She had a poetic aptitude for expression.
"I would let the chickens out of the coop. As they grazed, I would stare at the river. 'This is it, this has been the life for me that is about to end,' I would tell myself.
I was shaking. I was losing weight. I was sleepless at night and heart used to beat in a terrifying way. 'The river ghost has caught me and is bringing me down,' I thought. Little did I know that it could turn around so fast. I feel reborn," she narrated. A little perked up on this visit after medication dose adjustment on the last visit, a few days ago.
For those of us who have chosen medical subspecialties, this is as dramatic as it gets for the change in patient outcome. We are not the doctors who slit open the chest to plug the bleeding heart or crack open the skull to chop out a tumor from the brain or fix a broken leg after just a few hours of work. We are the ones who listen to vague prattle of patients, attempt to find what's bothering them by doing tests and tweak their physiology by several means to see if that helps. The outcomes are not necessarily dramatic.
At some level, the creed of medical subspecialty is an abstract one. We have to listen to vague words, grab non-verbal cues to direct us to the culprit. We do tests to explore our hunches. Abnormalities in these tests, we are asked to infer, reflect abnormality in certain body parts or processes. Based on these results we give our patients medications. We do not see these medications working with our bare eyes. But we take a leap of faith based on what someone else has told us about how it works. We work based on perception, hunches, and faith on certain tablets, capsules, injections or devices. It's a mushy field.
Yet, we choose this field with a notion that it helps suffering patients. And just like religious people who talk about their "doubts" on their god, we do have our doubts in our faith-heavy creed. I sometimes find myself asking, what are we really doing, when I see a patient who has to swallow twelve medications a day.
But the experiences of patients like our poet patient are what pulls us back to the vocation. Reaffirming our belief in the power and value of this creed.
However, Ms. poet's plight has another layer of story. Her suffering was largely inflicted on her and totally avoidable. The suffering, which spanned a length of life and death in her perceptual realms, was rather easily treatable and preventable.
She saw a doctor about a year ago with several vague symptoms. Her doctor found out that her thyroid gland was not producing enough hormones. He put her on a relatively high dose of thyroid hormone. But she never had a follow up after that. Her thyroid hormone levels were never checked and she kept taking the medication. That dose was excessive for her and caused all her symptoms.
At technical level, it was a very simple and routine problem. There was not much of threat to her life and the problem was easily solvable. But her suffering was indeed not so benign. She thought she was dying from the wrath of an unkind river ghost.
The question of why she had to endure such a suffering is a complex one. Perhaps she ignored the doctor's instruction to have blood tested after a few weeks. Maybe it was entirely her fault.
But what bothers me is that more likely the fault was entirely ours. If you have interacted with our Nepali doctors and power holders, as a nobody, I am sure an impassive face will come to your mind. This face is quiet, distant, and almost conceited. For the things you need to do, you are expected to find out using intuition. By heavenly mistake, if you happen to inquire this godly creature, wrath might spill out in violent waves, drowning you in an utter indignity. So it would be no surprise if this patient was never explained that she needed to have levels of hormones tested after 6-8 weeks or she heard a babble that she didn't understand but didn't have courage to ask.
For those of us who have chosen medical subspecialties, making our patients understand things is not a luxury but a basic necessity. Their outcomes and sufferings depend on it. We will not succeed always. But we have no right to put on our smug face and ask our patients to intuit us. In our mushy world, our conscience demands that at least we try.
(Addendum: This got published in Republica with some addition + editing on June 24th, 2014. They changed the title to "Cold shoulder" which I have a hard time relating to. But our mighty editors do not seek writer's consensus to change things. They just do it! Still, I have to take a solace because it is less cringe worthy than being changed to almost bigoted "White man's burden" for an article that guilelessly talked about "Resources and physicians" just because the patient context was the US.)
"I would let the chickens out of the coop. As they grazed, I would stare at the river. 'This is it, this has been the life for me that is about to end,' I would tell myself.
I was shaking. I was losing weight. I was sleepless at night and heart used to beat in a terrifying way. 'The river ghost has caught me and is bringing me down,' I thought. Little did I know that it could turn around so fast. I feel reborn," she narrated. A little perked up on this visit after medication dose adjustment on the last visit, a few days ago.
For those of us who have chosen medical subspecialties, this is as dramatic as it gets for the change in patient outcome. We are not the doctors who slit open the chest to plug the bleeding heart or crack open the skull to chop out a tumor from the brain or fix a broken leg after just a few hours of work. We are the ones who listen to vague prattle of patients, attempt to find what's bothering them by doing tests and tweak their physiology by several means to see if that helps. The outcomes are not necessarily dramatic.
At some level, the creed of medical subspecialty is an abstract one. We have to listen to vague words, grab non-verbal cues to direct us to the culprit. We do tests to explore our hunches. Abnormalities in these tests, we are asked to infer, reflect abnormality in certain body parts or processes. Based on these results we give our patients medications. We do not see these medications working with our bare eyes. But we take a leap of faith based on what someone else has told us about how it works. We work based on perception, hunches, and faith on certain tablets, capsules, injections or devices. It's a mushy field.
Yet, we choose this field with a notion that it helps suffering patients. And just like religious people who talk about their "doubts" on their god, we do have our doubts in our faith-heavy creed. I sometimes find myself asking, what are we really doing, when I see a patient who has to swallow twelve medications a day.
But the experiences of patients like our poet patient are what pulls us back to the vocation. Reaffirming our belief in the power and value of this creed.
However, Ms. poet's plight has another layer of story. Her suffering was largely inflicted on her and totally avoidable. The suffering, which spanned a length of life and death in her perceptual realms, was rather easily treatable and preventable.
She saw a doctor about a year ago with several vague symptoms. Her doctor found out that her thyroid gland was not producing enough hormones. He put her on a relatively high dose of thyroid hormone. But she never had a follow up after that. Her thyroid hormone levels were never checked and she kept taking the medication. That dose was excessive for her and caused all her symptoms.
At technical level, it was a very simple and routine problem. There was not much of threat to her life and the problem was easily solvable. But her suffering was indeed not so benign. She thought she was dying from the wrath of an unkind river ghost.
The question of why she had to endure such a suffering is a complex one. Perhaps she ignored the doctor's instruction to have blood tested after a few weeks. Maybe it was entirely her fault.
But what bothers me is that more likely the fault was entirely ours. If you have interacted with our Nepali doctors and power holders, as a nobody, I am sure an impassive face will come to your mind. This face is quiet, distant, and almost conceited. For the things you need to do, you are expected to find out using intuition. By heavenly mistake, if you happen to inquire this godly creature, wrath might spill out in violent waves, drowning you in an utter indignity. So it would be no surprise if this patient was never explained that she needed to have levels of hormones tested after 6-8 weeks or she heard a babble that she didn't understand but didn't have courage to ask.
For those of us who have chosen medical subspecialties, making our patients understand things is not a luxury but a basic necessity. Their outcomes and sufferings depend on it. We will not succeed always. But we have no right to put on our smug face and ask our patients to intuit us. In our mushy world, our conscience demands that at least we try.
(Addendum: This got published in Republica with some addition + editing on June 24th, 2014. They changed the title to "Cold shoulder" which I have a hard time relating to. But our mighty editors do not seek writer's consensus to change things. They just do it! Still, I have to take a solace because it is less cringe worthy than being changed to almost bigoted "White man's burden" for an article that guilelessly talked about "Resources and physicians" just because the patient context was the US.)
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