Beyond Duty by Ansul Noor (guest writer)
The
witching hour had passed. But for us ER doctors, the hours have no name. It was
a chilly October night and a Twilight-Zone
calmness gripped the steely corridors of the General ER of Dubai Hospital where
I worked. The fog of silence languidly crept through every examination room
lending an almost dream- like air of solitude to the usually jam packed and
chaotic world of trauma and emergencies.
For
an ER doctor, lack of chaos can be distracting and I battled to keep my wits
about me and stay busy in my head since the quiet had started to creep inside
my soul as well.
Before 1 am.
I
set about applying the finishing touches to a few admission notes; a man in his
50’s with liver cirrhosis, a child with febrile convulsions, and finally, a
lady who had presented with an acute abdomen and anemia. With little gap
between patient intakes, I scurried from one room to the other, preparing all
the initial lab/diagnostic work-up and subsequent paperwork after I had decided
to admit them to the ward.
Approaching 1 am.
After
stabilizing my patients and sending them to their respective wards, I steadied
myself and headed to the vending machine to get myself a hot cup of cocoa. It
was a habit of mine -- to remain on my toes until I knew that my patients were
safe and secure in their beds, ready for the morning rounds. Mentally, I
followed them up on their journey to recovery, and often found myself wandering
into the wards the next day, checking up on how they were doing. I had been
told by my superiors that this was not required of me, but I just had to know.
I couldn’t break the ‘habit’ and I’m happy I didn’t.
Few minutes to 1
am.
Calmness.
An eerie stillness. My fingers played with the cocoa stained cup, as I wished
for answers at the bottom of it—it was tassology but without the tea leaves, just
those intense spilt seconds of contemplation where everything freezes but your
thought process. The ER can be an enlightening place. It teaches us about the
fragility of life. It teaches us to tame our innermost fears and apprehensions
so we can channel them into constructive critical thinking and hopefully save
lives. It teaches us to have compassion in a mechanical setting, yet remain
strong enough to handle the chaos with composure. But often, the robot of
routine can seduce your mind and you can fall victim to indifference. How to
retain compassion without falling apart or becoming a robot is a daily battle
for the ER staff.
It’s
easy being a robot, shutting it all out, moving from one case to the next and
never looking back.
Therefore,
we must strive to find balance.
Post 1 am.
Still
in a thought daze, I was jolted when my pager went off. A young lady had
presented with shortness of breath and tachycardia.
Room
103 at the far end of the oddly quiet ER.
She
waited for me.
I
greeted her and sat down beside her. I extracted relevant medical/past history,
examined her and ordered some initial blood work.
She
mentioned that she had trouble sleeping these past few weeks and that she had
lost her appetite. Other than that there were no remarkable history/findings
except that she appeared anxious and afraid. I sensed it as she talked. Her
eyes were blood shot from lack of sleep perhaps?
Or
was it was from constant weeping?
She
was well dressed and spoke eloquently, yet her voice seemed to be filled with a
deep sadness that could be heard if you listened carefully.
My
initial diagnosis: Depression coupled with Generalized Anxiety Disorder (GAD). I
held her hands and we talked about life. She told me that since her parents had
passed away, she was in charge of the family business. The stress of daily life
was too much to bear, but most of all she was terribly lonely. She was a single
local woman who was trying to survive in a male dominated society.
She
struggled daily to overcome sad thoughts and everyone around her had started to
label and chastise her.
No
one understood this ‘invisible’ ailment. All she received were awkward stares
and her so called friends seemed to disappear.
It
is then I saw two glistening tears stain her cheeks.
"Doctora, I wish I
had met you before.”
“You are the only
one who really wanted to know how I felt, I feel much better now.”
What
she required was the medicine of compassion.
I
explained the benefits of psychotherapy and that she must follow-up with a
psychiatrist. I referred her to a good friend of mine who would be able to help
her through the struggles of life.
To
which she responded:
“Will
that doctor have the gift of kindness?”
“I
only need that.”
The Next Day.
As
with most ER tales -- I never saw that lady again. But she left an impression
on my mind for years to come. Often, the only action required of a doctor is a
kind word, a genuine interest in the ‘invisible pains’ of another. If you
forget your humanness, you forget your oath, and soon you will forget your
‘self’.
Might
have I behaved in a similar fashion if I were swamped with patients?
Only
my conscience can be the judge of that.
Nothing
in this profession is beyond the call of duty. Every encounter is special and
requires a unique protocol tailor designed to the situation.
Depression
and mental illness is greatly misunderstood even today. Core principles of
treatment should include patience, care and empathy, and of course medication
as needed. It can be challenging to devote time and effort to such issues in an
ER or busy OPD setting, but all you have to do is administer generous doses of
genuineness to cure that moment of anguish and loneliness.
Mental
illness is a hard thing and there is no greater medicine than knowing that
there is someone out there who cares.
I’m
sure we have all had such moments-in-practice
that may have influenced the way we conduct ourselves with our patients and
that allowed us to explore the metaphysical meaning of being a ‘true healer’.
A
medical degree does not make you a healer--- The journey does.
Discharge Summary.
Genuine words can
change or save a life. It’s a much needed soulful resuscitation, for both, the
sufferer and the healer.
About the Reviewer: Dr. Aneela Darbar is a consultant neurosurgeon at 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.
CREDITS:
About the Author / Illustrator - Photographer: Dr. Ansul Noor is passionate about healing and peace through storytelling, poetry and art ever since she was a young girl. She manages her blog ruhaatish - a verse memoir of her life and journey.
About the Reviewer: Dr. Aneela Darbar is a consultant neurosurgeon at 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.
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