Human life is pretty fickle; its fragility a truth as ancient as the human civilisation

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The term ‘successful doctor’ has a very vast description; you not only need to keep yourself updated with the latest medical guidelines while simultaneously retaining that which you learnt in medical school aeons ago, but you also need to be equipped with the presence of mind to deal with all types of crises – attendants who are angry, possibly violent, in a state of denial, uncooperative, and even threatening.

The first reaction to a loved one’s death is almost always that of shock, followed by denial of the unfortunate event before being proceeded by grief. What the doctor needs to remember, however, is that the deceased was not the grieving family’s patient, but a very, very important part of their life. Patience, empathy, and compassion are the only tools that can help a doctor communicate to the attendants – as clearly as possible – the reasons leading to the patient’s demise. Words like ‘cerebral infarction’, ‘non-ST elevated myocardial infarction’ – are Greek to them. Using simple language and using an easy-to-understand analogy along with a gentle explanation of what the term ‘palliative’ care entails, can help avoid unpleasant incidents where the deceased’s family may unfairly blame the doctors, inadvertently creating a ruckus in the hospital.

A very important – and yet, easily forgotten – clause of the Hippocratic Oath entails: ‘I recognise the special value of human life, but I also know that prolonging life is not the only aim of healthcare.’
What a lot of patients and their families also do not understand, is the fact that often – especially in our set up – they head to the hospital once the disease has progressed to a stage beyond that of a quick recovery, or when there are a few asymptomatic comorbids. In such a scenario, there’s not much a doctor can do except choosing between ‘management’ and ‘treatment’, and often, ‘symptomatic treatment’. Unfortunately, a lot of home remedies that are often the first option chosen by quite a few patients tend to aggravate the situation, further complicating the doctors’ job. All these factors combined – doctors are always treading on a fine thread that asks them to make quick one-minute moral decisions pertaining to patient health, patient and hospital safety, and sometimes, even cost-benefit analysis. But the important question, again, is whether to save a life – no matter how physically or emotionally compromised – or that of no dependency. What would you want? A few more years of bed-ridden breaths haunted by persistent nausea and weight loss as a result of the chemotherapy needed to cure cancer, or, a relatively easy, pain-free few more days spent reminiscing with your family?

Another important clause that is forgotten amidst the glory of doctors, is this: ‘I will promote fair use of health resources and try to influence positively those whose policies harm public health’.
How many doctors – out of sheer goodwill – do not charge their patients on rounds in hospital wards if all that they do is having to check the lab reports, a task that the medical officer has already performed? How many doctors weigh their patient’s financial situation before helping them decide the best course of treatment? Or how many doctors in power stand up to the unfair health practices and extortion of money that some private hospitals shamelessly engage in? How many the varying prices of diagnostic tests? These are questions that quite a few healthcare professionals and policymakers have yet to answer.

All in all, human negligence is very much possible and doctors are also humans, hence, remaining vigilant during your care is not only a good idea but extremely necessary. But let us also remember that human life is pretty fickle, its fragility is a truth as ancient as the human civilisation itself, and there’s not much that we fallible beings can do with our limited intelligence in the face of good, ol’ mother nature.

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specks of dust – like us – can only pretend to be stars

With my dearest, truest friend, Saba Saeed

 

Saba: Minds are weird.

Arfa: Hearts even more, Saba.

Saba: True.

Arfa: This walk is exhausting. It’s like walking on a thin rope under the lovely, lonely moon.

Saba: The moon is a funny thing, too.

Arfa: Throned up there in the sky, pretending to shine on lonely hearts down here as we string verses upon verses praising it’s beauty, forgetting how it silently mocks us when we lose.

Saba: It’s funny, though, if you think about it.The moon is just a rock. It’s a mirror shining off someone else’s light. It’s not even a star. It’s dead. And here we are thinking it watches over us. What an incredibly human thing that is! So typically human.

Arfa: We’re all made of the same stuff then, I guess. Doesn’t that make you feel a little better?

Saba: The culmination of everything I’ve learned is this; humans are soft.
Our bodies – a tangle of limbs and muscle and blood, throughout years of growing and education and heartbreak, and sometimes, literally breaking, still remain soft. Humans are warm.
Cliche to say that love is the greatest ability God has given us, yet, here we are, spending lifetimes sinning away and being forgiven because our children cry their hearts out at our passing for us to go onto a better place. We are born of blood, warm and flowing, and when we die, our bodies go cold. The soul is gone. What was human is now a corpse. Humans are tough.
And we forget sometimes that our blood is mixed with iron. Our bodies take things of stone, break them to take life from them and turn them into something that works something so fragile. We bear sadness and hurt, and lose parts of ourselves, and still breathe, our bodies screaming at us to live. And of course. Humans die very easily. We live through decades and struggle – striving to be something, finding purpose and enlightenment, and one mutated cell, one bullet, one second is enough for us to stop. Our bodies form scar tissue over and over, compensating loss of senses, tweaking itself over, all for survival, and all of this is lost before we have the chance to even think, was there something I could have done differently?

Arfa: This reminds me something I happened to think a few nights ago: specks of dust – like us – can only pretend to be stars on this giant ball, as we gaze up at what we think stars really are.

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Saba: But we forget. The light we see has traveled light years to reach us. For some, their luminaries have long since died. Would we be selfish enough to wonder if they are shining so brightly just to guide us for this very moment? That this universe, put together in all it’s mastery, existed for this very moment, for you to see this way?

Arfa: But am I really seeing it this way? What if this is just a dream? What if this is a dream that I’ll be rudely awakened from, only to wound myself once again, by the same shreds of glass?

Saba: Then we tread carefully. Hold onto a dream so tightly it’s forced to become reality.

Arfa: I wonder if it’s selfish to wish to be somebody else’s dream?

Saba: It’s hopeful. So many things humans do are selfish. Is it selfish to want to be successful? To be happy?

Arfa: Happiness, love – alas, all a dream!

Saba: A hope.

Arfa: That at the end of this all, the patience will pay off, love will win, and we’ll meet our old friend – our God – with happy smiles.

 

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Are we alive? Or thoughts that drift away from a God we’ve never seen but Who never fails to side with me?

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To watch the soul depart from its cage of mortality is akin to watching – that too live – a tragic reminder of your own death; how one day, we’ll leave behind everything, everything, and head to a land unknown. It punches you right in the heart and the room around you begins to shrink and you are scared; you are scared of what is to come.

When I saw our first patient die right in front of us, mocking any amount of medical advancements my seniors could boast of, I was overcome by both grief and disgust. After long years of rigorous clinical practice, writing the death note in a patient’s file becomes a part of your routine. It’s like watching a news channel broadcasting the death statistics of a natural disaster and exclaiming “Oh, only twenty casualties!” And then you remember that you definitely need to discuss yesterday’s sale at your favourite outlet with your fellow doc. Life doesn’t stop for anyone and there’s no room for sentimentality in a room full of medical equipment like a ventilator and a defibrillator, and well, perhaps the dead human body holds no dignity anymore, does it?

As I walked out of the I.C.U., I battled with myself – what sort of a doctor will I be? Will I actually do that? Or will I mourn those I couldn’t keep alive? It was in that moment – the heartbeat of my moment – that I decided: a small prayer for the deceased and their family and a relevant reminder to cherish the people in my own life and to take out the time to appreciate their presence in my life, was what I’ll do. And as I made this resolution – trying to calm the rising turmoil within – I was reminded of the lyrics from the song ‘Standing Outside A Broken Phone Booth with Money in my Hand’:

We sit outside and argue all night long /
about a God we’ve never seen /
but never fails to side with me… /
Am I alive or thoughts that drift away? /
Does summer come for everyone? /
Can humans do what prophets say? /
If I die before I learn to speak /
can money pay for all the days I lived awake /
but half asleep? /
A life is time, they teach you growing up /
the seconds ticking killed us all /
a million years before the fall…”

Really, though; are we alive? Or thoughts that drift away from a God we’ve never seen but Who never fails to side with me?

 

and the orange, crinkling leaves miss the twigs they rested on before the cold wind blew them away

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To confine it within scientific jargon, the human body is just a structure of bones covered with flesh, working according to a complex system that took centuries to be discovered — and is still incomplete — but is, in fact, so much more. Emotions, dreams, desires — all of that, you see? And then there’s the inexplicable — almost mystic — feeling of missing something — or someone — that baffles your heart and soul and gently reminds you of how beautiful vulnerability truly is.

So what’s this missing someone or something like? How the orange, crinkling leaves miss the twigs they rested on before the cold wind blew them away? Or how the sunflower craves to be kissed by the sun? Or how after being lost for so long, the sinner looks for the dervish that he’s born to be? Or how you are nostalgic for a dream you dreamt that one winter night when the stars were admiring the lonely moon? Or how you miss hearing your name… just your name; and the heartbeat it carried ever so lightly? Or how a mother misses carrying her child inside her, and then later in her arms, as she watches the child grow into themselves alone? Or how you miss yourself — the innocence in the sacred childhood, the bantering with your best friend in grade three, the carelessness of youth — and long to be acquainted with the real you again, just like you really are, free from the facade that the world requires you to adopt? How you miss God because you’ve been so busy, you think you haven’t heard from Him, when in fact, it’s you He hasn’t heard from? Or how you simply, beautifully miss what you are supposed to miss only so you know how much of you it actually is.

Maybe it’s that. Will we ever know?

Stars

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If you can hold the stars in place
You can hold my heart the same
Whenever I fall away
Whenever I start to break
So here I am, lifting up my heart
To the one who holds the stars

– Stars, Skillet (https://youtu.be/TbLJyjfyACM)

You know how you’re walking along the fine sands of the shore one fine summer evening – aimlessly wandering, admiring the picturesque view, using your cell phone’s camera to save the moment for a later date – and your lonesome walk is interrupted by a sharp object sleeping on the soft bed of the sea’s sand. You stop. You stoop down and pick up the object. It’s a sea shell, glistening with the dews from the ocean. You marvel at it’s imperfection and decide to take it home with you. It’ll look nice beside my study table lamp, you tell yourself. And then that sea shell stays there, for a long time, reminding you of that long walk down the beach.

There are people like that in our lives, too. Friends who make an entry into your life like that sea shell – without a warning, asking you to stop in your tracks, forcing you to rethink your entire existence and yet, lighting up your life like never before. Blessed are those of us who have such friends as fireflies in our lives, helping us find our way with their mere existence.

To those of my friends – and you know who you are – you truly are a blessing from the One who holds the stars.

The healthcare dilemma

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“In any case, seeing care for certain groups as an excessive cost reflects an arguably perverse way of thinking about health care in terms of human need. […] In other words, care for the sick is an economic burden only in healthcare systems where profit is the bottom line and public services are underfunded and politically unsupported – that is, systems in which only market logic is considered legitimate.” 
― Julie Guthman, Weighing In: Obesity, Food Justice, and the Limits of Capitalism

The history of the human existence takes us through a course that brings to our attention – albeit, much to our distaste – bitter truths that make us uncomfortable as we sit in our well-furnished homes drinking tea from expensive cutlery. Or as you go about tending to sick patients in a hospital clinic.

A twenty-six-year-old female attired in clothes that hung loosely from her frail body and clearly pointed towards recent massive weight loss walked into the pulmonology clinic of a public sector hospital in Karachi. She was accompanied by her old, tired father and a mother who seemed to be trying her best to fight their unfortunate circumstances. Her signs and symptoms suggested pulmonary tuberculosis and her disinterest in her health, a lack of desire to live. Why would a woman so young lose all interest in life? The resident on duty – a young woman herself – wondered. Her silent query was answered when the father later came up to her with involuntary tears in his eyes, asking her if a High-Resolution CT (HRCT) was very expensive and if he’d be able to afford it with his monthly salary of Rs 12,000. He had, after all, his daughter’s medicines, the house rent, the groceries, his own travel expenses, the monthly bills – amongst other things – to consider. The mother also told the resident that her daughter was a divorcee – an unforgettable, highly punishable social status, eh? – whose son had also recently died. That explained the young woman’s behaviour: the end of a marriage is the end of the world, says the society.

“My heart skipped a beat, Arfa,” the resident later told me as she narrated the encounter. “The tears in that helpless father’s eyes shook me to the very core.” She did all she could; directing the family to a government hospital from where he could get the tests done free of cost.

As I heard this sad tale of many a common man in our country, a million thoughts raced through my mind. Social and economic inequity, the ‘burdensome’ status of women in our country and why economic empowerment and independence is a much-needed survival tool for women, the negligence of a basic human right such as healthcare.
All of us are guilty.

We spend thousands on fine-dining at expensive restaurants but haggling over fruits and vegetables and clothes with street vendors is just a habit. One of those vendors could be earning a mere twelve thousand rupees. Let’s walk in his shoes for a bit? Imagine having to make important decisions like choosing between getting whether to pay the house rent or to get your daughter’s medicines.
The common man here dreams big for his sons but saves up for his daughter’s dowry instead; after all, the son will support him in old age while the daughter is supposed to go to another home. Survival in this vicious world is a skill that we all must be equipped with. And this ‘we’ constitutes of women as well.

Artists, writers, poets, and all those affiliated with the social and electronic media are under trial here: a country where every household has access to a television and a mobile phone; where political talk shows and morning shows are a daily feature, a lot of social awareness can be achieved if creative brains work the right way. Yes?

The ‘little’ tragic mistakes

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As doctors – someone who goes through long, gruelling hours of learning the secrets of the human body – we often tend to underestimate the importance of paying attention to the small details when we are dealing with the gross realities of what is presented to us as pathologies.

One small mistake, one act of negligence that is the sad result of a tired body working for hours at a stretch, one incident of forgetfulness; and you, dear Doc, could have put someone’s life at stake.

An X-ray of a female documented as ‘Mr Sarfaraz’ instead of ‘Mrs Sarfaraz’ could lead to an embarrassing situation for both the patient and the doctor.
A female patient whose OBS/GYNAE history is left undocumented after a huge ‘MALE’ is scribbled across the relevant section, in the ER of one of Karachi’s well-reputed hospitals, could result in a near-fatal treatment or management plan because of missing out on important medical information.
Forgetting to check the blood pressure of a known case of a hypertensive patient while taking their history in an OPD, is sheer irresponsibility.
Writing down the wrong file number on a sample of fluid collected from a bronchoscopy, perhaps, could lead to some disastrous misdiagnosis.

It’s these little details – the seemingly easy tasks that require less of an effort than retaining important drug side effects and pharmacology – that could rob someone of their smile. And it is these little details that we so unjustly underestimate.

Having heard of so many tragic ‘mistakes’, I am still naively surprised at how our doctors and future doctors haven’t yet realised that in a profession such as ours, acts of negligence like these incite the suicide of the very ideology that attires us in this white lab coat. But here’s some food for thought for our education policymakers: starting a clinical skills class early on in the five-year-degree could hone our future physicians’ skills so perfectly, that double checking facts and following basic health protocols would become an innate feature of their personalities by the time they are ready to take the Hippocratic Oath. After all, old habits die hard, don’t they?

The end of another universe

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Not very long ago, I wrote about how, as doctors, we will get to see the end of so many little universes around us and yet, still be able to sit comfortably in our rooms, sipping on a cup of freshly brewed coffee. Little did I know that soon enough – as a medical elective student – I’d get to see a tragic such end

*Sarah was a twenty-three-year-old young woman. Having delivered her second son – after a gap of twelve months only – just ten days ago, she was brought to the ER with complaints of headaches, drowsiness, and vomiting. The MRI revealed a left MCA, ACA infarct that had damaged an alarming 80% of her left brain; a possible result of Pregnancy Induced Hypertension. She was on the ventilator when I saw her in the I.C.U. the next day. Needless to say, things did not look good. They were not good. An E.E.G. – a quick test done to determine the brain’s activity – confirmed what every medical personnel in the I.C.U. already knew; Sarah was dead.

As I stood there, watching her pale face dim away from the life that she had just brought into this world, my heart ached for this young woman.

That young girl could easily have been me. Or you.

Instead of heaving a grateful sigh at my promotion to the fourth year of medical school – a privilege that not many are blessed with – I could have been Sarah, lying there comatose, oblivious to the hungry wails of her newborn, and the empty, searching eyes of her eldest. Instead of having a father who is my biggest support system, I could have had a father who found himself helpless in the face of abominable society rules that did not even allow him to take important decisions regarding his daughter’s health, but dictated that he waits for her husband and father-in-law to do so, who sadly, blamed it all on black magic, delaying medical help. Instead of a life that has granted me my basic rights, I could have had a life of non-existence, much like that of so many of my fellow countrywomen.

In those moments of watching a mother’s warmth die away, I said a small prayer – more as an act of resolution than as a cry for Divine help – for all the Sarahs of our world: may our women learn to prioritise their health, may our women not raise helpless sons like Sarah’s father, may our women not be wives of uneducated men like Sarah’s husband. I hope you, too, breathed an ‘amen’ to that.

And then I went home and had my evening tea and carried on with the mundanity of what life had to offer to a medical student. Winters were approaching. The ground was a blanket of orange and yellow leaves, all dry and withering. Like Sarah’s motionless body.

* Name has been changed for reasons of privacy.

A doctor’s heart

 

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Hurried steps from one ward to another. Long working hours at a stretch. Difficult night duties when on call. That is the real life of a doctor. I knew this, of course. But they very rightly say that experience is truly the best teacher. There’s something very powerful about experiences and empathy that takes our understanding to the next level, or the right one, let’s say. That is one of the many things that working as an elective student taught me. And for good.

It’s very easy to imagine that the life of a doctor is that of prestige and wealth. That may be very true. But what we very conveniently forget is what goes behind all this grandeur.
Imagine having to wake up every morning and rush to the hospital to attend to ailing bodies, often missing out on your son’s parent-teacher meeting, or your daughter’s sports day at school, or your own mother’s appointment with the doctor. Imagine having to miss out on attending your best friend’s wedding, or a night out with your cousins because you have a night-shift that may stretch into a 12-hour post-call. Imagine having to be on your feet all day, your wits intact, as your back aches and your feet shout for a rest. Imagine having to make important, life-saving decisions on empty stomachs and full bladders. Imagine losing a patient in the face of the complexity that the human body boasts of, and not blaming yourself for what was predestined. Imagine breezing through life as you watch little tragedies and big miracles every day.
Yes. That is a small window into what the real deal is.

Perhaps, it’s in these larger than life paradoxes that the simple secret of life lies in.
Seconds melt into hours and days into years. Between one summer and one winter, more than a few showers of rain grace this soil, either washing away fragile homes of mud-bricks and straw roofs or watering a healthy rice field. Someone, somewhere, crushes the autumn leaves. Someone, somewhere sings the songs of spring. And a doctor, a messiah, does all of that in the heartbeat of a moment.

The Lamp

 

The Lamp, Husain Sharif

 

I found this painting, ‘The Lamp’, by a U.A.E. based artist, Husain Sharif, in an old copy of Arts & The Islamic World (Volume 3, Number 4. Winter 1985, Spring 1986. Special Issue). It’s just a simple lantern painted with a striking mixture of bright and dark. But there’s something about it, something quite moving. Perhaps, it’s  the tilt of the lantern that caught my eye. That’s pretty much life, isn’t it? How we are supposed to be? Be the light in this dark, chaotic world. And the ones who are that beacon of light, are more or less trying to hang in there, too – everyone is – tilted like this lantern, afraid of the eerieness that could follow this glow, the silence that could haunt once the festivity ends. The dark after the light? Or the light after the darkness? And the answer to that lies thumping within our little souls.

He alone has the right to break,
for He alone has the power to mend.

He that knows how to sew together,
knows how to tear apart:
whatever He sells,
He buys something better in exchange.
He lays the house in ruins;
then in a moment He makes it
more livable than before.
 – Jalaluddin Rumi. Mathnawi I, 3882 – 86