The ‘Lesson’ by Murad M. Khan (guest writer)
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| Illustration/Photo-credit: Saniya Kamal |
The life so short, the art so long to learn
Opportunity fleeting,
experience treacherous
Judgement difficult
Hippocrates
'Of Medicine’
Learning in medicine is a lifelong occupation. Apart
from the books, patients are the main source for one's medical education. But
as doctors we rarely give them credit for what we learn from them. In our busy
lives and even busier practices, patients are reduced to `cases' and `cases' to
a set of signs and symptoms. Cases are only interesting when they present in an
unusual manner or are rare. The fact is that like an individual, every `case'
is unique and every patient, no matter how common his illness, a rare learning
experience.
On the first day of House Job at the Civil Hospital,
Karachi, Pakistan I am allotted 'my' beds - eight in all. They are a mixture of hernias
and hemorrhoids, appendicitis and cholecystitis. On two beds are young boys -
10 and 11 years old. Both are there because of serious accidents. One was hit
by a car as he ran after a cricket ball in the street. The other fell from the
top of a lorry he was helping to load.
Miraculously, both survived but sustained
complicated injuries. Both have been in the hospital for a number of weeks now.
The outgoing doctor informs me while one of them would be discharged soon, the
other is nothing but `a nuisance'.
Both have had major surgeries and, post-operatively, there
have been many complications. Both have had to undergo repeat operations for
their complications. I discover despite his injuries and multiple operations,
the one hit by the car is in high spirits and looks forward to going home soon
and resume his studies. `I want to be a pilot when I grow up', he says, echoing
many a young boys’ aspiration at that age. Significantly, he has a large family
of adoring parents, loving siblings, cousins, uncles and aunts. They visit him
morning, noon and night and get him food from home. They bring him presents and
make him feel that they care for him and need him. He appears to be on the road
to recovery.
The other one is an orphan, hundreds of miles from his
shanty home in a remote area in Baluchistan where, while working as a helper,
he fell from the top of a truck. He lies naked on a bed in an empty room, which
for some unknown reason, has been designated the 'Intensive Care Room' of the
ward. The only thing ‘intensive’ in the room is the stench of urine, which,
despite the ceiling fan, seems to hang in the air as a reminder of the young
boy's plight. He has a fractured pelvis, a suprapubic catheter, a colostomy bag
and ankylosis of both knee joints. A mass of skin and bones for the muscles
have long since disappeared. Even the slightest movement brings on an
excruciating pain. He spends the whole day moaning and crying in pain, asking
for morphine repeatedly. He has no appetite for the hospital food. He has no
visitors, no family, no friends.
He has no hope for his health, his discharge from the
hospital or the future. He says he has nothing to live for and keeps repeating
he wants to die. When he finds out I am his `new' doctor, he pleads with me to
help him in this. This is the one who is a `nuisance'.
Many years later, I would realise that what I had
witnessed was the power of emotional well-being in a person's recovery from
illness. The `will to live' versus the `give up' phenomena. The two young boys
in their own way had provided me my first real life lesson of human psychology
in illness - the interplay of which I would witness repeatedly in the
subsequent years.
Unfortunately the realisation came much too late to be
of any benefit for the young orphan. Barely two weeks after I moved from the
ward, I found out that he had passed away - alone, lonely and in agonising
pain.
CREDITS:
About the Author: Dr. Murad M. Khan MRCPsych, PhD is Professor of Psychiatry at AKU. He
holds special interest and expertise in Bioethics and Narrative Medicine / Reflective
Writing.
About the Reviewer / Editor:
Huma Baqir, AKU MBBS Class of 2017, is a
science-enthusiast and a self-proclaimed advocate of world peace. Her interests
encroach theatre, music, food, poetry, travel, public speaking, self-reflection
- and that beautiful, delicious little bridge between medicine and art.
Illustration / Photo-credit:
Saniya Kamal, AKU MBBS Class of 2018, is curious about life, the
universe, and everything in between. She hopes to become a neurologist, pursue
art, popularize meta-fiction, conquer the world and stay happy.
Editorial Note: This is second in 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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