It was my last working week before summer break. My clinic was flooded with patients eager to get checked up, and to take instructions for the four weeks that I would stay away. Amongst the patients was Prem Nath.
Prem Nath is a poet of repute and writes in Kashmiri under the pen name Shaad. His poetry touches the heart. He consults me from time to time, mostly regarding his son who often comes to seek reassurances for trivial complaints. This time, it was the son accompanying his father, helping him inside my chamber.
Shaad did not sport his trademark cloth satchel with a long strap slung from his shoulder in which he often carries copies of his books or a diary with his unpublished work. Nor did he wear his customary smile. This was unusual.
‘Pray, what can be ailing our poet laureate?’ I bantered light-heartedly.
‘Doctor Sahib, I am not well; I have contracted jaundice. It is getting worse by the hour.’ He put on a grim expression.
Shaad is generally a cheerful and engaging person, but in the matter of health he is like his son, fretful and neurotic.
‘It is a shame that jaundice has decided to visit me just when you are breaking for a holiday, leaving us in the lurch,’ he said as if it was a visitation by an evil spirit. ‘Pray, where should the patients go during your absence?’
‘I am around till Friday. That gives us four days to deal with your problem. In any case, you can always reach me on the phone. Now, let me know your story.’ I tried to sound reassuring.
Shaad’s problem had started 10 days earlier with loss of appetite and nausea. At first, he attributed it to something in the diet that would pass, but a few days later he started passing yellow urine, and his wife noticed yellow colouration of his eyes. By that time, the nausea was gone and his appetite was returning even as his jaundice was getting deeper. He didn’t report any pain or fever, except for a mild chill during the first few days of his illness.
Jaundice gave his eyes a yellow hue and his skin a light tan. His liver was enlarged and tender.
‘Shaad, this looks like viral infection of the liver,’ I said after I finished examining him.
He turned pale with anxiety. ‘Is my liver in bad shape?’
‘I do not think it is bad in your case since your appetite has improved and the nausea has subsided. I will order liver function tests. I suspect hepatitis E. That is the virus prevalent in Jammu during summer,’ I said.
He seemed alarmed. ‘Am I in any danger?’
‘I don’t think so.’
‘Could it be something other than a virus?’ Shaad asked.
‘Like what?’
‘Cancer.’
‘It seems very unlikely, but we will find out. We may conduct an ultrasound if necessary,’ I replied as I handed over the prescription to him. ‘You don’t need to come with the test results from the lab; send them with your son. And, please stop worrying.’
‘What about medication? What should I eat meanwhile?’ he asked impatiently.
‘Frankly, you don’t need any drugs; it is a self-limiting illness. You may eat almost anything you feel like.’ I gave him my stock answer to uncomplicated patients of hepatitis.
‘Anything?’ his son asked.
‘Yes, anything, unless some foods do not suit him. He may cut down on oils and fats for a while and take plenty of fruits and juices.’
‘But my food choice has been drastically curtailed. They don’t let me eat anything other than rice, gourd and squash. No oil, no butter, no mutton, no spices,’ Shaad moaned like a child.
‘Who is stopping you?’
‘My family, and others who come inquiring after me. They invariably come up with dietary advice, whether I seek it or not. I am utterly confused.’
‘Confused about what?’
‘The food I should eat.’
‘What would you like to eat?’
‘I would love to eat my normal diet.’
‘In that case, go do it; eat what you like.’
‘What about spices?’
‘No problem with spices,’ I assured him. ‘In fact, spices may be beneficial.’
‘Even turmeric?’ his son asked.
‘Even turmeric,’ I replied with emphasis.
Two days later, Shaad returned along with his son who placed the test report on my table.
He looked anything but Shaad which, translated from Kashmiri, means ecstatic. He once told me that he had initially given himself the pen name, Aijiz, which means jaded. That would be more appropriate in his present state of mind.
‘I came only to seek reassurance from you,’ he said apologetically. ‘After looking at the report, I am worried to death. There seems a gross abnormality in all the tests that you ordered.’
‘Yes, the enzymes have risen quite high, but I would not worry too much about it. I expect the inflammation to resolve on its own in three to six weeks. Thankfully, you are not pregnant,’ I said with a chuckle.
He looked surprised. ‘If it is a joke, I did not get it,’ he said.
‘But if you have conceived a new poem, it is all right,’ I continued in the humorous vein.
He forced a smile on his face. ‘You are teasing me with your riddles, Doctor Sahib.’
‘I am happy to see you smile again. The good news is that hepatitis E does not generally cause complications, except in pregnant mothers. You are only an indulgent father.’ I winked at him.
‘Oh!’ he exclaimed, understanding the joke. But he seemed still unconvinced. ‘In that case, I don’t need to worry about complications?’
‘Only rarely does hepatitis E result in any permanent liver damage, unlike hepatitis B or C.’
‘That is a big consolation. But the enzymes are so high; can I still eat my normal diet?’
‘I told you; you can eat what you like.’
‘Can we use oil while cooking?’ his son asked.
I nodded my head in affirmation. I was getting impatient with the father and son taking turns asking the same questions about diet even as I had detailed out everything, including all the facts about hepatitis E, as if I were teaching medical students.
‘What about medicines?’ he persisted.
I had no intention of writing a prescription for Shaad. He did not need any. Since I was breaking for four weeks, I would hate to leave him petulant if I did not prescribe a drug. A blank prescription would be like a blank cheque for Shaad to run from one doctor to another until one of them prescribed drugs with unproven efficacy in hepatitis. Reluctantly, I wrote a multivitamin pill for him. Father and son beamed with satisfaction.
But he would not leave unless I had answered all his burning queries. He had come armed with a long list of dietary items written on a page for me to tell him which ones were allowed and those that were not. He had other needless questions too—about the length of time he should stay in bed, whether he could take a shower and, again, about the duration of self-imposed dietary restrictions.
And finally, ‘When do I need to go again for my liver function test, doctor?’
‘You will not conduct any test till my return.’ I put my fist down on the table in exasperation.
‘But how will we know about the course of the disease? It may get worse while you are away,’ asked his son. This was not the first time I was up against this formidable father-son team.
‘As I see it, your father is already over the hump—he is stable in all respects, his appetite has returned and he has no symptoms other than the yellowness of the eyes. From there, he can only get better and better. In any case, the liver function parameters will take time to return to normal levels. Give the liver enough time to cool down, please.’
I turned to Shaad, ‘Stay calm for now, turn this adversity around and make good use of the time while you are resting. Write poems.’
‘I will; in fact a poem is already forming in my head,’ he exclaimed.
‘Not a doleful one, I hope?’
He nodded his head uncertainly. ‘Would you want us to boil the water we drink?’ He wouldn’t leave any lacuna in the safety measures.
I felt this was the most sensible question during the long interview. ‘Yes, I would advise that to everyone in this town.’
Shaad took my leave, not before reminding me that he would bother me on the phone.
He stuck to that statement. He phoned twice during my leave from work; both times wanting to know if he should conduct the liver function tests and what diet he could consume, and whether he could use a little oil in cooking now that he had vastly improved. His insolence was irritating and I was curt in reminding him that my instructions about diet stood, and that I expected a poet of his stature not to be fixated on his illness, nor remain trapped in myths about the dietary restrictions in jaundice.
Shaad was a sparsely built person, but when he returned to see me again after my vacation, his cheeks had caved in and the short clipped moustache looked rather big for his withered lips. He looked famished and seemed to have lost weight. However, his eyes were clear; there was not a tinge of yellow, and his skin had assumed his natural wheatish complexion.
‘Seems you have been starved,’ I remarked.
‘You are right; I was not allowed to consume anything except boiled vegetarian food. No oil, no condiments, no dairy products, no…,’ he complained like someone grossly wronged. ‘Now that you are back, I am waiting for you to declare me fit. And please let me know when can I resume my normal diet? When should I go for the tests?’
I was peeved at his obsession about diet and tests, and resisted the temptation to tell him off. ‘You can eat whatever you like. I already said that the first day you saw me; I say it again. For your satisfaction, I am ordering your liver function tests right away.’
He returned the next day, smiling as wide as his mouth would permit. The test results were almost within normal ranges.
‘You have the certificate now. Go make it public; paste the test result onto your door; show it to all your family and friends. And please do not ask me again about diet.’ I shook his hands to signal that there was no scope for any further queries.
Gingerly, he produced another file from his bag. It was an abdominal ultrasound. I looked at it amusedly and grinned.
‘I am sorry, I got it done on my own,’ he said apologetically.
I winked at him, ‘You must have read the report.’
He looked away, nodding his head like a child caught in a mischievous act.
‘Well, it is normal.’ I congratulated him.
‘So I can use oil for cooking and add turmeric to my diet now?’ The unusual mirth in his voice and his childlike naughty looks at once disarmed me. The query about diet was like the refrain at the end of each stanza in a Kashmiri devotional poem. I took his poetic predilection in my stride.
‘Yes, you can use oil in your cooking, and turmeric, and chillies, and any other condiments you desire.’
‘I was not allowed even a pinch of any condiments and, certainly, no turmeric,’ he said, looking rather accusingly at his son.
Poor Shaad was a helpless pawn on the social checkerboard where the movements of pieces are controlled by deep-seated myths that have survived for centuries. No amount of scientific evidence is able to ease the stronghold that folklore and entrenched tradition have on the psyche of people. In the case of jaundice, even doctors tend to perpetuate the dietary myths. How then could I blame Shaad or his family for what looked like stupidity?
‘In fact, turmeric is one of the best condiments that we know of. Besides it’s well known for its anti-cancer and antibacterial properties; it is anti-inflammatory as well. Turmeric should help rather than cause harm in hepatitis,’ I explained.
‘But turmeric is deep yellow; won’t it make the jaundice worse?’ he asked.
How ludicrous! Shaad’s blunt logic made me laugh. Was that the reason why turmeric was forbidden to jaundiced patients in common lore?
I eyed him with sympathy.
He hesitated for a while before he continued, ‘This may really look bizarre, but I have not been allowed to wear anything yellow all these days. We had drapes with yellow stripes removed from the windows. I hope that is no longer necessary.’ I thought that was the extreme one could go to cast off yellow. Poor yellow, the colour that symbolises sacrifice, had become a pariah, a monster. It was being sacrificed at the altar of superstition. When I jokingly asked about it, he confessed that he was forbidden even to look at yellow flowers. He was not allowed to offer the traditional marigolds during his worship of the deities. Since there were more skeletons tumbling out, I asked, ‘Shaad, what alternative treatments did you receive during the last four weeks besides what I prescribed? Be forthright with me; I am not going to chastise you.’ I was almost certain now that he could not have resisted the indulgence of his advisors amongst family and friends.
‘Frankly speaking, I was under great pressure to go for phanda, a type of voodoo practised in Jammu, but I did not yield. I stuck to your medicine and to the diet that my family offered—bland, colourless and flavourless. But a priest was called in all the same, to offer a special puja to drive away the evil spirits. I am sure all these measures do their bit in the resolution of jaundice.’
‘If you like to think so,’ I responded, not able to conceal my impatience. ‘You were seized with a virus, not any evil spirits or demons. Now you are exorcised of the bug, I hope.’
He smiled and said, ‘I will use that metaphor in my new poem.’
‘You are welcome.’
‘Finally, before I take your leave, I want to make absolutely sure about turmeric.’
That was the last straw. Had jaundice deprived Shaad of his sense and sensibility? I do not know how I resisted the temptation of landing a hard one on him. Instead, I ordered a bouquet of yellow roses to be delivered to him the next day.
