Where there is love there is life.
– Mahatma Gandhi
In this first month there is a lot I saw, learned and experienced. Love tops the list. I became an expert in arterial punctures as I did 4 to 5 of them each day in the floors. Each time I headed for an arterial puncture, many things automatically came to my mind: collect all of the required supplies, talk to and comfort the patient, cause as little pain as possible, don’t stick needle to self, dispose all the biohazard material appropriately and label and drop off the sample to lab.
In the second week of my internship, around 3 or 4 p.m., I was comforting a patient who was on a ventilator for respiratory failure secondary to COPD. Her bed was decorated with “get well soon” balloons and had a lot of candies around. Although her family stayed with her continuously, depression was slowly creeping in. She had tears in the corners of her eyes always and she agreed that she was feeling sad. A gentleman standing next to her requested that I be as gentle as possible. I nodded my head and answered that I’d do the best I could.
Respiratory failure had taken a toll on her and, as expected, she was not in good shape. She was very co-operative, however this time, as I was about to puncture her artery she started to cry. I stopped the procedure and spoke to strengthen her spirits and mine. I was confused, as to whether to go ahead with the procedure or not. The gentleman who had stepped aside for the procedure came and held her hands. He was short, with a perfectly maintained body.
Because of my inexperience, I assumed him to be her son, and said “Miss X, your son is back. I have assured him that I will cause least amount of pain and I promise you the same.” The gentleman was a bit upset now. He replied, “I am her husband and we trust you.” He hugged her. Pointing towards the Manhattan skyline, he said, “Love get it done; let’s go and dance in Manhattan after this.”
I apologized for misunderstanding. I obtained arterial blood sample in a single puncture. I thanked her for cooperation, informed the gentleman about this small success and started walking towards lab. My faith in humanity was restored as this gentleman was by the side of his wife who was in bed for a long now. They will stay forever in heart and they made me feel what is hard to define: love and life.
The first duty of love is to listen.
– Paul Tillich
Most of us decided to be in medicine because we love helping people. The greatest respect we can pay to someone is to listen what they have to say. I failed to pay this respect for an elderly gentleman. As I started my ambulatory block, the workload decreased all of a sudden. I was given the impression that it is a week that is more or less a holiday. During one of the ambulatory sessions, I had to care for a patient from a nursing home who had dementia. It is difficult to obtain the exact story in such cases. The lady who accompanied this patient had no knowledge of his history. She informed me that she was just a transport aid. The lady, however, handed me a pocket of papers, one of which made me understand that he was referred for gout.
As a specialty clinic I was instructed to take care of his rheumatological condition only, as nearly 15 more patients were waiting for us. This gentleman pointed finger at his tummy thrice, I neglected it and started asking questions about his joints — until he agreed to the fact that he has joint pain! The man went back to his tummy and repeatedly told me “my tummy hurts.” On examination he was running a fever; I noticed multiple tophi, but he also had severe left lower abdominal quadrant tenderness. I became suspicious of diverticulitis and called the rheumatology attending, who confirmed that the patient had acute abdomen. I was filled with mixed feelings. Though I picked up the disease in this gentleman, I did not listen to him. Initially I failed to give him even minimal respect as an individual, by not hearing to him.
The most terrible poverty is loneliness, and the feeling of being unloved.
– Mother Teresa
As a part of 21st century we are always in a rush, rushing for everything. Residents are expected to be in rush, or else it is perceived they are jobless or lazy. A blind elderly lady was admitted for gastrointestinal bleed. I soon understood that I am one of five people she got to talk to over the course of a day. Despite the fact that she stayed alone, her spirit will stay in my heart forever. I could see the hidden pain in the face, but whenever anyone in the team used to speak to her, her face used to glow! She used to reply with great involvement. I made a point to stay with her for an extra five minutes as I rounded in morning. Initially I thought I was caring for her, but soon realized that even in the face of her loneliness, her spirits elevated me to higher grounds on the days I was low. For me, nothing is scarier than loneliness. Let the tumultuous activity pause long enough to feel oneself as human.
If anything is sacred, the human body is sacred.
– Walt Whitman
One Friday, while on the neurology consultation service I had a whole day for myself. There were no referrals until 3:45 p.m. I was about to walk out of the residents’ den to grab my belongings and leave the hospital at 4 p.m. when my pager started beeping. A consultation was called from emergency department. The patient had sudden onset of left upper and lower extremity weakness that was thought to be secondary to stroke. We later concluded it to be Todd’s palsy secondary to medication non-compliance.
By the time I was done with the case it was 6:30 p.m. and my Friday evening plans were off track now. I was disappointed that I was leaving late, but before I left ED, this patient thanked me at least seven times. This made me realize we are not here for a 9 to 4 p.m. job, but, as doctors 24/7, we are here to practice the noblest of sciences on sacred human body.
Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek. Yes we can.
– Barack Obama
We have two options as residents. Either to follow the system that is not working to the fullest of its potential, hearing to voices that daily cry that nothing is going to change, or to participate in the development of better systems. We may have to face doubt, hatred and failure in the process. But it is an exercise worth trying hard for, as we are the future of medicine. An essential part of advancing medical science is daily reading and research; without which we can never evolve and explore the fullest of our potentials.
In my mentor, Guru Conrad Fischer’s words, it is important for us to have daily reading hours because, “The difference between what you know and what you should know is the difference between life and death to many over next 30 to 40 years.”
Pramod Theetha Kariyanna is a medical resident.