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Beware the Betel Nut Addiction: A Case of Hepatitis C

Submitted by on March 12, 2017 – 5:09 PM

Image result for betel teeth paanHis skin reminded me of the sooty wax on car engines. At another place, at another time, I might have eyed him suspiciously and clutched my purse more tightly. After all, there were all these cheeky sneaky fellas out there one should keep an eye out for. But, here, he was a harmless specimen. Before the doctor, in these clean white rooms, he felt misplaced. This made him all the more meek, sometimes pathetic, in his efforts to appear ‘nice’.

The doctor turned to him. After reading the reports he sighed, ‘You have hepatitis C.’


The patient’s hair was graying, and parted in the middle like a bouncy ‘m’, when he nodded vigorously. ‘Yes, yes. I understand. So what to do, doctor?’ As if it were just the seasonal flu that had to be tackled and he was all in for it.


Disease description, prognosis, treatment plan. The doctor hummed through the formalities. Cirrhosis, viral load, nucleotide inhibitors, hepatic encephalopathy. ‘Yes, yes,’ he understood everything just fine. He even managed to smile. I raised an eyebrow.


‘Just tell me how much it is going to cost, doctor.’


‘I’m afraid around 2 lacs.’


‘Ooooh that’s perfect. I really tell you, doctor sahib, it is OK.’ Was he trying to comfort the doctor?


I sat there watching. Usually the patients shoot me quizzical looks and I hasten to explain that I am a medical student on internship, would they mind if I could please examine them or observe? This patient however was way too nice. Of course, he knew good manners meant not asking silly questions, not challenging authority, not daring to express even his discomfort, or even asking what on earth hepatitis meant. And this was an ‘elite’ place that demanded his best behavior.


‘But before the treatment begins, you need to drop this revolting habit of gutka and paan (1), you understand?’ The doctor continued in a bored voice.


‘Yes, yes!’ His brother, who had come along and had been lying dormant, suddenly spluttered. ‘Doctor sahib, tell him that!’


The patient looked down sheepishly. Something in his toenails had caught his fascination. The doctor declared: ‘I refuse to start treatment, if you refuse to give up on that. They are toxins, you know. They will kill, while I here, am trying to save you.’


Toenails were becoming utterly engrossing.


The brother crowed, ‘Ooooh! Yes! He loves drama, loves courting death. Lump-of no-good. Paan, gutka, rat-lifestyle. And now hepatitis! Lord forbid!’


The lump-of-no-good was staring below so hard as though he aimed to scoop out a burrow through the power of his gaze alone. A burrow, to swallow him up.


There was a glaze of apologetic firmness in the doctor’s eyes. ‘Look here, your liver is already cirrhotic. You bang yourself with dirt stuff, you get cancer and you are dead. Just drop it ok?’


The brother was as relentless as psoriasis. ‘Our father, may his soul rest in peace, tried his whole life, to put this loser right. Leave gutka, paan, leave gutka, paan, he chanted till the last breath. But this hoity-toity Prince loves attention. I would say, he is the one who killed our dad. And now he will be satisfied when he himself squirms in the grave.’


The hoity-toity Prince was morbidly still. He gazed down, but his eyes were glassy. The cyanotic lips quivered as he still tried to put on an ambient smile. I realized how ill this man before me was, how full of holes was his life.


He reminded me of an old floppy sponge at a car-service, dabbed in a bucket of dirty water, heaved up and crushed by gristly fingers. All the moisture leaks out, and the frayed holes bore deeper and deeper. This patient was a young mechanic in Saddar, and I imagined him with his group of grey friends in a grey dingy shop. In the smog and grime of the city, he represented the mass of those countless faceless lads always there at the periphery of our vision. Just born to shuffle, make noise, cheekily grin with those betel-nut tainted teeth, work messily in workshops and finally evaporate.


The patient never returned. His medical report said, ‘Patient non-compliance.’ Social wisecracks at the clinic observed, ‘He has himself to blame. You heard the brother. Even his dad, died telling him so.’ The doctor shrugged his shoulders, ‘I don’t have time for psychotherapy. I informed him, what he needed to know, and what he needed to throw. The rest was up to him. He discontinued the treatment himself.’ I can almost hear the earnest brother snapping his gristly fingers and hissing, ‘Astaghfirullah! He was always a mess. Killed his father, killed himself. Attention-seeker.’


As I start practicing medicine, my hand shudders when I have to write the cause of death. I look at my hand too, and wonder, what really did kill the patient?


1) Paan and Gutka are tobacco preparations with betel or araca nuts. They are stimulant, addictive and highly carcinogenic.



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