Patient attendant: The real superhero

            I have been writing about the stress which patients and doctors go through. But there is a group of people who are seldom addressed. The patient attendant. Usually it will be the patient’s spouse or first degree relative. It is not uncommon to see a friend or neighbour accompanying a patient.

            To accompany someone sick to a hospital is actually a bad dream. One has to take out all the energy, keep all senses sharp, be quick to respond and keep patience at its height if he wish to get his patient out of the hospital quickly. Treating staff take it for granted that the patient attendant is a healthy person who is responsible for the welfare of the patient. Orders, instructions and directions are thrown at the attendant without mercy. The normal person will take a little time to get accustomed to that treatment.  

            Trouble starts from the registration counter. He or she has to fight for a place in the queue and wait for long hours to get a card. The fight continues for a waiting spot in front of the OP room. Again this person has to come with the patient and without the patient so many times before the patient gets admitted. In between he/she has to work his/her way out to find out where which sample goes, where which x-rays are done and where payments are made. He/ She has to make arrangements for the money, find and bring persons to donate blood and spend sleepless night with the patient.

            In the general ward only one attendant is allowed with the patient, who has to be there all the time. But no bed is provided for them. They are supposed to live on the chair that is provided. Majority of them are also working persons. So the more time they spend here, the more fiscal constraints they are going to face. The mental stress of a person who accompanies a sick patient is unimaginable. Although I don’t have to treat children now, during my house surgeoncy, I have seen depressed faces of people who has to look after sick children. Apart from the emotional attachment, it is about the physical work and stress they have to go through. Many a times, I also feel empty in my armamentarium with some patient symptoms.

            It is not only about money and physical stress, even the relatives of private ward patients who have people under them to take care of physical needs also has to undergo the mental stress. But they are better treated than the common man. The corporates know about this fact and some of them provide a hospital staff called ‘facilitator’ who takes them through these maze of hospital procedures.

But a naïve person can transform to a very good attendant in short time. As a treating physician, I can now identify a trained attendant easily. They ask sharp questions, wait and request for advice or service rather than get offended by the first response. They can easily pick up the lag, a phenomenon seen in any service institution. Unless there is a need from somebody’s side, things get postponed. For example a histopathology report which can be issued in five days might get seven days. By the patient comes with report a holiday will come, then the further test will take some more days. Like that the treatment goes extended. But an experienced attendant plans the things in advance and get the staff done things by persuasion.

            So I like to address them as superheroes, because they are the persons who act extra-ordinarily to bridge the gap between the treating facility and the patient while sacrificing their personal interests.

The never ending sleep

 

I don’t know what to put as a title for what I am going to write. Today morning I was greeted with the death news of one of our patients who was admitted in the ICU. He was a young guy who just touched twenty. An undergraduate student. He was having a normal life till one and a half year back, when he started having bowel symptoms predominantly constipation. Sad to say, none could treat his illness nor find what it is. He died without a diagnosis. He had underwent multiple laboratory and painful tests in this period and finally he ended up in our casualty with complete bowel obstruction.

***scene 1 ***

While trying hard to approximate and close the laparostomy wound on his soulless body, I glanced at his face. He was looking peaceful. It made me recount my first encounter with him while he was alive. He was in agony, he wanted to get rid of the giant nasogastric tube stuffed in his nose. His abdomen was hugely distended and I could see his bowel creating ripples on it.

***scene 2***

“Why can’t you help me to clean this bowl? Whom do you think you are…?” my senior colleague was shouting at the nursing staff, he was at the brim of a breakdown, taking part in surgery after continuous 48 hrs strenuous duty. The male nurse refused to help him with the big bowl which was overflowing with stool removed from our patient. His large intestine was the size of a trumpet and completely filled with semisolid and solid stools which had to be removed. The staff wanted the orderly to come to clean up the mess.

After taking part in his first surgery, I was happy that I chose to become a surgeon. We has made a diverting stoma which we believed to help him out of obstruction and agony. I was proud that we could give him the relief from symptoms, which he could not get from any physician. I was confident in explaining what had we done to him and how it is going to help him after the surgery to his sister. His sister was a well-educated girl. She cared so much for him.

***scene 3***

My colleague who was in charge of his bed for most of the time, told me, that his sister was grabbing his hand and not letting him go after her brother’s death. She was accusing us for doing those procedures, which ultimately relieved him from this world. His father was crying, he was recounting how dearly he looked after his son. The second surgery was done when his abdominal drain started showing pus, which was not expected. On second exploration, we found he had developed perforation of bowel at another site. But his body system had already been crashed that, he never made it to the normal physiological mode after second surgery.

There are things which are hard to explain. Like the loss to that family. The way his dreams were crushed. His eyes were vivid, it said he wanted to live. He wanted to enjoy life. He never have thought that it was his last journey from home, when he left to the hospital that morning. His sister had hope. She believed we could save her brother. But what happened was not expected. But somewhere in my mind I can recollect his face, after the first surgery, telling me he is feeling better.

The surgeon

         My friend and colleague who was actually fond of medicine, but now in the profession of cutting, always tell me that surgeon is an extended physician. A step forward which makes them eligible to cut open and repair the living body. Two years has passed since I joined for surgical training. As I stand at this point, celebrating the new year, somewhere I felt a little pride to be a surgeon.
      
        Surgeon is bestowed upon the permission to operate on human beings and relieve them of their suffering. Well it is not right to say that surgeon treats the disease or eliminates it. What he do facilitates the natural process of healing to take place. Basic principle of surgery whether it be small or big is, removing the dead or diseased part and realign the rest, so that they can stick together by nature's way. Even though man has been able to go to moon and come back alive,  he has not been able to understand the life force. There is no wonder, the people thought life is a power or spirit which is invisible. Even now, when I watch a patient die, I feel that some force or invisible spirit gets evaporated. Like the flickering of a dying flame.

     Surgery is an art when it comes to operating. It includes well planning, judicious selection of patients, procedure and instruments. Like a well trained and talented orchestra, it flows out like a symphony in the operation room. But what makes a surgeon is the follow up. The experience and analysis of the operated patients adds invisible power to the surgeons clinical skill.

     Surgery is medicine when treating patients. The surgeon has the access to all the medicines to keep his patients free of symptoms. But some times patient does not get symptom relief just by medicine and the radiological eye gets blurred that they cannot find a cause to reason the symptom. Then comes the call for surgeon, to open and see what is happening inside. Some times surgery is the answer.