​​​The Lesson​​​​​​​​​​​​​​

The life so short, the art so long to learn​

Opportunity fleeting, experience treacherous

Judgment difficult.

Hippocrates 

'Of Medicine’​

Learning in medicine is a lifelong occupation. Apart from the books, patients are the main source for one's medical education. But as doctors, we rarely give them credit for what we learn from them. In our busy lives and even busier practices, patients are reduced to `cases' and `cases' to a set of signs and symptoms. Cases are only interesting when they present in an unusual manner or are rare. The fact is that like an individual, every `case' is unique and every patient, no matter how common his illness, a rare learning experience.

On the first day of House Job at the Civil Hospital, Karachi, Pakistan I am allotted 'my' beds -  eight in all. They are a mixture of hernias and hemorrhoids, appendicitis and cholecystitis. On two beds are young boys - 10 and 11 years old. Both are there because of serious accidents. One was hit by a car as he ran after a cricket ball in the street. The other fell from the top of a lorry he was helping to load. ​

Miraculously, both survived but sustained complicated injuries. Both have been in the hospital for a number of weeks now. The outgoing doctor informs me while one of them would be discharged soon, the other is nothing but `a nuisance'.​  

Both have had major surgeries and, post-operatively, there have been many complications. Both have had to undergo repeat operations for their complications. I discover despite his injuries and multiple operations, the one hit by the car is in high spirits and looks forward to going home soon and resume his studies. `I want to be a pilot when I grow up', he says, echoing many a young boys’ aspiration at that age. Significantly, he has a large family of adoring parents, loving siblings, cousins, uncles, and aunts. They visit him morning, noon and night and get him food from home. They bring him presents and make him feel that they care for him and need him. He appears to be on the road to recovery.​       

The other one is an orphan, hundreds of miles from his shanty home in a remote area in Baluchistan where, while working as a helper, he fell from the top of a truck. He lies naked on a bed in an empty room, which for some unknown reason, has been designated the 'Intensive Care Room' of the ward. The only thing 'intensive' in the room is the stench of urine, which, despite the ceiling fan, seems to hang in the air as a reminder of the young boy's plight. He has a fractured pelvis, a suprapubic catheter, a colostomy bag and ankylosis of both knee joints. A mass of skin and bones for the muscles have long since disappeared. Even the slightest movement brings on excruciating pain. He spends the whole day moaning and crying in pain, asking for morphine repeatedly. He has no appetite for hospital food. He has no visitors, no family, no friends.

He has no hope for his health, his discharge from the hospital or the future. He says he has nothing to live for and keeps repeating he wants to die. When he finds out I am his `new' doctor, he pleads with me to help him in this. This is the one who is a `nuisance'.       

Many years later, I would realise that what I had witnessed was the power of emotional well-being in a person's recovery from illness. The `will to live' versus the `give up' phenomena. The two young boys in their own way had provided me my first real life lesson of human psychology in illness - the interplay of which I would witness repeatedly in the subsequent years.

Unfortunately, the realisation came much too late to be of any benefit for the young orphan. Barely two weeks after I moved from the ward, I found out that he had passed away - alone, lonely and in agonising pain.     ​

CREDITS:​​​

About the Reviewer: Huma Baqir, AKU MBBS Class of 2017, is a science-enthusiast and a self-proclaimed advocate of world peace. Her interests encroach theatre, music, food, poetry, travel, public speaking, self-reflection - and that beautiful, delicious little bridge between medicine and art.​​

Illustration / Photo-credit: Saniya Kamal, AKU MBBS Class of 2018, is curious about life, the universe, and everything in between. She hopes to become a neurologist, pursue art, popularize meta-fiction, conquer the world and stay happy.   

Editorial Note: ​This was second in a series collected as part of the Narrative Medicine Workshop at AKU on January 20th, 2016. The editorial work was performed by the Writers’ Guild, an interest group at AKU, with the purpose to promote a love of reflective reading and writing, within and outside of AKU.

DISCLAIMER: ​Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences. The views expressed do not necessarily reflect the views and policies of CCIT or AKU.​
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