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Case Study

A Case of Lung Fibrosis
Extracted from:
The System of Homoeopathy by Dr Rajan Sankaran.

Ed: This is the Extract of case 6 from the new book of from The system of Homoeopathy By Dr Rajan Sankaran

A man aged 38 years came to me in February 1995, with severe lung fibrosis. He had Tuberculosis in the past, which he neglected and developed fibrosis. He could hardly walk four steps or talk four words before having to stop for breath. He had been told that he would die in three months.

Dr: Can you tell me your story?
Pt: I had tuberculosis six years ago, which I neglected. It went from bad to worse and I lost one lung. I came to know that, as a side effect of the medication, both my kidneys were not functioning properly with excess loss of proteins.

I am losing weight all the time. My chest is always full, causing regular cold and cough. Every fortnight to a month, whenever weather changes, I get coryza, fever and chest congestion. Usually I am bedridden for one or two days in a month. My doctor has said that there is no treatment for my kidneys, except to take extra proteins. I could not undergo an operation for my chest because of my kidneys.

Dr: What complaints and symptoms have you now?
Pt: Congested chest and suffocation. I cannot move around at all. I get into a taxi at my doorstep to go to office. I have a sitting job. Then I come home and become a couch potato.

Dr: Forget all the problems for a while and tell me whatever you feel about yourself. Tell me about yourself, your childhood, dreams, hobbies, job, relationships, ambitions, grief's and disappointments, whatever you can say. All this is very important in Homoeopathy.
Pt: I am a bachelor. In my childhood we were very poor. I lost my mother at the young age of seven years. We were a large family and there was a scramble even for the bare necessities of life. I was supposed to be the only responsible person, though I was sixth among the seven children. A lot of burden was put on me even for domestic work, because my elder brothers were at boarding school. After my mother died, I literally had to look after my younger and second eldest brother, who is mentally retarded. I was average or little more than that in school, always came between first and fourth. Since I wanted to make sure I could study, I joined a boarding school and completed studying. Before long I lost my father and had to come up on my own.

I found a job for myself and have been living on my own. Life has always been a constant struggle from looking for a job to a place to stay; but luckily I kept on getting. I had ambitions like every individual, but I knew I could not achieve them because I did not have the means. So I had to take what I got. I had friends who were good to me and with their support and help I got few good jobs and made a little money for myself and today have a house of my own.

But all in all I have always felt incomplete, lonely. Maybe because of that I had a cigarette after my exams. At first it was one cigarette and from there it went on and on. I never took to drinking alcohol. Most of the time, my life revolved around my work. I would work very hard from morning until late night without bothering about food and drink, which compelled me to have tea all the time. All this I did because it gave me job satisfaction, I felt appreciated; I was looking for recognition and because the people in my office gave me recognition, I kept on working without thinking of the consequences. Would you like to guide me further?

Dr: Why did you not marry?
Pt: I did not marry because of the experiences of my family: my eldest brother's marriage was a disaster and ended in a divorce. The second brother married and he too did not have a happy life. The third brother also married out of compulsion. All these things have just put me off marriage. Later, when I did have second thoughts, I became sick and said: "Now forget it".

Dr: What happened to your brothers? You said that you are living alone now.
Pt: They are all in Poona and I am in Mumbai. Since the boarding school, which was twenty-five years ago, I have been in Mumbai and my brothers in Poona.

Dr: Do you have good communication with them?
Pt: Yes, very good connections. That also was only recently, when I was in a position to establish myself and give them something. Because they themselves were not financially sound to give me, although I am younger. So, now I can offer them some help.

Dr: And what about your brother who is mentally retarded?
Pt: He is looked after by my brother and sister. He is the second eldest, around forty-nine y.

Dr: Why did you neglect your sickness when they told you that you had tuberculosis?
Pt: I do not know. I just did not think it was important to take care of myself.

Dr: You knew that tuberculosis is a grave disease, so why did you not think it important? This point I am not so clear about? I am just trying to understand something about you. You knew it was serious, yet neglected it. What was the feeling behind that?
Pt: I do not know. Just futility, maybe. I do not know if I was feeling that my life is of no use.

Dr: And how do you feel about it now?
Pt: I do not feel like that. I feel that as long as I am alive and can help my brothers and sisters, it will be worth it.

Dr: Why must you help them?
Pt: Because they have always been looking upon me. Because they feel I was the one with advantages, especially since I was in a position to study, they considered me clever and it made me want to prove myself. I had to do things so that what they said was true.

Dr: What had you to do?
Pt: The household work: the cooking, marketing, ironing, sewing, technical things, repairing, decorating....just about everything. I liked it when they appreciated it. During Christmas when we would decorate the house, I would make flowers and put up the buntings, which everyone would love to see. And decorate the cars and the hall. Then painting. These were things people looked at.

Dr: Painting meaning?
Pt: I liked to sketch and draw. If the radio was not functioning I would repair it. I could fix the fuse at a very early age, when no one else would dare to touch it. These things I learned by just seeing.

Dr: Why did you do all of this?
Pt: Because it was expected of me by my father and my brothers.

Dr: What would hurt you the most?
Pt: Teasing. I was very thin so they teased me, they called me skinny, I would get irritated.

Dr: What was the feeling?
Pt: Irritated, I do not know exactly.

Dr: What are the things that hurt you nowadays? What are you sensitive to?
Pt: Nothing really. I just take life as it is. Occasionally I get depressed when I am very sick and in bed. That's all, nothing else. I just wonder why I wasted my life.

Dr: What do you mean, wasted your life?
Pt: The way I have neglected my health.

Dr: What are the dreams that you get?
Pt: Usually of day to day events, but very twisted and turned around; bits and pieces of the past. A dream that always recurs is that I am giving exams as big as I am today, because I have not passed, although in reality I passed with a first class. I believe I get this dream because I was staying as a paying guest with an aged lady who, when she heard I was to go abroad, did not want me to go. She got into a fit- took all my documents and threw them all down the chute and poured water over them and destroyed them. I had just finished my twelfth, and did not really know the consequences of being without my certificates. So, that thing seems to keep ringing in my mind; and comes as a dream that I am in a boarding school again and preparing for exams for my tenth class. The younger boys have caught up with me and I am still... I never appear for the exams in my dreams. It just ends without me appearing.

Dr: What is your feeling in the dream?
Pt: I keep asking myself if I did really finish and have my degree. I get up doubting whether I passed or not. I cannot go to any cupboard and look at my certificate and pacify myself that I have passed, because I do not have the certificate. I never got a duplicate made.

Dr: And what is this about the lady who tore your certificates?
Pt: I was living as her paying guest. When she tore my certificates I was totally upset... I cried the whole day. I went to my neighbour, who was also my friend. His father was there as well. They took me to their house and reassured me that nothing would go wrong and if necessary they would get copies of the same. The next day the landlady was so frightened by what she did that she took an overdose of a medicine and started acting crazy and had to be hospitalized. She died within fifteen days of the incident.

Dr: What do you feel about the whole episode?
Pt: I was worried as to the consequences of having to face the world without these documents, maybe I would miss a lot of opportunities.

Dr: And did you?
Pt: No

Dr: What other dreams?
Pt: Of my childhood, my house in Poona; happy dreams, though not exhilarating.(VP note the words- very specific for Opium- exhilarating) Dreams of being a child in the house playing; of my parents- just see them about the house, rarely my mother. Since the time I have been sick and in bed, I dream that I am walking faster than anyone without my feet on the ground, literally in the air.

Dr: What is your feeling in this dream?
Pt: Feeling of vigour and capability. I would see a snake during the day and dream of one at night. The snake would grow bigger and bigger and open its mouth and swallow me.

Dr: Were you scared?
Pt: Yes

Dr: What else?
Pt: When somebody fails, although he was warned, I get very angry. At work, I ask them to fax a message and make sure it is done, but it is passed on and everyone forgets about it. I feel I have not pursued it enough to make sure they did not make a mistake.

Dr: Do you blame yourself?
Pt: Yes, ultimately. At first I get upset. So too with my family. At first I blame them for the situation they are in and then blame myself. Sometimes I blame my father. He deprived us a lot by his drinking habits. I feel the root fault for all the family problems is my father. Maybe it was his lack of education, so how can we blame him? So I accept whatever has come my way.

Dr: Do you feel angry towards him?
Pt: Sometimes.

Dr: How would that be expressed?
Pt: I say to my brothers that whatever problems we have today, they are because of our father.. that helps us to compromise.

Dr: What are your worries?
Pt: The only thing I am bothered and worried about is that some day I will die. Will it be sudden, like suffocation, or gradual? How much time do I have? Will I be choked so that I cannot breathe? My chest gets so congested that there will be enough time for me to get it cleared up. Will I be traveling to work and meet with an accident? Or will I suffocate on the spot, because I will not be able to bear the pain?

Dr: Why should it worry you?
Pt: Anyone wants to know, to some extent, what chances he has. How long to live, what to plan.

Dr: Have you not planned something already? And if you died today would there be a big confusion?
Pt: No

Dr: Then why are you worried?
Pt: Maybe because I would like to let everyone know that it is my last .. not happen suddenly. Want the satisfaction that everything will happen like I want it to, and to my satisfaction. I would like to meet all my friends and relatives.

Dr: And do what? Why do you want to meet them? (He does not have an answer). What would they come and do or say?
Pt: I would just see their reaction.

Dr: Shat should they say to make you happy finally?
Pt: Nothing particular, I would be happy just to know that they will be sorry that I am going to die. Then I know they care for me.

Dr: Why should they care for you?
Pt: Because I have been there for them all my life.

Dr: You have done so much for them?
Pt: I want them to feel for me.

Dr: Not only because you did so much?
Pt: No

Dr: Did you ever feel loved by anyone as you are, without having to do anything?
Pt: Yes, I feel a lot of affection.

Dr: From whom?
Pt: From my relatives and friends. People at the office.

Dr: What about someone for whom you did nothing?
Pt: I am not sure.

Dr: What do you feel about that? Would you like that?
Pt: May be. Yes.

Dr: And that has not happened?
Pt: No

Dr: Can you think why not?
Pt: I do not know. Maybe I did not go about searching for that kind of love at all. As I was too engrossed in the recognition and appreciation given to me at work for the last ten years.

Dr: Is there any character in history or from the present day who impresses you or whom you would like to be like?
Pt: You mean a saint or someone? I used to have Mother Teresa's photograph with me earlier. I had brought it home and put it up out of admiration. But later on the admiration died. There were reports that she did these things only for recognition and propaganda.

Dr: She does not move you anymore?
Pt: No

Dr: So, what about her having impressed you at first?
Pt: Her passion for the most deprived. First and foremost to grow that old, to be loving and kind as she is. I thought she was the only true person, the existing proof of what people talked about. I wished I had a mother like her, here was a living example others were only stories of the past.

Dr: If you were to use just three words about her, what words would you use?
Pt: Kind, loving and gentle.

Dr: And why did you turn against her when you heard about the propaganda?
Pt: I started to think that it is others who do all the work and she is taking the cake.

Dr: What cake?
Pt: To be called a living saint.

Dr: If she did the work and got the recognition, it is okay?
Pt: Yes

Dr: You feel she is not doing it?
Pt: No, I feel her attitude has changed. She did not bother coming into the public before, Now she comes into the public. She is looking for recognition rather than really doing work.

Case Analysis
While taking the case and at the end of it I did not have any idea of what the remedy could be. And so my questioning was only aimed at understanding the person.

Look at the definite symptoms in the case:

·         He saw a snake. The snake kept getting bigger and swallowed him whole.

·         He was walking faster than others and flying.

Rubrics: So, the rubrics that one would select would be: 

·         Delusion, enlarged;

·         Vertigo, walking open air, as if feet did no touch the ground;

·         Delusion, snakes

The remedy that came through was Opium. Then I understood the symptom: "Benevolence". Also there is the symptom: "Delirium, reproaches himself for his folly".

I understood the case thus: He is creating this tragedy of his life with wanting friends and family to be there at his death. So his feeling is that no one cares for him and he wants at least that at the moment of death that someone can say they care for him. He is a man who is been doing for others all his life. He lives away from his family, still supports them and is dying.

Mother Teresa represents self-denial and service and unconditional love. His feeling is you have to serve without recognition and thus his admiration for her later dies. He sees a life where there is no loving and kindness given to him, thus his idealization of a kind and loving person as Mother Teresa.

One should go through the history of a patient and try to discern his story from how he perceived his life. That is his delusion, and his disease, and that is what has to be understood.

He dreams of a snake enlarging and eating him. In the other dream he is larger and flying above others. I could bank on these because these are totally not understandable. This means that somewhere in his deep subconscious these are important. They were recurring dreams.

This was my first case of a remedy belonging to the drug group or the group of addictive substances. This was a whole area I had not understood so far. The only thing I knew about Opium was pain/painlessness, visions, and constipation. I had nothing better to give him. So I gave him one dose of Opium 30C. From a study of these remedies of this group, I found some common themes;

·         A feeling of total isolation as if there is a distance between him and others, as if he lives in a vacuum and there is no possibility of any connection. Feeling isolated but not forsaken.

·         In order to connect they need to do a lot and help others. The symptom: "Benevolence" is common to the drug group of remedies.

·         In spite of doing a lot they do not get connected and they need to find something higher and hence the spiritual delusions and living in a world of fantasy.

·         In the feeling of isolation there is tremendous fear and fright, especially fear of death and injury. Death means isolation. "Fear of dark, groping in the dark" is a symptom if Opium. There is fear of the unknown: "Alone", "Frightful, dark".

·         Dreams and delusions of flying are also common to all drug remedies.

Follow Up After ten days
Pt: I feel a vast improvement in my chest, especially with regard to the stuffiness and congestion. I do not know if it is going to continue this way. I feel very light in my chest and less exhausted walking around. When I went to sleep after the remedy it was how you see molecules moving continuously and my whole body felt like something was moving all around. It was a pleasant turmoil, not scary, not painful. It was as though I had a realization the medicine was working.

Last time, I missed out one thing: Just after I realized in 1986 that I had this problem with me I left my job. I was so frustrated it led to suicidal tendencies. I took a piece of lead and put it in water and drank it. I do not know if I have been lead poisoned. I am generally better by ten to fifteen percent and more helpful.

(Comment: Opium is listed in italics for "effects of lead". More interesting is the suicidal ides: Opium is listed in suicidal by poisoning as an addition.)

One month later (09.03.95): Energy better. Dream that there is drainage all around the room and dark black water is gushing out and it is all out. The gutter is clear. Nothing is blocking it this time.

Pt: Mentally, I feel I will be one hundred percent cured and physically feel twenty-five percent better.

18.04.95: Less short of breath while walking. Dreamed of a snake, and I saw a sports field and there is a pit with mighty snakes. Two players fall in and the snake swallows them. Earlier it used to be me being swallowed.

I have a happy feeling, am mentally and emotionally stable.
The fear of everything coming to an end is far less.
(Comment: A healing dream)
The remedy was repeated again in the 30th potency.

The healing continued for 6 months and then he stopped the medicine, as he was feeling well. with one dose of Opium 200, when he reported an incident where he felt threatened.