Try somewhere else

Try somewhere else

A flash of memory alived about an uneventful incident in recent past that leaked busy my practice. Of late, the meaning of word “doctor” has undergone extreme metamorphosis. In my time a doctor mean a physician, teacher, a scientist, a lawyer, social worker and so what not. Patient is more aware of it than a doctor. Patient knows doctor is a super hero in their life “full of miracles” either as a part of duty or payment under table. In medicine, malingering or factitious is fabricating or exaggerating the symptoms of mental or physical disorders for a variety of secondary gain motives, which may include financial compensation, often tied to fraud; avoiding school, work or military service; obtaining drugs and job; getting lighter criminal sentences; or simply to attract attention or sympathy. A classic example is Munchausen syndrome. In Pseudologia fantastica the victim is unaware of this subconscious display. But I am just talking neither. The hero of this script is intelligent and aware but with a particular unresolved issue for which he was trying again and again to gain it. Everybody does love life .Execution needs a mean to meet the minimum need of life “food, shelter and dress”. I, you and so also my patient need it. “Lying to be healthy” is better than euthanasia is sometimes better, if it does no harm either employer or employee. Some live with dignity, some with indignity and some for life with neither like a mental on footpath. Life goes on, with winning a prize, in jail or neither. Choice is yours and mine. It was middle of September 2012. A big sunny day forced me to document a funny page “Try somewhere else”. Something was written for ever in my grey cells, a budding cardiologist. It was 32nd of spring of my life .Thirty patients were to be attended in outpatient department but last one “the hero of script, disease in health”. Well built. Height is five feet and 5 inch, 32 years old, black complexion, bright eyes and charming face, full sleeve, white shirt and large bail welcomed me with greatest devotion for that eventful day, the warmth of which filled and spilled into my end of tiring session   He was perfectly mimicking a gentle guy in simple dress; you would rate a little later. The last appointment for the day that leaked my statute. His abridged rehearsal of chief complaint was rare one .The documented medical record revealed he is a case of physiology of Tetralogies of Fallot, but a   real Google”. But, my patient was not believing he is sick, so also I without examining him and looking into his medical record. His  pink TOF phenotype was smacking and eluding his disease. He reminded again and again, sir, I am really fine but the preceding doctors who examined, certified I am not fit for underground mining job ,in shoe of my late father who died of accident . I add, he was the only son of a coal worker. He is married and had a girl child. His father died on duty. It was an accident out of underground fire flare up in 2008.He is trying hard to enter into the shoes of his father, the only bread earner of family and only hope of the family. He is still not in job. For him, it may be last chance, for me the first of its kind. He visited earlier this hospital five years back for a fitness certificate with freshly sprouting hope amalgamated with ecstasy of owning the front line .Aha! It is pity .Hope continued in hope with longer hypes. After an in depth evaluation of his health ,I verdict like a judge though he looks apparently looks healthy but his congenital heart disease does allow him for  light job on surface but not in the underground of mining though it would give him better salary . By that time, I was involved in him and his struggle in situ but could not meet his expectation. I tried of my science, finishing art acumen to help him out to the most privileged quartile. The heart defect was something like this: corrected transposition of great arteries with ventricular septal defect and pulmonary stenosis .A perfect matched synonym is physiology of "pink tet”. He had already revised his mind but I was revising mine. No more consultation with the before, after me I do not know. I think some of hospital staff has informed him, you may win here .It is like beautiful joke “The strangest ways to get pregnant, will hot pricks, needles and blueberry jam really help me conceive? My friends and relatives seem to think so, tiny girl asked mother after listening to television add”. He had an official letter, handwritten, doubtful legibility from the  colliery office, requesting a fitness for coal mining worker post. I used my bifocals.  The diagnosis was matching with previous one, even after cardiac magnetic resonance imaging with contrast enhancement. My verdict was orthodox; no improvement in my decision in his favor. The prescription did not sooth .I advised, Mr. you still can continue with light work on surface less than five metabolic equivalents. He smiled a constipated one. He left my chamber with a confusing look but some hope with certificate “fit for surface job”, something is better than nothing.  Thanks to his patience. “A hungry cannot sleep but thought in brain”. Exactly after three calendar months he returned to visit hospital campus and his hired monozygotic duplication visited me to get work done .The loyal and faithful twin visited me in his place .I did not know it. The conversion went on under cover. I heard  him, went through his outpatient book and examined him .He appeared apparently normal. The outpatient card of this ally had a mentioned same name, address, age, gender, physical profile of the real patient but the actor had no disease. He told he was sent fitness certificate for underground mining job. Some many patients in three months, I had not remembered anything of this created plot. I wrote for 12 lead electrocardiogram and an echocardiography study. Two hour later, a phone call came from a colleague in echo laboratory .Sir, what is your clinical diagnosis of Mr X? ECHO study is normal. But you remember, we did echo of this patient 3 months before .To my faint memory, this patient had some complex congenital heart disease. I laughed but immediately visited the echo room. The indexed person had normal 12 ECG and chest X-Ray. Redo echocardiography was normal. I was about to write fitness certificate for this person .To my surprise, an exactly similar looking person gave a handshake to the actor in disguise. The duplicate told to the real patient that all the reports are normal and doctor is writing certificate for fitness .A faint smile of my colleague alerted me stop to certify and bring the issue under the notice of hospital security. What, a narrow escape! Two monozygotic were there, I was seeing in two eyes at a time! I asked, the copy of my morning patient, does he has health issue? Before he answered, both the suspicions disappeared in no seconds .The face of real patient was drenched with sweat and he was looking frightened. I was praising his effort to get into his father’s shoe but I was admitting I would not be a good administrator. I have not seen them either again. He may be trying somewhere else. A very nice quote came to my mind when the person was walking away in my memory lane with aging of time “Some people think that the truth can be hidden with a little cover-up and decoration. But as time goes by, what is true is revealed, and what is fake fades away”. Time will reveal everything. It is a babbler, and speaks even when not asked. May God bless you? Let you carry on surface if not in underground. Don't try to solve the problem, surrender to it. The things that matter most must never be at the mercy of things that matter least. I could still remember the face of my hero, drenched with sweat, may be trying somewhere else for his underground job.