How will you handle this case? - What Will You Do Next?
NATIONAL JOURNAL OF HOMOEOPATHY 1999 Jan / Feb VOL VIII NO 1.
Dr Vishpala Parthasarathy
'Ph-ac
Counselling is the focal point of my practice today. With the world experiencing an emotional topsy-turvy, we have to be like the rock of Gibraltar, to whom the patient can turn to in times of great distress, confident that he will get the best advice possible. And for us, what better reward, then a patient saying: 'Doctor, I am perfectly alright, all thanks to you' and that too in a matter of 24-48 hours.
My acquaintance with counselling started when I was with the late Dr ML Dhawale. Once in a case of sterility, after taking the case and scanning all abnormal investigations, MLD told her: "Your work is your baby. Stay committed to it." Somehow that one sentence penetrated. She went away at peace with herself. No advice of trying GIFT, adopting etc, the advice usually given to such patients.
It was then that I understood counselling is advising the RIGHT action in that PARTICULAR CASE, at that PARTICULAR TIME.
From that day to this, has been a rich rewarding haul. I would like to share my learning with you.
Case 1 of this How Will You Handle it series:
Here, I am going to give the case as it happened - sequence by sequence and you have to plan your action, hypothetically, at each step. Then move to the next page for solution (a); then plan the next action, compare with solution (b) & so on. Only in the final stage shall we do the remedy. Counselling mainly solved this case. The remedy had only a minor role to play. Ready? Get set...Go!
Stage A:
The case was taken by my assistant (we will call her the Primary Care Physician - PP). She brought the casebook to me. Information available:
First Page of the SCR:
Female, aged 24, married 6 mths.
H 28, a businessman. Marwari family.
Fa: business. Mo: Housewife
Br 21. Si 18 - in school
Chief Complaint:
Since October 98- Evening rise of low-grade fever, every month for 2 days. Fever with burning soles, polyuria & vomiting.
No excessive perspiration, no appetite, no thirst.
- Since Aug 98-
- Gas, loud belching, pain chest and poor digestion 2-4 /wk: No burning. No constipation. Worse milk.
- Urticaria -3/w < sun, tension, bad news.
- Since Feb 98 -
- Monthly Headaches. Frequency is on the rise. AF Sun & loss of sleep.
- Colic 2/w
- Since Jan 98 -
- Tremendous weakness & exhaustion < slightest exertion, walking, lifting heavy wt. Wt - 43.5 kg. Lost 4 kg in 1yr. So, what is so unusual about this case? How will you zero in and prepare your interview?
Yes everything you thought of so far is right:
- A newly married girl has no business being so ill.
- First, with evening rise of fever, rule out Koch's
- All complaints started this year. There must be some problem with her marriage. But then why since one year when she has been married only 6 mths.
Was it a marriage without parental consent, or forced on her?
Koch's ruled out.
It was a love marriage - she is a Sindhi married to a Marwari. She was formally engaged one yr back.
- Husband is not good to her.
- In-laws are not good to her.
- Regrets marriage
In-laws stay in Rajasthan and come only once in 2-3 mths.
Pt lives alone with husband. Husband is very good to her. If she is ill, he even helps out in housework.
Another complaint surfaced: Since June 98, has irregular periods- would come every 55-60 days, with scanty flow, irritability, weakness and leg pain. Now since last 3 mths daily massage on abdomen has normalized the flow.
- Explore sex life.
- Either an inability to cope with husband's demands may manifest as illness.
- Or a busy husband, returning late, tired, not paying enough attention, may lead to loneliness and attention-seeking symptoms.
Normal sex life. Now what? Ask her point blank: Tell me about you and your problem.
Actually this is the first time I spoke to her. So far the PP who took the case was doling out the answers to me.
Pt answers very slowly: Normal. (PP said: she has a lot of confusion. She herself says she feels confusion in the head.
Qs: What else you want to tell me about your nature?
Normal.
Anything else you want to tell me?
No, everything is normal.
So, dead-end. What are you going to do?
Stage E:
This line of Qs not leading anywhere, so I just asked her what exactly her problem is. She said I just cannot get up. I am so tired and exhausted that I just cannot cope. I am so tired. Pt looks also very low & unhappy as if lost everything. She clinches this by saying no appetite, I just want to drink something all the time, especially fruit juice.
Now your remedy clearly emerges. Can we just give it and hope everything will work out?
The remedy is clearly Phos-acid 200 - 3 doses were given.
But is this enough?
Now I asked her to detail her whole life from the beginning.
