed discussion with other dentists. Apart from the x-ray, there is another way to find out about the breakage. These dentists are supposed to check their instruments after working on the patient. But again, I am talking about good and experienced doctors.’ He gave Aakash a condescending look. Before Aakash could explain, Arshiwala thundered, ‘I made a gross mistake coming to this doctor for my treatment. I got a negative vibe the moment I entered his clinic. I had to wait for forty-five minutes on the first day. The staff was rude. During treatment, his assistant pushed the suction tip so hard below my tongue that it still hurts. Not that the doctor’s hand was any better. I lost count of the number of times he jabbed me with his instruments. Oh goodness, I have been in a sea of pain ever since I first went to his clinic. Unbearable! I have never suffered this sort of pain with any doctor in my life.’

  Bharat Doshi intervened, ‘Madam, why not focus on the main point here? We all know that you had many objections during your clinical visits. But it’s usually rare for these objections to be blown into a lawsuit. Now tell us what happened after you left the clinic yesterday?’

  Arshiwala looked angrily at the interruption but since there was sense in what the lawyer said, she had no option but to reply.‘Well, the tooth started paining within two hours of seeing the doctor. Since I had a party to attend that evening, I went to a senior dentist who practices in my locality. He heard me out and checked the aching tooth. He suggested that I get an x-ray. I was stunned when he showed me the broken instrument in the x-ray image on his computer. He zoomed it thrice to confirm it.’

  Bharat interrupted, ‘Are you sure he never opened the canals in his course of treatment?’

  Arshiwala answered sharply, ‘What do you mean? Of course not. In fact, he advised me to continue the treatment with the same doctor. But continuing even another day with this useless doctor will be suicidal.’ So saying, she looked at Aakash accusingly.

  Constantly reminding himself of Bharatbhai’s cautionary words to keep calm, Aakash, with great control, ignored the non-stop humiliation. He pursed his lips together and asked, ‘On the phone, you told me that you were still in pain. Is the pain unbearable like before? Have you taken a painkiller?’

  ‘Yes, I am still in pain, although it’s not as acute as before. But, I constantly feel a dull ache over there,’ she answered brusquely.

  Kothawade, with a tone of finality, said, ‘The case is fairly clear. A careless doctor, accidently, broke an instrument in my client’s tooth canal. My client is very unhappy about this and wishes to file a lawsuit for the mental trauma and physical damage that she has suffered. She may have to suffer the loss of that tooth for no fault of hers. I know Bharat as an honest and eminent law practitioner for many years now and it was at his request that I am sitting with you all on a Sunday. That notice will be submitted in the Sessions Court tomorrow and will be re-directed to you again.’

  At this moment Bharat got up, walked over to Kothwade and whispered something in his ears. Kothawade looked at Arshiwala and said something in her ears. They ended up having a brief inaudible exchange of words which ended with Arshiwala shaking her head vigorously. The advocate looked at Aakash and Aneri, scratched his head, and said, ‘Bharat here has requested to settle the matter out of court. Bharat sir, that is entirely the call of my client. We, as lawyers, always wish for both parties involved to reach an amicable solution out of the court. But, we both know that it does not happen always. Ms Arshiwala is very sure that she was maltreated and wants to file a case of negligence here. And being her lawyer, I have to abide by her decision.’

  Bharat patted his shoulders and smiled, ‘I really appreciate your time, Mr Kothawade. I have been in this field for more than twentyfive years and can easily say that no one entertains a meeting on a holiday. May I request you for another favour? I am not saying this because I am related to Aakash, but I would have advised the same to anyone walking into my office. An off-the-court settlement has always been the best option as both our experience goes. Before I give my final word here, could I kindly have a word with Aakash in private?’

  Kothawade looked at Arshiwala and then nodded his head silently. Aakash got up and followed Bharat out of the office into the corridor.

  Aneri smiled and tried to strike up a conversation with Arshiwala. But this time around, she soon realized, Arshiwala had no interest in doing so. The five-odd minutes went by in pin-drop silence, except for the occasional sound of Kothawade riffling through his papers and Arshiwala tapping her fingers on the table.

  Bharat Doshi appeared calm as he looked around the table. He closely observed Arshiwala who was sipping tea from her cup. Cookies on the tray lay untouched. Deep within, Bharat knew he was dealing with the case of a lifetime. The same case would have been a cakewalk if a stranger had sat opposite him. But, it was his son-in-law that he was representing this time. Any unnecessary remark from his mouth and Aakash would suffer an irreversible setback to his career. The crucial ball was in his court and he had to serve with all his might at the right time and with the perfect stroke. Everyone’s eyes were fixed at him, except for Aakash, whose head hung low.

  Doshi got up and paced around the corners of the office. Clearing his throat, he sat down and tried to hit that masterstroke, which would define the lives of his loved ones.

  ‘I really appreciate Ms Arshiwala allowing me those fifteen minutes with Dr Aakash. I could easily entitle those minutes as “my crash course in dentistry”. I myself have undergone extensive treatment with Dr Aakash recently. His college professor, a highly reputed and senior doctor, performed a surgery on me and his parting words lauded Aakash as an efficient doctor with a bright future. Who knew that his powerful words would come crashing down in a matter of just a few weeks! Doctors know how fragile their profession is – one mistake and their whole professional world crumbles to dust. Even before I start discussing the intrinsic details of this case, I would like to describe a doctor who enjoys immersing himself in the cases of his patients. His professional world is made up of his patients and they go on a journey along with him. When Ms Arshiwala stepped into Dr Aakash’s clinic, she inevitably stepped into the small happy world that he had created around him with, albeit, little experience, but colossal effort. Now today, when she expresses her desire to leave his world, he has, in his own right, felt that unavoidable pain. But I ask you all, what right does anyone have to crush that little world he has built while leaving?’

  Pin-drop silence spread across the whole room. Aakash had now raised his head and was listening to his father-in-law with interest. Arshiwala had tried to interrupt but was politely waved off by Bharat Doshi. He resumed in the same steady composed tone.
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br />   ‘Before I start discussing the technical details of this case, I would like to remind you all of the most important aspect when we deal with such a case – the relationship between a doctor and a patient. Whenever a patient walks into the clinic and decides to go ahead with treatment, he or she puts his or her faith on the doctor to make everything all right. When, actually, the doctor has only assured you that he will do his best to make everything all right. This small confusion in the expectation level creates havoc at times. We all are aware of it and read it in the papers regularly. We all have witnessed the same today. Lack of faith. All of Ms Arshiwala’s statements and the doctor’s statements point to only one direction – that the patient had started the treatment with a lack of faith; with a doubt in mind.’

  Bharat looked at Arshiwala who lowered her gaze to the ground. He took a sip of water and resumed, ‘Dr Aakash has not denied or rejected the possibility of file breakage while working. We just saw that his x-rays don’t show the broken fragment. Have you ever wondered why? Because he knows that file breakage is taken upon as one of the complications of the treatment and certainly not a dental negligence hazard. Kothawade sir, before coming here, I was just googling some statistics on file breakages. You will find thousands of forums online mentioning file breakage experiences. If each of them was to begin knocking the doors of the court, our legal system would be chockfull of these cases.’

  Pausing, he popped a cookie into his mouth. He was looking directly at Arshiwala now.

  ‘And yet, being a layperson, like Ms Arshiwala, I completely empathize with her. There is no denying that pain can cause immense mental disturbance, especially if it’s a toothache. I was just asking Aakash about his protocol on informing patients about the breakage. And he admitted that most dentists dread informing patients about it. ‘Mr Kothawade, you would also be surprised to hear that many of these cases with broken file fragments inside the canal have a good prognosis and remain asymptomatic throughout a patient’s life. Aakash was just explaining that multiple attempts are always made to retrieve these fragments. The tooth is still treated normally even if the retrieval fails.’ He looked at Aakash and confirmed, ‘Didn’t you say that bypassing the fragment and going ahead with root-canal filling is an option?’

  Arshiwala and Aakash were staring at each other now, not knowing what to make of each other’s expression. Bharat broke this gaze with his final words, ‘Lastly, I would request Ms Arshiwala to think again about dragging the matter to the court. I can totally understand the trauma that she has gone through in the past few days, but dragging the matter to this extreme could very well mean playing with someone’s hard-earned career.’

  This time, his eyes pierced Arshiwala’s.

  ‘I am not sure if Aakash is a good doctor or not. But if you go ahead with this, I will never know if he will ever get a chance to be a good doctor.’

  Arshiwala was silent, her face expressionless.

  ‘Phew!’ Aakash collapsed on the couch as soon as he reached home. He gulped down two glasses of water before he could utter a word. His hands were shivering from the unprecedented experience that he had had earlier that day.

  After the meeting, Ms Arshiwala had agreed to withdraw the case but not without conditions. Aakash had to reassign her case to the best root-canal specialist practicing in the city, Dr Navre. Aakash called Dr Navre, requesting him to take on her case and, fortunately, was assured that the best care would be taken of the patient. The other condition was that, should the tooth give Arshiwala any trouble in the future, Aakash would be obliged to pay for its treatment, extraction and replacement by a reputed implantologist. Kinjal, Chhaya, and Kinnari rushed towards Aakash and gave him a warm hug as Aneri and her father looked at the scene beamingly.

  Chhaya laughed, ‘Aakash, we have your favourite food on the dining table. Just get there as quickly as you can.’

  As Aakash got up wearily, Bharat ruffled his hair. ‘I know you have had a tiring day,’ he said, ‘but it has ended well by God’s grace. Just get back to your practice, and work your way up with determination and fewer complications!’ he said, laughingly. He hesitated, before making up his mind, and announced, ‘If this brings you further relief, here is the icing on the cake. We are returning here for good, for ever! Aakash and Aneri, you have won. If your intention behind deliberately misplacing a few belongings was to make us miss each other, it worked big time! We have not only realized that we are better off together, but it has also opened up new vistas for an exciting future.’

  Aakash and Aneri looked at each other with open mouths and a trace of embarrassment, a reaction that their parents were certainly not expecting. ‘Motabhai,’ Aakash, finally said, ‘you just saw that I had a close shave with a career-annihilating experience. I thank you from the bottom of my heart for getting me out of it today. But, by now, we have all realized that I need some sharpening of my management and practice skills in dentistry.’

  He looked at his dad. ‘Dad, last week, I submitted my scores and letter of application to the Chester University in London for a PG certificate programme in clinical management. They have considered it. Aneri is also planning to take a year’s fellowship at the University of Law, Birmingham. We are planning to move to London this May for a year to boost our respective careers.’

  It was the turn of the parents to look stunned this time. It had been a day of shocks and surprises.

  Chapter 27

  ‘AAKASH, I AM very surprised by this recent turn of events. I always thought that you never wished to leave us for any length of time. You said so yourself. And what puzzles me most is, when did you find the time to give the GRE-TOEFL exam?’ asked Ashwin in a somewhat hurt tone.

  ‘Papa, only Kinjal knew,’ said Aakash, a little sheepishly. ‘It is just a minor online exam requiring minimal preparations. I was feeling fed up of the whole match-searching business a few months ago and decided to give it a shot. I used my free time at the clinic to prepare.’

  He came and sat next to his dad. ‘Papa, I know I should have informed you, but I, myself, had completely forgotten about it. Shortly after giving it, I met Aneri and life took a different course. I got reminded of it only a few days ago. Papa, after all that has happened these past few days, I am very keen to pursue that PG course. My extensive research tells me that none of the correspondence courses in India offer specialization in medico-legal aspects and legal-advising ethics.’

  He sighed, ‘You are right! I never thought the day would come when we would be parted from each other, but, today, I feel my dental career requires that upgrade to help me scale heights in the future. I won’t have Motabhai saving me all the time from cranky patients with unrealistic expectations. Papa, I know that you are likely to tell me that I should not mix my professional issues with my personal life. That I should leave the issues of the clinic behind the closed shutters of my clinic. But, Papa, we all know that it’s easier to talk than to act that way.’

  He got up and walked around the room. ‘Dad, you know, I may be a good doctor, but, it’s not enough. I wish to be a good practitioner as well, with managerial capabilities.’

  The whole room was listening to the young man in rapt attention. Aneri forced a smile on her face and tried to speak, but was immediately cut short by Bharat.

  ‘Ten Days, Aneri. Just ten days, we don’t meet and when we do, this is what we hear! Such an important decision and you people did not even ask us once? So many dentists deal with all these complications daily. Should all of them start pushing themselves abroad to upgrade their practice?’

  ‘Dad,’ said Aneri, ‘the University is offering Aakash a generous scholarship based on his GRE scores and online interview assessment. Also, remember, you always wished for me to pursue a fellowship programme in Law. You were the one who dropped a word of recommendation to Woodson & Associates for my internship. It’s an amazing coincidence that both of us are headed to the same destination.’

  ‘Aneri, beta, it was all right to make these
plans before marriage. Don’t you think your priorities have changed now and that you should be focusing on family?’ enquired her father.

  ‘Dad, please don’t make this tough for us. It upsets me to leave you alone here. But it pains me even more to see Aakash fight his professional battles unarmed. The events of the past few days have caused him great misery, and made him lose confidence in himself. If he is to succeed in his career, fulfil his dream of seeing his clinic scale heights, and for me to fulfil mine of taking over the reins of our firm smoothly from your hands, we need to make this sacrifice.’ Aneri took her dad’s hand as tears welled in her eyes. ‘Dad, please let us go. It’s just a question of a year. We might not be able to do this once we start our own family. Aakash’s junior, Neha, will manage his clinic till we return.’

  ‘I know you all are surprised how everything fell into the place so quickly, in a matter of ten days,’ inserted Aakash. ‘Trust me, even we are surprised that everything worked out so smoothly over just a few phone calls. Maybe we are just destined to go ahead with this.’

  Kinnari, who was toying with the dishes on the dining table suddenly broke in, ‘I don’t get this, Aakash. Till some time back, you were rooting for us to live together. You could pursue this clinical management course here in Mumbai as well. There are many institutions offering you the same course here. You don’t have to miss your practice for that. Do you even realize what kind of losses you would incur even if your friend is running the place? All those patients that you generated over these years will simply move away.’ ‘Mummy, many dentists choose to do post-graduation along with their established set ups. Our field demands staying updated all the time. If you remember, my sir himself had gone to complete the same course leaving his clinic in my hands for a year; before I opened my clinic. Yes, you are right. I do have the option to pursue this course locally. But then, what about Aneri? She may not get this chance again.’