Kausar: unforgettable memories

By Dr. Muhammad Hafizullah

I could not believe my eyes - here she was -live and healthy. We had referred her to Karachi for emergent surgery, when she showed no signs of recovery after a protracted illness, entailing a life-threatening infection of valves of heart called infective endocarditis.

She was in her late teens with grossly enlarged heart that rendered her very symptomatic. She had flunked school after primary education but she was very sociable and soon became the centre of attraction for everyone in the ward. The nurses would discuss her 'achievements' of the last day, the orderlies would try to stay away from her and doctors - juniors and seniors would discuss her serious illness and lack of response to antibiotics. She was operated upon and her two valves were replaced and made a fantastic recovery and bounced back to life.

She was a gregarious character who refused to take her illness seriously. The ward staff was very sad while saying her goodbye as she was leaving for Karachi. I remember a few nurses having tears in their eyes. Her magnetic personality attracted nurses and soon she became very good friend with them. She developed good relationship with most doctors except for a couple. She could not stay neutral - she had to either like or dislike someone. She confronted a senior consultant on a ward round, when he was not so polite to her. At another occasion she sided with a young house officer, who happened to be on the receiving end due to omission in carrying some orders.  Poor patients in the ward were very happy, as she would share her food with them and at times buy medicines for them. Orderlies in the ward were happy as they would receive their regular 'gratuity' from her. The ward round would last longer as the whole staff had to spend more time with her - primarily due to the seriousness of her condition and secondarily she had many questions that had to be answered thoroughly.

Cardiology outpatient department is one of the most frequently visited clinics in Lady Reading Hospital. We usually attract more than hundred patients and previously when we had small rooms it used to be an ordeal entering and exiting OPD.

Immediately after her operation, she would visit the OPD frequently. Normally patients report to lower OPD and only selected cases are referred to consultants. She was one of the rare exceptions, who refused to go to lower OPD. She would barge into consultant OPD, scan the consultants and select the person who she wanted to be examined by. She never waited and none ever tried to enforce discipline on her. She would enter with a smile on her face and interact loudly. She refused to be intimidated by the rush or urgency of situation. She would take her time and exchange social pleasantries.  More often than not she had one or two more patients from her village for medical consultation.

Her father was a farmer and a local leader. I started receiving plenty of fresh vegetable and fruits. One day I found a big load of cut sugar canes, turnips, carrots and corns. It became difficult for us to consume and we ended up distributing it among our neighbours. After a few days she sent butter and yoghurt. Another tranche of fruits and vegetables was received a week later. I had to put my foot down and urged her very strongly to stop the practice.

Her only argument was, "sir, I want to send a few things for my nephew and niece; this makes me happy and you have no right to stop me!" She had a central role in her family and everyone loved her. Soon I started getting referrals from her. Because of the interest she took in others' problems and willingness to help, she became a de-facto medical adviser. She would write her name on a chit and refer the patient to us. Her referrals included her relatives and friends. And then it became a norm, almost everyone coming from her village would be carrying her chit. My junior colleagues would refer to them as 'special 'patients. Even my consultant colleagues would refer these patients to me. Many of them did not have cardiac problem and I ended up referring them to my other colleagues. I was very impressed with her zeal to help the poor in distress.

Her mother was in tears as she came to my office. Kausar was admitted to Psychiatry unit following an episode of 'irrational behaviour'. She remained in the unit for a week and I would see her every day. It was really heart breaking to see her in a condition when she could not even recognise anyone. It was very annoying to see the 'tigress' maimed under the influence of psychotic drugs.  Lying still and not to wear a smile were not a part of her personality. Slowly she improved but remained under the care of psychiatrist for a long time. The aggression in her nature, perhaps, stemmed for her illness.

Late in the OPD she entered clad in shining clothes and wearing jewellery. That was not like her! I could see a young man hiding behind her. "Sir, you did not come to my marriage but I am not angry -you must be very busy," she accused and then very kindly exonerated me without any defence. "This is my husband," she introduced and he extended his hand for a genuine warm handshake. I was very happy as she seemed very excited. She did not seek medical advice before tying the knot and I was very concerned about her illness and the outlook.

She disappeared from the scene for quite some time. No medical follow-up and very occasional referral chit. One of her uncles needed angiography and he ended up in a private hospital. She got him discharged from the private setup and brought him to us for angiography and later angioplasty. She had mellowed down and aged considerably in three years. She gained weight and lost her vivacity and much of charm. The responsibility of marriage had taken its toll as compared to her care-free youth in her parent's house. She did not have any children and our efforts to seek an opinion from obstetrician went in vain.

The news of her death saddened us all. I never got the details of her illness and to be honest was never interested in digging up the information. She withered away but left some good memories in lots of hearts and minds. She was the only one of her type. Ever-ready to help everyone that sought advice or material help. Even after many years, I still get patients who were referred to me by her. They still remember her fondly and many have tears in their eyes mentioning her. Her old unfortunate mother still visits me as a patient or accompanying other patients and still feels proud in referring herself as 'Kausar's mother'. 

For many patients and doctors too, seeing patient is strictly a professional duty - patients visit OPD or clinic and get a professional advice and that's all. Doctors see hundreds of patients a day and do develop a fragile type of relationship with them. But very infrequently, we as doctors, enter into an enduring relationship. I always wonder as to what distinguished her form the millions of patients that we see day in and day out. Is it she belonged to a relative well to do class? Was it her communication skill or mannerism? Or was it her heartfelt sincerity and honesty? May be all - but undoubtedly her unlimited honesty and boundless veneration and sincerity was the main prop of our relationship.