A game of Chess
As a medical student, an important and memorable part of my journey has been to try and understand the complex cocktail of emotions brewing inside a patient’s mind. Experiences are the ink of the unwritten future. Indecisive. Unpredictable. We all have our stories, I’m sure you must too. We all face our own battles, our own demons. We are all afraid.
I still remember when my grandfather was diagnosed with Stage IV lung cancer. It’s been almost a year now. In his prime, he was like Superman- A man of Steel. I mean literally, because he used to work at the Tata Steel factory in Jamshedpur. Now he can barely climb a flight of stairs without stopping to catch his breath. When we got the news, it was probably the most morose and depressing one we’d ever heard. I mean, not that we’d never known anybody who had cancer, but this time it was my very own ‘Acharya’ (meaning guru).
Fear guides our survival. It is an innate algorithm with an unparalleled evolutionary significance. It is also the one emotion we’re most afraid to experience. Just a few months ago, I was working on Palliative Care at the Command Hospital in Pune. While on the surface, the patients seemed very accepting about the nature of their condition, little did I know that the gateway to their cellar of emotions was just one question away- Are you afraid of dying?
This seemingly obvious question opened the gates to an almost unexplored dimension of thoughts, fears and emotions. People never want to talk about death. Death in itself has become a whispered illness. It makes them feel vulnerable. It makes them feel human. It is when I learned that it is not our existence that scares us, it is our absence. Interacting with patients, physicians and social workers, I learnt that fear is a direct manifestation of expectations. The more you have to lose, the greater the fear of death becomes.
A patient asked me -”Is death painful? Does it hurt?” How do you answer that?
On the other side of this spectrum, you’ll find the carefree patient. Like when I found Anjali, who was diagnosed with Non-Hodgkin’s lymphoma at the time. The first time I met her, she was watching stand up comedy on her phone while on chemotherapy. When I asked her what about her condition troubles her the most, she asked me to take a look across the room. I saw a few patients sleeping, a few just gazing at the hospital ceiling while laying in bed and more than a few dull, troubled faces. She then said- “These people were patients much before they had cancer. They regret their past, worry about their future and ruin their present.” Today is a gift, that’s why it’s called the present- This was her motto. (Then we talked about Kung fu Panda :p)
In conversation with Colonel(Retd) NS Nyayapathi- Founder of Vishranti Palliative Care Centre (Care India Medical Society)
On the spiritual front, I gained rather interesting insights. Why do bad things happen to good people? Is God just and fair? Or is he all powerful?
On asking these questions, I realized that the world is divided into two belief systems. One belief is that God is fair and he loves his children and would protect them from all harm. But still, innocent people suffer. This implies that God is not absolute. Patients of this belief system still redeemed their faith in God and believed that suffering was God’s way to test their virtue.
The other belief is that God is all powerful and whatever happens is a manifestation of his will. Therefore, if this is true then God can never be fair because bad things do happen to good people and God is to blame. Patients of the latter belief often became atheists and lost faith in God; or so I have witnessed.
AFMC Cadets at Vishranti Palliative Care Centre, Pune
Learning the power of human touch
I couldn’t help but ponder about the striking similarities between the art of conversation and a game of chess. I mean, reading out from questionnaires doesn’t get you this far. You have to improvise. It is an art of patience. And like in a game of chess, there are also 3 phases to a conversation with a patient- The opening, middlegame and the endgame.
The opening is where you try and establish a rapport with the patient. Patients usually don’t like talking about how many times they puked, coughed or whether their pain is a 6 or a 7. Honestly, they get bored. So, when I saw 10 year old Vishnu who was diagnosed with Acute Lymphocytic Leukemia(ALL), playing around with his Superman action figure, I naturally spent half an hour trying to convince him that Batman could kick Superman’s butt. In the end however, he ended up convincing me why Superman is the greatest superhero of all time :)
Some openings are better than the others. I remember asking a patient how he was feeling and he distinctly replied-”If I would be feeling well, I wouldn’t be in a hospital.” Pretty obvious don’t you think?
The middlegame is a much more progressive ground. It is rather important to lend a good ear at this point. While the opening decides the degree of compliance of the patient, the middlegame is all about building up on that trust and trying to understand the patient’s thoughts and concerns. It is at this juncture that a clinical evaluation of the patient would prove to be most fruitful.
Hope is a wonderful thing. False hope- not so much. This is my endgame lesson. Probably the most precious gift from my experience with cancer patients was when one of them held my hand and said-”Thank you for giving me hope. I feel less scared now.” These seemingly plain, simple words hold a deeper meaning. They are inherent with the realization that just a small act could bring great meaning to someone’s life. But false promises are the most fatal form of expectations. While empathy is a great asset in communication, its extent must be well guarded by professionalism, honesty and truth.
The art of giving
Part of the journey is the end. Mine has just begun.
सर्वे सन्तु निरामयाः। - May all be free from disease.
The motto of Armed Forces Medical College, Pune.
Learning to spread smiles
“For I know the plans I have for you,” declares the Lord, “ plans to prosper you and not to harm you, plans to give you hope and a future.” (Jeremiah 29:11)