House Call

I had no idea what to expect as we drove our Scorpion truck out into the
desert that hot, dry late morning. I did know that the request to make a house
call was one that I could not refuse.
I was a physician and acupuncturist from New York visiting my daughter
who was working with a small NGO in Northwest Rajastan. The organization
works with an Untouchable caste, so when I was asked to visit a member
of a much higher caste, I knew this demand needed to be satisfied. At
times subtle and at times grossly obvious the caste system was alive and
flourishing in this remote section of India. Everyone knew everyone in
this intricate web of existence going back almost a thousand years. From
the little I knew of the intricacies and complexities of the caste system my
going out to pay a house call to the elder of this Rajput family could only be
good for my friends. An American physician was a very rare commodity in
this isolated region, so attending to an ailing elder of a superior caste at the
behest of my Untouchable caste friends garnered them a bargaining chip in
this ancient dance of power.
As my guide/interpreter was having a great time speeding through the
shifting desert sands, his passengers- my wife, daughter and assorted friends,
held on to whatever they could for dear life. As anyone who has ever
traveled in India by car knows that getting to your destination is in itself is a
religious experience.
After a half hour journey, we came upon a small cluster of simple sun baked
mud walled huts with thick thatched roofs. Barbed wire, to keep the family’s
goatherd from devouring their roofs added to the forbidding atmosphere of
this desert enclave. My patient, the family elder, was slumped on a metal cot
out in the blazing sun. He extended a bone thin arm to me, offering a feeble
handshake and managed a weak joyless smile as I began my examination.
His sweat soaked shirt open to the waist revealed his cachexic muscle
wasted frame. He was a man of about 65-70, although he seemed far older.
Looks are deceptive I found due to the harshness of the desert climate.
His fragile body was burning up with fever and racked with paroxysm of
productive coughing, spitting up blood-tinged sputum.
The more I examined this man, whose name I never learned, the worse
the prognosis became. Percussion of his posterior thorax revealed the dull
thud of consolidation where the hollow resonance of air should have been.
Palpating the lymph nodes around his neck revealed rock hard, fixed masses,
which are almost always an ominous sign. Placing my stethoscope upon his
chest revealed what I suspected, very little air was moving and I could hear
pronounced rales or crackling sounds emanating from his lungs.
The diagnosis seemed easy to arrive at but difficult to deliver. My patient
had advanced lung cancer with a secondary pneumonia. As I made it clear
to his sons the severity of his illness I realized that they were aware of
his grave condition. They were very familiar with death from high infant
mortality to the ever-present specter of disease and accidents. They knew, as
did their father that his end was rapidly approaching, that he would die in the
desert where he was born with his family and goats around him.
So why summon us to be part of one of this family’s most private of life’s
events? I was as comforting as I could be, offering him some palliative
acupuncture, antibiotics and then I sat by his bedside to be with him.
The bond that he and I forged in that brief time under a scorching sun, with
both his family and my family watching as silent witnesses is as ancient as
human history. The ritual of a healer ministering to the dying creates a space
that for a moment is greater than the sum of the individual participants. It
provides the power to heal. Not cure the disease but to heal the patient and
ease his fears, allowing him to die more peacefully. The presence of the
doctor in the family’s home, sitting at the bedside of the dying patient brings
a sense of both reality and comfort to the household. And in the end that is
the power of the house call.