A good doctor needs to empathise with the patient and his family
- Lee Wei Ling

I have been looking after K for 20 years. He is severely men tally retarded and suffers. in addition. from cerebral palsy and epilepsy.

The cause of his condition is not definitively known. Chromosome studies have shown an abnormality - a balanced translocation - which his mother also has.

Individuals who carry a balanced chromosomal translocation possess the full complement of genetic information but some pieces of their chromosomes haveswitched places. It is estimated that one in 625 people in the general
population carries a balanced chromosomal translocation.

Chromosomes are structures in our cells that carry our genetic information. Normally, we have 46 chromosomes - or 23 from each parent.

Individuals who carry chromosomal translocations are typically healthy. However, they have an increased risk of infertility, and if they are female, of miscarriages or stillbirths, or having children with birth defects.

K's mother is a normal intelligent Indian woman though she too has a balanced chromosomal translocation. Her parents-in-law live with the family and they, as well as her husband, did not want to tempt fate by her having a second child. She bore the brunt of caring for K as well as the blame for giving birth to a handicapped child.

As a paediatrician and a neurologist, I consider not only my patients but also their families to be my business. I asked the mother whether she would like to try for a normal child. She replied that she very much wanted to. So I urged her to try.

She duly got pregnant. Because of K's congenital abnormalities, the obstetrician did an amniocentisis. The result showed the baby had the same abnormality as K and the mother.

K's mum asked my advice about getting an abortion. To this day I don't know why I was confident enough to urge her to carry the baby to term.

My logic was that since the mother had the same
balanced chromosomal translocation as K but was normal, the balanced translocation was probably a red herring and not the cause of K's handicaps.

Sure enough, a beautiful normal baby girl was born. Later, K's mother became pregnant again and again gave birth to a normal child - this time a boy.

Her parents-in-law and her husband were delighted to have two normal children. They seemed to have forgotten the psychological pressure they had, perhaps unwittingly placed on her.

Over the years, K has grown bigger in size but with no improvement in his condition. His mother finds it tiring to look after a handicapped adult child as well as her ailing parents-in-law.

But each time she sees me, we are both happy, for it was with my encouragement that she decided to have more children - both normal. She hopes these two will one day look after her and her husband, as well as K.

Life has many risks. Less than 100 years ago, giving birth itself was a risky business which could kill the mother.

I am by nature a risk taker - but only in matters that concern men. I am much more conservative when taking risks involving other people. What prompted me to advise K's mother to continue with her second pregnancy was partly logic and partly sixth sense.

Logic suggested to me that the chromosomal abnormality was a red herring. In addition, medical science tells us that people with balanced chromosomal translocation can often be normal.

I have not solved K's problems although I have been able to reduce the frequency and severity of his seizures. But his mother is grateful to me for encouraging her to have two normal children. Indeed, that is the most important thing I have done for this family.

Medical practice is partly scientifically based but a good doctor needs more than medical knowledge. He also needs to empathise with the patient and the patient's family.

I am not a great doctor, but patients and their families can quickly detect whether or not a doctor is sincere or merely going through the motions with yet another patient on his list of patients for the day. Many of my patients and or their families are my friends.

Being a doctor is a privilege not because of the money we can earn or the social status our profession confers on us. It is because of the opportunity our profession gives us to share in the lives of our patients and their families and to try to make their lives better.

I finished my A levels planning to be a veterinarian. My parents persuaded me to be a doctor to humans instead, and that is what I have been doing for the past 32 years. I look back with quiet satisfaction at the little I have done to ease the suffering of my patients and their families.

The writer is director of the National Neuroscience Institute.