Pay heed to the little life traumas that hit us daily [PODCAST]

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“Taking stock of all these experiences, I feel like I have no answers. They lead me to a space of unrest and dissatisfaction for not having a pill that would instantly drop 10 kilos, cure hep E, curb food craving or resolve a heartache.

But I feel grateful for bypassing most life hurdles that people live with, those hurdles that life chooses for them rather than themselves.”

Natasha Khalid is a physician in Pakistan.

She shares her story and discusses her KevinMD article, “Pay heed to the little life traumas that hit us daily.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back on the show Natasha Khalid. She is an internal medicine resident in Pakistan, and she wrote the KevinMD article “Pay heed to the little life traumas that hit us daily.” Natasha, welcome back to the show.

Natasha Khalid: Thank you for having me again.

Kevin Pho: So we’ll get into your article in a little bit, but for those who didn’t listen to our first episode, can you just briefly share your story and journey to where you are today?

Natasha Khalid: So I’m a physician based in Pakistan. I am currently doing my internal medicine residency at the Indus Hospital, Karachi. Besides that, I love writing, and I’ve been a part of the narrative medicine society for the past, let’s say, five to seven years, with many published articles.

Kevin Pho: So we’re speaking towards the end of January now. Tell me, what is practice like in Pakistan today?

Natasha Khalid: It’s actually quite tough, because the number of patients keeps increasing day by day, right? And especially with COVID coming along, it gets difficult to isolate a certain set of people into, let’s say, COVID and non-COVID wards, just ensuring that the patients with other diseases are not suffering from COVID or acquiring it in the hospital. So I think one of the things that we face difficulty with is separating the two parties.

Otherwise, practicing, again, like I’ve mentioned before, is fun, but it’s also tough, because we have a huge problem with medication compliance with our patients, and that’s probably because they cannot afford the medications. So even though we can prescribe them things for their ailments, we can’t get the compliance. So that’s one of the biggest struggles we feel.

Kevin Pho: Now, we are entering our third year of COVID, and that’s the majority so far of your internal medicine training. In general, how has COVID affected your training as a physician?

Natasha Khalid: It has affected it in such a way that we can’t have a lot of scheduled activities on a regular basis, right? Because we need to limit the number of residents in a room, or we have to limit the number of residents present at one time under one roof. So a lot of activities that were fun to have and required simulations and stuff in-house now have to be Zoom-based, right? So even though it’s there, it’s not as good as it was initially, in the non-COVID era.

And a lot of cases for my upcoming juniors that I see get shunned away because they’re suffering from COVID. So let’s say we’re admitting a case of carbon monoxide poisoning or just basic anemia. If they come back positive, then they’ll go to the COVID ward, where there is a set of people rotating, and not the general medicine population.

So I feel like it has affected it on a certain level, because my first one and a half years was not a COVID year, and I feel like I got to see more cases, and work was tougher in another way. But post-COVID, there’s always this COVID element that’s coming along; there’s always this isolation element that’s coming along. And somewhere in between, we lack residents in the middle of the year because we’re affected by COVID, and doctors are always the first ones to acquire it, so a lot of people are under isolation. So it overburdens you in a different way than it did initially.

Kevin Pho: Let’s talk about the KevinMD article that you wrote. It’s titled “Pay heed to the little life traumas that hit us daily.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Natasha Khalid: So it was sometime last year, when I was the floor senior, and I was going through a lot of patients that were coming in again. COVID had mellowed down, and we had a good influx of patients of different varieties coming into internal medicine, like they do. And that is where I saw many young deaths, which is a very unlikely thing for me, and especially young girls that were dying, who were somewhere in their mid-20s.

So, you know, there was this kid who had been electrocuted and was perfectly fine, and died within, let’s say, the next three or six hours of hospital admission, and there was no way to revive him. And I think in that moment, it just came to my mind: There’s such a common thing while growing up in Pakistan, basically, that there’s this water system that people have in which they have to turn their electric motors on and off. I don’t know how familiar you guys are with it, but that has been a part of our lives, and thankfully nobody got electrocuted through that. But this kid got electrocuted and died, so this is something that could have happened to anybody.

Similarly, I went through this thing in 2016. I had hepatitis E, which is a kind of jaundice, and then later on, the other year, I had hepatitis A. Both times I was very upset because I had to be on bed rest for a week, and I wasn’t used to that. I thought that just disturbed what I was doing; back then, I was taking my exams. And now I saw this girl, somebody who was also a colleague, who had gotten hepatitis E, had gotten intubated, was pregnant while that had happened, and eventually died within a month of intubation and being admitted in our hospital.

So I think that was one death which affected all of us, and simultaneously, two weeks later, we had another similar case of a 24-year-old going through the same thing, and the data also supports that the mortality is really high. So I felt like that did make me realize that a couple of years ago, I had gone through a similar thing, but I was so thankless about the fact that I recovered. I was like, “You know, I have to recover. There’s so much I have to do.” So these are little things that you never pay attention to, but when you see a patient, then you’re like, “OK, this has happened to me, and this person died.”

Other than that, while doing clinics, I remember this very young guy came to me, diagnosed with type 1 diabetes, and he’s been coming to us very regularly. Every time he comes to us, I’m like, “OK, your sugars are upside down. What have you been doing?” And then he admits after a while, “OK, I’ve had juice, I’ve had chocolates.” And it makes sense for a 16-year-old or 14-year-old to indulge in all of this. And then one day, very seriously, he’s like, “Doctor, can you just tell me one medication that would help me curb the urge to have sweets?” And I ended up laughing in the clinic, because I was like, “I wish I knew this.”

So that is what inspired me to write this article. All of this was going on, and I felt like the subconscious was stirring in too much.

Kevin Pho: Now, when you’re in a hospital and you see all these young patients unfortunately dying, how does that affect you as a physician?

Natasha Khalid: It upsets me a lot, and then there is this unexplained, I’ll say, depression that exists. And I think one coping mechanism is that all of us residents talk about it, and then all of us friends in different hospitals talk about it. But obviously, people do have the common concept that you, as doctors, see mortality so much on a daily basis that it doesn’t affect you. But it does. Obviously, it does affect us, and sometimes some incidents do, like the ones I just mentioned.

Some 77-year-old dying is a predicted thing, you know, somebody who has 10 comorbids. But let’s say a 21-year-old is diagnosed with something out of the blue, and then you’re like, “OK, his life is changing at this point.” Counseling geriatric patients is easy, making them understand how to go about things. But counseling a 21-year-old, suddenly, that “OK, no more sweets, no more of this, no more of that,” and then they’re like, “OK, what just happened?” “You can’t lift weights anymore, you can’t do this anymore.” So that’s a very limiting thing that happens.

Kevin Pho: So one of the things that you mentioned after these unfortunate cases is that you get together with your colleagues and you talk about it; you share cases. So take us into one of those meetings. What do you guys talk about, and what do you say to each other to comfort each other after the unfortunate deaths of young patients?

Natasha Khalid: OK, so we don’t really say stuff to comfort each other, but we do share our sentiments, which makes us realize, “OK, we’re also connecting on the same level,” that it has affected us. But we’re not really saying something to comfort each other; we’re discussing our incident and how it affected us. So we’re having that conversation over whatever coffee breaks we have in between.

So again, I feel like all the residents should have some sort of counseling in that matter, because mortality for residents worldwide is there, and that’s also one of the reasons narrative medicine is getting such a hype around it. But we discussed our sentiments about it, what we thought, how it affected us, and how things happen. But again, the next minute, there is a rush call; the next minute, there is a consult in the ER which you’re trying to make sense of and trying to get sorted, so that you never have the time to process something.

And that does not just limit itself to us residents. I think consultants are also a part of this, and nurses also go through this. They see something in one second, and in the next one, they have so much work again that they can’t really process it. And similarly, when you’re going home, there is so much stuff that you have to do. You have to meet your parents, or you have to connect, you have to cook, you have to eat, you have to clean yourself and your room, and maybe work on the presentation, so that you don’t get to process things. So I feel like writing, in that case, has always helped me.

Kevin Pho: We’re talking to Natasha Khalid. She is an internal medicine resident, and she wrote the KevinMD article “Pay heed to the little life traumas that hit us daily.” Natasha, I want to talk about how writing is therapeutic for you. So tell me, what kind of stories do you write, and how exactly is that therapeutic for you after a difficult day or seeing a difficult case?

Natasha Khalid: OK, so I started off writing about social issues, and mostly things that involved a bit of a psych element in them, and that further moved, after my residency got a little tougher, into just narrative medicine. So let’s say I am narrating an event about how, before a test, all of us have anxiety, and how we’re cracking some joke which also makes sense and is so apt in that moment. And similarly, if I’m talking about, let’s say, what a patient said to me, and in that moment it really did make me realize, “OK,” it gave me a pause that was much needed. So it helps me in such a way that it brings me perspective into things and makes me feel more grounded suddenly.

And when, let’s say, other people get to read it, let’s say if my article gets published on your page, the audience is so vast. So I have people who contact me from, let’s say, some other continent, and then they’re talking about how they find it relatable, and how sometimes they tell me their story down beneath my own article. And that just makes more sense, like, “OK, we’re humans experiencing the same thing.” And that way it does feel therapeutic; that way it feels more human and more relatable at the same time.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Natasha Khalid: My take-home message for the audience, especially the residents out there who are going through the pandemic and dealing with patients, and while they’re doing that also getting tested, is to write about your experiences. Because at one point, hopefully, fingers crossed, COVID will end, and people will want to know how we dealt with it. So I feel like these narratives would be something we can read back into. So for the future, let’s say an audience reading and trying to read back into what happened when COVID came, this could serve as a source of information that they can use.

Kevin Pho: Thank you so much for coming back on the show and sharing your time and insight.

Natasha Khalid: Thank you for having me, like always.

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