Known Hands by Rija Rehan (guest writer)
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| Photo-credit: Saniya Kamal, AKU MBBS '18 |
But then, once in a while, you come across someone who makes you break all those rules; all the boundaries that you had set for
yourself. The water breaks through the dam, pushes out and finds the life it
belongs to. And by water, I mean actual waterworks.
So I met a patient in the ward today. And I realize
that because of the Hippocratic Oath, I am not allowed to say who, what, when
or where (but whatever, who needs those anyway); a story can still teach us the
most important lesson ever learnt, without mentioning any of those
insignificant details. One, of human values: respect for the most basic thing -
the human relationship.
She was an 86-year-old lady (see how I avoided the
'who' - demographics don't matter), suffering from a severe exacerbation
of pneumonia, which had led to sepsis (at this point, it sounds like a clinical
presentation. But I don't intend to bore you, I promise - and no specifics). Her
condition, yesterday, had been really morbid: she was sitting propped up on her
bed, barely awake. Her mouth was open because it was almost impossible for her
to breathe normally and she could not be aroused via any kind of stimulus. We discussed her case and moved on. It was okay;
a pretty normal occurrence in a medicine ward.
Today, however, whilst visiting the same patient, I
noticed something different. There was a man sitting on a wheelchair, very close
to her bed. Obviously, it was her husband, a 92-year-old (say ‘MashAllah’ in your heart, all of you!
Please...I'm rooting for this couple). He held her hand in his hand, kind of
like how one would take someone's hand in order to shake it. Except, of course,
she wasn't shaking it in return. He just held it. And with his forefinger, he
kept drawing imaginary circles in the middle of her palm. It was beautiful. He
kept giving her these tactile stimuli to make her wake up somehow. But, all to
no avail.
As normally happens on a round, the doctor explained
to him how his wife had sepsis, and that was why she was getting drowsy.
After listening to the entire history and explanation, I saw the man shake his
head, almost like an obstinate child unwilling to accept the
explanation from those ‘stupid adults’. He argued that she had had pneumonia
before, but her condition had never deteriorated to this extent.
The nurse, at that point, added how the patient was
up at night, and then had gone to sleep at 5:00 am. The attending tried to use
this bit of information as the reason for her drowsiness. The 92-year- old man
shook his head again.
"No. That is not the case," he said
sullenly. "You don't understand. I am asking you again. Why is she not
responding? Why is she sleeping all the time?"
He patted her hand.
"Know something?" He reminisced, "She
used to be the principal of a college." He was watching her with pride...along with a hint of sadness. “She handled dozens of teachers and hundreds of students on an everyday
basis. She would enter a room and people would give her their full attention.
Everyone was in awe of her." He smiled and extended the fingers of his
free hand, directing our gaze towards her.
"So you see, she hasn't been like this. This is not her. She's never been this drowsy, never this quiet."
"And you might not be able to see it
now but she is wonderful. Almost 20,000-30,000 students graduated from her
college during her time. She has received so much love and induced so much fear."
At this point, he laughed outright.
I smiled and nodded encouragingly at the remnant of
this woman left behind. My attending kept nodding too, all the while uncomfortably
checking the tubes going in and out of the almost lifeless elderly lady.
"Do you know she has a double M.A.", the elderly gentleman continued, his voice full of reverence now. "She did M.A. in English and in Farsi."
At this point I got even more interested in their story because I felt that it would be a good idea to let him keep talking while I practice my 'good listening' skills. "Really? That
sounds amazing!"
That was all the encouragement he needed. He became even more enthusiastic, "She went all the way to Iran, to do her M.A. in Farsi. Double MA! MashAllah. Very intelligent, this lady…" he finished, all the while with his hand still entwined in hers, his face gleaming.
And then on remembering something else, he gave us a little chuckle. "You know, if I ever wrote any articles, she would always correct the English! Grammar bhi aur spellings bhi (the grammar as well as the spellings). "
All this time, I couldn't look away from their
hands. How beautiful they were. The pale crinkled up fingers, bonded together,
and the very conspicuously bloated green veins jutting out from every
direction. The beautifully symmetrical, ridged nails, a reminder of the time
that had gone by ever since the hands had touched one another for the very
first time. It was a picture-perfect moment. And yet, the story that I was
listening to was too much for me to bear. How do you explain to the man that
this may be the last time he was holding her hand?
He looked at her almost lifeless, barely breathing, pale face again, and then sighed deeply. "She's not
like this. She's brilliant."
At which point the consultant started talking in
sheer medical jargon, so that he wouldn't have to explain anything more to the
man, whom none of us had the gall to speak with anymore.
I realized this was the frickin' Notebook, or other movies like it, playing out in front of
me. Those stories you hear about in which people spend their entire
lives together. Those happy enough-for-each-other couples. They do exist.
It was not the first time I had come across a
critically ill patient. Nor was it the first time I was about to lose a
patient (God forbid! As I alluded to earlier, I'm rooting for them, so please pray for them).
But it was definitely the first time I felt
such a strong connection during a patient encounter - so beautiful indeed that I needed to excuse myself, walk out…and cry.
CREDITS:
About the Author: Dr. Rija Rehan, AKU MBBS Class of 2015, is a budding psychiatrist. She's
also interested in the performing arts, astronomy, literature, singing
badly and celebrating the many beauties of life.
About the Reviewers / Editors: Huma Baqir, AKU MBBS Class of 2017, is a science-enthusiast and a self-proclaimed advocate of world peace. Dr.
Maryam Huda is
Director of the Urban Health Program, Department of Community Health Science,
AKU.
Editorial Note: This is from a series collected as part of the Narrative Medicine Workshop at AKU on January 20th, 2016. The editorial work was performed by the Writers’ Guild, an interest group at AKU, with the purpose to promote love of reflective reading and writing, within and outside of AKU.
DISCLAIMER: Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences.
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