The First Step : Realisation

I have talked to about 35-40 odd patients in the course of my project. They have all come from various spheres of life. The majority have come from the lower and the middle class. After all, in a tertiary care centre like SGH, this is exactly the kind of patients you get. The experience has been very enriching. I have learnt a lot about the lives of these people.

It is said that Medicine ensures that you remain in contact with your own soul- the soul that understands pain, fear, joy, love, anger, frustration and every other emotion that we have to deal with. The human touch remains. You come to know about the kind of problems that people have to deal with. The Common Man is still common. He still has to face the regular stress and strains of life. The patients who come to Sassoon, have to catch buses early in the morning to get here, have to wait here in line to get their case papers made, have to run around in all directions to go the one place they need to get to. We, doctors, add onto their troubles by not spending enough time with them, acting as if they are not important to us. Aged patients come to get their monthly or weekly medications. Instead of treating them with the respect that is their due, the Residents scream loudly at them because they can’t hear properly. Is it their fault that age has finally got to them? Patients are considered to be our God. We, as doctors, learn from them. We need to behave properly with them. There was a time when patients were given decent care. That has suddenly changed in the past few years. The dearth of doctors at Government institutes and the politics has led to the decline of humanity in this noble field.

Do you know what most of these patients have told me? They have given me their blessings, simply for spending 20 minutes talking to them; for touching them, examining them; for doing small things like measuring their height and weight. They say it feels satisfying that a doctor at least talks to them. Most of the doctors just come, write in their files and go. There is no patient-doctor communication. We are taught about the Doctor-Patient relationship in PSM (we even have a question on it in our examinations). There doesn’t seem to be any relationship in SGH today. I was so surprised the first time I heard a patient say these things to me. When a number of patients told me the same thing thereafter, I realised that there, indeed, is something lacking in today’s students.

In our first clinical posting, we are taught the importance of History-Taking. We are taught the individual importance of the Name of patient, his age, sex, address, occupation, etc. Along with this, we are also told that we need to talk to the patient. Talk, not just about his symptoms, but also about his feelings, his thoughts, his needs…all this to just create a rapport. ‘A patient needs to feel comfortable with his doctor’ is a line repeated a lot of times in that first posting. It is seldom remembered later on. Students become very busy trying to extract the symptoms and signs that they know of, from the patient. He doesn’t remain human anymore. He becomes an object of interest. An object to use when required and throw away when finished.

Today, I met a patient who’s case I had taken about 10 days  back. I had liked her a lot at that time. She was happy, friendly, chatty. It was a delight to examine her. She told me that she had to have an angiography done, for which she would probably be re-admitted. She seemed amused by the fact that her Diabetes had gotten her into the hospital. That was then. Today, she was a whole different person altogether! Her appointment yesterday had been cancelled because none of her relatives had been able to come. She had been told to stay Nil By Mouth today, because the Angiography could take place today. The nurse had told her that if no relative came today, her appointment would have to be cancelled again. She was on the verge of tears, this lady. She wanted to go and get her angiography done all by herself. “What is the need of relatives?”, she asked me exasperatedly. I tried to explain that in case anything happened to her in during the procedure, somebody should be around. “If I die, let them just throw me in a corner! I don’t mind that. I just want to get this done. None of my relatives are coming. I had told them, but nobody has come yet…” and she started crying. It was heart-wrenching. I tried to calm her down by telling her that things would get better….that I’d talk to the people concerned and see what could be done…that she shouldn’t just lose hope. She took my hand and kissed it. That is all that she had needed. She had just needed a little bit of talking. She had needed somebody to just stand there and talk.

I haven’t stopped thinking about the whole case. What are we turning into? We all need a little bit of love and care. It may not be possible to give the best care in SGH. But, it is a hospital for heaven’s sake! The patients here should at least be given the basic care that they all require. It is tough being a Resident, I understand. They have to study, look after patients, keep a tab on the whims and fancies of their guides and manage to get some sleep too. But, I think, as doctors, it should be a part of their case-taking to just spend a few minutes with each patient and ask about their problems. Or just spend a few minutes talking to the patient about random things. That is all.

If there is one thing I have learnt from my experience as a student in Sassoon, it is humanity and consideration for others. I have had a good childhood. I was given everything I asked for. My parents put me into a great school, allowed me to go for parties, took me on holidays and did everything possible to ensure that I have a bright future. Somewhere deep inside, I know they had to take a lot of trouble raising me and my brother. They have managed to rise out of nothing to something. I was always aware of that. Yet, they ensured that I did not have any difficulty in living my life the way I wanted to. But, not all people, in this world, are like me. There are people who grow up in difficult situations and stay in such situations all their lives. There are people for whom a 10 rupee bus ticket is expensive…people who have to fight over water and bathing facilities every morning…people who live on a single meal daily. These people need the same, if not better, treatment than a person like me, if they end up in the hospital. They require that consideration and love that a Doctor is supposed to show. I have learnt to show this consideration. I have learnt that we are supposed to heal the wounds of the patients, and alongside, heal the wounded soul of the patient too. It is our duty to ensure that every patient discharged from under our care, goes home, a better person. It is my duty that when I finish my interaction with a patient, he feels healed mentally. I may not be able to do anything to reduce the pain or other symptoms of the patient. I should, however, be able to make a difference to the mental state of the patient- make him satisfied that he has been examined…assure him that he will get better.

Today, I felt the whole purpose of this field was put in front of me, in the form of those tears. My parents keep talking about patients being thankful to them for saving their lives. I never understood the real meaning of that line. Today, I think I did. I felt the hurt of that patient. I know that if her angiography has been done today, tomorrow, I shall feel the happiness too. I’ll know that she won’t be shedding more tears and will be happier. Isn’t that the ultimate aim of a Doctor? Cure the patient physically, mentally and socially?

Jill, I think you took an important step today…you saw yourself as a doctor who shall look after her patients with proper care. There shall be just a few more steps and you will reach that goal – A Good Doctor :-)