Many years ago I met a young girl who was still in school who had attempted suicide.
I asked her what had happened. She didn't open her mouth. Tears rolled down her eyes.
Her family told me Chennai police had informed them that they found her in a public place.
The girl had gone missing for one day and reunited with her family. However she attempted suicide.
She survived.
It took a long time for us to develop rapport with her to listen to her story.
She was in class XI and was aspiring to do MBBS. She had got more than 90% in X.
Family gave her a smart phone. She got messages from a guy who told her that he lived in the neighborhood. It was friendly. She chatted and unwound from stress.
He later expressed love feelings. Few more days later he told her that he wants to marry her n eloping was only option
This process took about 6m.
He then took her from her town to Chennai. He offered her a soft drink. She felt drowsy during the journey. She did notice that he was continuously on phone with someone. He told her that he needed to make arrangements.
She asked him for the number of his friend so that she could store it just in case his battery died. He did not give.
In Chennai, both of them waited outside the bus stand. Minutes became hours. The guy got her some snacks. He was calling his friend on and off.
At one point he told her that he will go and get some food. He told her not to go anywhere.
She did exactly that. However some concerned citizens informed the police about this girl and finally she was back home.
The story Iooked like the guy groomed her and was trying to traffic her. The team that was supposed to pick them up probably had some issues and didn't turn up. The guy saved himself and exited from his plan.
The girl survived the kidnapping, trafficking and life of a sex slave
She being a young girl didn't realize this. For her it was that her boyfriend left her and that she had to face shame in her home.
We discussed ways to limit the info to a small circle. She reentered school with the gave saving cover story of hospital admission.
Life moved on.
Not all girls are lucky like her.
Some are like #ShraddhaWalkar
May God give wisdom to our children

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More from @askdheeraj

Nov 16
Our dept of Child and Adolescent psychiatry consultants call me to help out in few special cases of adolescent boys with externalizing disorders and adolescent girls with addiction issues.
Today I met a young girl who had multiple issues. +
Cluster B personality + Opioid dependence.
She also had a different style of haircut. I asked about it and told her I liked it.
We then went on to discuss various aspects of her Rx. She even agreed to come as a day care patient to occupational therapy dept. +
While I was leaving I shook hands with her and bid goodbye.
She then said "Bye bye Einstein sir".
Patient, her mom, resident and the CAP faculty, all of us broke into laughter. Realized how even a complex case can be dealt well with proper rapport and validation in interaction +
Read 4 tweets
Nov 8
I met an old lady who had #schizophrenia. She was on antipsychotics for more than 50 years. Never remitted. Had delusions of infidelity on her husband. He loved her and brought up his kids. The kids are grown up and married now.
She was also a cancer survivor. Docs repeated the same medicines as there weren't too many problems even though she was not fully well too.
I took a bold decision to start her on #Clozapine, a drug with risks but also better efficacy. Discussed with her and family.
They agreed to monitor her blood counts and the process started. She did well. Her delusion resolved. She smiled at her husband after long time. He was very happy to see her change. I was thrilled to see the joy in their family.
Read 6 tweets
Oct 25
A year ago I got a call from a Prof of Developmental Pediatrics. He asked me if he could transfer a patient whom he has been seeing for the past 16 years. The patient was 19 years old. He had cerebral palsy and he could not speak, though could hear and understand instructions.
Met the boy with his mom. The boy was suicidal. It was heart breaking to see him cry on the first visit. He felt rejected by his dad, who was a mechanic. His dad would say words like "less intelligent" and "dumb". I phoned his dad. Requested him to come and see me.
The dad was old generation type man, hardworking and reticent. Wouldn't connect at an emotional level. Suggested how valuable his role was to build the boy's self esteem and future. Gave some tips to build their relationship.
Never saw the dad again. He never made changes.
Read 7 tweets
Oct 23
A resident told me that he didn't find psychotic features in a case that he had to present. I had seen the patient before and was convinced there were features. I went to clarify it in his presence. We spent nearly two hours and felt we had enough evidence.
However we felt there were more that we need to uncover. We sent off the patient as he was sleepy.
We then analyzed why it takes so much time, why it is required and why it is fulfilling in doing so.
A proper Dx helps initiate right Rx and stop Rx that aren't useful or are exacerbating the problems.
When many docs have seen a case and failed, even though it is possible that they were all wrong, it is possible that they got some things right.
Read 6 tweets
Mar 17
The head of a particular department called me last week to inform me about a staff in his department. He was surprised to note that I knew the person and had referred him for more detailed work. I then told him where I see staff in his campus (without regn) to decrease #stigma
Today I saw three patients from his dept. He had sent them. He had enough trust. Would continue to work with all of them.
It is a great joy when people in your hospital start recognizing your work. Nothing pleases a clinician more than referrals from colleagues.
One of the three had optic neuritis. He is off #alcohol now. He is struggling with #tobacco. I told him it is understandable that he couldn't stop even though he knows the price he is paying is hugh. This is how #Addiction is. Told him to consider a quit date.
Read 4 tweets

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