(I believe that diseases are keys which can open certain gates for us. I believe there exist certain gates which only disease can open – André Gide)
Ican’t forget the innocent expression on his shining face, the faint smile on his lips, and his small sharp eyes looking directly at me as if trying to fathom my mind. The expression changed but little during the course of subsequent interviews with him, as if it were sculpted permanently there.
When I saw Moti Lal for the first time, he was accompanied by Sanjay, his distraught son. A week earlier, his voice had suddenly failed him midway during dinner and he had put his hand on his throat in a helpless gesture. Surprised, his wife asked him if he wanted anything in particular. He answered in a whisper but could not complete the sentence. She thought he had choked and offered him a glass of water. He drank a little and tried to answer the volley of her questions, but short of a barely audible whisper that tired him quickly he couldn’t go far. She was puzzled, for he didn’t cough as one does when choking, and his breathing was unusually quiet. She made him gargle with a glass of warm saline, believing that some infection in his lungs might have travelled to his throat, but it made no difference to his voice.
‘It must be the cigarettes that you still manage to smoke in spite of the doctor’s repeated warnings. Now get some rest; you will be fine by morning,’ she said reassuringly.
Next morning she found him unable to speak. He answered in gestures. She got him to gargle again, gave him a pinch of black pepper to grind under the teeth, rubbed his throat with turmeric poultice, and made him sip cinnamon tea—all to no avail. His signature smile and his sharp shining eyes made it all the more poignant for her. Unlike her, he didn’t look frantic, not even overly concerned. That is when she phoned her son.
Moti Lal was a chronic respiratory invalid. Seventy-three, short and slightly built, he had a history of 60 pack-years of smoking that had changed the elasticity and architecture of his lungs and chest cage to produce the characteristic barrel chest of emphysema and chronic bronchitis. His face was pink and suffused though he did not look the typical pink puffer. He was in no visible distress either because of his respiratory affliction or the loss of speech. His eyes looked at you innocently as you asked probing questions that he answered fairly well by sign language. It was a problem not in the understanding of speech or its formulation but in the delivery. However, he could eat, swallow, wiggle his tongue, purse his lips and blow his cheeks normally.
I studied his file. Several doctors, including a chest physician, an otolaryngologist and a neurologist, had already been consulted. Each of them had ordered investigations relevant to their specialities, including blood counts, biochemical profiles, respiratory functions, CT scans of chest and neck, and MRI scans of head, yet remained clueless about his loss of speech. Laryngoscopic examination had revealed normal vocal cords. He was taking his customary medication of bronchodilators and steroid inhalers, and had been additionally prescribed a course of antibiotics. The chest physician had recommended intermittent oxygen inhalations. An anti-depressor had been added to the medical regimen but it had made no difference to the speech outcome.
I addressed the son: ‘His tests are all normal except for the respiratory function which is compromised by long years of smoking. Nevertheless, I feel he is doing reasonably well on that front. He doesn’t seem to have suffered a stroke that could have affected the speech mechanism. I tend to agree with the laryngoscopic findings of healthy and well-functioning vocal cords. As such, I don’t see any organic reason for the loss of speech. I am sure it will return sooner than you realise.’ I spoke candidly, encouragingly.
‘But it has been more than a week that our ears are thirsting to hear him speak,’ lamented Sanjay.
I turned to the patient again and asked him to say ‘Aaa.’ He opened his mouth and seemed to make all the effort without producing any sound.
‘Moti Lal, try to grunt, as if clearing your throat,’ I asked him gently.
He looked at me in amusement.
I repeated my command firmly, ‘I want you to clear your throat. Come on, cough up; you should know how to do it better than anyone else.’
Before he realised it, he produced a light barking cough. I hastened to offer it as proof that his vocal cords functioned well because that is where the sound is produced, be it cough or speech. However, my explanation had no impact on the duo. They looked at me uncomprehendingly.
‘But he is not able to speak even a word,’ Sanjay moaned.
I again asked Moti Lal to say ‘Aaa.’ He gestured in the negative.
‘All right, try to cough again,’ I coaxed him. But he couldn’t make the sound he had just produced. All efforts went in vain as he strained and contracted the neck and abdominal muscles in trying to cough.
It was embarrassing.
‘His speech will return as suddenly as it stopped; it is only a matter of time,’ I said in a tone of finality. ‘Meanwhile, let him not strain his vocal cords; it seems they need some rest. Long years of smoking and talking can put the cords in a defiant mode. And who knows, Moti Lal may want to observe maun for a few more days like the yogis,’ I joked, winking at Moti Lal meaningfully, trying to make light of what seemed a grim situation to them.
While he continued to maintain his stoic stance, smiling his mysterious smile, his son eyed me with a mixture of curiosity and scepticism.
‘Let me see him next week again,’ I suggested and, as an afterthought, ‘why don’t you also get your mother along?’
They were back in five days, Moti Lal with his signature expression, his wife and son distraught.
‘There has been no progress in his speech; he has not even produced a whisper,’ the son complained, his mother nodding in unison. ‘Our home is in utter despair. There is a daily stream of visitors inquiring about his ailment, offering suggestions, recommending this doctor and that, compounding our confusion’.
I was not surprised. It is in the nature of Kashmiri Pandits to go public even with a common cold, inviting sympathy and unsolicited advice in the bargain. Soon the news spreads and people start flocking to their home, expressing profound concern, looking into the prescriptions of doctors, searching the test reports minutely for any deviations from normal, staring at the X-rays and scans, making sweeping statements, citing anecdotes, suggesting alternative remedies and recipes.
‘It is your own mistake to make his maun a national issue,’ I reprimanded them.
Moti Lal sat in front of me with his enigmatic smile, mute as ever. I repeated my commands to say ‘Aaa’, to cough, to grunt, to hum, to mumble, to chant. He responded to each of my commands with frantic efforts, contracting his neck and abdominal muscles, bending his torso forward in the process, but not a sound could he produce. He was visibly breathless from the effort but mute like a stone.
His wife and son watched with disappointment.
‘Does he snore?’ I asked his wife.
‘Occasionally,’ she replied.
‘Did he by any chance speak in sleep?’
Sanjay’s face lit up suddenly as if he had retrieved a lost link, ‘Yes, sir, now that you ask. My sister, who has come over to help, watches over him at night. The night before, father had woken up in the middle of sleep and asked her to switch off the AC, for he felt cold. She suddenly realised that he had spoken in a normal voice. “Papa, you spoke. You spoke just now. You asked me to switch off the AC. I will go tell mother,” she had said excitedly. He looked at her in surprise. “Try speaking again, Papa; try calling my name,” she begged him. He tried but couldn’t utter a word. Next morning, she reminded him about it but he maintained total ignorance. We believed she might have just dreamt the whole thing because of her desperation to see his speech restored.’
Sanjay certainly provided a sound explanation of the incident but I believed his sister, and if I had even an iota of doubt about the nature of aphonia in the patient it evaporated altogether.
‘It convinces me about the non-organic nature of his speech loss. We call it psychogenic aphonia. It may occur after a sudden shock, or as a manifestation of hysteria, or severe depression,’ I spelled out my diagnosis for the first time to them.
But they were not interested in my arcane theories. They wanted results. They were dying to hear him speak again, while I was trying to probe the depths of his mind. Until I got some idea about the nature of his internal conflict, treatment would not be effective and cure elusive.
Suddenly, I realised that I had forgotten the basic question we ask every patient—history of a similar episode.
‘Has it happened before, I mean loss of speech?’ I asked. His wife looked at him, as if seeking his permission. If she read anything from his face, I couldn’t fathom it, for I did not see him even batting his eyelids.
‘Yes, doctor,’ she replied, ‘he would go into phases of total withdrawal, not eating or speaking for several days.’
‘When did it happen?’
‘It is a long story. His life has been full of vicissitudes; so many highs and lows,’ she sighed while Moti Lal maintained his expression of stoic resignation. His demeanour had not given me any reason to believe that he was concerned about his problem.
I decided not to pursue the line of inquiry in his presence but to experiment with a strategy I sometimes employ with such patients—autosuggestion.
I turned to him. ‘Moti Lal, your voice box is in a state of fatigue. I am sure it will recover soon with medication and some more rest. I am prescribing a tonic that will help your cords regain strength to speak again. It should work in a few days. Watch out, my good friend,’ I said, looking him in the eye, patting his back lightly, nodding my head encouragingly. I asked Sanjay to report his progress in a week.
The son reported back, animated. ‘Sir, it happened exactly as you said. Yesterday, we looked expectantly at father asking him if the tonic was working. To our amazement, he touched his throat and strained to produce a grunt successfully. We watched with bated breath and encouraged him to speak. He did; in a faintly audible whisper, he asked for some watermelon. It was music to our ears. But our rejoicing was short-lived; he relapsed into silence again.
‘I am happy about the development. I hope your mother is relieved to some extent. Last time she spoke of the vicissitudes in his life. Can you please elaborate?’
Putting on an air of importance, Sanjay recalled, ‘There was a time father was flying high. He was the king and the kingmaker in his business. I have heard his friends boast that he would light his cigarette with a hundred rupee note.’
It was not the first time that such queer exhibition of riches going to the head had become part of the folklore in Kashmir.
‘Where did the money come from?’
‘You might have heard of KMD?’
‘There used to be Kashmir Motor Driver’s Association bus stand at Budshah Chowk in Srinagar, if that is what you speak of.’
‘My grandfather started it with a fleet of his six buses. KMD became a large organisation of the major transporters of Kashmir. After grandfather’s death, father and his younger brother took over the business. When all was going well, uncle, who father trusted with all the transactions, swindled the company, siphoned away money from the banks and mortgaged the buses to other transporters, leaving the company broke. Father lapsed into acute depression, renounced his office, sat home, smoked away and ate little. That was in 1986.’
‘Did he go mute then as now?’ I was impatient to know.
‘Not exactly. He spoke little and so low that he was barely audible, but did not go completely mute. He recovered completely in a few weeks.’
‘Any other time?’
‘Yes, four years later, when terrorism engulfed Kashmir and we were forced to flee. It was the rudest shock for our family. From the airy second-floor balcony of our house at Rainawari on the backwaters of Dal Lake, overlooking the Hariparbat and Shankaracharya hills, it was a precipitous fall into the vast wasteland of Jeddi at Jammu where we found ourselves in a tent provided by the relief organisation. He felt deeply claustrophobic inside that tent. He would sit for hours on the roadside, smoking bidis, brooding. That is when he relapsed into the same state as when he had lost his business. You said smoking has caused that barrel chest, but I feel it is more the dust during Jammu summers that has found its way into his lungs. Somehow, we survived. We were moved from the tent to a room in Nagrota refugee camp where we grew up and married. He has recouped a lot since we were shifted to the one-room apartments in Jagti. We have more space now. I have been allotted a separate apartment and so has my brother, for we both have families of our own. But I visit my parents almost every day.’
‘And your brother?’
‘He parted ways after he married. Hardly comes to see them.’
‘Did it make him sad? Did he stop speaking at that time?’
‘Not really. My brother is hot-headed. He would run into frequent arguments with father, often accusing him of frittering away his gains and ruining our prospects like the currency notes he would light his cigarettes with. That label stuck to father like a trademark that people often alluded to in social conversations.’
‘Is there anyone else in your family?’
‘My second sister.’
‘Where is she?’
‘She lives in Delhi. She, too, parted ways with us way back in 2000 when she married outside the community against father’s wishes. That was his biggest shock, worse than the loss of business and our home. That is when he stopped speaking for a full week. But it was expected.’
‘From what you say, there was a precipitating factor every time he stopped speaking. What can it be this time?’
‘I can’t think of any reason now when the worst is over. I feel he may be in dread of a serious disease.’
‘Like what?’
‘Cancer. Last month when his breathing turned really bad, the chest physician casually alluded to it. Told him he had no oxygen in his system and if he continued to smoke he might get cancer. It made him sad, even angry, but he did not go mute.’
‘And did not stop smoking, either?’
He blushed as if he were at fault and not his father. ‘He smokes very little, hardly once or twice a day.’
‘In any case, I don’t see any evidence of cancer anywhere, either in his lungs or vocal cords. We have to find the trigger for his present episode of silence. Did anything unsavoury happen on the day he stopped speaking?’
‘Nothing that I know of.’
‘Any tiff between your mother and him?’
‘She is very devoted to him; I don’t remember her ever raising her voice at him.’
‘Did anyone phone or pay a visit?’
‘We phoned my brother and the Delhi-based sister just to keep them informed about father’s poor condition so they may not accuse us of keeping them in the dark. You know the charade of love and loyalty people put up in such situations even when they may be totally estranged?’
‘I understand what you say.’
‘We heard nothing from sister, but my brother did pay a visit. He came in the evening. I had already left for my own apartment after spending time with father. Mother was in the kitchen. She saw him coming; told him she would fetch him a cup of tea while he sat with his father. But he stayed only a few minutes and hurried out of the room just when mother was ready with the tea. She was puzzled but he said he was reminded of an important appointment.’
‘And your father stopped talking after that?’
‘It seems so, because mother asked him to dinner soon after brother left and that is when he couldn’t speak.’
‘Does your mother recall overhearing any argument between the two while she was making that cup of tea?’
‘I don’t think so; she would have told me.’
‘I would like to see your father tomorrow. Alone.’
‘Sure, sir.’
Moti Lal was ushered into my chamber—shining face, sharp eyes, inscrutable expression. Sanjay waited outside.
‘Well, sir, how are you feeling this morning?’ I addressed him deferentially, playfully.
He gestured to say he was fine.
‘It seems the tonic helped you to some extent?’
He nodded his head to say yes.
‘You should regain your full voice soon enough.’
He gestured in the affirmative.
‘You live with your wife and Sanjay visits you often? He is a devoted son?’
He repeated the affirmative nod.
‘I hear your second son paid you a visit some time back?’
He blinked his eyes uncomprehendingly.
‘What transpired while he was with you?’
He gestured rather uncertainly.
‘Was there an altercation?’
He looked intently at me.
‘Was he nasty?’
The smile faded, the pink face turned pale, the eyes lost their sparkle and he froze like a statue.
I held his hand, pressing it gently. ‘Come on, Moti Lal, speak. Consider me your own. It will help you share your feelings.’ His eyes dimmed. A tear trickled down along his right cheek.
‘Did he hit you?’
He started sobbing, his hands trembled, his eyes blinked repeatedly to stem the incoming tide. And then the dam burst, tears rolled down in streams as he grunted and sobbed and coughed and cried like a child, his body convulsing with grief.
I held his hands firmer. ‘Speak; it will set you free,’ I said endearingly.
‘Doctor Sahib, you are an angel;’ he uttered in staccato voice, ‘Only you understand my state of mind. I felt it when I met you the first time. I am sorry for behaving like a child. Yes, I have gone through hell in my life, but I never felt as bad as when my son humiliated, cursed and threatened me…’
He was speaking fluently now, ‘Yes, I am at fault. I called him a henpecked nincompoop. “Did you seek your ladyship’s permission before coming here?” I asked him as soon as he came to see me. It infuriated him. He called me a demented old man with a loose tongue that he would chop off before I spoke another word. My tongue froze the same instant, as if it was cursed. It was like a spell...’ He clutched my hand tight, lowered his head on my arms and continued to sob and shudder.
‘Well, the spell is broken. And for good, I hope. Don’t you agree?’
He nodded in the affirmative and spoke aloud, ‘Yes, yes, it is over.’
‘You made your wife and son pine for your voice,’ I said in a conciliatory tone.
‘Sir, do you think I did it on purpose?’ he asked like an innocent child, still sobbing uncontrollably.
‘On the contrary, you strove hard, like the great fighter you have been all your life. I am sure you have enough resolve left in you to not let it happen again.’
‘Never.’ His face beamed with a wide smile and the sparkle in his eyes grew into a flame, one of gratitude, as if in recognition of my awareness about his inner conflicts.
I called Sanjay into my office to take delivery of his smiling father.
