Monday, September 24, 2012

A Doctor's Anguish as a Patient, for the Patient

Dr. Srinivasan Krishnan is one of the most affable, approachable and gentle doctors (he is my nephrologist) you can find around. He was in fact referred to me by another doctor and what I found of Dr. Krishnan put me greatly at ease. He is available, approachable and has this wonderful way of putting you at ease instantly.

But recently he was diagnosed with colon cancer and is undergoing treatment. He wrote about his experiences, his thoughts on how much doctors can do so much more for patients to make them feel more at ease. I reproduce what he has written (a month ago) as it is and one can hear the anguish in his voice as he worries over how much more he could have done, doctors can do.It is a wonderful, heartfelt and touching piece of writing by the sensitive doctor.

Close encounter  with Yamaraj----Lessons learnt

- Dr. S. Krishnan
Three days of symptoms -severe abdominal cramps, constipation and mild distension. That’s it. I was in for a deep shock. As the Gastroenterologist decided to do a sigmoidopscope in an unprepared bowel, my thoughts were racing. Just reassuring myself that nothing can go wrong with me. And lo behold – the next minute my world came down crashing. I could see the concentric growth on the monitor, occluding my  descending colon. The subsequent events unfolded at a rapid pace – surgical resection, chemotherapy , FOLFOX regimen in full swing. As I (and my family members) gradually accepted the reality – my moods went  through phases of disbelief, anger,denial, feeling of why me?, despondency and  ultimately meek submission and acceptance of the inevitable.

No matter how scared or overwhelmed we feel  the emotional trauma and its effect on the psyche, time is a great healer. We adapt to the circumstances and move forward. Probably that is the way it should be.
After two rounds of chemo, since my blood counts were behaving well my doctor permitted me to attend o.p for an hour everyday before I could turn insane, sitting at home.

I realized how important each complaint was, however trivial they may seem. I understood nausea, anorexia, fatigue – all these terms. I also realized my folly in ignoring these in many till a few months back. Now ,When I inspect the vascular access , the counter punctures, the minor hematomas etc  I feel the pain. I realise that this is their life-line, It certainly deserves tender loving care.

While interacting with the dialysis patients I  have started realizing the subtle signs of depression. Non compliance to the dialysis schedule and the medications/ irregular follow up, were also related to the emotional disturbances which we very often overlook.  I could see the enthusiasm with which my Dialysis medical officer would correct the UFR, calculate the spKt/v, dialysis prescription to achieve a ‘good’ dialysis. Little would he analyse the QoL.  The medication prescription written very often resembles a mini pharmacopeia . How often have we analysed their sleep disturbances,, social support and quality of life of the care givers. I feel, I could have done better .

As I look back, on the day of my surgery how well the nurses tried to pep me up, as I was wheeled into the theatre. How well they received me in the Surgical ICU, took care of all the lines with utmost care and concern. Each member of the team excelled in bestowing  that little extra tenderness.

I recollected my days in the bed with the continous chemotherapy pump set for 48 hours. I would eagerly look for the Oncologist to drop in and reassure me and my family members that all is well. That also made me ponder – how often have I sat down beside the patient and heard him or sat with the family members to tell  them about immunosuppresion.

The practicing nephrologist needs to be an all rounder – physician,well wisher,psychotherapist,and a good soft-spoken gentleman. Lets recollect our undergraduate teaching that health is defined as not only the absence of disease and infirmity but also the presence of physical, mental and social well-being. I reckon that our Post graduate training empowers us with lot of skill in tackling disease. Life teaches  us the rest – how to deal with people.


Madhav said...

Every doctor should read this.

I think its depression that got dad in the end. Not the cancer.

Rajendra said...

Good one. Wish him all the best!

Unknown said...

I fully understand how Dr. Krishnan feels. I have undergone 3 renal transplants, a multitude of complications and finally bilateral total hip replacement! My third transplant was 6 years ago. I am a surgeon by training but now am in palliative care. I also teach communication skills to health professionals. You may want to see an article I wrote in 2004; many more complications followed!
Dr Nagesh Simha

Harimohan said...

Madhav I agree with you. I think Vardha is doing a good thing now with his hospice.

Harimohan said...

Raja, will convey that.

Harimohan said...

Dr. Nagesh Simha,
I read your article and have forwarded the same to Dr. Krishnan too. It is amazing to see how you coped with the illnesses and the complications. Like you said the Master Planner surely has some greater design for you, a greater purpose. Wishing you good luck and a speedy recovery.