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R Muralidharan
THE rains had stopped for a while. The damp and murky July weather was adding to the gloom of my homesickness. It was July 1985. I was just two weeks old at the PGI, Chandigarh. The slowly whirring ceiling fan was unable to alleviate the oppressive humidity in the Emergency ward milling with patients. Being a first-year resident, my status was that of a houseman, the lowermost rung of the hierarchical ladder. The senior resident on duty that day was revered for his knowledge and clinical acumen, and feared for his stern demeanour bordering on arrogance. I was summoned by him to the triage (where new patients arrive) to help out with a ‘puzzle’.
There was this Tamilian woman, in her early thirties, a contract labourer with the PWD. No information was available from the husband and bystanders, except that she had no previous medical illness and was found unconscious in her house an hour before. She was drowsy with cold limbs, very slow pulse and heartbeats and low blood pressure. Her clothes were soiled with vomit.
Fresh from the Thanjavur medical college in Tamil Nadu, where I had seen a handful of such cases, I could suspect yellow oleander (shrub with bell-shaped yellow flowers and green four-faced fruits) poisoning. The fruits and seeds are extremely poisonous, specifically to the heart. Chandigarh has these shrubs in plenty. Called kaner in Hindi, the flowers are used in puja. The ethnicity of the patient was a major clue since due to some reason many cases of suicidal oleander poisoning have been from Tamil Nadu or Sri Lanka. My senior from north had not seen such a case before so I explained to him what needed to be done. The specific treatment was started and the woman recovered in the next few hours and sheepishly admitted to having ingested crushed seeds of the plant after an altercation with her mother-in-law!
My senior resident spread the word around, giving me full credit for the successful management of the case, catapulting a humble junior to overnight stardom!
Many important lessons were learnt that day. First, geographic and ethnic background of patients should be an important consideration in any clinical problem solving. Second, institutes with a cosmopolitan mix of people from across the country, or even the globe, stand to gain by collective wisdom of individuals with different training backgrounds. In subsequent years, I saw several instances to substantiate this. I learnt to diagnose diseases that we hardly see in South India and, in return, I could contribute in other areas where I had more experience. Doctors who were trained in Bihar and Bengal were well versed in managing kala azar, whereas we from the South could share our knowledge on filariasis; both these infections are less common here.
But the singularly most important lesson was through the candour of my senior resident, who despite his demigod status, confessed he did not know something and was willing to take help from, and give credit to, the junior-most member of his team. He showed by example one of the most important tenets of leadership.
Even today when I see the yellow flowers, I recall the memories of that day that continue to reinforce in my mind the glorious ethos of my alma mater.