Whether it be the overly-friendly, prescription pad grabbing 2 year old - who attempts to climb into your lap while you are trying to maintain a professional distance, (I'm the youngest one of the team. I barely feel older than the patients I am supposed to be treating. Must. Act. My. Age.) the wails at the sight of what you thought was your "friendly-face" 6 year old, or the infant who sleeps peacefully through his immunizations - with a sense of humor, OP day can be lots of fun.
However, there are times when you feel horribly limited in your role as a 'doctor.' When a patient's medical problem is secondary to something social, economic or emotional - something that, try as you may - you are powerless to resolve.
We saw one such patient recently.
A reportedly 16 year old girl that came with a complaint of breathlessness and was completely normal on examination. On further questioning, the so called 'breathlessness' seemed to be psychogenic hyperventilation rather than true exertional, or otherwise breathlessness. Moreover, the patient admitted to admission in the hospital 1 month earlier for attempting suicide by overdosing on her mother's medication. We began to inquire as to the reason for her suicide attempt, (Which in itself is both insensitive and wrong. Subtler approaches are necessary, especially for a touchy adolescent. However, I suppose that in a country of 1.2 billion people, bluntness and directness is almost a way of life.) and expectedly, she wasn't exactly eager to pour out her soul in front of two strangers.
As a matter of course, the treating physician began to 'counsel' her, 'Not to try this again. To be a good girl. And to study well in school from now on, so that when she grew up, after her education, she could have children and be a good mother.' (Note: If that sounds feudal to you, its not. Its the way things work in this nation. The catchphrase of every mother, grandmother, older sister and aunt. Follow the right path, and things will fall into place. Repeated like a broken record.) Sigh, if only it were that simple.
In this country, where doctors are used to having their word obeyed like that of God, the concept of proper 'counseling' is hard to sell. Nevertheless, this physician had already done far more than any other paediatrician would have. Most would have overlooked the history of suicide attempt, auscultated briefly, ordered for investigations, and been on their way. Its the utter lack of training or awareness on these holistic aspects of medicine, the flip side of physical health, that is a grave limitation of most allopathic practitioners. Sadly, its almost a cultural issue. The culture of medicine (in my limited experience) in this nation, does not allow for time to consider the patient's non-physical needs, and the training barely addresses this aspect.
Anyway, as we good naturedly gave the patient advice, attributing without a doubt, her behavior to adolescent hormones and other inanities, the mother dropped a sudden bombshell of a fact. "She is getting married, soon. Her marriage is being set." For an educated 16 year old in an urban setting, whose mother could afford a private hospital, that seemed a little strange. The mother later revealed that she had been diagnosed with cervical cancer and was a known epileptic, had been a single mother for the last 10 years after her husband left her for another woman, and had a son studying in the 3rd grade.
We should not have been so quick to try to solve the daughter's problems. To begin with, we didn't know what they were.
Ideally at this point, we should have offered the mother referral to a support group for her condition, as well as advice as to where to get good medical care. We should have, perhaps, led her to realize (after further understanding of her situation of course) that she really wasn't as powerless as she thought. Leaving aside our role as doctors, perhaps it was our duty as fellow women.
But instead, we listened to her story, gave her a rather lame rallying statement, and told her to come back next week for a psychiatric consult. (Who by the way, was referred to as "the special doctor.")
As a doctor, I'm not sure I fulfilled my duty. However, there is the absolute need for professional distance. As idealistic as you are, if you do not remain within your limits, you risk losing your judgement, and perhaps even professional integrity. But I am beginning to realize, more and more, as I go through internship, that you set that distance. Its your comfort level that will dictate how much you do for a patient, how much you allow yourself to care, how much you can get involved. Until now in medical school, everything was dictated. The normal WBC count is 4000-11,000 cells/mm3. The lifespan of an RBC is 120 days. Clinical postings is from 9am to 12pm. Now, those lines are not as apparent. You have to take care to draw them. Use your judgement. And other such things we are out of practice doing, from 5 years of textbooks, memorization and written exams. Its a balancing act, the understanding of which, has created extraordinary people out of a mere physicians. Someday, I hope to balance these things.
As a woman, I wasn't surprised to hear her story. I am exposed enough to not have the delusional arrogance to assume that everyone's lives are as good or as easy as mine and that when things go wrong it isn't because people are not living the 'right way.' But its not easy, even knowing all of the above, and expecting this sort of situation to arise, to not feel sympathy for that young woman. There isn't anything wrong with sympathy, except that its the sort of useless emotion that creates things like charity. I'd rather not feel bad for her and powerless than to feel something else that could lead me to want to help her.
Yes, its 2010 - and this is still the state of womanhood.
2 educated women from the best of backgrounds, feeling powerless to help 2 of their brethren (haha - what a word to use in this situation) through a tight spot.
Its been a learning experience, and I understand now this label of the 'Girl Child.' I understand in part, that I everyday perpetuate that stereotype by acting powerless.
Powerlessness in a woman is far more dangerous than in a man. Simply because you are behaving in a way that is expected of you. If you're a man and powerless - you're weak. If you're a woman and powerless - you're ''just a woman."
And no one should ever be allowed to say that about you.
3 comments:
This is really fascinating. Sometimes we do forget the way things are for people. And in India, things are far less open in terms of mental health than the US ( like you were saying, the special doctor).
It sounds like you are learning a ton about your profession and about life in general.
Hey, this was really enlightening. The 'girl child syndrome'(sic) is still very prevalent in India.The paucity of counselling for the youth is showing in the heightened suicide rates in recent times. With technology in close proximity, the exposure is in manifolds. Without trained counselling, such cases will recur.
P.s- Stumbled upon your blog, fascinating reads :)
This made for fascinating reading. Really well written.
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