Speaking for Myself 199
Learning from our
patients
OM PRAKASH
VIGNETTE 1
Mrs DB was 78 years old. During her long
journey through life she had lost her left breast,
gallbladder, uterus, all her teeth and the lenses of both
eyes, but not her urge to live. Long-standing diabetes took
its toll and she suffered from frequent episodes of cardiac
failure. Her renal function declined and added to her
difficulties. As her physician, I was struck by the devotion
with which her daughter (Mrs MB), a cheerful, chubby woman of
40, cared for her. There was never a frown on her face during
the trying and long periods of her mother’s stay in the
hospital. I repeatedly warned Mrs MB that her mother’s end was
close at hand and that family members should prepare
themselves for the inevitable. One evening, Mrs DB suffered a
cardiac arrest and passed away. We tried to console her family
members and they seemed to accept the event as inevitable.
After a few months, I was walking towards the wards when I
spotted Mrs MB near the laboratory, where she had come with
her son for some tests. I remarked about how impressed we were
by the devoted care she had bestowed on her late mother. I
added that my repeated reminders that her mother was very ill
were solely to ‘soften the blow’ as it were. She looked at me
and said (I translate), ‘I knew all that very well, Doctor!
But you know, my mother did not know it!’ I stood there,
stunned for a few moments. It took me some time to realize the
profound and fundamental truth. After all, in our attempts to
mitigate suffering, our primary concern should be the patient.
Did I miss this point somehow, I pondered, in communication
with my patients? Should I have adopted a more sympathetic
tone while talking with those patients who lived by that thin
thread of hope?
VIGNETTE 2
Mrs SM was a 30-year-old, voluble and vivacious woman. She
had had fever for over a month. Many an investigation had been
done, with no definite diagnosis. She had lost weight and was
admitted. We reviewed her case in detail. The only new finding
was a suspicion of bilateral enlarged hilar nodes. A CT scan
of the chest confirmed this; an ultrasound examination of the
abdomen revealed enlarged para-aortic nodes. A laparoscopic
node biopsy showed a strong possibility of tuberculosis and
treatment for this was started. Her fever continued unabated.
Her hospital stay was anything but uneventful. Apart from
fever, myalgia and an episode of atrial fibrillation, she had
night sweats and loss of hair. She became mildly depressed and
anxious. Her husband, Mr SK, was frequently at her bedside. He
was very patient and unobstrusive, and had abundant faith in
the treating team. One morning, her blood pressure fell and
she was transferred to the intensive care unit. She had
several loose motions and stool cultures grew
Shigella. Though given antibiotics for
shigellosis, her condition did not improve. We thought, just
in time, that we may be dealing with systemic lupus
erythematosus (SLE) instead of tubercular infection. Serology
was strongly suggestive of SLE and systemic steroids caused a
remarkable remission. She became well in a few weeks and
returned to work. She keeps in touch with us by way of
greeting cards on Diwali!
VIGNETTE 3
I saw Mrs JR about 7 years ago, when she
was 64 years old. She had a long medical history. The first
time I saw her she smiled apologetically at me and related her
medical problems.
It indeed was a long one. At the age of 30,
she had under-gone mastectomy for cancer, followed by chemotherapy and
radiation. Multiple gallstones and inflammation necessitated
cholecystectomy at the age of 41. When she was 50 years old,
she developed hypertension needing medications. This was
during her husband’s illness due to a cerebrovascular stroke.
When she was 60 years old, she was diagnosed with angina and
this was complicated by the presence of aortic regurgitation.
These were treated with coronary artery bypass grafting (CABG)
and aortic valve replacement; she continues to take warfarin
and checks her prothrombin time regularly. Two years earlier,
before she came to me, she developed haematuria which,
unfortunately, turned out to be due to cancer of the bladder.
She continues to take local injections and undergoes
cystoscopy on a periodic basis. The angels of health continued
to toy with her, and she developed syncope due to complete
heart block. She is on a pacemaker. Despite these problems,
which would make any mortal quail, Mrs JR is one of the most
serene and uncomplaining patients I have had the good fortune
to take care of.
Let me comment on these individuals with varied illnesses.
It is commonplace for us to treat very ill patients who are
often in the last stages of an advanced illness. There are
those who would not really like to know that their end is
close at hand; there are others who accept the reality
gracefully and are calm in the face of imminent death.
Further, in our cultural context, doctors have to deal not
only with patients, but with a large number of close relatives
and friends; not infrequently, some of these people, well
meaning no doubt, impose their opinions on whether the patient
should be told the stark truth or not. What should the doctor
do? Clearly, there is no rigid stand one can take. But the
point that we often miss is very obvious, as demonstrated by
Mrs DB’s daughter’s remark. Mrs SM and her husband were the
epitomes of fortitude. In the face of a prolonged illness,
they made our job easier by reposing immense trust in the
treating doctors. Her husband, in particular, managed to take
impeccable care of her emotional needs and thus kept her
morale conducive to healing. When we remarked about this
aspect after his wife was well again, he just shrugged his shoulders and smiled. This marriage, I
remarked to him, was certainly made in heaven! What can I say
about Mrs JR? She continues to make me feel inadequate, to say
the least! Her abiding trust in the Divine has perhaps a major
role to play in her life’s journey; further, her respect for
life in general and a deep desire to have a good quality of
life despite all odds, are amazing. We, as doctors, have a unique opportunity
of seeing people in various states of distress. Even as we try
and help them through difficult times, I feel that we have a
great deal to learn from those whom we treat. Perhaps
inculcating this in the medical curriculum will help make our
vocation more humane by enhancing mutual respect between
doctors and their patients.
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