SHOWCASE- ‘Squamous cell carcinoma of the eye’- treating physician-Inerdev Sahu
This lady aged 72 years consulted me on 20/6/10, along with her two sons.
The conversation between us went somewhat like this-
I: yes what can I do for you?
SON- my mother is having problem in her eyes for 15 days.
I; it doesn├óÔé¼Ôäót looks like 15 days problem to me
SON: may be it is a month old to be approximate
I: what treatment did you take for her?
SON: nothing much showed to local doctors they prescribed eye drops and it went on increasing.
I: did u show her to eye doctor?
I: sorry I cannot help you she needs an eye doctor; it is beyond my capacity to handle her. (They looked at each other as if discussing something).
SON: no, no doctor we once consulted an eye doctor, he told us that there is a small abscess in her eye and it will go away soon.
I: where is the report?
SONS: he didn├óÔé¼Ôäót give us any report
I: O.K then show her to the eye doctor again and bring me the reports, then I will be able to help you. (LONG SILENCE)
SON: these are the reports, we are coming from Delhi and one of our relative, whose mother was treated by you for cancer, suggested your name.
I: people from here go to Delhi for treatment and you are taking a reverse direction, considering that you people know everything and the risk I will start with the treatment but it is not one day affair ,how will you people take the follow up ,
SON; we have a house here also and mother will be staying over here for treatment,
I:O.K now let her speak and if you interrupt in between I will throw you out of the clinic.
SON; mother abused a doctor at AIIMS and told him that she will die but not take their medicines ,she is irritable and not talking to doctors properly ,how will she able to tell her problems.
I: that├óÔé¼Ôäós not your problem; just put your fingers on your lips.
I asked the patient : Mother please tell me your problems, if you want you can abuse me and if the pain is more you can slap me also.
Patient: Son, I am illiterate but I am not a fool, I can understand people very well, for last 8 months my problems started and they took me to the big doctors ,the first time when one of the doctors examined my eyes I don├óÔé¼Ôäót know what he put into it, a very small thing and I had visibility and that also went away, and my pain started increasing ,I went on telling my sons that my problem is going on increasing but they scolded me and told me you don├óÔé¼Ôäót understand anything whatever the doctors are doing are for your good .Just tell me it is my eye and my body how can they know what is happening to me. I shouted at the doctors in the hospital because they were pulling my eyes as if I am made of plastic.
I: you are right, people are qualified but uneducated, mother I don├óÔé¼Ôäót think you will get your sight back in the right eye.
Patient: to hell with the sight, what I have to see at this age, you just remove my pain, it is intolerable.
I: no problem I will remove your pain, tell me about it.
Patient: you see for last 2 months my eyes burns like fire ,it will start from here and it will spread to my face on the right side and then half of the head on the right side. I have burning in my abdomen, burning in legs and there is great burning in my soles.
I: what do you do during this pain?
PT: (irritated) what you mean, I don├óÔé¼Ôäót understand what to do at that time.
I: ok no problem.
It was too much for the day and I didn├óÔé¼Ôäót want a slap from the old lady so I thought it is better to work on the above symptoms. Her right eye was bulging and the entire eye was covered with a grayish film (see photo taken on 17/10/10 in this there is reduction of at least 60%) there was constant watering from her right eye flowing all over her cheeks. Further questioning to the sons didn├óÔé¼Ôäót reveal anything substantial, they told me mother takes medicine for her heart for the past 40 years but couldn├óÔé¼Ôäót elaborate on for what, how and why.
I concentrated on the burning and trio of burning came to mind ARS, SUL, and PHOSPHORUS, out of these 3 I ruled out ars because fear and anxiety was not there, phosphorus is also like arsenic so I thought of sulphur to be given but due to paucity of symptoms I was not confident.
Considering the side I prescribed lycopodium to the lady thinking if it will not work I will go for sulphur,whereas if I prescribe sulphur now then I cannot give her lycopodium later on (the series is calcarea,lyco,sulphur).I called her after 15 days.
When she came after 15 days her complaints were as it is, but the lady told her sons that she will take treatment from me or no treatment at all. This time I prescribed her sulphur and called her after 15 days.
When she came after 15 days (22/7/10) she was very much happy, all her complaints had disappeared, and no pain anywhere but the condition of the eye remained as it is, except the watering which was 25% less.
I gave her placebo for a month, she came on 22/8/10 with no complaints, I again gave her placebo.
On 15/9/10 she came with her 2 sons and they started lamenting
SON: doctor on 13th mother had a very severe attack we had to take her to the hospital and admit her
ME: please don├óÔé¼Ôäót panic and don├óÔé¼Ôäót shout, my mind stops working if somebody shouts and then I will also shout and louder than you all, so both of you please cool down (most of the times relatives are the biggest hindrances and may lead you astray)
ME: mother you tell me what happened
PT:I got very severe pain in my eye and this pain radiated to my entire body, it was so much severe I couldn├óÔé¼Ôäót speak, very much severe ,I felt that my eye is growing and it will break and fell off from its place. I also felt that suddenly I will be able to see from this eye.
Me: what about the burning and what did you do, what time did you get this attack.
PT: I didn├óÔé¼Ôäót do anything and the burning is not there, the problem is just in the eye and that day it radiated in the entire body. I got the pain near about 4-5 in the evening.
ME: to the sons, tell me why did you take her to the hospital, did she tell you, what was she doing on the way to the hospital, I mean was she shouting, telling something specific, just describe everything you saw. (People are very much dumb headed) was she afraid, how she was sitting, did she ask for water or something else what treatment the doctor gave to her. Did she faint due to pain or did you find her sweating due to pain.
SON: she didn├óÔé¼Ôäót tell anything but we thought she will become unconscious and she was just sitting in the vehicle, the doctor gave her injection for sleep.
I started thinking HELL, what to do now?
ME: did she had such an attack before?
SON: 40 years before, since then she is taking the pills for the heart.
ME: mother think and speak did you feel anything else in the body.
PT: (irritated) see I don├óÔé¼Ôäót lie and I told you everything, but my chest was jumping up and down and sometimes it happens like this and yes that day if you had squeezed my sari water would have come out ,I was so much wet with perspiration.
ME:she was well entire day then she suddenly gets the pain in the evening, what happened any argument in the family, any type of tension, what was she doing before the attack. that day.
SON: no such type of thing happened everything was routine.
SON2: that day mother took food for our children working in the field in the afternoon, I told her not to go, she didn├óÔé¼Ôäót listen to me.
ME: how much distance is your field (when I ask such question to my patients I know they are abusing me in the mind and thinking what the F**k has this to do with their problems)
SON: it├óÔé¼Ôäós about 2 kms approx one way.