The exorcism of Emily Rose
The second title may seem abrupt as the article proceeds. It is the title of a 2005 American horror film directed by Scott Derrickson loosely based on the story of Anneliese Michel and follows a self-proclaimed agnostic defense lawyer representing a parish priest who is accused by the state of negligent homicide of a young woman named Emily Rose after he performed an exorcism. The film brings out the conflict between medical fraternity and the fraternity of church over the death of Emily Rose. The film gives a very balanced unbiased opinion over the death of the woman by being both politically and scientifically correct at the same time. Rather the onus is on the audience to believe what they want to believe.
It was 7 o’clock in the evening. I was involved in a regular chat with one of my friends on facebook when I got a call from a nursing assistant on a post at 16000 ft. The doctor is usually not deployed in this terrain at such a height. So to provide medical cover to the troops serving there, nursing assistants are available giving them first aid and monitoring the patient till the evacuation by air effort takes place. It was an unusual call at such an hour of day indicating some kind of urgency. I could sense the apprehension in the voice of my nursing assistant. The things were definitely not in his hand.
“साहब, यहाँ एक केस हो गया है. एक सिपाही की पूरी बॉडी अकड़ गयी है, उसके हाथ पाँव मुड़ गए हैं और पूरी बॉडी हिल रही है.”
I got concerned as soon as I heard these words. I poked him further to get required history of the patient and other necessary details. It all started with a headache and numbness in both the upper limbs and tongue followed by two episodes of tonic spasms involving the whole body. In medical terms patient had suffered two attacks of seizures at an interval of 10 minutes lasting five minutes each. I enquired whether the patient had any such attacks in the past. The nursing assistant told me that patient had a similar attack previously while worshiping in temple when his body got stiffened. I ignored this history at that time. I found it to be insignificant. I immediately instructed the nursing assistant to give him an intravenous shot of injection diazepam to control the convulsions. The injection was given and the seizure activity stopped. Vitals were taken at this moment and they were found to be stable. It seemed to be case of Cortical Venous Sinus Thrombosis (CVST). CVST is a rare form of stroke that results from a blood clot in the venous system of brain. The symptoms include headache, numbness, weakness of one side of the body, seizures and altered sensorium. This condition though particularly rare but is fairly common at such high altitudes. The reason being the low oxygen concentration leading to increased hemoglobin and increased viscosity of blood making it more prone to phenomenon like clotting. Moreover, decreased physical activity at this altitude and such weather conditions combined with decreased water intake and more urine output contribute to the factors leading to conditions like CVST. I looked out of my window and realized that the weather was totally packed. It was snowing heavily and no stars could be seen. There were minimal chances of patient getting evacuated by helicopter. And the patient in any case could not be brought downhill by other soldiers on foot given the risk of avalanches and snow slides. It would only mean risking the life of other four to five people. I called up my officer of the unit and explained him the condition of the patient and my probable diagnosis. I also informed my senior medical consultant who advised me to put the patient on priority and raise a demand for heli evacuation. All these formalities were on. I again called up the people on the post and enquired about the general condition of the patient. The officer at that post told me that the patient is otherwise stable but is talking unusual things. At first I gave up a shut up call to the officer there and told him stop the bullshit. But he insisted me to listen to him.
“सर please आप मेरी बात सुनो. सर जब आपने injection देने के लिए बोला तो उसके बाद यह बिस्तर पर ठक कर के गिर गया और फिर एक दम से उठा और बोलने लगा, ‘ माता रानी तुम सब को कभी माफ़ नहीं करेगी. मुझे पता है किस ने मंदिर के पैसे चुराए हैं. माता को सब पता है. मेरी आत्मा बहुत नाराज़ है तुम सब लोगों से. गाँव में भी पहले किसी ने ऐसा किया था. उसको माता रानी ने बहुत कड़ी सज़ा दी थी. मेरी आत्मा को भभूती चाहिए.’ सर patient बुरी तरह से अपनी पूरी बॉडी हिला रहा है और सर झटक रहा है. जब यहाँ लोगों ने मिट्टी उठा के भभूति की तरह इसके माथे पे लगाईं तो एक दम से बिस्तर पर गिर पड़ा और सो गया. सर इसे और कुछ नहीं देवी आई है और इसलिए यह खेल रहा है.”
These were the exact words of the patient as told to me by the officer there. I ridiculed all this stuff and thought that the patient is not in his senses because of the clot. On further enquiry I came to know that the patient was from sirmaur district of himachal Pradesh and the things like black magic, jaadu toona, devi etc are very common in that belt of himachal. The patient had similar such episodes in the past and was observed by other people of the battalion in mandir before.
When this whole episode happened my senior officer decided not to raise the demand for evacuation of patient at that time. He explained me that it is a fairly common occurrence in people of sirmaur district and it is more of a psychological thing which has got aggravated because of the tough living conditions at that post. Moreover, the religious sentiments of the troops must be respected. But I insisted that the patient is critical and anything can happen to him if he is not being evacuated. Even if the weather doesn’t permit evacuation, at least raising the demand for it will save us from administrative repercussions in future if anything happens to the patient. At least it would show that we were concerned and we identified the problem timely for the betterment of patient. I explained the problem of CVST to the officer and told him that such type of behavior could happen in this condition also because the patient is not in his senses. I ridiculed that such type of behavior was related to his upbringing and place of origin.
While the discussions were hot, several other senior officers were put into picture and their opinion was taken. Everybody insisted that it is all psychological and nothing medical. I was abusing them to the highest order in my heart and calling them ignorant. Although I was the principal medical adviser for the troops there but being the most junior officer I couldn’t interfere much. Meanwhile the pandit of the battalion was consulted and his opinion was taken. He advised that a pooja would be undertaken coming Tuesday and we all would apologise to maata rani for our mistakes.
I called up the post again and enquired about the patient. The nursing assistant and the officer there informed me that the patient has become perfectly stable and is talking normally. I talked to the patient.
He said, “saab yeh mujhe pehle bhi hota rehta hai. Jab bhi ghar mein koi takleef hoti hai to mujhe maata aati hai.”
The medical adviser down below told me that it is nothing but psychological and there is no need for immediate evacuation. By this time I was also almost convinced that the things are under control and nothing sort of CVST has happened to him.
I also took my decision back and decided to go with the flow leaving everything to the destiny. Hope he gets fine and the attack doesn’t recur. The decision was taken that a big pooja would be held coming Tuesday and all the troops will apologise Maata rani for our mistakes.
I was convinced that the patient certainly didn’t have CVST. But can I explain the things medically? Yes the patient might be schizophrenic. In schizophrenia patient might feel possessed and he might have auditory and visual hallucinations associated with paranoid behavior. Or the patient might be having hysteria or the conversion disorder which may have all such type of symptoms and behavior. Or the patient might really be under supernatural possession. People behave weird when they feel possessed and under the effect of some supernatural power. But my grooming as a doctor expects me to be rational and scientific.
It was a clash. A clash between local customs and medical science. A clash between religion and science. A clash between man and god. medical science has come a long way. But it still needs to be politically correct and ecologically adaptable.
Is the patient schizophrenic? Or is he really possessed?
I rest the matter for discussion…
The second title may seem abrupt as the article proceeds. It is the title of a 2005 American horror film directed by Scott Derrickson loosely based on the story of Anneliese Michel and follows a self-proclaimed agnostic defense lawyer representing a parish priest who is accused by the state of negligent homicide of a young woman named Emily Rose after he performed an exorcism. The film brings out the conflict between medical fraternity and the fraternity of church over the death of Emily Rose. The film gives a very balanced unbiased opinion over the death of the woman by being both politically and scientifically correct at the same time. Rather the onus is on the audience to believe what they want to believe.
It was 7 o’clock in the evening. I was involved in a regular chat with one of my friends on facebook when I got a call from a nursing assistant on a post at 16000 ft. The doctor is usually not deployed in this terrain at such a height. So to provide medical cover to the troops serving there, nursing assistants are available giving them first aid and monitoring the patient till the evacuation by air effort takes place. It was an unusual call at such an hour of day indicating some kind of urgency. I could sense the apprehension in the voice of my nursing assistant. The things were definitely not in his hand.
“साहब, यहाँ एक केस हो गया है. एक सिपाही की पूरी बॉडी अकड़ गयी है, उसके हाथ पाँव मुड़ गए हैं और पूरी बॉडी हिल रही है.”
I got concerned as soon as I heard these words. I poked him further to get required history of the patient and other necessary details. It all started with a headache and numbness in both the upper limbs and tongue followed by two episodes of tonic spasms involving the whole body. In medical terms patient had suffered two attacks of seizures at an interval of 10 minutes lasting five minutes each. I enquired whether the patient had any such attacks in the past. The nursing assistant told me that patient had a similar attack previously while worshiping in temple when his body got stiffened. I ignored this history at that time. I found it to be insignificant. I immediately instructed the nursing assistant to give him an intravenous shot of injection diazepam to control the convulsions. The injection was given and the seizure activity stopped. Vitals were taken at this moment and they were found to be stable. It seemed to be case of Cortical Venous Sinus Thrombosis (CVST). CVST is a rare form of stroke that results from a blood clot in the venous system of brain. The symptoms include headache, numbness, weakness of one side of the body, seizures and altered sensorium. This condition though particularly rare but is fairly common at such high altitudes. The reason being the low oxygen concentration leading to increased hemoglobin and increased viscosity of blood making it more prone to phenomenon like clotting. Moreover, decreased physical activity at this altitude and such weather conditions combined with decreased water intake and more urine output contribute to the factors leading to conditions like CVST. I looked out of my window and realized that the weather was totally packed. It was snowing heavily and no stars could be seen. There were minimal chances of patient getting evacuated by helicopter. And the patient in any case could not be brought downhill by other soldiers on foot given the risk of avalanches and snow slides. It would only mean risking the life of other four to five people. I called up my officer of the unit and explained him the condition of the patient and my probable diagnosis. I also informed my senior medical consultant who advised me to put the patient on priority and raise a demand for heli evacuation. All these formalities were on. I again called up the people on the post and enquired about the general condition of the patient. The officer at that post told me that the patient is otherwise stable but is talking unusual things. At first I gave up a shut up call to the officer there and told him stop the bullshit. But he insisted me to listen to him.
“सर please आप मेरी बात सुनो. सर जब आपने injection देने के लिए बोला तो उसके बाद यह बिस्तर पर ठक कर के गिर गया और फिर एक दम से उठा और बोलने लगा, ‘ माता रानी तुम सब को कभी माफ़ नहीं करेगी. मुझे पता है किस ने मंदिर के पैसे चुराए हैं. माता को सब पता है. मेरी आत्मा बहुत नाराज़ है तुम सब लोगों से. गाँव में भी पहले किसी ने ऐसा किया था. उसको माता रानी ने बहुत कड़ी सज़ा दी थी. मेरी आत्मा को भभूती चाहिए.’ सर patient बुरी तरह से अपनी पूरी बॉडी हिला रहा है और सर झटक रहा है. जब यहाँ लोगों ने मिट्टी उठा के भभूति की तरह इसके माथे पे लगाईं तो एक दम से बिस्तर पर गिर पड़ा और सो गया. सर इसे और कुछ नहीं देवी आई है और इसलिए यह खेल रहा है.”
These were the exact words of the patient as told to me by the officer there. I ridiculed all this stuff and thought that the patient is not in his senses because of the clot. On further enquiry I came to know that the patient was from sirmaur district of himachal Pradesh and the things like black magic, jaadu toona, devi etc are very common in that belt of himachal. The patient had similar such episodes in the past and was observed by other people of the battalion in mandir before.
When this whole episode happened my senior officer decided not to raise the demand for evacuation of patient at that time. He explained me that it is a fairly common occurrence in people of sirmaur district and it is more of a psychological thing which has got aggravated because of the tough living conditions at that post. Moreover, the religious sentiments of the troops must be respected. But I insisted that the patient is critical and anything can happen to him if he is not being evacuated. Even if the weather doesn’t permit evacuation, at least raising the demand for it will save us from administrative repercussions in future if anything happens to the patient. At least it would show that we were concerned and we identified the problem timely for the betterment of patient. I explained the problem of CVST to the officer and told him that such type of behavior could happen in this condition also because the patient is not in his senses. I ridiculed that such type of behavior was related to his upbringing and place of origin.
While the discussions were hot, several other senior officers were put into picture and their opinion was taken. Everybody insisted that it is all psychological and nothing medical. I was abusing them to the highest order in my heart and calling them ignorant. Although I was the principal medical adviser for the troops there but being the most junior officer I couldn’t interfere much. Meanwhile the pandit of the battalion was consulted and his opinion was taken. He advised that a pooja would be undertaken coming Tuesday and we all would apologise to maata rani for our mistakes.
I called up the post again and enquired about the patient. The nursing assistant and the officer there informed me that the patient has become perfectly stable and is talking normally. I talked to the patient.
He said, “saab yeh mujhe pehle bhi hota rehta hai. Jab bhi ghar mein koi takleef hoti hai to mujhe maata aati hai.”
The medical adviser down below told me that it is nothing but psychological and there is no need for immediate evacuation. By this time I was also almost convinced that the things are under control and nothing sort of CVST has happened to him.
I also took my decision back and decided to go with the flow leaving everything to the destiny. Hope he gets fine and the attack doesn’t recur. The decision was taken that a big pooja would be held coming Tuesday and all the troops will apologise Maata rani for our mistakes.
I was convinced that the patient certainly didn’t have CVST. But can I explain the things medically? Yes the patient might be schizophrenic. In schizophrenia patient might feel possessed and he might have auditory and visual hallucinations associated with paranoid behavior. Or the patient might be having hysteria or the conversion disorder which may have all such type of symptoms and behavior. Or the patient might really be under supernatural possession. People behave weird when they feel possessed and under the effect of some supernatural power. But my grooming as a doctor expects me to be rational and scientific.
It was a clash. A clash between local customs and medical science. A clash between religion and science. A clash between man and god. medical science has come a long way. But it still needs to be politically correct and ecologically adaptable.
Is the patient schizophrenic? Or is he really possessed?
I rest the matter for discussion…
