Oath of Hippocrates

by Sudarsan S

  “He has been coughing for the past two days. Dry cough. There is an older member of the family who has had tuberculosis in the past – I am told about 30 years back – and there seems to be a faint trace of its recurrence now, as yet unconfirmed. Is there anything I can do to protect my kids?”

  The father of the children fidgeted nervously. The doctor looked at his assistant, a recently-graduated understudy and asked him what he thought. Ram felt like a person at a party who knew the punch line of the joke another person was going to tell. The urge to blurt out the answer was too much and he turned the other way.

  “Sir,” the understudy said, looking at the doctor, evidently pleased by the fact that the doctor had asked his opinion real time, “to start with, the child and the other person may avoid close proximity and sleeping in the same room. Second, there is this new drug on the market with a potential to be the T.B. Immuniser. However, it is in evaluation...”.

  Dr. Svaminathan interrupted him, turning towards the parents. “I am not recommending that you have your kids given this T.B. Immuniser. It is just out on the market and costs Rs. 4000 and you can insure both your kids, if you want to, that is. It is your choice.”

  The parents looked confused. After a minute of whispering among themselves, they decided to decide later on the immunisation and promised to visit his clinic later for the DPT booster shot.

  After they left, the understudy asked the doctor, “But, sir, isn’t it still under evaluation?”

  “Yes, but whom will we evaluate it upon? Besides, affordability is not an issue here”, referring to the rather well-to-do appearance of the family.

  In a few weeks, Ramanujam had earned the goodwill of all the visiting doctors of the paediatric annexe, whom he had the opportunity to assist. On his part, he found this phase of learning as the most fulfilling than anything he had done in past. The stint gave him the opportunity to assist many visiting doctors, ergo, study different personal approaches to the patient and the problem. Hawks, doves and in between, is how he classified the doctors. For two doctors like M. Svaminathan, he found one like Dr. Niveda Bhargava. Not a week passed without Dr. Niveda judging the affordability of the patients’ family and waiving her fee for consultation or even surgery. To Ramanujam, who had hitherto shunned the idea of a role model, she was the epitome of what the medical professional should be. But, his more lively moments were in the presence of Dr. MS.

  Even Dr. M. Svaminathan, with his reputation as a hard-to-please guy, warmed to Ram’s presence and had acknowledged his greeting on occasions. A rare gesture from someone who barely acknowledged the existence of people below his status. After a couple of months of service, one fine day, he turned around to Ram. “What is your name?” Till that day, all his attendants had been referred to as ‘that tall guy’, ‘the dark, short one’, because he didn’t believe that their names were worth learning.

  “Ramanujam, sir”. He was following the existing practice in 3H and where the medical professionals were addressed ‘sir’ or ‘madam’, and not ‘doctor’.

  “Studied anything?”

  “Yes, sir. Dropped my B. Pharm. course after a couple of years.” A deliberate lie.

  “Better. See, I need someone like you at the clinic. If you can come there after your duties, it would be of help. Monday to Friday, evening only, 3000 per month, one day leave per month allowed”. Dr. Svaminathan didn’t wait for a response. He believed that anyone at Ram’s level would need the money he was throwing.

  In the evening, Ananta proceeded home and Ram presented himself at the clinic. A ground floor flat on a busy road in a thick residential locality. Clean set-up with minimal decor. There were a few tips on immunisation here and there. An exquisite monthly calendar with photographs of plump fair-skinned infants and toddlers blared the name of the medical shop nearby.

  “Your name again?”

  “Ramanujam, sir”.

  “Yes. You will number the patients and send them in order. After each leaves my room, you will come into my room to check how much fees to collect. Or, when I ring the bell. Any vaccination/inoculation medicines, you will acquire the medicines from the adjacent medical shop. You don’t have to pay the pharmacist every time. We pay them monthly. Don’t let the patients’ parents run around for the medicine, syringes, etc. By the way, this is the pharmacist's itemised bill and my payment for the last month’s medicine. Good chance to introduce yourself to them. Be back soon. Patient count will soon grow”.

  Within a week, Ram had a good understanding of the dynamics of operating the clinic. The doctor reluctantly conceded that the new attendant was better than his predecessor. The rack was adequately stocked with vaccines and boosters, the implements were there at a reachable distance on the desk and at the right quantity for the day. Only a doctor would know where each thing needs to be present, thought Dr. Svami. Unfortunately, in a couple of weeks, the relationship was to show signs of being short-lived.

  The family that was given a surrogate recommendation for T.B. Immunisation had come for the DPT booster shot for the younger kid. The father asked Ram for the bill. This was the first time since Ram joined that someone had asked for the receipt. He had found the receipt booklet in the drawer a week earlier. Ramanujam pulled it up, filled the details and knocked at the doctor’s door. He knew there was no patient inside.

  “Yes?”

  “Sir, the last patient wants a receipt. Needs your signature”.

  “You filled it?”

  “Yes, sir. 450 for the booster and 200 your fees. Total 650”.

  “No, it is 500 for the booster and 250 for me. 750. Get it? Here is a new one with my signature. Give it to them and come back”.

  Ram promptly did as he was bid and was back in the doctor’s room.

  “Sir?”

  “When billing, ask me”.

  “Sir, the booster cost ...”.

  “I am saving the patients the trouble of getting it themselves and who will pay for refrigerating it? You?”

  “In that case, if the patient gets the vaccine themselves, they will pay the consultation fee alone?”

  “None of your business”.

  “I am sorry, sir. What about your fees, sir? It used to be 200, till the previous patient.”

  “What is your problem if he is able to pay? If he is asking for a receipt, he is getting it reimbursed from his company. If I am giving a receipt, I have to show it in my Income Tax declaration”.

  “OK, sir. I understand. As regards the rest of the money, the government doesn’t need to know. In other words, black money, sir”.

  “It is my money. I decide what to do with it. I have to pay rent, the electricity and you.”

  “Sure, sir, I understand it is difficult to do that with rupees 4000 you earn each day at this clinic alone”. The biting sarcasm in the monotonous words wasn’t lost on the doctor.

  “Look. You won’t get anywhere with your attitude. This is the last minute of your employment here. I don’t want to see you again.”

  Ram smiled. “My own words, sir”. He had quit his job in just over two weeks.

  Though he had been kicked out of his job at the private clinic, Ram still had to face the doctor at the 3H paediatric care unit on visiting days. The doctor refused to look in his direction. After the last patient had gone, the doctor whipped out his mobile and scanned for missed calls. One was from the pharmacist adjacent to his clinic. Dr. Svami returned the call.

  Ram was sorting the files before returning them to the database room, when he heard the doctor, “Is that so? No, not from my side. Yes. I will see to it.” He disconnected and shouted.

  “You! I am told you stopped buying from the pharmacist next door to my clinic”.

  “That is correct, sir. I had a look at the past month’s bill that you asked me to pay and realised that they were adding a 2-8% over each item’s actual cost. So, in the interest of saving you money, I changed to a different pharmacist.”

  “Did I ask you to save me money?
”

  “No, sir. Nor did the patients ask you to stock the vaccines”.

  “Not your business. What the pharmacist charges is between me and him”.

  “I understand, sir. In return you get free calendars and prescription books with his name at the bottom and you get to show higher expenses to the IT department. This time, they will be genuine, though”.

  “Didn’t I tell you not to show your face to me again?”

  “I would have loved to honour that word of yours, sir, but unfortunately 3H annexe duty has placed me here. Since the time is over, at least you won’t be seeing me for the rest of the day. By the way, like your pharmacist called you, in case ClariScan calls you to check why your patients have stopped visiting them, you may tell them that your former page-boy directed them to RS Scans because they are 40% cheaper and do the identical job. Oh! That means you lose the 30% commission you were getting from ClariScan for each referral”. Ram closed the door behind him to the sound an object being hit hard.

  “Dr. NR wants to see you”, said an attendant from the main wing. The attendant had known him by face and name during the first day by virtue having given him instructions on expectations.

  Ramanujam assumed that his run-in with Dr. Svaminathan had reached Nanjunda Rao’s ears. He walked as fast he could to the main wing and knocked at Dr. Rao’s door.

  “Sir, you wanted to see me”.

  “Running into problems, my young friend?”

  “Sir, with Dr. Svaminathan, I had a disagreement on...”

  “Oh, well, you have a problem with Dr. MS too? No, I called you about the two people who came looking for you. Your relatives, I understand. You ran away from home? I thought high of you”.

  “Can I tell you my version of the story?”

  Dr. Rao nodded in response.

  “I am from a village on the banks of the South Yamuna and was studying in the capital. As I told you earlier, I am on a break to see the medical world as a non-doctor to understand the other side of the medical profession, before I join the establishment. My family in the village knows my whereabouts, and my cousin and I have been calling them regularly. This is their number. You can call them to check if you want. We did not run away”. Ramanujam wrote down the phone number of his household on a piece of paper and handed it to the doctor, hoping that the doctor wouldn’t call the number and tell them he was calling from Bangalore.

  “If that is the case, who are these people looking for you? They said they were your relatives and I had sent them to the paediatric wing sometime back after asking Basavaraj to give them your residence address as well. I was thinking you would come to me after meeting them. Who are they?”

  “I don’t know. To be honest, I had some mysterious ill-wishers in the capital and my break was forced upon me, not voluntary. In case you read last week’s Capital Times, you would have seen an article “Ethics of Animal Testing and the Myth of Safety”. That was penned by me. I had been doing similar things in the past and earned my stock of enemies. It could be one of them”.

  “It was you, was it?” asked the doctor with a hint of disbelief.

  “Any idea how they looked?”

  “Two men. Impeccable. Dressed in white. Just go and find out what they want. We don’t want any trouble here”.

  Ramanujam now knew whom to avoid. He asked Ananta to stay behind at the hospice after his time and leave with him as Ram did not have to go to Dr. Svami’s clinic any longer. He had other reasons for not wanting to send Ananta alone. Their lodging in Byrakere, where they had moved to after their first week at Honnappa's house, was located at a dead-end and was rather lonely even during day-time. It was not the ideal place to be accosted by hostile company.

  In the evening, when they boys returned home, they found a lot amiss. The door lock was broken. Inside, all things had been thrown about with precision to ensure that no item remained in its place. The toilet bowl was stuffed with papers.

  “Should we call the police, Rama?”

  “I doubt if they can help. I just wonder how we were found”.

  “The cricket match!” exclaimed Ananta. “We were flashed on TV. They will be coming back for us”.

  “No, probably not. It is just a warning for me, otherwise, they would have lain in waiting. They got our address from the hospital records and decided to teach the lesson here”.

  “What next, Rama?”

  “I am not learning my lesson, but discretion is the better part of valour. For some more time, I need to be incognito. I will have to move elsewhere, to some other city”.

  “What are you saying, Rama? We just came here. Life is good. We got jobs, free tickets to ...”

  “...which proved to be our undoing, Ananta. The past week has been eye-opening for me. At the same time, I have opened areas of enquiry including an RTI – right to information request, which will be fairly revealing, if answered, and will damage a few reputations”.

  “You have something personal against your professor”.

  “Yes and no. He is the one I know most. That is personal. Make an example out of him and a few bad men will turn over a new leaf. There are a few loose ends to be tied.”

  CHAPTER 19: A Man of Letters

  There are many loose ends to be tied, thought Ghafur. The boy had taken his advice to run, but not to hide. Ramanujam had written to him a few times. It had no contact details and no return address. His letters were always delivered along with Dr. Yadav’s. There were times when the professor had seen the letters before Ghafur sorted them.

  And, today was the day both had to happen. Ramanujam’s letter reached and Dr. Yadav had sifted through the mail for his own letters.

  “I didn’t know you had relatives in Saharanpur, Ghafur”, said the professor without raising his head.

  Nor did Ghafur. “Must be some long-lost relative planning to come to the city, sir”. Ghafur turned the inland letter around for the sender’s address. There was a small scrawl which would have looked like Urdu to an Urdu illiterate, but was nothing but a bunch of lines and dots made to look like Urdu or Arabic.

  “How did you know it was from Saharanpur, sir?”

  “Oh, Ghafur, don’t think I have the habit of going through your mail”, laughed the professor. “As I picked it up, I saw the PIN code, which I recognised as a Saharanpur PIN code. Ask your relative to write his address in Hindi, else if you are not to be found, the postman will have difficulty delivering it back to him”.

  Ghafur had left the office perplexed about the origin of the mysterious letter. Ghafur’s address was also written poorly. He ripped open the letter to find Ramanujam’s lettering. At least, the boy was safe.

  It said:

  Ghafur-bhai,

  I hope the Lord is keeping you in good health and spirits. My stay in Bangalore has been an adventurous one. Last night, my hospital and house were visited by some friends and they have left their mark. But, not on me.

  I received your message about the likely elevation of certain persons close to us. A tree falls in Purab Pradesh and my mentor becomes head of the country’s leading food certification agency.

  Your nephew, Qasim has been doing an excellent job of sending me the mails. Why he has to do this for a stranger, I do not know. I cannot thank him enough.

  If memory serves me right, FADRA came out with the approval notice for SARS vaccine under our institution’s blessings in early 2003. During my time in the capital, I had had a litre of the concoction made and sent to Queen Institute for verification of toxicity of contents and the likely potency on humans and the results are with me.

  I came to know certain things about the transaction very recently. The worm in my brain (as you so quaintly put it) is demanding a ransom to go away – can you find a copy of the signed document and have a copy sent to your nephew? As always, when he finds time, he could scan and send to me.

  I remembered your advice about discretion being the better part of valour and have chosen to leave this city. My next letter
, God-willing, will be from elsewhere. I think I have reached the end of my requests. Tell Qasim not to lose faith. Faith will sustain and justice will prevail.

  Sincerely,

  Ramanujam

  Why can’t this idiot be like the rest of them, thought Ghafur. Why am I even helping him? Do I believe in his cause or is he doing what I wish someone should be doing? Human thought had so many layers each one displaying its own colour.

  Whatever this guy chooses to do, may God be with him in times of truth. As he put it, faith alone will sustain. As if in concurrence with his thoughts, the muezzin sounded from the nearby mosque.

  CHAPTER 20: The Last Resort

  The muezzin sounded from the nearby mosque. For the first time in many years, Ramanujam was hearing the call for prayer without the aid of a loudspeaker.

  “Tell me, Rama, what are we doing near these beautiful backwaters of Kerala? If Ayurvedic massage is what you had in mind, remember that we don’t have enough money to buy an Ayurvedic pill”.

  Ramanujam laughed. “True, we are left with just as much money as we had when we left our village”.

  “It was nice of Dr. Rao to ensure that we got paid our wages for the time we spent in 3H despite our abrupt departure”.

  “Yes”.

  “You didn’t answer my question”.

  “I am doing some research work remotely. I have got ourselves a job in preparing concoctions at the Alappuzha Ayush Centre. That should sustain us”.

  “Food and shelter, Rama?”

  “In house”.

  “Excellent. I believe you get great toddy in Kerala”.

  “True. You take one sip and you are on the next train to home”.

  “Do not read too much into my statements, Rama. I just made a comment, not a statement of intent”.

  “Mine was the other way”.

  “Peace, Rama.”

  “Indeed. Peace is what beckons us. Look at these tranquil waters, uncomplicated lives, contented people.”

  “In this place, we might be the only crooks, Rama”.