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The cost of never wanting to be a burden

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  Self-Erasure Is a Symptom. We Reward It. Patients Pay My grandmother refuses to go to the hospital even when care is free.She says her pain is “not serious enough.” She worries about wasting doctors’ time. She apologizes for being unwell. Clinically, she looks stable. Medically, she is not. What she has is not stoicism . It is self-erasure. Self-erasure is not a personality trait. It is a learned belief that one’s needs are a burden and must be minimized to deserve care. It develops under scarcity, violence, gendered expectations , and chronic guilt. It is common. It is dangerous. And medicine keeps missing it. Patients with self-erasure do not say “I am suffering.” They say “It’s okay.” They say “Others need it more.” They say “I’ll manage.” Clinicians often hear these as reassurance. They are not. They are warning signs. We call the outcome late presentation . We blame awareness, access, compliance. But the delay is not logistical. It is moral. These patients ra...
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THE COST OF BETTER CHOICES

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  The Cost of Better Choices I didn’t fail to choose because I was careless. I failed to choose because I was trying to choose correctly . An air fryer with ten modes. A CCTV camera that also runs on solar power. Phones with endless configurations. Robot vacuum cleaners that promise intelligence. I didn’t buy most of them. Not because I didn’t need them but because the number of options quietly overloaded me. Repairing my old phone had a lower cognitive cost than choosing a new one. This wasn’t minimalism. It was exhaustion. The same pattern repeated elsewhere. I couldn’t buy a watch for my brother. The options were endless, the standards invisible, and the fear constant: What if there’s a better one I’m missing? When my other brother finally bought it, I felt relief not because the decision was made, but because the responsibility was no longer mine . Buying gifts became another trap. Too many choices meant no single choice felt sufficient. Once, I bought two gifts ins...
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68F WITH FEVER AND ABDOMINAL PAIN

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 A 68 YEAR OLD FEMALE CAME TO OPD WITH COMPLAINTS OF PAIN ABDOMEN SINCE 4 DAYS  FEVER WITH CHILLS SINCE 4 DAYS VOMITINGS AND ABDOMINAL DISTENSION SINCE 3 DAYS CONSTIPATION SINCE 2 DAYS PATIENT WAS APARANTLY ASYMPTIMATIC 1 WEEK BACK THEN SHE HAD COMPLAINTS OF LOOSE STOOLS 3-4 EPISODES WATERY,NOT ASSOCIATED WITH BLOOD AND MUCOUS, LARGE VOLUME,BLACK COLOURED LASTED FOR 2 DAYS,THEN SHE HAD COMPLAINTS OF PAIN ABDOMEN,DIFFUSE,SQUEEZING TYPE ASSOCIATED WITH  COMPLAINTS OF FEVER  WITH CHILLS,INTERMITTENT,NO EVENING RAISE OF TEMPERATURE ,WITH VOMITINGS,BILIOUS,NONPROJECTILE FOR 4 DAYS AND ALSO COMPLAINTS OF  OBSTIPATION SINCE 2 DAYS CLINICAL CASE OF DIABETES MELLITUS SINCE 10 NYEARS ON MEDICATION. NOT A CLINICAL CASE OF  HYPERTENSION,TB,ASTHMA,CAD,EPILEPSY,CVA   PERSONSAL HISTORY MIXED DIET APPETITE:LOST SINCE 1 WEEK SLEEP: ADEQUATE CONSTIPATION SINCE 2 DAYS BURNING MICTURITION SINCE 10 DAYS ADDICTIONS NONE   GENERAL EXAMINATION PATIENT IS CONSCIOUS...
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58 M with acute asymmetrical polyarthritis

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 COURSE OF LIFE EVENTS:PERSONAL HISTORy 58 male hailing from narayanapuram ,choutuppal, born in 1964 A 6 years got seizures,  from 7th class he got one sided headache associated with bilious vomiting ( stopped at 32 years) studied until 10th class ,kabaddi player long jump(13feet) ,  he started smoking, From 1990 he started consuming alcohol,1994 he got job as a  supervisor in mumbai , got addicted to gambling and alcohol 75ml per day for 15 years , usually smokes 30 cigarrette per day for 15 years , Rich person at those times, usually takes high protein diet.  admitted in hospital for cold with  headache done spinal injection( lumbar puncture ? meningitis?)for 20 days . He quit smoking and alcohol there after .He quit job in mumbai due to some brother disputes and lost his money .He does real estate and also upasarpanch has anger episodes in 2000s ,he got swelling at 1st MTP with severe pain , swelling developed in a day  , joined in a hospital for 10...
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50F with pyrexia under evaluation

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  50 year old female, health care worker ( aayamma in orthopedic hospital ) resident of miryalguda presented with complaints of fever since 1 week, nausea and vomitings for 3 days, Rt shoulder pain since 1 week. She works in a orthopaedic hospital, does washing of patients clothes, OT gowns, other clothes with cleaning the hospital premises when ever it’s necessary. After reaching home she manages to do her work and take rest. In 2005 when her parents went to daily work ( daily waged labourers ) met with an road accident and expired, following which in there memory she tattooed there names on her right forearm. ( similar tattoos where present on her both knees, couldn’t give exact reason for them ). Since 10-11 year she had both knee joint pains for which she took analgesics with a frequency of 4-5 per month which did not effected her daily routine. Her son got married 10 years back, with daughter in law entering into her family, she got some rest and continues to work in hospital....
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