Sunday, July 1, 2007

Fragile

Have you ever known the feeling when you want to do something for somebody so bad that it hurts, but you just cannot?
Have you ever felt so inadequate that it makes you want to cry in helplessness?
Have you ever been in a place when people around you feel hopeless, but you cannot come up with anything to console them?

I have.
Since the past couple of weeks.

I am posted in pediatrics these days. And at times, i am depressed.
Why? Because,
Nothing in medical education prepares us to tell vulnerable parents that their child, the one sleeping on the bed rather blissfully, might not make it until long.
Nothing in all the extensive training braces us enough to stand the grief of a mother (who works 14 hours a day as a coolie, for a less than hand-to-mouth existence) who is told that her child will not survive unless she went through a surgery that costs 6 lakhs of rupees, a sum of money she cannot even imagine there being.
And nothing, absolutely nothing can make us strong enough to answer the question parents dread we would answer in the negative : "Is there any hope, at all?"

One understands that by choosing medicine we have chosen a path that requires us to be a lot stronger than most people our age. But it remains that we are just 21 year olds, trying to pass exams, going through lives as complicated/mundane/hormone-driven as any 21 year olds', and that we do not have any answers.
We might have cut open a dead body, but that's just where our bravery ends.
We might look dapper in white coats with expensive stethoscopes, but that's just where our being doctors ends.

A few days ago, i spoke to a woman whose son had been admitted in the hospital. The son was a cherubic 3 year old with cerebral palsy, the fault perhaps of a local daai, who took too long to deliver the baby, or whoever else's. But one thing is certain, the child had cerebral palsy. A fairly common condition in the wards, and sometimes very crippling.
This particular child had a global developmental delay, meaning all aspects of his development were either retarded or absent. A truth the mother has grown accustomed to be oblivious to. She says the child looks at her, turns his head toward sounds she makes, and smiles from ear to ear when spoken to.
The reason this story is throat-gulp inducing is because all of it is impossible.
The child has cortical blindness, his brains cannot read the images brought by his eyes.
The child cannot hear any sound, let alone those the mother makes. He merely turns his head hither and thither, acknowledging a world only he lives in, a world not inhabited by even this woman who has given her all for this baby, her only one, for the past three years.

What do you tell her when she asks you, "He is alright, isn't he?"
Do you tell her that the apple of her eye does not have the eyes to see you, or the mind to recognize you, ever? Do you tell her this and hope to have the courage to console her?
You don't.
We don't, either.
We say, "Please talk to senior doctors, we are just students", and whisk away from the place to find a strong pillar to punch our clenched fists against. Not because we are incapable of helping the child medically, but because we are incapable of even saying words that would comfort her, albeit momentarily.

Worse is a visit to the neonatal ICU, where little babies weighing as little as 900 grams, looking no larger than the palm of your hand, struggle it out with their small lungs, failing hearts and tightly clenched fists, praying in their own languages, 'please god, please, i promise i will be a good boy'.
With a hundred tubes sticking out all over their bodies, synchronized beep-beeps are all they have for company with the beeps more often than not, counting down their final breaths and heartbeats.

And you merely tap at the glass cabin that is their home,
and feel helpless.

This is a phase every medical student goes through, i guess. This is the stuff hospital dramas on TV are made of, since forever. Only, this is the only thing they get close to showing the truth about.

Over time, we get refractory to this whole phenomenon, i am told. It amuses, or perhaps angers some of my non-medical friends when i sometimes talk of death and illness in a matter-of-fact manner. It angers me, in retrospect, when i think of myself having become thus, where illness is a case to be taken, and death, a figure on the register. But this is the only way i know of being. The system has not prepared me, or any of my friends to deal with situations like these.
Death, to us is cessation of cardiopulmonary activity and non-reactive pupils, as opposed to it being a bereavement and loss of livelihood to an entire family.

If depersonalizing oneself is what it takes to make it as a successful doctor, then may be i will not be one. For, i still feel sad for a woman of 40, whose only chance of being a mother counts its last few minutes on an ICU bed.
I am not saying others do not feel sorry for her. They do, in all likelihood. But won't talk about it, because talking about it makes people think they are vulnerable. And "sissy". And that's anathema, but of course.

This post might seem a little too dramatic and serious, especially as it comes right after a feature on bombshells and thunderthighs. But telling this was essential, to me.
Until such a time as medical science progresses to a state where every patient is cured, we can only do one thing. Hope, and pray. (To a god whose existence, in the wake of all this, seems more than debatable.)

But then, that is all we an do.
Pray for the little children, and their families.
As i am sure you will all.

25 comments:

Anonymous said...

i don't know what to say, goo.
i've seen you like this before.

and i'm sorry i haven't been around lately.

although it's an alarming thing to say, it will pass. and you are a wonderful human, and that will make you a better doctor.

=)
much love and pride.

Kavitha said...

A very touchy write up....I always wanted to be a doctor but could not as I did not get a seat. I was then very disappointed. Now I am married to a doctor and I share his pain and anguish...well, as much as possible, and that I realize might be very little. You guys are the "wounded healers"....

tangled said...

:'(

um can't say more at the moment.
but :'(

all or nothing said...

I don't know what to say...

Amogh said...
This comment has been removed by the author.
Amogh said...

Get on with your job, mate!

More seriously, I am sure the mood will pass, though the truth in your sentiment might not. You are preparing for the day when you will have to face the question instead of passing it on to the senior doc.

I believe that a doctor is in a great position because he has a chance of being noble, truly noble. (Lawyers, I am afraid, don't get anywhere near that high pedestal in spite of some claims of 'being part of justice being done'... at least in my books). For every despairing situation, you'll have twice the number of opportunities to make people feel better, to ease their pain, to cure disease, to conquer death even... and to give life. Be a good doctor, make use of these opportunities!

And if you want to read a story about a guy who's been there, felt that... read Maugham's "Of Human Bondage". It's a classic.

But if you are still in that mood, get to see the lighter side of the medical profession with Richard Gordon. I love his writing!

Anonymous said...

"Worse is a visit to the neonatal ICU, where little babies weighing as little as 900 grams, looking no larger than the palm of your hand, struggle it out with their small lungs, failing hearts and tightly clenched fists, praying in their own languages, 'please god, please, i promise i will be a good boy'."


=(
very nicely written..

Quietly Amused said...

Ok after that pretty much all encompassing post and the comments ranging from love, to sympathy to a get on with it, I'll have to admit that these questions are ones that float through anybody's mind in the midst of medical training and nothing generates these thoughts faster or more effectively than pediatrics. While we can understand a 50 year old alcoholic dying of liver failure, or at least rationalize it, there is no defense against a infant with leukemia. For anybody involved. But it's not hardening yourself that'll help... it is the realization that despite being doctors, being near worshiped by patients and attendants alike, we are not infallible. We actually have very little to contribute to the human body's capacity or incapacity to recover. All we can do is ease pain and suffering. that too only to an extent. we offer empathy to keep ourselves sane, and push ourselves to exhaustion only to not have to think about every thing that is not in our control but should be.
It's not easy, it's not impossible and it only comes with time.

Spunky Monkey said...

@anonymous, that ain't so anonymous - What do you care?
You are leaving.

@Kavitha - Thank you, Kavitha. "Wounded healers" sounds a little too dramatic. After all, we are doing o charity. To earn a livelihood is, one must also remember, one of the reasons why we choose to be doctors. But i am sure, being a doctor's wife, you understand the intricacies of this much better than most lay people.

@Tangled - Then, you must see those kids. Sad stories some of them, really.

@All or nothing - That says quite a lot ya.
(All or nothing reminds me of a law in physiology. But that of course interests none that stop by here.)

Spunky Monkey said...

@Amogh - The opportunities to do all the things you mentioned form part of the reason why we choose to do medicine. But for some reason, i choose to blame the insanely unhuman curricular requirements, our nomenclature of things around us changes rather radically, and for the worse.

Have heard too much about Maugham. So, may be it IS time to read "Of Human Bondage" after all.
And i have never read Richard Gordon. Doctors is all i have read as far as "medico-literature" goes. After that, you can't really blame me for not reading more books of the sort. Oh lord, what hideousness that was.

@anonymous - Aw, thank you. I liked those lines myself too.

@Neuroboy - You are so right about the pediatrics bit. I have been doing the hospital rounds since long enough for one to assume that i would be refractory to such situations. But looking at those sick children, sick for no reason they know or understand, makes you want to put things in perspective. Some maternal hormone surge or something, Pituitary only knows.

Kavitha said...

Hey Spunky, charity or not...All of us choose our professions for a livelihood..to earn. But the price you pay for it is much higher than we do...Anyways, I feel Docs who think the way you do will be able to understand and reciprocate to the kin of your patients much better than anyone...

Anonymous said...

what do you care,
you didn't even say bye.

Malaveeka said...

Amogh: You're wrong about lawyers.

Spunky: I sound insensitive but post new post!

Malaveeka said...

Amuls = Anon.

Anonymous said...

tugged my heartstrings. you come across as a very sensitive n caring person. you should write more often about things which happen in the life of a medico..would make an interesting read for the rest of us.

Spunky Monkey said...

@Malaveeka - I am so lazy, and out of ideas these days. Guido Anselmi types. Dry.

@anonymous - How kind of you. Thank you very much. But why would you not leave your name?

Shamanth said...

"Well written" just seems so out-of-place. I cant imagine handling death first hand the way you speak of. Doesnt it drain you? Or give you a bah-what's-the-point-of-this-all feeling? Do abstract musings and novels and movies about life and death prepare you for this?

The way you doctors get to see life and death up close, I wonder how I'd react to such circumstances as those you write of. You make me want to sample your life, to experience it - alas, I'll never find out.

I was reading about Kavery Nambisan writing about her experiences in Bihar and UP an hour ago, and I'm amazed, moved by the way you guys work.

Spunky Monkey said...

Hey Shamanth,

Like you say, 'death' does drain you, (more like sap you actually), but the curriculum somehow manages to keep us not as affected.
In that, we cut up cadavers in the first year; and realise that it is pretty much a wax model we are hashing into.
In second year, we watch postmortems happen; feel dizzy for a bit, puke if at all, and know for a FACT that nothing could get worse. And it is true, nothing is worse than a postmortem.

The only things that still manage to affect us is having to face the family, and telling them answers. Being students, that responsibility does not really lie on us, but we'll get there in a year. Then...I don't know what the situation would be like. I'll let you all know, in any case.

PS: It's funny you should mention Kaveri Nambisan. I have met the woman, and sorta interviewed her for an audience.

PPS: I really did not think people would have read her book. The Hills of Angheri, I am guessing is the book you have read?

Anonymous said...

SM,

Was reading through your archives... Was really moved by this post... A 'Spunky Monkey' publishing his emotions is such manner !!... I am... how do I say... loss of words..

But great work...

I was reminded of a ol' saying in Kannada pertaining to Medicos... 'Dinna sayooniga aalu wavara yaaru'

Keep them coming..

Cheers!!!

archer...

Siri said...

This reminds me of a week in the waiting room of a hospital.
It was morn afti and evening waiting outside the ICU. The hospital had a small waiting room outside the ICU and a larger waiting room elsewhere. A woman stood guard at the door at the ICU corridor and tried to get everybody out of the small waiting room and to get only one relative of a patient staying in. Initially, it seemed ruthless of her to shout,scream and cuss at people staying there for the dads, mums, children they loved that were lying inside, in most cases, dying. Through the week, we got talking and she told us that she was from a security agency and that she hated this job. "Imagine shouting at these poor things. They're all so anxious" she would say. On another day she was grim and told us that 4 people had passed away in two days. Another time, she spoke, repulsed at the idea of nurses that weren't the least bit bothered by the conditions they worked in. "They aren't affected by death. They can eat in peace even if people are lying dead around them. Apparently they take oaths to not be bothered." (sic).

I went there a month later to find out that she'd left the job.

As for doctors, after losing a loved one, somebody told me that the doctor's words kept her strong and going.

beyond it all I shrug and say you have it tough out there. AS callous as that sounds, it is nice to see people affected by what they see around them. A doc friend of mine was thoroughly pissed off with the indifference senior docs display. So maybe, it is nice to be affected after all.

aww I dunno. shrug shrug

Spunky Monkey said...

I don't blame the senior docs; it is this cycle everybody goes through, only it is rarely ever a cycle. They have seen far too much to be affected. Like they say, Dina saayorge aLor yaaru?
Worse than the job of the ICU attendant you speak of is the job of an autopsy assistant. It's gruesome.

(Little clue to you: If you ever find a novel/novella about an autopsy assistant in bookshelves in the next ten years, assume it's by Spunky Monkey)

camphor said...

*tears*

I've known a senior doc who does 'feel', but figures that he can't get his job done if he hurts for everyone he sees, so he locks up during the day and usually goes home and sitsd in a dark room with silence. He's a surgeon. At one point, he would drink if he lost a patient - but not any more. Not because he cares any less, but because he's also a human - a man - and he needs to survive.

Spunky Monkey said...

It gets very hard after a while, to remain sensitive, that is.

Bit Hawk said...

Very touching!

Spunky Monkey said...

Can you imagine? I wrote this. The spunky monkey. I must have drunk or something.