|Year : 2019 | Volume
| Issue : 1 | Page : 89-91
A glass of water
Department of Plastic Surgery, Chinmaya Mission Hospital, CMH Road, Indiranagar, Bengaluru, Karnataka, India
|Date of Web Publication||4-Apr-2019|
Department of Plastic Surgery, Chinmaya Mission Hospital, CMH Road, Indiranagar, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
In large cities, cancer management has moved to highly specialized centers that provide holistic care. Hence, freelance consultants very occasionally encounter cancer patients. Sometimes due to a variety of reasons, one may not have much to offer to a patient in terms of medical management. However, empathy and small acts of kindness can have a major impact on patients going through tough times and must be always remembered. A glass of water is a true narrative of how seemingly benign words can make a patient aloof when one least expects and how small acts of kindness can change their equation with the doctor. It reinforces the fact that the art of medicine is still the better half of the science of medicine and must be practiced at all times.
Keywords: Cancer, communication, empathy, patient care
|How to cite this article:|
Chauhan N. A glass of water. Indian J Cancer 2019;56:89-91
Cancer management is developing at a rapid pace. Because it requires a multidisciplinary approach, in most large cities, dedicated cancer care institutes have come up that provide holistic care to cancer patients. Most cancer patients directly approach these centers for specialized care. Plastic surgeons play an important role in reconstruction following excision of malignancies, but owing to the reason stated above, it is rare for a freelance plastic surgeon not working at a cancer institute to encounter such patients. And rarer so to get something to write about such an encounter!
This is a (real) story of my rendezvous with Mr. SN.
My first meeting with Mr. SN cannot be described as a pleasant one, not even in the wildest of imaginations!
Before I begin my narrative, I wish to briefly outline the facility that lead to my brush with Mr. SN. The general surgeons at our hospital have an attached dressing room, while all the surgical superspecialities share a common dressing room. I being a plastic surgeon, dealing with trauma, burns, and reconstructions, occupy this other dressing room (henceforth called as dressing room no 2 or DR2) for the maximum duration of time on any given day. Almost all my patients need dressings, and going by the teachings of my MCh professors, I never (I repeat never ever!!) hand them over to anyone else. I have hence been declared the uncrowned queen of DR2 by the staff who time and again joke that the DR2 should be officially declared as the plastic surgery headquarters for all practical purposes. Being the one who has kind of usurped the DR2 ever since I joined there, I have always enjoyed the privilege to finish my dressings first.
All was going as per routine, until one fine day when my queendom stood challenged! And the one who challenged was none other than Mr. SN! He had been shifted into the dressing room by the staff on instructions of the spine surgeon and for one whole hour he occupied DR2 as the surgeon had not yet finished his OPD consultations and was not able to come to the room to dress him. The patient could not be moved in and out of the room again and again as he was paraplegic and recently operated. Hence, the staff gave me a sorry look and asked me to wait until the spine surgeon came and finished the dressing. Left with no option, I returned to my OPD room and finished evaluating my remaining patients. By the time I came back to the dressing room, another hour had passed by. However, to my dismay, the spine surgeon had not yet arrived and my patients had started breathing down my neck and complaining that they had been waiting for nearly 2 hours for dressing. Although I could empathize with SN's condition, somewhere inside I was fuming (in all probability due to the challenge posed to my territory). Added to this, nagging by my patients and their attendants raised my temper further. With great difficulty I swallowed my anger and decided to wait, until a call from the OT sister broke the last straw of my patience. I had posted a case at 2 pm but some emergency case had come which they wanted to post at 2 pm and since the OT was free before that they wanted me to start my case at 1 pm and finish it before 2 pm or else to operate only after 7 pm. A quick glance at my watch and I realized that it was already 12:30 pm and all my patients requiring dressings were still waiting for DR2 to be vacated. With all my patience tested, I marched toward the staff nurse seething with anger and expressed great displeasure at their lack of coordination with the doctor. I suggested that next time they should take a patient inside only when the concerned doctor had come to DR2 and not to block the dressing room in advance causing inconvenience to other patients for hours at stretch. She responded that she was just a staff nurse and could not say no to orders from any doctor. Mr. SN and his attendants were all ears to this conversation, and by the look on their face, they were not exactly pleased by my suggestions to the staff nurse. To my relief as soon as my conversation with her ended, the spine surgeon had arrived. He finished dressing, SN was shifted out, and I hurriedly finished my dressings and headed to the OT. This was my first meeting with SN!
I had learnt from the staff nurse that SN would come for dressings on alternate days and I made it a point to finish my dressings before he came so that I never encounter him, but little did I know that fate had different plans! I kept bumping into him or his attendants almost every other day for the next couple of weeks, somewhere in the waiting area or near the dressing room. Needless to say, the look on their faces suggested that there was a kind of cold war going on at my supposedly unconcerned and unkind suggestions to the sister at SN's first visit. Over a couple of weeks after my first brush with him, I learnt that SN had been operated for some spinal tumor. A month into my first encounter with Mr. SN, I had almost forgotten the incident when the spine surgeon called me one evening asking me if I could see one of his patients who had developed wound dehiscence following a surgery. I asked him to send the patient the next day to my consultation room. To my surprise, the patient was none other than SN! He and his attendants were aghast to see me. With great reluctance they let me see Mr. SN's wound. He was having marginal necrosis with total dehiscence of the surgical site and frank cerebrospinal fluid (CSF) leak. He looked much weaker and exhausted than when I had seen him for the first time. He coughed badly and was diagnosed as having severe bronchopneumonia and uncontrolled diabetes besides the wound problems. On going through his medical history, I came to know that he was 83 years old, diabetic, and operated for a spinal tumor at the level of 9th thoracic spine a month ago. He and his family at the time of diagnosis itself had made the decision that they would let the spine surgeon remove the tumor in the hope that the patient's paraplegia would improve but in case it turned out to be a malignant tumor they would not want any adjuvant therapy. Histopathology and immunohistochemistry had revealed it to be a low-grade B cell lymphoma but the patient only wanted palliative treatment. It was decided that the patient would be admitted under the spine surgeon for observation of CSF leak besides being treated for bronchopneumonia and I would look after his wound and daily dressings. After discussion with the patient it was planned that once Mr. SN's pneumonia improved, the CSF leak would be repaired and flap cover would be done for his exposed spine, so that the quality of his remaining life would not be compromised.
Nervousness was palpable on both sides! From their looks and attitude, it appeared that the patient party was not very comfortable with me managing their patient. On the other hand, even I was not exactly keen to manage a patient whose family did not trust me or my intentions. After a long deliberation and convincing by the spine surgeon, the patient agreed to be treated by me. For the first 2 days, I would visit the patient daily, do his dressing, write my notes, and come back. I wanted to talk to the patient but he was too breathless to talk. Attempts to talk to the attendants were also not paying off as they were reticent for the initial 2 days.
On my third visit, the patient's general condition had improved a bit. As soon as I wished him good afternoon and he opened his mouth to respond, I noted his dry tongue. A quick glance at his urobag showed dark colored urine. The next question was a spontaneous, “Are you thirsty? Would you like to have some water?” Back came the response in affirmation by nod of his head. The attendants had been asked to wait outside till I finished my dressing and the sister had gone to arrange for a dressing trolley. So, I spontaneously picked up the glass kept on the table besides his bed and poured water from a bottle kept there. SN eagerly snatched the glass from me like a child and in a matter of seconds drank the entire glass and asked for one more. I happily obliged. I was all smiles inside, somewhere patting myself at having diagnosed his dehydration when he broke the silence and said that “How did you know that I wanted water? You will become a very good doctor one day. You can read a patient's mind. I was thirsty for quite some time now and wanted to drink water but doctors and sisters have been coming for rounds back to back, and then they had started me on nebulization so I couldn't drink water.” I finished my dressing and went to write my notes, after which I left the hospital. This was my first conversation with SN! And it left me happier as that awkward silence was broken.
On my fourth visit, he had improved a bit further clinically and to my surprise opened up to me about his family, life, and profession. His family also shared with me the challenges they had been facing since he was diagnosed with the tumor. They told me how his life came crashing one day when he suddenly developed paraplegia. According to his family, he was an extremely self-reliant person; his whole life and the news of the tumor had broken him completely. On my next visit, he had a child-like excitement in his eyes and told me that his childhood friend along with his wife was coming to see him from Chennai. He excitedly shared what all he had asked his wife to cook for his childhood friend and how he had been asking his son to call her every now and then to know if everything that his friend liked was on the menu. Over the next 4 days, I had gained the trust of the patient and his family and they would share important events of the previous day with me. They had become comfortable with me and I had renewed enthusiasm to treat the patient who showed trust in me. After all, finally they and I were on the same page that they would let me try my best to heal his wound. The rest, they wanted to leave to God.
Suddenly, SN became critical the next day and needed ventilatory support, but he and his family had decided against the same when he was fully oriented and had signed a note in advance at the time of his admission. To my disappointment, by the time I reached the ward they had already left with him against the advice of his primary doctor and I could not meet SN that day. As I was leaving, the staff nurse handed me a note they had left for me. I opened it with trembling hands. It said “Thank you doctor for all your efforts but he wants to spend his last days at home. Hence, we are taking him.”
I do not know how long he would survive but “the glass of water” that broke the ice between him and me is going to stay in my memory for quite some time. On reflection, I realize how a small spontaneous act as small as offering a glass of water changed my equation with the patient. The patient's family that had been almost been at war with me (sans the visible weapons of destruction!) had suddenly started respecting and trusting me and my treatment. I realized that there may be times when we may not have the exact solution that can cure patients but small acts of kindness that show that we care for them can ease their pain a bit and help them spend their last days well. This is especially true in patients with cancer. Even with all advancements and path-breaking research, we will often encounter situations where we cannot scientifically help such patients much. As I walked to the DR2 with a heavy heart, Leo Buscaglia's quote echoed in my mind, “Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.” This incident brought to my mind the famous quote by William Osler that I could not comprehend when I read it for the first time as a MBBS second-year student, “A good physician treats the disease, a great physician treats the patient who has disease.”
As I reflect, I also wonder at what my response would have been, had I drunk a “glass of water” when I was fuming on the very first day of my encounter with SN. Could it have extinguished my anger, resulting in a calmer approach to the staff, no cold war from the patient's family, and lesser stress to myself? Well… that only a “glass of water” would be able to answer when I drink it next time I'm displeased with a situation beyond my control!
Till that happens, I leave the readers to reflect on the Hippocratic advice of “Cure sometimes, treat often and comfort always!” This quote perfectly sums up what we as crusaders of cancer need to remind ourselves at all times.
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Conflicts of interest
There are no conflicts of interest.