The eyes that never left me

The terror in her eyes told me she was frantically thinking she would die. I knew it, because her stare was penetrating – all of a sudden my whole integrity, my being and all my thoughts were swallowed by her eyes, in one full gulp of terror.

When they say that time slows down when things are falling apart, it’s almost true. Thinking back on that day now, I feel every second, every gesture amplified, as if it took forever. However, back in that room, time felt as if it was horribly slipping off my hands, and every sound of the ‘gas and air’ was deep and rapid and almost piercing into my ears.

Within the space of an hour the room had filled with two doctors – one still to come-, two midwives and me, the useless medical student. First I thought the suturing might be going a bit slower than usual as the midwife felt out of practice. As time kept ticking, however, I had this feeling of something-just-not-right growing bigger and bigger inside me. And the midwife felt it too. As did the patient.

“Do you mind calling in my senior?”

And so it began. From the senior, it was the doctor, then it was swabs, then more doctors, then the anaesthetist, then swabs, and suturing needles, and screams, and tears.

As the blood kept flowing, and the doctors firmly repeated to the patient to stay still and relax – imagine how well that was going – I felt as helpless as never before.

So I did the only thing I knew how to do.

I picked up some tissues, and stood by the patient’s side, picking up her tears. I held her and told her to breathe, and things would be okay. And without words, I just said that I was there.

That’s when she looked right into my eyes. I never felt a gaze that strong, full of fear and life and terror and fight. Those eyes sent me into a state of surreality for the rest of the shift. I saw them everywhere, if I closed my eyes they were there. But in the moment, I held her, and felt her pain and her wet tears on the tissue I just replaced.

The bleeding stopped.

I saw her later, on a quieter ward. We gave each other simple smiles and spoke formalities – but our eyes met again, and without words, she said thank you.

Don’t give up on them

As she gained confidences in her speech, she attempted to speed up, and then the words for jumbled again. But she had learnt – take a deep breath, stop, start again. 

It took her weeks of hard work and determination. Weeks on a ward, away from home and friends, for that word to come back. At the beginning, it was frudtration. She screamed “no!” at all those people who did not inderstand, she pushed them away, she cried. The stroke had taken away her words, that she had used for so many years, teaching in school, knowing the literature so intimately. And all of a sudden, gone. No way to express that the TV was too loud so she couldn’t collect her thoughs, no way to ask how to get the words back. I have to admit very few people were confident she’ll regain more than basic expressions over time.

So she tried, and talked. She talked to anyone who was around, to friends and family, and tried and tried and tried. She wanted those words back. That willpower turned into an incredible medicine – she did not give up. Everyday, as words got jumbled – deep breath, stop, start again. And now there we were, weeks later, having a conversation. She was healing, not with drugs, but from the inside. 

As I moved to the next bay, I could tell he had given up. With his hands over his forehead, he tried to get a word out, then shook the head, tried again, and then scoffed and stopped. He could have done it, I wanted to tell hin, I wanted to shake him, look at her! She did it! But too much time had passed now. 

Don’t give up on them, don’t let them give up. Even when you think there is nothing you can do, there is still lost they can do. And they can heal, from the inside. 

Whose body?

“Do you want to hear what your heart sounds like?”
I never even thought about it, and all of a sudden it just felt so natural. I had just spent 10 minutes taking a history from my patient, listening to him describing his ailments as well as very personal details about his life, and then moved onto listening to his heart, checking pulses and all the rest of the tick boxing. As I semi-mechanically went through the process, it almost felt like the patient’s body had temporarily been consigned to me – my mind was working through symptomatology and differential diagnoses, now fully concerned with analysing the body in all its parts to figure out the reason for his admission – and it was now in my “domain”, somewhat. It’s as if at the beginning of every consultation patients agree to temporarily give up their exclusive intimacy with their body for someone else to get to know it closely, hold it in their hands and take it close to them, as it belonged to them. Of course, it’s all in best interest, and there is nothing particularly odd about that either (surprisingly enough).
However, it seems that while doctors do their doctoring with patients’ bodies, they rarely share their own art and discovery with the patients themselves.

So, as I heard that loud whooshing sound on the left sternal edge, it dawned on me. Whose body was this then? I had discovered something about the patient’s very own body that they were not aware of. Almost as if I knew their body better than they did, in that particular respect.
“Do you want to hear what your heart sounds like?”
I just blurted that out, in half excitement. Had it been my body, I would have wanted to find out that there was something I hadn’t known about it before.
“Yeah, why not – go on then”
I popped my stethoscope in his ears.
“Can you hear that?”
“Oh! I see!”

It was almost like giving that body back. Not keeping a portion of the patient’s body to ourselves, forever precluded from going back to the owner.
It’s worth remembering whose body it is.

It wasn’t mine. It was his.

Silence

Silence. The first act was silence. And he exploded in a river of emotions, of pain that had been bottled up for too long. I like to think it was almost osmosis. Silence invites words, not just to fill the space, but to go beyond – as if they were attracted to not only fill the space in between us, but my space too. In those few minutes of silence, I gathered a deep understanding of the man standing in front of me. A man who had not been given any silence in months in which to pour his emotions. It was a river closed off by a dam – once the dam was broken, the river flowed with energy, but then placated itself and went back to its usual stillness.

Medical students often fear silence. There is a precise list of questions, a method, a sequence we go through in a patient history to specifically avoid that silence. Part of that is due to the time constraints we are often reminded of, that will be part of our professional lives. A precious 10 minutes per patient. And then there are the patients who seize the silence with force, and fill it with rambling words – they scare medical students too, and perhaps more than silence itself. When you can’t use silence, you have to revert to the questions, and the sequence and the method. But how much more superficial will that consultation have been, albeit necessary.

Silence breaks the barriers between us, vanishes the dams, and lets the rivers inside us meet and flow together. Silence is where souls touch.

 

 

Swallowed

Sometimes it’s so easy to just get sucked into medicine, to never come out. Your life revolves around it, your friends are all medics – I’ll be damned, all you talk about is medicine (look at this blog)! It’s not until you give yourself a chance to emerge from the big black sea of medicine that you realise how far down it had dragged you. It’s almost like a beautiful mermaid, and you’re a sailor – except it’s a lot less pleasurable and a lot more grievous.

People talk about the precarious work life balance in medicine, and everyone seems so incredibly aware of it – “yes of course, work life balance, one of those things you need to watch for”. And then poof, it’s gone and you don’t even notice. So much for keeping an eye out.
It’s almost paradoxical, really – we’re here looking after people’s quality of life, and end up forgetting what life is about altogether when it comes to our life. Are we then referring to some sort of idealistic, imaginary good life, that we want our patients to have, if we don’t ourselves have any idea of what that is? How can we possibly treat, give advice to someone, try and “improve their life”, if we base our practice on textbook notions of life?

I don’t want to be swallowed. I don’t want to disappear in the big black sea of medicine. I don’t want medicine to be who I am. And I guess this doesn’t just apply to medicine. So often we are swallowed whole by our jobs, our commitments and roles, our duties and obligations at that particular point in time.

But as you breach through the dark waves, as you take a big gasp for air, then you know there’s so much more. And you can’t let it go. Don’t let it go. Otherwise there’s no point in even opening that textbook, in talking to that patient about their ailments. If you’re empty, and there’s nothing to you but medicine, then that’s it.
You might as well not have lived at all.