Stories of Rehabilitation: Elementary, Dr. Watson

Given her dazzling looks, Mahua can become a film star if she chooses to be one.That is if she can walk – she can’t at the moment. For the last three months she has not been able to stand. It is a recently acquired handicap and her anxious parents have drifted from one doctor to another till they landed up in our rehabilitation centre. She is currently undergoing treatment here.

I look forward to the treatment sessions with Mahua, which I have been asked to supervise. The sessions start with the lady therapist giving electrical stimulation to her thighs and legs and then she has to perform a whole set of exercises. She is one of the few patients in whose case I have not been able to diagnose the cause of ailment. My senior consultant, the leader of our rehabilitation team, has made a diagnosis, which he has withheld from all of us. Though treatment has started, the elusive diagnosis challenges me. I have, therefore, enough reason to have special concern for Mahua.

When Mahua first came to our rehabilitation centre, two things struck me immediately. Nineteen year old Mahua was strikingly beautiful. She was tall and fair, well dressed in a pinkish salwar and kameez, and did not wear any obvious make up. A small bindi on the forehead, nails well manicured, nail polish and bindi the same shade as dress. No lipstick on her rosy lips – she hardly needed any – or maybe there was, so discreet that I failed to notice. The radiant beauty of Bengali women has always fascinated me and Mahua was an embodiment of classical Bengali beauty.

The second obvious thing was, of course, that she could not walk. Two of her relatives lifted her from the wheelchair, laying her down on the examination couch.

The sequence of her disease leading to her disability was quite melodramatic. About a year ago she had started limping due to pain in her knees. As the pain increased she stopped attending college and her medical tour began. A host of investigations was done and treatments started but to no avail. When she was brought to our centre, she was completely bedridden.

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I like these challenges. The routine activity of attending to patients is gratifying, but not stimulating enough for the grey cells.

When senior asked me to make a diagnosis, I examined her thoroughly. I scrutinized her examination results all of which were normal. I was baffled. Senior chuckled when I reported my confusion and said, “Well, I have provisionally made a diagnosis and we will treat as such. Let her attend our centre daily and I think we will have her on her feet in three to four weeks. In the meantime let me tell you that there is an important clue leading to the diagnosis. If you miss the clue you miss the diagnosis.”

The treatment sessions were painful for Mahua, particularly the electrical stimulation, but she faced it bravely. I was sympathetic to her woes.

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It became a daily routine. She would stare at us with a tolerant smile, when suddenly her expression would change. The lovely face would be distorted with pain – even the grimacing face was so attractive!

Within a week she started to show signs of improvement. I was still looking for the elusive clue in her liver, joints, blood reports, MRI scans. Why had doctors, whoever were consulted that is, missed the diagnosis? In any case I was happy, very happy and reported this to Senior, whose patronizing smile told me he had foreseen it all. Feeling like a dumb ass, I was jolted out of my wits when the therapist told me, “Careful Doctor, She is developing a crush on you.”

I was thoroughly perplexed. Was it true? Yes I had noticed her unblinking adoring stares. It was also true that her looks haunted me at times. But how is that possible? I am past the meridian of my life. And I am not good looking, by any sense of the term. I am just short of ugly, so much so that I cut my hair short; this way I do not have to look at the mirror daily. Deep inside I have a notion that the primary reason why my wife married me was to cure me of my failings.

The situation was delicate. Nevertheless I felt a little pride. For the next few days I took particular care to dress and even risked glancing at the mirror. My attendance at the centre became more punctual.

Yes it became clearer over the next few days. Her looks revealed all. This was going too far. With alarm bells ringing inside my head, I reported this to Senior.

He was unfazed as usual. With a sardonic smile the b_ egoist said, “I think I understand her problems. But what about you? Why do you look perturbed? What matters here is if you have made the diagnosis yet?”

I had not. I kept pondering as I took leave for the day. Was it Jerome who said, “You are as vulnerable as the good looking guy.” A sleepless night  of looking at my life in retrospect, and there I was – my old self again the next morning. I was late for my duties; the laundry tag was still attached to my collar till a junior pointed it out.

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It was a beautiful day. The golden glow of the afternoon autumn sunshine heralded the forthcoming Durga Puja festivals. I was euphoric : my leave had been sanctioned and preparations were on at home for our long overdue trip to the mountains.

Cured of her ailments Mahua had bid us goodbye the previous day. We had gathered in the conference room for a clinical meeting.

We were all keyed up to discuss the mystery of Mahua’s ailments. Senior took full advantage of the situation and appeared to patting his own back with his theatrical presentation.

“Yes,” he started, “you have guessed it right. Mahua has some mental problems. To be precise she was suffering from conversion disorder – a psychiatric disease manifested as physical ailment. Mental trauma – a broken love affair I presume – triggered off the disease sequence.

“No. She was not malingering. How did I know that she would be alright in three weeks? Well, Mahua was suffering from a long time. And deep in her mind she wanted to come out of it. We helped her out with medicines, painful stimuli etc. She, however, may have relapses and needs psychiatric treatment.

“How was I sure about the diagnosis? Elementary my dear! Like imbeciles you missed the all important clue. Now let me ask you one by one. Did you notice anything about her when she came to us on the first day?”

Nobody volunteered an answer. Breaking the prolonged silence I blurted out, “Mahua is very beautiful.”

“So you noticed that!” was the sarcastic reply amidst peals of laughter. “But there is nothing unusual about a person being very beautiful and very handicapped at the same time.”

“Didn’t you notice the nail polish? It was well done, the colour daily coordinated with her dress. That is very unusual and was the most important clue to the diagnosis. How can a young girl with such a disability be so meticulous about her dress and appearance? Such indifference to the physical ailment can only mean an underlying psychiatric disorder.

“And finally” said Senior shifting his gaze towards me, “Love all your patients; but never let your mind wander beyond the professional domain.”