Peculiar Parsi Patients

On Parsi New Year we share with you an insight into the idiosyncrasies of the people we love and cherish – what makes us so special and wondrous.

“If you operate on me, I’m sure I will get 100% better,” said Percy, a middle-aged, mid-sized, mild-mannered gentleman. He was single and lived with his mother, a status that is quite familiar and widely comfortable among Parsis. “My back is on fire,” he exclaimed animatedly, as he pulled out a cargo of blood tests and MRIs done every single year and religiously organized in colour coded folders.

“Your lab values are fine. The images look perfect. Your spine looks better than mine!” I said candidly after a detailed examination. “I’ve tried yoga, physiotherapy, medications, injections, acupressure and acupuncture, cupping, and even black magic,” he continued. I was curious to find out what the last one entailed but figured it would be best to move ahead; the voice in my seasoned brain whispered to me that this was going to be a long consultation.

“Anything else bothering you?” I asked, trying to get a more holistic perspective. Surgeons are often blamed for their single-pronged ‘you need surgery now’ approach, the kind where “When all you have is a hammer, everything looks like a nail.”

“My mouth is always dry. I’m extremely agitated and irritated all the time. I keep forgetting stuff. I’m perpetually tired and can’t multi-task. There is a constant feeling of doom. I keep burping and the ‘gas’ in my tummy never seems to subside; I’m not sure if it’s because I wear my pants right over my belly button. My eyebrows hurt a lot – not my head, my eyebrows; there is a difference. People think I’m crazy when I tell them this, but it happens mostly after sunset, and when it does, my nose itches. I’m constantly losing hair – I can’t be bald at this age!” My interest arose: Finally, we had a symptom in common that I thought concluded the description, but after a brief pause, he continued.

“There’s always something itching in my throat and I have to drink tons of water with a teaspoon of glycerol to clear it, but nothing seems to work. And if I cough to get rid of the itchiness, I go red in the face. I’m not sure if being constipated has anything to do with this constant feeling that something’s stuck in my throat.” I started sinking in my chair.

“I passed a stone in my urine recently. It was as painful as delivering a baby!” He placed the stone on my desk, neatly preserved in its original form in a plastic container. “Wow,” I said, my eyes widening to the circumference of the earth. I wanted to ask how he had retrieved it, but pretended to contain my intrigue and let him proceed. “The space between my ribs hurts and my knees are always crackling. I have this tingling sensation in my little toes all the time and my skin is so sensitive; it doesn’t tolerate temperatures above 32 and below 19 degrees. I’ve seen over 200 doctors and no one can help me,” he concluded, carefully placing the plastic container back in a zip lock. “Please operate on me,” he pleaded one more time.

I told him that I was a surgeon, and that if there was one thing I was confident of, it was that he didn’t need surgery. I recommended guided physiotherapy, a change in medication, and a psychiatrist. I explained that a lot of his problems were psychosomatic and could be addressed by a detailed assessment and personalized therapy. This was a prognosis he had probably heard earlier, as evidenced by his melancholic exit.

A few weeks later, Percy sent me an email stating that another surgeon had finally understood his problems correctly, operated on him, and that his back pain had disappeared. “How does one identify a patient who doesn’t need surgery but benefits from one?” I wondered to myself. This kind of placebo effect is often short-lived, but in this case, someone had delivered it: he had bolstered the patient’s confidence and provided a solution, leaving me perplexed about what had actually been done.

Thankfully, Percy’s case is not the norm. On some occasions, when I’ve told patients they didn’t need surgery and when they were eventually operated elsewhere, they returned solemnly stating that the surgery didn’t help.

In a slightly different context, I remember another lady who had severe back and leg pain; her MRI showed a grotesque compression in the lumbar spine. These symptoms disappeared remarkably after surgery, but 3 days later, just before discharge, she developed excruciating abdominal pain. Clinically, the abdomen was soft: the ultrasound and CT scan were clean and an endoscopy from both ends was clear. She insisted that something needed to be “removed from the stomach.” An experienced general surgeon, gastroenterologist, internist, gynaecologist, and urologist conducted every test there was and gave varying combinations of medications, all of them confirming that there was no need for surgery. She was in immense pain for 2 weeks, and every time we told her we were giving her a pain injection (but gave her sterile water instead), she said her pain had temporarily vanished, only to return when the injection bottle hanging on the IV pole tethered to her arm was almost empty. Frustrated, they got discharged and were admitted to another hospital that removed her gall bladder the next day. Miraculously, her pain then evanesced forever.

There is more to disease pattern than we understand of it. Patients don’t read medical textbooks. There is an alchemy to discerning the functional component of an organic illness. Sometimes, patients invent symptoms to claim compensation or exaggerate them to prolong leave. Others genuinely believe that there is something wrong that can only be fixed by surgery, even when the surgeon feels otherwise. Can one ever justify performing an operation that is scientifically unwarranted, but which ends up completely curing the patient for some unforeseeable reason?

It takes a surgeon about 5 years to learn how to operate. But it takes us 10 years to learn when to and when not to operate and perhaps 15 years to adjudge on whom to and whom not to operate.

Here’s hoping that you never need surgery or even pretend to need one.

Stay safe. Stay sane. Yet, stay special.

Happy New Year.

26 Comments on “Peculiar Parsi Patients
  • Jyoti Girish Raut says:

    Your write up is excellent.

  • Dilip Trivedi says:

    Perfect explanation Dr Saheb.

  • gurudutt bhat says:

    I loved your observations they are universal and apply to all patients.

  • Dr Rajesh M Shah says:

    First of all” happy new year to you and your family”, sir. I enjoy reading your articles…. As far as today’s article is concerned, let me tell you, we as a family physicians, dealing with such patients quiet frequently. But in this article it’s quite funny yet surprising….

  • Rita singh says:

    As always very interesting and amusing write up

  • Lakshmi says:

    Good to know that you and a few other drs are not knife happy . The mind is a separate entity is established in your essay . Thank you

  • Dr Deshpande Shrikant says:

    It takes a surgeon about 5 years to learn how to operate. But it takes us 10 years to learn when to and when not to operate and perhaps 15 years to adjudge on whom to and whom not to operate.
    It’s very true 👌

  • Sandeep Mohe says:

    Excellent……A patient can be so complex when the mind rules over the body.

  • Harish M. Belani says:

    Mazda, you are a Superb & Engaging Writer. Am forwarding this to several physicians and surgeons and others. More Power To You.

  • Sanjay Sonar says:

    Lovely incisive humorous and thought provoking stories , always. Thank you Dr Turel

  • Akanksha Sharma says:

    Very insightful. Had me gripped till the last word!

  • Dr A K Banerji says:

    Lovely as usual,looking forward to the next one.Delayed happy new year

  • Vipul shah says:

    As usual you are excellent in your Article & very correctly describe Psychology of Patient ……

  • PIYUSH VYAS says:

    Why (only) Parsi patients.
    It’s common with others too.

    An experienced doctor like you, treats a patient clinically and also psychologically.

    Keep it up – yeomen service to mankind.

  • Mahashweta Biswas says:

    Excellent write up with a lot of humour. Best of luck Mazda n keep sending us your experiences.


  • Avinash Karnik says:

    Once again your expertise on when to open a patient laced with the flare for good, honest and humorous writing skills can’t be kept without admiring. Well written and hope to read many more articles coming from you.

  • Beena seth says:

    Very well written as always

  • Laina says:

    Great article, Dr Mazda!

  • Dr Sham Agroya Neurosurgeon says:

    Impressive Mazda Happy new year

  • Marzin R Shroff says:

    Eloquently written as always. Except that it’s not just us Bawa’s that have this syndrome. Maybe we do epitomise it though.
    Keep sharing your thoughts always
    Cheers and Happy New Year

  • Dr.Farida says:

    Happy New Year Dear Dr.Mazda

    Long live our “Peculiar” clan !

    Wonderful write-up…as always .💐
    Yeh ♥️ mange the New Year !💐

  • Ajayi Kolawole Odebunmi says:

    Once in a while , one sees cases like this and truly psychotherapy helps but after a very long time. Sometimes one sends them to another doctor to avert facing their stress . Thank you for sharing this.

  • Samarth borade says:

    Excellent piece of writing,from both perspective.
    Patient and a doctor

  • Prem Prakash says:

    Nice write about the common problem which we face which is, no problem at all..

    Happy new year to you and family mazdaji


    Really enjoyed reading that Mazda!

    Wow… you have really experienced all kinds of ailments and symptoms!
    Thanks for sharing- was a great read!

  • vanka udayakumar says:

    very nicely explained about the difficulties of Doctors who face such kind of patients – Not only in Surgery ; but ; more predominantly in Medical division. Nearly ; 3 out of 100 patients ; Doctors have to face these patients.


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