Pain by Mayera Tufail (guest writer)

Today started off as just another day in the orthopedics clinic – you know fractures, fixations, and such.

“Haris!” the nurse called out in the waiting area and without further ado handed me the patient’s file.

I sighed. “Another arthritis…” was the lingering thought, as I entered the room.

What surprised me was the cute little boy sitting on the bed, with a huge bandage on his left leg. I was expecting someone older, not as cute, but with arthritis, all the same.

After confirming my patient’s name, I proceeded with history taking – medical students are particularly good at that task. Haris was an eight year old with Ewing’s Sarcoma, a serious cancer of bones. As an aside, any disease with such a daunting name is likely to be really bad for you. For the Ewing’s Sarcoma, Haris had undergone an extensive surgery to take out most of the malignancy in the left leg.  Surgery was followed by three cycles of chemotherapy.

It was when I asked Haris one particular question that the encounter took an interesting turn. The question, I thought, had been phrased rather simply.

“Haris, are you in pain?”

He giggled in response.

I thought he had been unable to comprehend what pain meant when asked about it. Perhaps this word was beyond his vocabulary but I was to learn otherwise.  I cut short my history taking.  

While waiting for the attending surgeon, I befriended Haris by drawing smiley faces on a few tongue depressors.   I didn’t notice that the surgeon had entered the room and he had already instructed the nurse to remove the bandage and plaster on Haris’ leg. Haris was oblivious to what was happening as he was busy playing with the cartoon-covered tongue depressors.

By the time the plaster cutting saw was out and buzzing away ominously, Haris realized too late what was about to happen. He had not been explained beforehand.  I wonder what good explaining to him would’ve done though. His anxiety probably would not have diminished knowing what was about to happen.

Although Haris attempted to jump off the bed a few times, irrespective of my cajoling him with all sorts of presents if he were to lie still, he had to be held down for the whole procedure. As the saw made its way through the plaster, Haris’ screaming overcame the noise created by the saw itself. Maybe the cutting action of the saw was putting undue pressure on the wounds underneath? Unable to bear the sounds any more, I requested another nurse to take over so I could step outside the room.

I could hear him screaming for help through the door of the examination room. I thought Haris’ loud anguish would nudge angels to descend to ease the innocent child’s aching body and soul. Maybe it did, because soon both the saw cutter's and Haris’ sounds diminished and then dissipated altogether. I went back into the room.

Haris' left leg looked like a matchstick – one that had been kindled repeatedly.   

I handed him three more tongue depressors with smiley faces on them. I had made these while I was standing in the hall outside the room. Although I wiped Haris’ tears, I was happy that no more emerged.

Haris’ dad scooped him off the bed. The child looked funny perched in his dad’s arms - his hands clutching his precious cargo of tongue depressors that had been put to good use. Just before exiting the room, Haris looked up at me one last time, smiled, and waved goodbye – rather, six smiley faces on tongue depressors, waved me good bye.

How someone so small who had undergone such immense pain could house such a big heart, was beyond me. This was the residual thought, as I walked off to see my next patient.

Pain taught me a valuable lesson today. 

[from Narrative Medicine]

CREDITS:

About the Author: Mayera Tufail, AKU MBBS Class of 2018 and avid doodler in anatomy class, is an aspiring pediatric cardiothoracic surgeon. She wants to revolutionize the way medicine is taught all over the world. Managing to see a superior colliculus in a flower and cross sections of brains in branded logos, she can’t wait to make people see the world through her eyes.

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.