"Tamo, I am having severe pain abdomen; had 5/6 bouts of diarrhea and also vomited once," someone's would wake me up at dead night and frantically ask what he should do. I would have just got up from deep sleep (mostly in the REM stage)* and wont be able to think for a sec. I think everyone must have realized this: it's very boring and difficult to talk to a sleepy or drowsy man.

So to clear my mind and refresh the brain page I would start talking the normal things first- the basic things, "May I know who is calling? Oh Hi! What happened?" then after a few seconds I would take up the local or STD telephonic consultation.

As explained the disease to him and the severe pain abdomen and the cause of that-like the electrolyte imbalance that had set in because of the diarrhea, the uselessness of the anti-spasmodics and promotion of ORS and then the correct way of making the solution, one deep inner voice would call out, "Dr. Swasti isn't it unethical to prescribe over the phone."

Suddenly after hearing the voice I would stop speaking but the man at the other end (usually a friend or an acquaintance than otherwise) would scream, "Hello, hello Dr. please carry on!" the scream would bring me back to the ground and Ah I would continue the consultation.

I would also tell him some danger signs which should guide him to understand when to rush to the nearby Hospital. Many of my colleagues would have had the same type of experiences. But for me the call would make me start thinking and at any point where the thinking gets blurred I would head straight for the rack that house all my Medical books and search for the one on Medical Jurisprudence.

Many such nights are common in my household. The cell phone had become a "Dial a Solution" no. Even as the dilemma of ethical and unethical issue would bug me for days together, these consultations for my close friends' and community members had become inevitable. Let's consider the situation of a case of diarrhea. My friend is staying in Dwarka or Mukhrejee Nagar areas and it's already 11 o' clock at night. There would obviously be many clinics and Hospitals in these areas.

Although I am not generalizing the whole thing, I am sure many of my friends have had bitter experiences in many of these Hospitals. Thus a bout of diarrhea by a DU student in Mukherjee Nagar attending one such clinic usually shell out Rs 600 to Rs 1000 for the whole episode-the admission ,the iv line and the investigations. The clandestine RMOs more often scare these patients rather than reassure them. The "Main Hoon Na" effect of an assuring doctor seems to be a forgotten trait and the trend is more of "do it now kya pata Kal Ho Na Ho" hence these call are made to me quite often to ask whether it is inevitable to step into the hospitals.

Let me illustrate this point further with this story. Once while I was in the middle of a marriage procession, I got a call from a known to. He frantically told over the noise, "Tamo, they are asking me to get operated immediately otherwise it might burst."
"What might burst?"
"This swelling just below my umbilicus which has gradually increased over a month"

"Is it tense? Are you having fever? Does it increase it while coughing? Does it go back while you lie down?" the Dial 100 consultation carried on. I was glad that Prof. Mansharamani, a retired Prof from the Maulana Azad Medical College with whom I was having dinner at the marriage party didn't know Manipuri.

Finally I told the caller, "To the best of my understanding I think you are having umbilical hernia. We will meet and let me see you. It's not an emergency case unless it's complicated like say it's strangulated with a loop of intestine. Nothing to worry right now and you can get it done as an elective (planned) operation." So the hernia which had appeared due to a weak spot in the musculature or erstwhile weak areas of union (during the formation of our body in the womb and little after birth) had become a Rs 10000 bill.

The bill was an emergency but not the patient. Any way after the consultation I asked the Prof. before me, "Sir, umbilical hernia is still operated as a planned surgery?" the Prof. looked at me in bewilderment and said, "Yes, of course, Swasti. Then I was finally reassured that the protocol remained the same in our Bailey and Love's Text book of Surgery.

I am in no way trying to prove my excellence of my telephonic diagnosis or belittle the doctors at many such hospitals who had saved many lives in emergency situations. I am just highlighting aberrations which are quite natural and inevitable for any profession. The only way out is to increase our knowledge and understanding of our own body and the disease. It should not be trying to become a doctor overnight. Unfortunately health is only valued and remembered when it is lost and the doctors mostly talk Greek-with all the Medical jargons. This article and many such upcoming articles in E-pao are attempts towards this capacity building.

Ring, ring… another call, I thought. And it was correct; my sister-in-law making a long distance call from Bangalore. "Da, do something for the cough. It's not going with the Mox, Cetrizine and cough Syrup."(This was prescribed by me 4 days ago). She was most likely having allergic bronchitis. Her past history was also quite suggestive. She was undergoing training for Airhostess for an Airlines company and I could imagine a coughing beauty serving hot coffee and so I had to act fast.

So I suggested that she go to a nearby Hospital. "I don't see any Hospital in this area" she shot back. So, reluctantly I prescribed an inhaler. "The inhaler is very costly, is it correct, Da?"she called again standing in front of the pharmacy. I didn't need much effort to convince her, she followed the advice.

In such a situation how could I explain why I need to examine her with the stethoscope to hear the banshuri called rhonchi caused by the airflow in the narrowed airways and the blood examination to rule out TB and a PFT (pulmonary function test) to finally confirm the obstruction of the airways? For her it was just a simple cough which just refuses to go away.

Again the inhaler prescribed didn't turn out to be effective because she was using it for the first time and had to do so secretly because of her fellow trainees who otherwise thought she was having asthma. Also it ought to have been explained and demonstrated by the prescribing doctor and the patient should have practised before him too. Another lost trait, isn't it?

Luckily a recent trip to Bangalore gave me the opportunity to get a full investigation done for her and she was put on oral medicines-the corticosteroids and the dilators. Last week the phone rang again, "Oh Da, it was exciting. The flight took off without me even realizing and I did the announcement…." Her maiden flight excitement reached us and the gladness filled my heart and like before in many such moments of my life I close my eyes and prayed to Him and thank Him for making me a doctor.

* REM means Rapid Eye Movement meaning a deep stage of sleep. During that stage the eyes move, about by itself and hence the name.