'L' is for the Way You Look at Me by Rija Rehan (guest writer)

Photo-credit: Saniya Kamal, AKU MBBS '18

How do you tell an eight year old the worst news she will ever hear?  What can you say to her, to make her feel that the idea of dying isn't that bad after all?

Marium doesn’t have her parents with her. She’s with her phuppi aur phuppi ka susar (aunt and aunt's father in law). Wow! Worthy intimate relations present to offer emotional support?

As these initial medical interactions usually go, I take the full history from the 'close' relatives and perform the exam thoroughly just to go the extra mile to impress my attending. In all the forty or so minutes it takes for me to gather information and study scans, Marium keeps drawing my attention.

She's sitting in a corner, just observing everything I do with those big eyes, those big katora (cup) eyes. Every time she blinks, they look bigger than before. The eyes are full of fear and confidence at the same time, asking me so many questions. Yet, she's waiting quietly for me to get done. But not at all silently! Because she's gasping for air at the same time. And wheezing. Because she can't breathe. 

You know, on account of the tumor she has, growing behind her nose. Also, she can't eat - inability to swallow. Nor sleep - inability to rest.

While I present the patient’s history to the attending, I decide to mention the extra details, "The aunt mentioned that Marium cries all night because of the pain. So much, that everyone at home refuses to sleep in the same room as her..."

"Hmm. Okay. I have all the information that I need" says the attending, and then, "Bachi ko Cancer hai!" (the girl has cancer).

Blunt. Just like that.

There’s momentary silence, then the following back and forth:

Marium’s aunt: "Khatray ki baat tou nahi hai, doctor sahab?" (Nothing dangerous right, doctor sahab?).

Marium’s attending: "Arey! khatray ki bat kaise nahi hai. Mar jaye gi bachi!" (Of course it’s dangerous. Girl will die!).

Me (in my head): Really?

Yes. That's how callous the consultation was.

Marium’s eyes become even bigger than I thought they could. I see a single tear drop, which she wipes away. But then, maybe she just loses the will to fight or pretend altogether. She lets it out. The internal plumbing starts leaking and the pool overflows. Marium is now using her entire dupatta (scarf) to wipe both sides of her face. She won't even try to stay quiet or keep her grief hidden.

The attending keeps going through the radiology films and reports when Marium's reaction is finally noticed. An eyebrow is raised and a confirmatory question asked.

"Kya umar hai bachi ki?" (how old is the girl?).

"Aath saal" (8 years), I have to swallow a lump myself to speak.

"Hmm…samajhdar hai! Ro rahi hai (she's smart, she's crying), which means she understands what is going on in this room."

Of course she understands! I want to scream. I want to cry too. But of course I can't.

I mean, yes. You might be an accomplished oncologist who deals with children with cancer everyday. But I TOLD YOU that these people have no idea! They think its tonsils! You could have been a little more thoughtful! No?

I mean, I am not saying I can empathize with Marium any better than you can.

Because I definitely can't. I have NO idea what ‘Marium from Chitral’ feels like right now. Having travelled across the country for this single interaction. Alone. Brave enough to go to a doctor without her mommy, to seek a ‘cure’. Hell, I am a 23 year old medical student and even I can't do that.

Yes, Marium’s smart enough to realize she is going to die. This is stage 4. Her airway is blocked. She will die. Sooner than anyone else she knows. And she can't stop crying.

And you know what that reminds me of? The whale from ‘The Hitchhiker's Guide to the Galaxy’. That scene where the whale suddenly develops this awareness and comes to terms with its identity, only to perish a moment later.

Was that all Marium's life destined to be? The length of the whale's fall?

I am so depressed. For her. About her. I can't breathe. I feel like I have this constant urge to vomit, ever since I've seen her. I feel guilty. For being the evil news-bearer. The face Marium will always curse. Death the personification.

I don't know how to end this piece.

[from Narrative Medicine]

  

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. You may review her previous contribution to this blog here. 

About the Reviewer / Editor: Dr. Simi Rahman, AKU MBBS Class of 1997, is a Pediatric Hospitalist at the Keck School of Medicine in California, USA. She has interest and expertise in Narrative Medicine. 

Editorial Note: This is from a series collected as part of the Narrative Medicine Workshop at AKU on January 20^th, 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.