Vakati Panduranga Rao (1934- 1999)
“Six- Four, game, set and match to Manohar!” announced Rayman who acted as Umpire.
“Congrats Manohar! That was a good game,” Ravindra conveyed his appreciation shaking Manohar’s hand.
Accepting his greeting he complained, ‘Somehow, you are not your self today. Otherwise, will you let me win so easily?”
They packed their Tennis racquets.
Ravindra was Hospital Superintendent at St. Bernard. Manohar was Collector, Customs. Rayman was Captain of a ship and had come to Madras on vacation.
After the match, all of them sat leisurely in the Tennis Club lawns and sipping tea.
The sky was turning grey slowly. Neon lamps lighted suddenly as if they were coming out of a reverie. The Club boy was busy roaming all around and supplying things demanded by members.
“Yes, I don’t know why, but your focus was not on the game today,” reiterated Manohar.
“Some nice new nurse?” winked Rayman mischievously.
“No. No. My friend is a Rishyasrunga,” defended Manohar.
“Who is he?” asked Rayman.
After Manohar recounted the story of Rishyasrunga, all of them had a hearty laughter.
“Then Dr. Ravindra! You must follow me to east. You must stay for a week in Bangkok… then …”
“Is Bangkok such a catalyst?” interrupted Manohar.
There you find a dozen catalysts in every building. The beauties there can transform a Rishyasrunga to Vatsayana in one night…”
“Why? Your eastern voyage is exclusive to Ravi or there is room for this poor Customs fellow?”
“What a question! Don’t the Customs people and Captains on the sea have extended relations for lives?” said Rayman.
“So you both collude to leave me alone,” spoke Ravindra at last.
“No. No. In a city like Bangkok a doctor never goes out of demand.”
The three laughed heartily once again having understood the pun.
“But once my friend takes up a case, nothing can distract his attention…” said Manohar browsing through the pages of the magazine on the table.
“Is he doing any research?”
“Nothing like that. During my stay for six years in states, I developed passion for reading books, magazines and journals relating to medical subjects. That habit is continuing. That’s all! I ruminate about what I read and try to put into practice as far as possible. I am not doing any research as such.”
“Research is exactly what you do!”
“No. No. Research is a kind of deep meditation. A state of unwavering yogic trance. The enzyme or the bacteria you are searching for becomes the divine and oblivious to the world around, all your attention in thought, word and deed should be diverted towards that. For such an inquirer his lab becomes the Naimisha Forest. I don’t stand a chance….” Replied Ravindra looking deep into the horizon with a desperate air.
A Seagull passed them by with a squawk.
With his attention diverted, Manohar remarked, “My god! When you have reached Naimisha from Bangkok that means you have completed one circle. But forget about it. Look here. This makes a very interesting reading. He started reading from the interview of Björn Borg published in Time magazine: ‘Borg says: once I step into the court and start playing, a kind of overwhelming confidence seizes me saying… so long as I am there how could anybody win? I am the superman in the court. I must be there where the ball lands… and suddenly a new idea flashes in my mind… and I play a very unconventional shot that was not there in the copybook. People may get bewildered. But it seems so natural to me. As the idea in the brain traverses through hand and meets the ball, there is nothing comparable to the rhythm. That is my empire. My writ rules there. My shot cannot miss its aim. It is a kind of dreamy state. A blissful state…”
Manohar took a break and said, “We care to read these words just because the person who spoke them was a dexterous Arjuna of the Tennis world. Had they been uttered by any other mortal, we would just brush them aside dubbing them as the prattle of a pervert.”
“So true! It is hard to believe.” Said Rayman.
Ravi said, “If somebody on the top of a hill hails there is a village on the other side, it is quite natural for the man at the foot of the hill this side to scoff at him saying, “You mean a village? On that side of the hill? You want me to believe? Don’t take me for a fool”. But, Manohar, Borg is no mean mortal. He was a Yogi, who started his career at a tender age of 15, and left no Himalayan peak in Tennis world unconquered planting his flag of authority. It is beyond our imagination what kind of devotion, unswerving determination and uncompromising practice. Just read further, you will come to know.”
“You are correct. All through the year, Borg practices a minimum of 4 hours each day without fail. Once he wanted to bring a slight change in his service. They say, he practiced hat small change for two hours every day for two weeks.” Manohar read out from the magazine.
“Because he had such kind of devotion, his body could translate into action what his mind has planned about. Didn’t our people say ‘wherever the mind hovers, the world follows suit?’ Borg has proved those very words hat world walks the way your mind thinks. In a way, this proves the ‘bio-feedback system’ in medicine,” Ravi was going on.
Boy interrupted him and said, “Sir! There is a phone call for you.”
He went in to answer the call.
“Ravi! Are you still at the club?”
“Yes. Are you feeling better now?”
“Fine. I thought of going out somewhere if you turn up early.”
“It is already past seven. There is an important case at the hospital. After tha…”
“Is it the same Mrs. Khambatta?”
“Yes dear! Her condition continues to be critical.”
“Hello! Hello Meena!”
“I am here only…. Where can I go? After all?”
“There again. No. You should not get into depression… switch on TV… In another half-an-hour there is a program by your favorite singer Janaki.”
“I liked your suggestion Ravi!”
“Like Janaki in Asoka Garden I will be here; and songs of Janaki shall keep me company… very appropriate!”
“Then Mrs. Janaki! Then, am I Sri Ram or Ravan?”
“I suppose you are only Sri Ram. Even if you are a Ravan, it is OK with me.”
“What do you mean Meena?”
“I say, it is important to have love for Sita. Had he not, Ravan would not have taken her away.”
“Agreed. I will be there by 8.30. OK?”
By the time he returned taking the call, Rayman and Manohar also got up to leave. Within the next five minutes the three cars had started.
An old model Austin car of Dr. Ravi stopped at the hospital portico.
“Good evening Dr.!”
Bowing his head in response to the greeting of the Anglo-Indian nurse at the reception, he went upstairs to his room. He searched under M in the Index of the filing system for a case file.
He got it.
“Malini Khambatta… admission: 26th July…” That means 28 days had passed since she was admitted.
Ravi was going through the history of the case…
34 years of age. ED of a shipping co.
Her husband is a Squadron Leader undergoing training in Russia now. Her 12 years son is studying in Doon Public School.
She came to Delhi from Bombay only 2 weeks before admission. After holding consultations with government she visited Tokyo. From there she dashed to Singapore to settle the issue when the staff of a stranded ship of theirs went on strike. From there she had been to Colombo. As she got down at Madras airport she had slight fever. As night progressed she developed acute body ache. By next morning she had a peculiar sensation of her fingers.
She joined the hospital at 8 am. They conducted some preliminary clinical tests and started palliative treatment. By the fifth day she developed difficulty in moving her neck, fingers hands, and legs. Her ESR was found to be over 80. Within the next three days it crossed 115. Her movements gradually became difficult. She started developing lesions under the skin.
He conducted all possible tests on her. Discussed the case with fellow experts. They found it hard to diagnose it. Ultimately, they noticed that the Collagen, which binds the cells of various tissues with one another got poisoned. And it has reached the tissue in the backbone. Consequently, all the body tissues are disintegrating into millions and millions of cell pieces. After two-days of prolonged discussions they decided it was Ankylosing Spondylitis . And the unanimous opinion of the experts was that it was impossible for her to get out of it.
Ravi consented to their opinion but was not wholly convinced.
He locked himself alone for five to six hours and seriously brooded over that.
That evening sitting beside Malini’s bed and said, “Listen to me Mrs. Malini! Pay attention to what I am about to say. You are well educated, knowledgeable and have seen the world. So treating you as my friend I want to put facts before you…” He gave a brief about her disease. “Statistics say that the chances of survival for people afflicted with this disease is one in five hundred. I don’t care about the other for hundred and ninety nine people. I want you to be that one off chance and back to normalcy attending to your routine. But, here is the challenge. I cannot do alone nor can medicines alone bring about the turnaround. Your cooperation is absolutely necessary. At no point of time you show signs of despair.” He paused looking into her face for reactions.
She was ears to what he was saying. Ravi continued…
“You have a long life ahead. There are many things you have to achieve. You must be determined to achieve them all. And I should convince me. Then together we can raise a war cry against the disease.”
She smiled. Though she had to struggle to say what she did, she did not relent.
“Doctor! I could bring a turnaround within three years in the loss-ridden shipping company. I could shut up the mouths of people who doubted my ability pointing out my gender. There is a project at hand. Our country is far behind in container shipping. I have dreams to diversify my company into it and serve the nation. Even if I were confined to this bed, take it from me, I am going do it…”
Ravi raised his eyebrows in surprise. She continued…
“Last year I joined as a student under Ustad Hafiz Khan to learn Sitar. It is my dream to give at least one solo concert within the next four years. That is a promise I made to Amar. Amar is my husband. I keep my promise. When I have such a promising life ahead, be that I have a one in five hundred chance, when I get the support of a doctor like you, I will certainly come out of this abyss taking the support of your hand.” There was a glow of hope in her eyes and as she lifted her hand with all effort to indicate her will, Ravi took her hand and said, “That’s what self-confidence is! We have already won half-the –battle. From tomorrow we are going to start a new treatment.”
That night Ravi did not go home.
“Will this adventurous attempt succeed? Can I achieve what I wanted? Can she with sheer self-confidence and I with the support of bare minimum of medicines regenerate her interior body parts which are ready to crumble to pieces any moment? Will all his assurances reduce to empty promises?”
This very common challenge every honest doctor faces in his life, stood before him assuming global proportions!
Before this body, every inch of which looks an endless stream of wonders so long as it works smoothly, years of study and decades of experience comes no nought and will be silenced once there occurs a small error in its rhythm. Is it its dismissal “Huh, what do you know after all?” or a warning that “there is a lot you should learn still”?
Be that the bio-chemistry prepares umpteen formulaic preparations, no body resembles another. We cannot say with certainty that for the same disease, the same medicine works identically on two bodies. Even in such an enigmatic state, if medicines seem to work, perhaps it is not medicines alone that cure! There is something incomprehensible that helps the cure!
For classification sake all species of mangoes come under Mangifera Indica. But each of them has its own unique taste. So is the body, each with its own character no matter it resembles every other in broad design, shape and matter.
“Yaramita vanamalinaa sakhii!” (Confidante! She who consummates with Vanamali…!) is one of the most popular Octrains that swelled from the pen of Jayadeva. When Balamurali renders, it would expound the angst behind, when Ghantasala renders it would be holistic and sweet, and while Bhanumati renders it, the melody would kindle a sweat twinge. Where lies the difference? What do you call it? Personal identity!
There it is! There lies the secret!
It was like epiphany! The truth he randomly witnessed on different occasions elsewhere seemed to have taken form to appear before him.
He started reading the research medical journals more thoroughly. He went through the latest issue of “Lancet”, “Chemical and Biological Interact”. He had earlier studied Walter Bradford Cannon of “Wisdom of the Body” fame, René Dubos, Blackwell, Arthur K Shapiro, but today their research, experiments and works seemed converging one end. Today when he reread them, he was seized with inexplicable inspiration. In that lone insulated meditative state he had the revelation of Placebo.
Placebo was a mystic divine damsel Mohini holding the pot of Nectar in her hand.
That which is, yet it is not, is Placebo; that which is a myth but makes its presence felt is Placebo.
If the commonest of the commoners Peri becomes a king, it is Placebo.
Placebo means “I will please” in Latin.
Placebo is an imitation medicine.
If you can manufacture a sugar tablet which looks exactly like the medicinal tablet, it is placebo.
When the patient asks for a medicine repeatedly, the medicine administered to just please him (not that it cures his disease) is placebo. Normally, in the experimental stage of a new medicine on trial, doctors give placebo.
When Ravi was in US, he read the articles and speeches of Arthur K Shapiro, Henry K. Beecher, and Louis Lasagna on Placebo Effect. They wrote that placebos not only look like real medicines, but also act like them.
But in the present state, it seemed that if mind is the fulcrum of the body, the force that conjuncts the two is placebo. It explained body is different from the mind. Placebo is the elixir that transforms the strong desire of the patient ‘to live’ into life-giving medicine and presents it to the body.
With renewed vigor Ravi got up.
He explained to the duty doctor what he should do and instructed him to keep everything ready by nine next day.
He left for home.
Wall clock showed it was 4 am.
Before stretching out he looked at the bottle on the table. It was Gardenal!
Meenakshi might be suffering from sleeplessness. But he advised her not to use Gardenal.
Poor Meenakshi! Because of her heart trouble she took long leave from her college. He was not able to spend more time with her. Their daughter Vijaya studying medicine also looked busy with her studies, games, picnics and other activities and with her friends and did not have time for her mother.
As Meenakshi turned aside in her sleep, the vermillion on her forehead glistened red even in that scarce lighting. He kissed her on her forehead and eased on his bed.
He was fast asleep.
“Malini! You are great! Let us unite and defeat…”
Meenakshi got up from her sleep with alarm. Ravi was saying something in his sleep.
“When did he come home? When she called the hospital in the evening the duty nurse answered that he instructed them not to disturb him even if there was a call from home.
“What’s that work? Why he chants the name of Malini? What is the nature of their ‘union?’ Who do they want to defeat?”
As the tranquilizing effect of the medicine ceased, Meenakshi got suspicious and angry.
After ten minutes, it was Ravi’s turn to get up agitated.
Ravi gave injection to Meenakshi who was wriggling with chest pain. He took her into his lap and explained her everything. She heard him patiently.
“But he was not like this. He had treated so many women patients before but he never talked in sleep like this. What does it all mean? What’s happening to Ravi?
“Am I losing my attraction after having entered forties? Is there a vacuum growing because of my ill-health? Or that both of them are unable to cope up with their darling daughter Vijaya taking off to wings having come off age? Am I losing Ravi because I was seriously engaged in my teaching and college administration work, until three months before? Or with nothing else to do, am I demanding from Ravi more than before when I was busy with my own life?”
He took her in his lap and gently caressed her locks and cheeks with fingers filled with love, compassion and concern. But that could not alleviate her pain, and the physical closeness was in stark contrast to how far she felt aloof from him.
Everything he said just remained empty words.
After a while her pain ceased and slowly slipped into sleep.
Ravi felt like a bird endowed with wings but restrained to take off. He was overwhelmed with compassion for Meenakshi but felt helpless. He caressed her locks, as wavering as her mind, once again and set her properly on the bed. He called out the hospital and asked for a nurse to be sent home. He got up.
“For the first time Meenakshi complained of burning sensation in her stomach. She never had such complaint before. What new complication is up for challenge?” he thought as he completed his shaving and bath. The coking maid did not turn up. He made a bread toast for himself and put some coffee in flask for Meenakshi.
He reached hospital by nine.
He visited Malini’s room. She greeted him with a smile, like a lightning amidst clouds.
He greeted her back with a “Good morning,” and turning towards duty doctor asked, “Is everything ready?”
“Yes, Sir!” he replied.
“Then let them bring the medicine here.” Duty doctor went out to bring the material Ravi asked for.
“Maliniji! The journey begins… I am now going to administer you a medicine that has never been used before. Besides this, I will put on an intravenous drip. While one attacks the disease, the other gives additional strength to the body. Together they should drive off your pain forever.”
The duty doctor and the nurse returned. Ravi gave Malini injection and put on the drip. Then sitting beside Malini’s bed he said,
“You remember what I told you the other day? Your body constitution took a beating because of undergoing extreme stress. It is time for you relax absolutely. You should keep a happy disposition by keep smiling and reading funny, humorous and amusing stories. You may read Wodehouse, Herriot, James Thurber, James Thorne Smith Jr., etc. All these books are available with Sister Mary Kutty. She will read them to you for one or two hours daily. I will send you some collections of Jokes. Every evening you should recount the best joke you read or heard. OK?”
She expressed her consent with her eyes.
He came out of her room. As he was about to enter his room he was reminded of the Tyagaraja Kriti, “For the great man who has control over his mind, of what use are the mantras and machinations?”. And he laughed within himself rationalizing “if it is that easy for everybody to control his mind, who will remember you and us, Swamy Tyagaraja!!!”
After completing his rounds and attending to other work, he visited Malini again. She was blissfully asleep needing no sleeping pill. He immediately got the ESR tested. It was down by 9 points. In a matter of 4 hours the direction of the disease had taken definite turn. Is the enemy beating the retreat?
He reached home.
Meenakshi was awake.
Nurse went out after seeing him.
“How are you darling?” She laughed sorrowfully.
“Do you have pain still?”
“I don’t think so. But it is dull.”
“May be it’s the side effect of the medicine. Let me get you some invigorating soup.”
He went into the kitchen and asked the maid to prepare a soup to his prescription, and brought it to her.
“Ravi! Take your dinner first…”
“You take the soup first. I take my meal only after that. After that the King and the Queen shall sit together and review the world situation… that is the agenda tonight…”
He returned within fifteen minutes finishing off his meal.
“What’s this? You did not take even half of the soup?” he asked.
“Enough Ravi! Thank you!”
He looked at her enquiringly with his eyes as if asking “why this ‘formal’ conversation?”
Meenakshi was looking out of the window. The sky was overcast. A faint sun-less luminescence.
After five minutes she uttered, “Ravi! I want to join duty.”
“Meena! Your heart rate has not stabilized. You may not be able to stand the stress of teaching, administration and meetings…”
She nodded her head in disagreement and said, “No Ravi! I am unable to put up with this stress of sitting idly. Routine is the best shield for my unrest. So, shall I join duties from Monday?”
Thinking for a while Ravi said weighing his words, “As a doctor, I can see the merit of your argument. But as a husband, I cannot accept your request Meena!”
She laughed but there was no life in it.
He waited for her to say something. But when she did not say anything for a while, he said “Come on Meena! You wanted to say something. Get it off your chest. That is good for your health.”
“You said that ‘as a husband I don’t allow you to go.” It was so pleasant to hear. As your wife I ask you one thing. Do you agree?”
“Come on. Let us go to Kulu or Manali for one week. Can you come?”
“Tell me Ravi! Shall we?”
Ravi did not say anything for two minutes. It was raining outside.
“I know Ravi! You want to come. But you have a compelling work. If you leave that, you won’t be peaceful even in Heaven. I don’t blame you for that. But that is also the case with me. My work needs me and I need my work as badly.”
“What you said is true, Meena. But, I think it is not fair.”
“No, Ravi. You can’t abandon your work for my sake. And leaving my work, I can’t sit in front of you idly for what you are going to say. We have passed that romantic age. It is quite natural that each of us try to find a meaning for our lives. There is no need to feel guilty about it.”
“But Meena! There are two things here… The first thing is that my asking you not to join duties is not for my sake but keeping in view your health. I love to spend eons with you. What I say now is not for myself. And the second thing… our streams of life have been flowing merged for over twenty five years. But why is this Sahara all of a sudden? Why is this very dry logic?”
“When the magic of life has vanished, all that is left is only logic, Ravi! Besides, I am a history Professor. I can only speak dry words, not any damp or moist words. When I made a matter-of-fact statement, you felt it like that.”
“Meena!”… He took her into his arms. But he felt, it would have been better if she had taken him into hers.
…No… There was no response in the two bodies.
The rain stopped outside. The clouds cleared. But there is no trace of dawn.
Four weeks passed in the same vein. Meenakshi joined duty. But surprisingly she called him when he was at the Tennis Club.
“It’s fine even if he were a Ravana, but enough if he had love for her…” that’s what she said. What did he, then, do or not do?
As he was browsing through the case sheet, duty doctor had arrived.
“How is Malini?” he asked.
“She is able to sit up on her own, sir!”
“Good! I visit her during the rounds,” he noted his observations on the case sheet before filing.
In the last four weeks Malini’s health had improved beyond expectations. ESR had almost come to normal. Placebo had really worked wonders. Within three weeks she was relieved of all her knee pains. She was able to sit up with some minor support. In another four to five weeks she should be able to walk on her own. That would mean he had got an answer for a teething problem.
Has mind control over body? Now, he would be able to give a positive answer with supporting proof. He has to consolidate all his trials and results and write a detailed Paper for the journal.
He entered her room.
“Hello doctor!” Malini greeted him first.
“How are you Mrs. Malini?”
“Very fine. Am I the successful one of the one-in-five hundred odds?”
“Yes. You have proved it. What is that? A letter from Amar?” he asked. He remembered her entreaty not to disclose her condition to her husband.
“Yes… the same routine stuff… that Vodka is nauseating. By the way, when can I get up and walk, doctor?”
“Whenever you feel you can. Whenever you feel motivated to walk.”
“Is it?” he eyes widened in surprise. “Then let me get off this throne tomorrow itself,” she mimed a queenly posture.
“Who is there?” Ravi extended the mime with a clap of hands as if calling somebody at the door.
They both laughed.
“By the way, shall I recount today’s joke? This is vintage wit… of Charles Dickens. A male character created by Dickens says like this to others: ‘look here boys! I always follow my wife’s advice on all matters related to home. She has that sharp wit. But, I refuse to admit it in her presence. You ask me why? It’s a matter of discipline! Don’t you think there must be discipline at home? For that!’”
He joined her laughter.
“The acronym MCP was created exactly for such people. Isn’t it?”
“She looked at him questioningly what MCP meant.
“Male Chauvinistic Pig”
She laughed again.
“Doctor! Doctor!! Yesterday I received a surprise post.”
“My Ustadji sent a cassette of his rendering of Rag Jaijavanti. That’s just divine! You must hear it when you can find time. That is not Sitar at play… just a replay of Cosmic Dance of Shiva by Parijata flowers… an overwhelming rain of stars…
As she was speaking vivaciously Ravi thought within… Like a bird hopping from one branch to another, how many dreams, and how many goals has she! She will certainly regain complete health. Move around and would achieve what she wanted. She would live a fruitful life of hundred years. That is the power of the mind!
Following night Ravi asked Meenakshi “About one month back you proposed to me going to Kulu. Shall we go there next week?”
“Sorry dear! Just two weeks passed since I took a long leave. It does not look nice if I go on one-week leave again. That too, being a Principal…”
Ravi nodded his head. Life takes very strange turns… In Greek Drama … they call it Nemesis… he recalled.
That was full moon day of Sravana month.
Ravi who went out to attend a meeting in the morning, reached hospital by noon.
Staff nurse informed him that Mrs. Malini had enquired for him many times.
Apprehensive of some complication cropping up he went into her room with acute concern. She was quite normal. The vermillion in the furrow of her hairline was shining bright. She got down the bed and approached him putting her steps steadily.
When she said, “Doctor Brother! Today is Rakhi Poornima. I am waiting to tie this Rakhi to you since morning…” she was really surprised. He held out his right fore arm.
She tied the Rakhi. She tried to touch his feet for his blessing and since she was not in full control of her body she staggered. He lent support preventing her falling down. Malini put her hand on Ravi’s shoulder for support. And as she was walking towards her bed gasping for breath…
Exactly at that moment…
Meenakshi made a terrible shriek “R…A…V…I…!”
Ravi looked back. He saw Meenakshi desperately trying to take table for support before collapsing to the ground.
Needing Ravi’s signature on a joint account Meenakshi hurried to hospital in her car from college and not finding him in his room, she came searching for him in the ward.
Ravi was dozing in the sofa outside the ICU, struggling to keep awake.
A milk van stopped on the street outside making a lot of noise. It shook off his sleep. He looked at the watch. It was 5.52. He peeped into the ICU and looked enquiringly towards nurse about Meenakshi. Her looks conveyed her condition was steady. Another 24 hours should pass.
He returned to his place and watched out through the window. Milk van was leaving. There was an artificial pond in the foreyard. The lotuses which shone bright under the full moon last night looked wan and shriveled. He looked towards the orient sky. There was a spray of crimson on the eastern horizon. Sun was readying to appear.
On the other side of the road, at the tea stall, “Suukti Muktavali” (Pearls of wisdom) commenced. He could hear clearly:
“One begets the results from Mantra (holy hymn), Tirtha (holy water), astrologer, doctor, and guru commensurate with the opinion you hold about them.”
Yes. He has to consult another specialist. When she cannot hold respect for him as a person, how could she hold respect for him as a doctor? More than his personal feelings or his failure as a doctor, her life is more valuable.
For her to survive, her cooperation was imperative. That was fundamental.
He walked into his room and dialed Dr. Agarwal.
Elsewhere in the hospital, an attendant nurse was writing a letter to Amar as Malini was dictating her.
RS Krishna Moorthy & NS Murty
Read Placebo Original story here