Month: March 2015

Categories
Opinion Reflection

Dear Doctor

Dear Doctor,

I hear you when you speak of that girl in the hospital ward. The ‘overdose in bed three.’ I hear the harsh judgements sneering through your lips, the sighs and the mutterings of ‘what a waste of life.’ As a student, I am all too privy to such remarks made in the corners of these hospitals. I have fallen upon them again and again.

Please do not be so quick to stereotype. Do you know how it feels to have your mind infiltrated by such intense emotions of self-hatred and loathing? Do you know how lonely it can be to lie curled within the four walls of your bedroom, just you and your mind waged in an eternal battle?

Yes, I realise how cliché that sounds. I know you have just come back from speaking to a young gentleman who has been paralysed. I know you have spent your years dealing with the terminally ill, holding the hands of the dying as you speak to a family overwhelmed with grief.

How can a teenage girl compare? Yes, she may appear to have everything. But aren’t humans’ more than just molecules and proteins? Don’t we all have dreams and desires of our own? What is it that makes us human? Our relationships, our goals, our ability to connect with one another. How would you feel to have these vital components torn away from you? No, it is not the equivalent of the man next door whose wife has just died. But that does not mean that she does not deserve your attention and your respect. You may have lived through the battles of the emergency department, the grievances of the families, the diagnosis’s of tumours to children barely in their teens. But she has not.

Look at her, sitting on the bed, her head bent over her lightly covered shoulders. Look at her, fingers fidgeting with the bed sheets, unsure what to touch or who to speak to. She is scared. She is in a new place. There are bright lights glaring down upon her, strangers rushing past her, eerie machines beeping at her. And inside her mind, the battle is continuing to rage. Look at the scars glistening upon her skin as she cowers in a blanket, trying to hide her wounds from the world. Aren’t those battle scars as well?

Imagine how it feels to have a mass of doctors suddenly gathering around your bed, all looking upon you with pity. Do you realise how exposed it can feel to be probed with such personal questions? The intricacies of your mind held open for a stranger to dissect.

‘Do you have any plans to end your life?
What methods have you thought about?’

She needs a friend. She needs someone to take her hand and ask her how she is feeling. Forget the Fluoxetine, the charts filled with drug doses. It is not a prescription pad that she needs. She needs a human touch.

I know she cannot hear you as you make your curt remarks. I know you will walk towards her filled with smiles and concerning eyes. I have seen that gentle handshake that you have mastered over the years, the slight pitch in your voice as you gently prod your questions. There is no doubt that you have a bedside manner. And within one minute you are gone, the prescription chart left upon her bed for the nurse to dispatch the drugs. The girl still sits there, her posture unchanged, unsure if the conversation had taken place.

I know you are busy. I know you have a team of doctors to command, a list of patients to see, a hospital to run. Yes, I know you have sat through hours of exams, studied well into countless nights to get to where you are standing now. I have respect for the devotion you have put into your career.

But please do not forget that young girl. Please remember to hold your tongue the next time you see a teenage overdose. Yes, to you it is another statistic to keep record of, another prescription to fill out. But to that teen lying in the corner, throwing up the contents of her stomach? She wanted to die just two hours ago. Do you know how that feels? To feel hopelessness so deep, that the future is but one long tunnel, filled with uncertainties and fear. Do you know how it feels to hold a bottle of pills in your hand, staring longingly at the container, at the hope it contains inside?

Yes, she will be fine. She will be discharged within a few hours, another free bed to fill. But please, the next time you come across such despair in someone’s eyes, do just one thing; sit down on the bed beside them, and ask them how they are. Look into their eyes as they speak, and let your whole being be encapsulated by their story. Let them open up to you, with patience and empathy. If someone had done this to them before, do you think they would be in this position now?

Please, the next time you blurt out another cutting remark, a sneer at the cries for attention. Look across the room at your patient sitting there. Look at their posture, their body language, their eyes. Does this look like the sort of person who needs your judgement? Or does this look like someone who needs a listening ear?

 

Featured image:
Writing with Ink by urbanworkbench

Categories
Poetry

For Med17: Thank you.

I find a glimmer of light.
It is the shape of a keyhole
and wavers. I crawl
blindly in a sudden desperate desire
to find the lock
and the source of light that is behind it.
The keys in my pocket jangle.

When I am in the hospital I am a stranger
amongst other strangers. Only
because I am wearing a white coat
I am supposed to know where
to go. The hallways bustle with white noise.
I hug myself and move quickly so no one
can see me shaking.

There are several keys in my pocket.
Keys made to open to secure
to keep safe to rescue.
Keys that are purposeful and always always
come with a lock. But there
one key is still being formed
is new and raw
is lockless.

The streets are full of ice
and wherever I step
the dark glimmer cracks.
I feel that if I am not careful
I may miscalculate a step and then
the crystal surface of my confidence
hair-thin
will collapse, will bring me ankle-deep
in barely frozen water rushing unintuitively upwards
rising into my socks past my white coat
soaking my barely used scrubs
ice-water surging towards my knees
femur gasping in its acetabulum
thoracic spine shaking
like a suffocating fish.
I am drowning in the thought that
I am not enough.
The snowbanks drip in the sunlight
and sparkle.

I sit amidst all my past and present identities
and begin to make out a new one ahead.
It is mirrored in the M4s: knowledgeable mature
scruffy in a responsible doctor-like way.
Will I too become like them?
I am not afraid of how I might change but rather
what I will lose after a year in the hospital.
The lock to my growing key remains unknown.
And yet, I sense its existence—
a path of light filtering through the darkness
towards me…

…and you too. Your light
your key
your lock
our journey.

Med17: thank you
for the past two years
and for the years to come.
I have my key in one hand
and your hands in the other
as we search for our hidden locks together. We walk
and look and celebrate when one of us finds a lock that fits
that opens up a bright new world of excitement.
Where will you be?
Where will I? Only time and walking and sharing together will tell.
And the doors one day will open
leading to new rooms and new doors
and our keys will jangle
like the sound of clapping hands
like the sound of many smiles
breaking ice.

 

Featured image courtesy of Stephanie Wang Zuo

Categories
General Lifestyle Opinion

I Will Not Try To Fix You

Disability—The Oxford dictionary defines disability as “a physical or mental condition that limits a person’s movements, senses, or activities.”

Although some disabled people have medical ailments, the two conditions are not synonymous. While a disabled person might require medical attention, disability is defined by social barriers, not pathophysiology.

It is an umbrella term and includes impairments and activity limitations. Impairment is a problem in the body’s structure or function; activity limitation is a difficulty encountered by an individual in executing a task or action.

Disability is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives. Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.

Those with disabilities have capacities for motor, sensory, and cognitive tasks that differ from the “norm.” Each individual has different qualities and capabilities, but defining this “norm” is practically impossible. Society can create barriers that do not allow an individual to develop to his or her full potential. Likewise, society can remove disabling barriers. A wheelchair user cannot get into a building with steps at the entrance, but a ramp or a lift completely removes that particular barrier. Seated before a ramp, is an individual in a wheelchair disabled?

An individual with Down Syndrome can hold meaningful employment if provided with appropriate support. Down Syndrome itself is not a disability; it is a medical condition. An individual will experience specific barriers that emerge because of the relationship between impairments and societal barriers. The presence or absence of medical conditions can cause one individual to vary from another in terms of motor, sensory, and cognitive function, but an individual is only disabled when appropriate accommodations are not made.

As a societal construct, disability fluctuates in different settings. In a completely adapted home, or with adequate assistance, an individual might have no disability at all; while, in an environment without assistance, this person might become disabled.

Physicians treat medical conditions and, as such, they tend to focus on the “limitations” and “abnormalities” associated with disabled people’s conditions; heart disease, for example, in those with Down syndrome. Disabilities, however, are not medical conditions in and of themselves. The role of a physician is to assess the health of a disabled person, provide treatment for associated symptoms, and anticipate as well as prevent future complications. This can greatly improve a disabled person’s quality of life, and, in some cases, even prolong life. Fixing the disability is not in the doctor’s job description.

How do you, as a medical student, perceive disabled people? Do you feel as if medicine failed them by not being able to “cure” them?

Disability is not tragic; it is tragic that society doesn’t appreciate the abilities of disabled individuals.

Disabled people often report being patronized by medical staff, being described as having “a fate worse than death”, or carrying an “unhealthy gene”, as well as “suffering” from a condition. Consider the power of language. Great advances have been made in both medicine and technology, and even more in the public’s perception and understanding of disability.

Disabled people have more freedom, independence, and equality than they did previously, but there is further work to be done. Rather than making a distinction between disabled or not, physicians should be leaders in embracing diversity and independent living for all of their patients, including disabled people.

Dr. Chris Smith – a disabled associate professor of communication arts and sciences at Calvin College, USA – recently spoke about perceptions towards disabled people, stating that “the ultimate test of living in community is found in our willingness to change our minds about one another.”

People with disabilities have the same health needs as non-disabled people – for immunizations, cancer screening etc. They may experience a narrower margin of health, due to both poverty and social exclusion, and also because they may be vulnerable to secondary conditions. Evidence suggests that disabled people face barriers in accessing the health and rehabilitation services they need in many settings.

As future physicians, it is important to view disabled patients equally to all others, whilst acknowledging the barriers they face. When approaching your disabled patients, do not define them by their impairment, do not pity them, do not try to “fix” them; rather, appreciate their abilities, recognize them for their values and behaviors, support them to achieve their aspirations, and, most importantly, listen to them.

Featured image:
disability by Abhijit Bhaduri

Categories
General Literature

Moby Dick and Medicine

Last weekend, my classmates and I went on a ski trip to a most excellent resort in Vermont. This trip was partly a literature retreat for me, as I chose to reread a large portion of Herman Melville’s Moby Dick on the drive there and back. Upon arriving at the resort, I was inspired to write this post for two reasons. Firstly, the main room had a scenery that I felt to be most conducive to writing (see photo). Secondly, I had been thinking during the drive up to Vermont about how rereading Moby Dick, or any other piece of imaginative literature, is related to rereading texts in medicine, including our current lung unit’s clinical cases (as some of my classmates had been doing in the van), or even re-“reading” a real-life scenario during a pulmonary ward rotation. I realized that there are many similarities, some of which I will share in this post. Again, my central question is: what is the usefulness of reading imaginative literature for the progress of science and medicine?

Photo courtesy of Tony Sun
Photo courtesy of Tony Sun

First, I’d like to introduce, or for some readers, re-introduce Melville’s Moby Dick, a supreme example of American Romanticism. The Romantics were involved in a movement that affected Western art, music, and literature, primarily in the 19th century. In America, the chief Romantic writers were R.W. Emerson, N. Hawthorne, H. Melville, W. Whitman, and H.D. Thoreau. These writers wrote about the art of rereading texts, created characters that had to re-experience situations, and presented the meaning of redoing what has already been done or experienced. The last is of crucial importance and is what unifies the first two themes: rereading and re-experiencing. For any belated reader or writer, there is naturally an anxiety of comparison with precursor writers and readers. Belated individuals may ask themselves: how can I read in an original way, or, how can I write original ideas? For Melville, his question might have been: how can I create and write an original character that embodies vengeance, when Shakespeare had already done so with Iago, or John Milton with his Satan. But Melville overcame this anxiety. He created Ahab, a fusion and reworking of the characteristics found in Iago and Milton’s Satan.

You may ask: how does Ahab and Melville relate to science and medicine, and how is Romanticism related to the art of medicine? I see two main links, one being that reading the Romantics enables one to be more knowledgeable about the issue of originality, and two being that observing how the Romantics handle the art of redoing enables one to redo something and still retain originality. These two links are not mutually exclusive, and the second naturally follows the first—learning what originality is enables one to redo things in original ways. Take this for example: a pulmonary intern (keeping the lung theme) sees a case of fibrotic lung disease that had been presented recently at grand rounds. Now, repeat this situation maybe ten times, that is to say, the intern sees ten more patients with fibrotic lung disease and goes to ten more grand rounds on fibrotic lung disease. Could such repetitiveness lead to boredom for the intern? I can’t answer this from experience, as I’m only a first year student, but I’ve heard the answer to be: “Yes.” A bit of originality could help the intern out here, so here I invoke the experience of reading and rereading Melville: when I reread Moby Dick, or reread any other book, I remind myself to be more aware of where I reread, how long I reread, and how I feel when I’m rereading. And then I compare these to my previous experiences of reading Moby Dick, that is to say, where I first read it, or, where I previously read it. I would argue that the intern can try something similar with clinical cases and grand rounds: where did I last see this case of fibrotic lung disease? And how did I feel when I last saw this case? These questions can make each case of fibrotic lung disease original and interesting.

To finish this post, I’d like reflect on my previous post. In my first post titled “Imaginative Literature and Medicine,” I laid out my objectives and motivations for writing in this blog, and I identified three focal points that I can discern in the medical humanities: 1. a literary focus, in which writers identify characters in literature that are scientists and doctors and write about these characters; 2. a medical focus, in which doctors and scientists reflect on personal anecdotes and write about them creatively in the form of poems or short stories; and 3. a practical focus, in which writers identify links between literature and medicine and argue for the usefulness of reading imaginative literature in practicing medicine and science. My interest is in the third category, and admittedly, I think this is the most underdeveloped of the three categories. This second post on Melville, Moby Dick, and medicine (a convenient alliteration, I might add) is meant to not only continue where I left off in the first post, but also to start a trend for future posts, in which I will be drawing more links between medicine, science, and the American Romantic writers: R.W. Emerson, N. Hawthorne, H. Melville, W. Whitman, and H.D. Thoreau.

Featured image:
Ahab reloaded by José María Pérez Nuñez