Ventriloquism in medical practice

Ventriloquists in magic shows or in Double-Take on NDTV pale into woeful insignificance before the performances of some of the finest ventriloquists encountered in a doctor’s chamber! I watch at least three of them in a day and am sure my other colleagues too are seeing the same numbers, if not more. Only they must have missed the diagnosis or worse still, resigned themselves to Fate!

The signs and symptoms are so blatant that the diagnosis is instantly obvious. But I did flounder in making the diagnosis the first time because it was early in my career.

Two women entered my office and sat across the table. The younger one sat before me and the older was to her left.

“Which of you is the patient?”

“She.” the older one thumbed at the woman before me.

“Good. Now, what’s your name?” I asked the patient. At which she abruptly twisted her neck to the left and looked at her escort.

“Ganga Lakshmi.” Ganga Lakshmi’s friend answered.

“How old are you?” Ganga Lakshmi looked left again.

“Um...twenty three..maybe.”

“How long have you been married?” Straight query, left turn- “Two years or about, isn’t it, Gangu?” Ganga Lakshmi nodded vigorously. Poor thing! She was such a pretty face...God was cruel.

“Is she like this-from birth?” I now directed the question at the older woman itself.

“No. No. Only now. She wants to have a baby.”

“Is there a family history?” I asked.

“Of what, doctre?”

“Uh-deaf-mutism? ”

            “No..no...why do you ask madammu? Gangu, do you have any deaf mutes in your family?”

“No...There is no one akka!” Ganga Lakshmi said, crushing my spot diagnosis.

“Oh! That’s good.” I hid my disappointment. “ But why does she have to answer for you?” Ganga Lakshmi once again turned left.

“She is verrry shy, doctre...”

That was the beginning. Shy, illiterate, cannot understand doctors, scared of hospitals, cannot comprehend your dialect, doesn’t reveal all (symptoms)...so go the reasons for seeking the services of ventriloquists.  

Over years, I have seen them in all avatars possible, before coming up with a very broad classification. (This by no means includes all the smaller genre.):

1. The Professional Ventriloquist (PV):

Any age, either sex; related or unrelated to the patient.

Self-styled saviors/ agony-aunts of the neighborhood, often the landlady. Before consulting the doctor, the patient updates this designate PV with her complete CV and medical history. At the doctor’s office, the patient’s job is simplified to only glancing at the PV whenever asked a question. The understanding and innuendos between the two is a lesson in circumspection to poker players and cricket-match-fixing-bookies!

 A cough-“She has severe pain at night doctor.” Throat cleared once-“She has headache also,” Throat cleared twice, -“The headache increases in the afternoon,” and so it goes on. I have tried to interpret the signal communication but must confess I have failed because of a lack of uniform code. A nudge may be ‘Anxious to conceive,’ in one Patient-PV duo but might signify a want of abortion in another!

2. The Obligatory Ventriloquists (OV):

Often relatives of the patient-the husband, mother-in-law or an aunt.

“When did you have your last menstrual period?” Just glance at the husband. HE has it entered in his pocket diary.

“What is your problem?” The MIL starts off even without an innuendo. “She is always sleeping doctor...Says she is unable to do any household work even in the mornings....” and continues her timetable till she is snuggled into her bed!

Mothers accompanying daughters wail, “She doesn’t eat ANYTHING doctor,” as I look incredulously at the 82 kilos of mute protoplasm-statue spread on and out of the poor chair without even a shameful squirm!

3. The Memory-jogging Ventriloquist:

Unlike in the previous cases, the patient is not vocally challenged. She gives a complete account of her problems herself and as I finish jotting the last of her symptoms, it is the memory jogger’s turn.

“Did you tell her of the loose motions you had three weeks back?”

“Did you recount how you threw up in the bus?”

“ Tell her about that...that recurring backache..once a year, doctre. Exactly on the same date!” Instantly revved up, the patient starts from the very beginning. I have no alternative but to sheepishly follow the forgotten symptoms’ trail. The ventriloquist stands overseeing the exercise, gloating, as I have an urge to double-punch that I-know-all smirk.

4. In-absentia Ventriloquist: 

The Physical subtype:

When a single person barges into my office, out of turn, oblivious to the reprimand by the receptionist or protests by other patients, I brace myself for this genre of ventriloquists.

“My wife, she is at home...very busy.  But she wants to postpone her periods”

....Or “...She has pain here it seems doctor,” his hands run across his chest and I pray they don’t wander anywhere else. But he plunders on “She has pain here also-in lower abdomen....” The man wants to save consultation fees, avoid transportation costs of bringing the patient AND wants to be considered a good husband.

Then the concerned sister- “Doctor, my sister has had a fall in the bathroom. Could her bones be broken?” The caring younger sister thus enquires about her dear sibling who has fallen down in her home in the suburbs of Ahmedabad! She expects me to have not just X-ray eyes but long-distant vision too!

The Aural subtype:  

“Doctramma, my wife has some lady’s problem, will you talk to her on phone?”  Says a black-lipped chimney thrusting his mobile at my face.           

5. The second opinion Ventriloquist:

They typically barge back in just as I am settling in relief after finishing with a difficult patient.

“Doctor, she did not understand your instruction (But I have repeated it twice!) Can you tell me once again?” Yes. Second time then. Again, just as they are at the door, they do a 180 degree and come right back. They are of course oblivious to my sigh of relief, which has now stopped in its tracks, transforming into a helpless wince!

            “Sorry, doctre...... I had a very painful right knee all of yesterday...can you prescribe some tablets for it?” (free consultation)  Or “ ummm...Doctre, could you just check my BP once?” or “This cold, madam. What to take?”

As years went and the menace reached epidemic proportions, I had to discover a cure. Listening to THEM and treating the OTHER human being was confusing my psyche.

            After days of intense brainstorming, I hit on a novel idea.

            “Lady, if you are reporting her symptoms, why don’t you get yourself examined and you take the treatment instead of her?” I said gleefully to the next ventriloquist I countered. She was one of the most vocal lot, handling many mannequins and I was having vengeful visions of using all uncomfortable instruments at all the uncomfortable places on her on the pretext of a FULL check up!

            But wasn’t she shrewd? “Sorry, doctor. Please carry on. I shall wait outside.” She backed out. I was triumphant! I had succeeded in ousting the first ventriloquist! Hurray! It could mark the beginning of sanity. I was in great moods as I could continue my practice without the ‘ashareeravanis’!

            I settled to seeing the patient now and began giving routine instructions prior to a gynaec exam.

“Could you come down a little?...Some more...relax...relax....Don’t be scared...I’ll not hurt you...A little more...a little...” I was coaxing gently when suddenly a loud shout filled the room.

            With a sinking heart, I saw her silhouette across the translucent partition-bent torso, eyes plastered at the keyhole, while she said “Arraeee, Rashmi! Be co-operative.... do as the good doctor asks! Don’t get scared. I’m here itself, waiting outside the door!”

            Ventriloquism had conquered Medicine. It was immortal!