Wednesday, March 18, 2015

Other Side of the Coin

Being a doctor in practice for more than five years now, like most other experienced doctors, I am probably going through that phase of experiencing life on the other side of the doctor-patient relationship. My father used to say that he went through a lot of emotional breakdown seeing patients and their families go through illness and loss in his initial years as a doctor. He used to be sensitive to patients' and families' emotions. He later grew a little more philosophical and little more detached and may less emotionally perturbed on loss or sickness of his patients.

But since I left my training and into the real world, I was more mechanical and probably insensitive to the patient's emotions at first. Probably because I was myself going through a lot of changes in my personal life like starting to work, moving to a new place, getting married, having a child and so on. Other part of it is probably that I am an 'alien' in a new country. Unless you have lived there for a certain number of years and have developed social relationships with people around you, you do not get to know or own the country or culture you move to. It also depends on how long you spend at one particular place. I started to learn some culture of the country I moved to but not deep enough for me to understand how a person going through serious illness would handle and experience from a perspective of a native.

Then there came a time when I started experiencing it myself, first-hand as a patient or patient's family about how it feels like in the health care setting I work for. That experience is something that gave me a lot of insight. Insight on a lot of different things like what would be the worries that patient's have when they see the doctor, how important is accessibility to them for future questions, how would the family dynamics help healing a person, how important a nutritionist, a nurse, a therapist, a room cleaner is in interacting and making the patient life better. After all said and done, all health care is for the patient. As a doctor, I control a major portion of it but not all of it to make my patient's stay in the hospital or a visit to the office comfortable and tension or worry free. There is definitely a certain amount of psychological stress that no matter what anybody says the sick person and his family will go through. We can only direct them and try to alleviate the tension by letting them know about they do not know.

As somebody has put it 'The Unknown'  is what that really makes anybody in the world stressed. Even death, if they know that they are going to die in a certain way, people could die in peace. Most people might agree tht death is the worst thing that might happen to a person. But I think even worse than death are the questions about the unknown about the circumstances, family, pain and sufferring are the ones that make the fear of death worse for anybody. I had patient's with terminal disease who on revealing their diagnosis and prognosis were completely content with their life and achievements and ready for the inevitable and on assurance about what to expect would do amazingly great. I also had patient's who actually break out in tears because of the diagnosis or prognosis, but most likely be explained by some lack of clarity of thought about family support or changes in plans and the whole after math. I am not denying that 'knowing bad news' is horrible. But bad news becomes extremely painful if it involves lack of knowledge on what is going to happen and the patient is left in the dark.

Wednesday, May 21, 2014

Stories of a 'Selfie' and 'Divine Law'

I am not a veteran in medicine. I consider myself to be naive. But even with the little experience I had in this profession, life seems to be a very fragile crystal sculpture that could be amazingly beautiful if handled right but could be easily shattered into pieces if otherwise.

We (with my other colleagues and friends in my profession) play a routine game in figuring out what the tipping point was in a person's life, trying to figure out what led to a person's entirely complex medical story. I intentionally avoided the word 'history', commonly used phrase in and around doctors' offices. Though the word brings its roots from 'His Story' a lot of times it used as if it has nothing to do with the person's life. It is intact, however complex one's medical history may be is actually a saga, a clear story. There is clear format. Like my wife always says 'All Bollywood / Tollywood movies are the same basic plot'. 

Hindu Philosophy already has this all figured out (like we always love to believe) that God has a story written for us. I partly agree with that. Well again, I do not want to get into the free will and pre-written debate. I said, I only partly agree with that because only a few of the stories of downfall of a life actually seem to be 'beyond control'. Of course, Medicine is Science. It tries to explain things and put logic into things and predict what could have caused so and so and try to fix it. So as Practitioners of Medicine, we try to deduce logic out of wrecked lives due to ill health and intervene. When we do that, the starting point of the down spiral for each person can be vaguely classified into groups. 'Selfie' and 'Un-provoked'. 

'Selfie' here is not a self taken photograph like it is popular as now a days, but it is a self-inflicted injury without the knowledge or wisdom about the consequences. Please stress on the word Wisdom. People make wise choices only after they 'learn' to be wise. No body is born wise. A sharp and garden variety of a selfie is the age old 'Fashion' of Smoking. Tobacco has been a commercial crop for more than a few centuries. It built nations and flourished in then fast growing economies. It is deep rooted in the culture and commerce. Not until the 1960s did anybody even know it is liked to cancer. How could you 'Blame' some body from the early 19th century or for that matter until recent times about their tobacco smoking? If new research comes, saying all cell phones can cause cancer, would you be willing to part with your  life partner?(You know, the actual life partner, your mobile phone, not your wife). Coming back to the point, considering Smoking in current world has enough policies and information against it, those who recently ruined their life due to tobacco, could be considered a selfie. Having said that, I know a lot of people in my professional and personal life that smoke as a result of stress or strain in their life. Emotional, Professional Stress and ever growing demands of the modern society is making us run like machines, forcing us to seek coping strategies. Again, the debate of 'freewill' and 'predestined destiny' comes into picture. Somehow or the other people pick up smoking as their coping strategy. People like me who strongly believe in Medicine and Science say that it is a 'Selfie'. Choose a coping strategy that could be 'healthy' and gets you out of the emotional turbulence, rather than one that compromises health and puts you in more trouble is a 'choice' one should be able to make (especially when he is knowledgeable and wise).

Other side of the coin, an 'un-provoked' down ward spiral is the one that makes me pity some one. It is something that we could not find a reason for. It is something that either we have not found a causative association with anything and something we cannot explain by logic. The more and more you know medicine, it is pretty much obvious that 'selfie's are more common. So, we can safely say a person who does not self inflict injury would have more likelihood of surviving longer than otherwise. But it disheartens us to know for example some body got, lets just say, lupus. Lupus is a auto-immune disease, one of many where our body identifies our own body cells as foreign and starts attacking them. Diabetes in young could be a form of Autoimmune disease but the other kind due to eating heavily disproportionately than what one spends is more common. So lets say a person has lupus, or even basic asthma, the cycle starts with steroids to control symptoms but no relief and it perpetuates into side effects of weight gain, then high blood pressure, then diabetes mellitus then coronary artery disease so on and so forth. This vicious cycle is unfortunate. This is not started by a selfie. But, Hope in Medicine is that, the vicious circle could possibly be intervened. At some point, say for example, avoid the trigger for asthma, seek early medical attention for reducing the number of attacks requiring steroids, could help preventing pre-diabetes turning into overt diabetes by exercise and diet. There are still some poor souls, nothing works and they still spiral down, but these are rare if meticulous care of breaking the cycle at all check points is looked at. 

I am far from saying, we could all live forever. I am theist. I believe in science to the extent of that. I still believe that after all said and done, unprovoked and unexplained destiny of ill-health and ultimate truth of death awaits every living being in one or the other form and it is probably predetermined by the Almighty, by what ever name one might call. My one and only advice to you all is figure out your tipping point and avoid tipping if you could and enjoy the life you have. Listen to your body and hear your mind. If they say they need help, they definitely need help. 

Syam Prasad Mallampalli