Analysis

Yours falsely: a lesson in learning

BMA News writing competition runner-up Rajive Mathew Jose is relieved when his letter giving his father misguided medical advice goes unheeded

I read the letter again.

Those were the days before the internet and emails, and the main source of communication between my parents on the south-west coast of India and me studying medicine in the scenic coastal town of Pondicherry were letters and phone calls. Letters arrived from my father on a fortnightly basis, and — apart from the date and one or two sentences — were replicas of the previous ones.

This one was different though. It read….

‘Dear son,

‘We hope you are studying well.

‘We are glad to hear that you have passed your anatomy exams. Your mother and I have been praying to St Jude, the patron saint of desperate cases. You must be feeling proud.

‘I went to see Dr Kumar last week for my blood pressure, and also showed him a lump which came up on the back of my wrist a few months ago. It is round and is the size of a gooseberry. He examined it and told me it is a ganglion, and has offered to remove it for me.

‘Now that my son is in medical school, I don’t have to bother Dr Kumar about medical terms.

‘Son, what is a ganglion? Do you think I should get it removed?

‘Your mother and I are doing well. You must study well. Please drink a glass of milk every night before going to bed. Most importantly, do not be going after the girls in your class. You must concentrate on your studies.

‘Your loving father.’

Prophet recognised

I felt elated. I had not gotten over the euphoria of passing the pre-clinical examinations of which anatomy was my greatest fear. Now, I am being taken seriously by my family, who want medical opinions from me. A prophet is finally respected in his own homeland.

The only trouble was the whole thing did not make sense to me.

I had come across several ganglia in my pursuit of anatomy. There were three in the neck, of which Stellate ganglion was the largest. There were several around the vertebrae and some inside the abdomen. I could not remember reading about any in the wrist or hand.

I quickly checked my copy of Gray’s Anatomy (which was a gift from my aunt when I got into medical school, and was largely unused). No, there are no ganglia in the wrist.

Second opinion

However, I felt I should take a second opinion. I went across to my neighbour’s room. I took the letter with me after carefully blacking out the bits about St Jude, milk and girls. Srinath, my neighbour and the genius of our batch, read through the letter.

‘Surely, there are no ganglia in the wrist,’ he said.

‘Exactly,’ I said with relief. ‘See how the quacks con the poor unsuspecting public.’

‘However,’ Srinath said, and with style produced an anatomy book from the shelf behind him like a magician plucking flowers from the air. He opened a page and started reading.

“‘The posterior interosseous nerve passes between the muscles as far as the wrist joint. Here it ends in a pseudoganglion and supplies the wrist joint”.’

‘A pseudoganglion it is then,’ I said, impressed by my neighbour’s superior knowledge.

‘Yes,’ he replied. ‘But I don’t think it warrants removing. You must tell your dad to keep away from this doctor.’

‘Of course,’ I said, as I walked back to my room to write a reply. It read…

Confidence of youth

‘Dear father,

‘I read about the lump on the back of your wrist. A ganglion is a lump made up of nerve tissue, which is there in every part of the body. I have done an exhaustive research in medical literature, and also asked an expert about your lump. There are no ganglia in the hand or wrist…’

(I pondered at this juncture as to whether I should write about the pseudoganglion, and finally decided not to in case I confused him.)

‘…Please do not go under the scalpel on any quack’s advice. Though I belong to the profession, I must say that there are a lot of unethical practices in this world…' (I liked the sound of it).

‘…I will be starting my orthopaedic posting next week.

‘Convey my regards to mother.

‘Your loving son.’

Further research needed

A month after my orthopaedic posting started, I was confronted with a lump on the back of the hand.

‘Surely you must know, it is a ganglion,’ one of the registrars told me.

‘Ganglion?’ I replied. ‘But are there ganglia in the hand?’

He strongly advised me to do some basic reading, which made me wonder whether I should send a telegram to my dad the next day.

GANGLIA EXIST ON WRIST STOP FOLLOW DR KUMAR’S ADVICE STOP SORRY FOR THE CONFUSION STOP

Of course I did not send the telegram and did not enquire about the ‘ganglion’ any further. During my next vacation, I was relieved to note a scar on the back of my dad’s hand. Neither of us mentioned the topic though.

Benefit of experience

As a consultant in hand surgery, I am confronted with ganglia on a weekly basis.

Despite the reprimands of the PCTs, a few of them find their way into my operating lists. While taking my registrars through the procedure, I sometimes narrate this story to them.

A little knowledge is surely a dangerous thing!

Post scriptum: This story happened more than two decades ago in India, when anatomy was taught in its pure form in the pre-clinical years. Today’s medical students are taught clinical anatomy, which may be helpful in preventing some of these mishaps. Maybe.

  • Rajive Mathew Jose is a consultant hand surgeon from Birmingham. He was a runner-up in the annual writing competition organised by BMA News, the weekly medico-political newspaper for BMA members. The theme of this year’s competition was ‘a little knowledge’.

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