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The Rare Movement Disorders

By Shobha Nandavar

My friend called up to enquire if I was attending the ‘Rare Movement Disorders Consortium’ at NIMHANS that weekend. As not unexpected, I negated. Movement disorders were rare in general practice; rare movement disorders were rarer, I mused.

Instead I dreamt of a relaxed walk through the cobbled alleyways of Bangalore on a Sunday morning. The eighth Cross of Malleswaram, not short of Dalal street was replete with street-smart street vendors who could give a run to the traders of BSE. How they notched up and down the prices faster than the Sensex just based on the countenance of the hagglers!

My ruminations were cut short by a repeat call from my friend this time to persuade me to attend the conference by alluring me with the names of national and international bigwigs. To spice up he added that I might never see such rare movement disorder cases throughout my life. The idea of foregoing a Sunday morning of buying second hand fictions, gorging on the street food and buying flowers was difficult. Nonetheless I could see his point.

Going to NIMHANS, my alma mater was pure joy any day any time. Here I was at the doorstep of the convention Centre at 7:30 on a Sunday morning.

I had an idiosyncratic flair for rear ends, dead ends, cul de sac and the like. Accordingly I perched on a rear seat for a bird’s-eye view of the ‘Rare movement disorders consortium’. My short stature must have made me a lover of the tall seats evolutionally, I reasoned. I could peer over the heads of my peers to look for a long lost friend or a hip new entry into the city with whom I could bond over tea during the break time.

Conferences were no child’s play but bore a semblance to the Arangetrams. The dishevelled hair and the jaded eyes of the organising committe members were a testament to the gruelling work over the preceding year. Picking up speakers and chairpersons was just short of choosing candidates for Lok Sabha polls. Every hosting team wished their conference would turn out to be a mega blockbuster, going down the pages of history as an all -time hit.

I was keenly observing the various movements of the movement disorder specialists. Suddenly the lights went off and the knight with a shining caller mike, none other than the speaker catapulted into the limelight. That signalled the conference was up and running.

The PowerPoint slides were chock-a-block with newer and rarer diseases. Next arrived majestically reams and reams of the genes tagged to these movement disorders. When 99.9% of the genes were similar in human beings how a mere 0.1% difference between us led to such a bewildering array of diseases left me in a tizzy.

The runner up slides dished out the diet. They were a tad easier, but I still needed to fathom what diet contained Phenylalanine, Lysine, Methionine and Betaine.

At discharge from hospitals, one of the important sermons was the diet recommended to the patient. Paradoxically medical journals hardly carried any information on dietary regimens. Medical schools too barely taught anything about the diet, might be the medical teachers who wrote books never had enough time to have two square meals themselves leave alone planning diet for their patients. 

The shrill unmistakable call from the emergency room set my whole being into flutter fibrillation. Casualty patients had to make their presence felt when the doctor was enjoying a conference, was just planning to retire for a nap on a Sunday afternoon, was setting out on a family vacation or enjoying the climax of a movie, I muttered. The next two hours were gone with the wind; reading scans, procuring medicines, talking to the terrestrial and extra terrestrial relatives of the hapless patient about his prognosis, I rued. Nevertheless I was geared up for this saga.

The young casualty doctor at the other end was narrating about a patient who asked for an injection and abruptly became comatose. The doctor himself was breathless and nervous. Sunday casualties were casualties in the true sense for one and all; I mulled and decided to speak to the staff nurse to get further details.

The patient was a regular who would meander to the ER to receive a sedative injection. Like all gods with their favourite days, our patient’s choicest ‘vaara’ was Sunday, when the effect of Saturday night whiskey had petered out.

I jubilantly set foot into the conference room with my head held high like Kohli after a six, basking in the glory of fast track clearance of the ER case.

After the intermission the next talk to be screened was the much awaited Botox one. The speaker was quite good, a dash of humour made the deliberation ever fascinating. I did inject Botox to an occasional patient to the eye muscles, to the neck, to the legs and the like. It needed special expertise to decide which muscle to inject, which not to, the dose and the strategies to prevent sudden movement of patient especially while dealing with the eye muscles. 

I was ardently listening to the talk when I got a shock of my life. The entry of the slide with red flags left me bemused; I was doing exactly the things in the list of ‘don’ts’.

I started recapitulating about all my adventurous Botox patients in a jiffy. My habit of saving names of patients with their diseases like chorea Pinku, psychosis Leela, head eater Balu and so on and so forth had come handy at this trying time.

One patient whom I had injected into the neck, a fortnight back had not turned up for review. I was distraught, had I punctured her carotids with my antics ? So out I went into the foyer and rang her up; her mother picked up the call and said that she was admitted and curtly hung up.

Continued here....