Mahesh walked into my office with a bit of a limp. “My right foot is dragging,” he said, as he made his way uncomfortably to the chair in front of me. “I have a lot of back pain and it’s going down my right leg,” he showed me, gesturing with the palm of his hand. I listened patiently. “The orthopaedic doctor we saw told us it’s sciatica and suggested some medication and physiotherapy,” his anxious wife explained, “And now that he’s not better, they want to give him an injection,” she added, pulling out the MRI of his lumbar spine for me to see. Like most patients, she believed that’s where all the answers were. I allowed the films to sit on the table for a while.

I’m delighted to have trained at a centre where we focused on clinical medicine. “Talk to the patient, hold their hand, touch them, examine them, and only then look at the scan,” the words of my teachers echo in my mind every day when I sit for hours in the OPD. I asked him to lie down and relax his leg, while I toggled my hands behind his knee and lifted it up a little to see it go into an uncontrolled jerky spasm. I took a reflex hammer and tapped the knee, and the leg was ready to fly out the window. “Your leg is spastic,” I professed. “This cannot be a problem in your lumbar spine; it has to be higher up,” I said, as I went on to check the sensations on his torso. The right side was entirely numb below his ribcage. I ordered an MRI of his thoracic spine instead, demonstrating a master class in clinical diagnosis.