Bangalore House Call: A Patient’s Story

On a highway traversed by cement trucks and Beetle-Bug auto-rickshaws we travel north from Bangalore, India, for a house call. It is 2007, and the city leaves us grudgingly. Between fields of loose chocolate soil and sprigs of beans poking skyward, the skeletons of homes and businesses rise; armies of workers lay brick from wooden scaffolds; hawkers sell car tires, shock absorbers, beds and tombstones.

Stanley Macaden, MD, an internist at Bangalore Baptist Hospital, inches our van forward in heavy traffic. In the back seat, two community health nurses chat quietly while Dr. Macaden reviews the details of our house call with me: “Thirty-one years old. Rheumatoid arthritis for 20 years. Non-ambulatory. It’s a difficult case. She has much pain and often cries throughout our visit. She’s cared for by her mother, who does a good job, but they are set in their ways. We’ll take a look.”

With each passing mile, the traffic thins and the rural nature of India declares itself. An egret stalks fish in a verdant pool of duckweed and water lilies. Hawks soar lazily overhead. Stands of palm trees shade thatch-roof homes. Wandering cattle, oblivious to traffic, stray into our lane and stop momentarily, chewing, flicking their tails. We turn off the paved road and bounce along a rolling dirt lane before pulling over at a low-set, tin-roofed hut facing a narrow alley. The dust settles as we gather our supplies. At the entry, cow dung has been dried into a hard, odorless welcome mat.

The Patient

Inside, I make out a rumpled sheet on a thin gray mat. It is rectangular, about three and a half feet long. Embers from the morning fire glow in the far corner of the hut. Light from the open entry sends a shaft of light to the edge of the sheet, and as my eyes adjust, I can make out a faint blue discoloration to the fabric. I lightly touch the smooth, velvety linen. The sheet rises and falls. Beneath my hand, there is a young woman.

Maria’s mother squats next to the hidden form and coos a greeting as she unwraps the edge of fabric where a tuft of hair protrudes. A woman’s head emerges. Her facial skin is like a newborn’s: plump and fat, unwrinkled, downy hair around the lip and chin like the fuzz on a peach. Mother’s and daughter’s eyes meet. Another day begins.