CASE 1

A sixty-eight year old man, Mr. E.C., consulted me on 5.6.'96 for acute bronchitis. An X-ray picture taken later showed consolidation of the entire right lung. The radiologists and physicians were uncertain as to whether the patch was pneumonia, tuberculosis or cancer.

The patient could hardly speak a few words before he was breathless. His lips were cyanosed. He had a baggy swelling below both his lower eyelids.

D : Tell me about your problem.

P : " I have severe bronchitis. I have suffered from blood pressure from '85 onwards. I have no other troubles. The blood pressure I have tried to control with medication so I have never been in trouble. Now I can't walk, can't talk much.

Bronchitis I had on 10th May. It was diagnosed as severe congestion. My older brother, who is a doctor, has been telling me to leave cigarettes. If someone tells me to give up smoking from within I know that I won't give up.I had been trying to since the last ten years. Psychologically there was some block somewhere and I did not leave. This is the end result.

" Now I have been able to leave completely since May the 16th. There after I have never had the urge to smoke; I am never going to smoke. This illness has also made me compulsively retire though I have wanted to for some time. I have been a practicing chartered accountant since the last forty-two years. Now I have been able to retire once and for all. My immediate concern is to get cured as fast as I can, to come out of this problem as fast as I can. Two things have been decided, no smoking and no going to the office.

" My blood pressure has always been under control. Sometimes I bring it down to 130/70 without medication but that is rare. "

D: Tell me something about your nature.

P: " I am sorry I have not been able to fill up your questionnaire completely.

"My nature has undergone a drastic change since 1987. Before that I was balanced; my only problem was smoking."

D: What had happened in 1987 ?

P: " I began Vipasana meditation. I'll be very honest. I read about Vipasana. I went and saw the place, the institute. I liked it very much. I have this bad habit of reading. Then I felt  my life will change. Slowly I am changing it. When I saw the place I told my friend about it and he joined it immediately, but it was two years before I started going there. Now I go there regularly, but before I joined there was this disease in the mind of not being able to give up smoking. I could not make up my mind. I used to feel I am going for Vipasana. It gives me balance of mind. I do not take blood pressure tablets when I am there.

When I come out I have my blood pressure measured and it is 130/70. But that lasts only a short period. "

D: Tell me more.

P: " All my life I was a club member. My mind was divided whether to go to the club or the office. I want to leave the club, but am not able to. There was a struggle. When in the office, I used to feel that now I will close the office and go to the club. The club was an excuse to carry on smoking. It was a vicious circle. "

D: What was this struggle ? Can you tell a bit more about that ?

P: " Do I want to leave the club or no ? "

D: Why did you want to leave the club ?

P: " The club was not suitable at that juncture of my life. It was only an excuse to carry out smoking. They don't have any other game there but cards. "

D: What is the harm ?

P: " No harm. It was just a waste of time. I would go to the office and feel I have to go to the club. I used to be a committee member, and even now they have requested me many times to become the president or a trustee, and I have refused. I am the oldest member of the club. I have many friends there. I have played cards with millionaires, judges of the high court, the best of magistrates. But now there is a new generation. But I cannot leave. It is an excuse to smoke. I do not want to waste time going to my present club where they do not have any other activities but cards. They used to play snooker there earlier; I had introduced that. But the new generation are all gamblers.

They have bets of a hundred thousand rupees when they play cards. "

D: And do you gamble as well ?

P: " Yes, and that's what I am worried about. We used to gamble at very low stakes. If I sit at the club I may win or lose just five hundred rupees. I believe in club life, not gambling. "

D: What is club life ?

P: " I told you I had a lot of friends there. But now there is a new generation and they think we bet like children. And I want to leave this club but I am not able to. "

D: So, why haven't you been able to leave ?

P: " I don't know why. There was a mental block. The club was an excuse to carry on smoking. I knew cigarettes were harming me since so many years but somehow I could not give up.

But since 10th May this year I have been hit badly as I have never been hit in my life and my eyes have opened. I have also decided not to read a single newspaper. "

D: Why ?

P: " I want to get cured first. I do not want to read trash. If I read something I feel I want to do this or that. So, I've decided not to read unless I have to study something. I told my son, ` Bring big boxes. Dump everything in them. ' I don't even watch TV. I only watch international games, like if there is a tennis match. Movies I have never been interested in. "

D: What dreams do you get ?

P: " To be very honest, I can recall no dreams. "

D: Did you used to get any dreams earlier ?

P: " Sometimes I feel, once in six months or so, that I have had a dream, but I cannot recall them. "

D: Tell me about your present complaint.

P: " Total breathlessness. Plus I am told the entire air passage is choked up. Bronchitis. " I am sorry I have not filled out some of your form but if you ask me questions I will tell answer them. I will give you a true and honest reply. "

D: What are the things you are emotionally sensitive to ?

P: " If someone disbelieves my word I get very upset. Call it an emotional reaction. "

D: For example ?

P: " If I make a statement to you and it is questioned. "

D: What do you feel ?

P: " If I feel someone has misunderstood me through no fault of mine. "

D: What is your feeling ?

P: " If I have told the truth and they don't believe me. I am a person who speaks the truth. I feel disgusted. It is the tradition of our house not to speak the untruth and this man does not believe me. I am disgusted. I feel bad. "

D: What do you mean by ` disgusted ' ?

P: " I have made a statement of fact and I am not believed. You have asked in your questionnaire, ` What are you proud of ? ' I wrote ` of myself ', at my son's insistence.

If you ask me the truth, I want to lose the identity of ` I ' for a long time. This sense of ` I ' should be removed from the mind, it should not be there. ` I ', ` mine ', ` me ', I want to get out of these. "

D: What do you mean by that, when you say proud ?

A: " I have come up on my own in every respect. I have fought my battle alone. I honestly have come up on my own. My father and mother and brothers were there and they did not refuse to help me. But I believe in helping myself and standing on my own legs.

" One day when I was young and had just started my office, my father said, ` Here are the keys to your new car.' There were many important people in the house. ( He names a former prime minister. ) I told him I did not want the car, I would get one on my own, I was not like my eldest brother who took whatever my father gave. I wanted to get it on my own. I believe in struggling on my own and standing on my own legs. In front of all of them I said, ` Thank you, I will earn it on my own, keep the keys.' He felt bad and so I apologized  to him. I told him I was not his first son, I was completely different and that I had the guts to tell him this.

" I would go to my father in my suit and boots on a Sunday morning, and if he asked me where I was off to I would say, ` I am going to the horse races. Wish me luck. ' These are the guts I showed to my father and he has always appreciated it.

" Just as I had the courage of conviction , so did both my sons, and neither of them have joined me in my office. I felt very hurt at first. Neither of them have entered my office since the last ten to fifteen years.

" Till my parents were alive I used to tell them, ` I'm not your first son. I'm your second son. '

D: What is the difference ?

P: " The difference is that my two brothers will pocket my father's money. I will not. "

D: Why ?

P: " Because I must earn it; that is what I believe. " You asked me what I feel if someone doesn't believe me. I feel like dying, because I was honest. I like reading and going for Vipasana, and feel that I should draw myself from all this and lead a quiet life. "

D: Do you have any heroes in life ?

P: " No, to be very honest. I carry myself as my model. But I never ask anyone to follow me. I do my things my own way. "

D: Any historical character you respect ?

P: " I do not know much about history; I am interested in sports. I was a very good cricketer. ( He gives the name of a famous Indian cricketer and says that they used to play together.) I had once bought this new bat; it was the best bat available at that time. One Sunday morning I showed it to my father. My father had learned that I was spending too much time playing cricket. He thought I was wasting my time. So, he called the servant and asked him to put my bat in the burner. He said, ` No more playing cricket.' He had my bat burnt, and that is how my cricketing career ended. "

D: What did you feel ?

P: " I felt bad but I could not defy my father. I did defy him in one way, not openly. Instead of cricket, I played table-tennis. I always defied others in one way or the other: playing table-tennis, badminton. And then the very first year I represented my college in table-tennis. "

D: When you are very angry, what are the changes in your body ?

P: " Shall I tell you the truth ? I have never been angry in the last twelve years, and before that I cannot remember. But I used to get angry before. "

D: Would you get very angry ?

P: " I believed in right and wrong all my life and if somebody does something wrong instead of doing right, I don't spare any words to tell him that. "

D: Any action ?

P: " I will tell you something. Once, in 1976 when I joined the club committee, there was an old accountant who was a Christian. I never took interest in club politics before. One of my good friends had been the treasurer of the club the previous year. We were climbing the stairs of the club, and I was asking him if he was rejoining. This old accountant club was walking down and looked at my friend and said, ` Many treasurers have come and gone. ' That blighter had the cheek to tell my friend this. I did not say anything, but kept it in the corner of my mind. I felt this guy must be taught a lesson on how to talk to office bearers. In the next election, I became the treasurer purposely. On the first day, I sent him a memorandum.

Nothing oral, everything was written and official on the club letter-head. ` So much work is pending and I need a reply from you immediately. ' In the back of my mind I thought, ` What does he think himself to be ? Does he think that without him the club cannot run ? ' Many committees before me had tried to get rid of him but could not. Every day I would give him three memos documenting his being late, etc. all in writing taking his signature for confirmation. At first I thought I would give him a chance. He would come coolly at noon instead of 9 A.M. and would quit at 4 P.M., like it was his father's club. I warned him enough orally and with memos.

After three months, one Saturday I typed a two line letter saying, ` Your services are hereby terminated; you are no longer required here and can pick up your dues. ' I gave him the letter personally and asked for his signature. I said I want charge of your accounts, books, table etc. I told him to take his personal belongings. I had called the police in case he made trouble. I said ,` I don't want any of your personal belongings here. ' He asked, ` What do I do now ? ' I said, ` Let me sit in your chair. ' Then he asked again, ` What do I do now ? ' I said, ` Go home, come and collect your dues on Monday. ' He realised I was crazy and he left. He returned on Monday to take his cheque. He went to the president of the club and said, ` Look what he has done to me. ' I gave him a  receipt. After a month he went again to the president asking for a character certificate and he was sent to me. He tried to approach the secretary but he too asked him to see me. He came to me and requested me to write just two lines. I called my secretary and dictated, ` He is disobedient, useless,... ' and so forth. He said that he didn't want this kind of certificate. I said that was the only kind he deserved and would get from me. He said, ` I want a job.' I said, ` That's not my problem. ' I removed him. I said, ` You should have thought twice before saying what you did. You held the entire club to ransom. ' But that does not mean that I'm revengeful. I'm very good, even with the clerks. "

Click Here to read the Case Analysis and Follow Up.