Kaleidoscope: Broken pieces can make a beautiful picture

 || Hari Om ||

For those of you who do not know me personally, a brief introduction:

 I have completed my MD in General Medicine from KEM Hospital.

I joined Tata Memorial Centre, Mumbai as a Senior Resident in Medical Oncology in December 2020.

This is a collection of my thoughts and feelings that I have imbibed in my Oncology residency. This is a branch that not many are ready to step into. A branch everyone, patients and doctors alike, associates with suffering. But where there is suffering, there is hope. And in the midst of darkness, we appreciate the light even more.

Kaleidoscope: Broken pieces make a beautiful picture

Working in the medical field for more than 5 years now,  and particularly in the last few years, working in oncology, I have got an insight into how fragile our lives really are. We live in bubbles, secure in our own illusions. A feeling that things will always be the same. It is not always so. We are all just a word, a sentence or phone call away from the bubble bursting. The picture-frame shattering into a thousand shards; jumbled pieces that may never be the same again.

This is true for all of us, whether we see it or not. And getting diagnosed with a medical problem, particularly something that sounds as scary as “cancer” can shake the very foundations of a person’s life. I have seen that happening, I see it every day. But I do not write this to spread despair or sorrow. No, I write this, because even where I saw darkness and suffering in patients’ lives, they showed me so many ways in which they find joy and light for themselves. 

 

 

They picked up the broken pieces of their lives, accepted them and rearranged them till the picture was bright again. Till the cracks arranged themselves into the intricate patterns of snowflakes, and light could shine through. A thousand different colours, a changing picture with just a small shift of perspective. Like a kaleidoscope. And those that try to find the light for themselves, add a bit of light and colour wherever they go.

 

 

 

 It's not that I feel that just positive thinking is enough to cure or heal, not at all. All I feel is that a touch of positivity makes everything easier. That applies to all our lives, not just for those who are ill.

I would like to quote a patient of mine here. She was under treatment for a stage of her disease that would essentially require her to be on some form of chemotherapy life-long. She was already a few years along in her treatment when I met her. By this time, many people are (understandably) tired of visiting the hospital some 2-3 times a month, and fed up of the constraints that puts on their lives. Not this lady, not at all.  Her energy and enthusiasm exceeded that of even the doctors. We looked more-unwell than her! I asked her the secret to her spark. She told me her very simple philosophy. “The hospital is my temple. I visit it once a month, to get my life extended by another month. That is God’s blessing.”

I was stunned. She had turned her chemotherapy into a pilgrimage, something she actually looked forward to. She had looked past all calculations of life-expectancy and was just living her life for all it was worth. She opened my eyes to a new perspective about my work too. I was a priest now. A priest in the Temple of Life. I counted my blessings a little more that day. 

Very often, we allow our work and life stressors to get us down. I know it happens to all of us. And I have always found that when my own flame is burning a little low, God sends me an Angel. By this, I mean that He sends someone into my life that is so full of warmth and light, that I remember to try to be that way too.  I have met a lot of patients and even their relatives who have changed my way of thinking. I recently met a young lady who is pursuing her own medical residency after completing her Cancer therapy. She had enough light and energy in her to power the electrical fittings in the room. We could have probably asked her to step in as a back-up generator in the event of a power outage.

She was admitted in our ward for fever. And each time her fever dropped a little below 100F and she felt just a bit better, she would walk around and talk to the other patients, to tell them of her struggles, the things she has overcome; that they would make it too. In the short time that she was in the ward, the other patients, and even this doctor (me), felt just a little bit brighter. Just a little bit happier. “Just a little bit” is a lot.

Hair-loss is something that has a really strong psychological impact on the patients. Its something that doctors know will happen, but we are not the ones who have to live with it. In this context, I came across the heart-warming tale of 2 sisters, one of them planned for a cancer therapy. As soon as the diagnosis was made, the other sister got her own hair cut short.  They faced it together. She shared her experience with another one of our patients who was a bit upset at the time, hurting from the loss of her hair. And after they talked, I saw that child smile, really smile, for the first time in so many days. It was beautiful.

It is very easy to lose sight of that which kept keeps us going. We all carry our own burdens, and it is definitely important to shoulder these as well. But if we can carry them without losing sight of the little joys in life, the little things that make us who we are, I think we could walk a great deal further.

A particular event stands out in my mind. I remember that I had a night duty that day.  I was tired. I was stressed about something ( we are always stressed about something, it’s a matter of degree). In fact, I had a truck-load of pending submissions. So I geared up to try and finish some work while I could.

I entered the patients’ room to just see that everyone was okay. To my surprise, I found the room alive with singing and laughter. The 4 patients in the room were playing “Antakshari.” It sounds fictional even as I write it now. I felt as if I’d walked into a scene from a movie. I was happy to see them having fun, but I was a bit worried that my presence would dampen the mood. I tried to beat a hasty exit.  It was not to be. Their ring-leader, the one who had started this Antakshari business in the first place, called me back in and asked me to join in as well! I couldn’t exactly say no, so I joined in; shyly at first, then with an enthusiasm to match my friends in the room. See, I said friend. I entered the room as their doctor, and left as their friend. We sang together for almost an hour that day. And somewhere, a little piece of my soul was renewed that night. The pending work also went much better, and all the weight on my shoulders felt so much lighter.

So it is for all of us. We all face these times when the world tilts on its axis and it seems like things will never be the same again. In those times, we need our Faith the most. We may be able to see only a jumble of pieces, a mess where nothing makes sense. Sometimes, the pattern is not for us to see. God’s Hand is at work.  Transforming those broken pieces into a beautiful mosaic, His masterpiece. His Plan will always prevail. We just need to open our eyes to see. 

 

 

 

Even in the darkest of the times, the Sun always rises again. And while we wait for the sunrise, It helps to light a little candle for ourselves, for those around us, so that the path becomes visible again. If we can give a little joy and add a little colour to lives we touch, this world will be a more beautiful place.

 

 

 

 

 

 

 

 

My older blog posts are listed at the top of the page.
If you liked this, do read the others too!

 

||Shree Ram||

|| Ambadnya ||

|| Naathsanvidh ||

 -Dr Arnav H. Tongaonkar ( DrArnavMHT)

26.3.23

 

 

 

 

 

 

 

 

Connect 2.0: Healing the Doctor-Patient Relationship

|| Hari Om ||

For those of you who do not know me personally,

 a brief introduction:

 

 I have completed my MD in General Medicine from KEM Hospital in 

September 2020.

I joined Tata Memorial Centre, Mumbai as a Senior Resident in Medical Oncology in December 2020.

This is a collection of my thoughts and feelings that I have imbibed in my Oncology residency. This is a branch that not many are ready to step into. A branch everyone, patients and doctors alike, associates with suffering. But where there is suffering, there is hope. And in the midst of darkness, we appreciate the light even more.

Connect 2.0: Healing the Doctor-Patient Relationship

This blog post is a continuation from something I had written as an MD General Medicine Resident. "Connect" was a concept that I visualized, where doctors and patients get to know each other better as people, get to understand who and what they are, when not bound by health and disease. People, getting to know other people. No hierarchy.

Now, I’ve spent almost a year as a Medical Oncology resident at Tata Memorial Hospital. 

Medical Oncology in many ways differs from the rest of medicine, in that we are not always treating to “cure” and that simply disease control or symptomatic relief are also acceptable outcomes. The branch of oncology is very vast and complex, and as a junior “Senior” resident, there are many questions thrown my way by the patients that I may not be able to answer immediately. Work is exhausting, hours are long and the reading matter is more exhaustive(and exhausting) than I’ve ever encountered before. But all said and done, work is very rewarding.

More rewarding still is the lives we touch and stories we see unfolding in front of us.

 

Most of what I’m writing here is not just about myself, but things I’ve observed from my teachers, seniors and colleagues, and of course our patients

At the end of the day, people are people. Both doctors and patients have the same needs, wants, likes and dislikes as anyone else. True, we are bound together as the sufferer and the healer, but that doesn’t really change who we are as people (or at least it shouldn’t).

Also, we doctors invariably end up spending more time in the company of our patients than we do in the company of our families. If you’re spending so much time with someone, you may as well get to know them well.

 

All it takes is a little conversation. A few sentences more than the basic: “ How many times did you get fever today ?” , or “How is the nausea ? “ . A few sentences that remind the patients that we are human too. A short conversation on cricket, the news, politics, a snippet about the latest Bollywood gossip, or even discussing our favourite singers! All it takes is a moment to form a connection, to provide a topic to discuss, to laugh about. To smile, together. 

 

Here, I feel the initiative lies with the doctor to spark off the connection. 

 

Patients often hesitate to ask questions even regarding their illness, making off topic conversation a distant entity. Once you open the doors, there’s so much more you can learn about each other. In fact, once there is a normal conversation going, people feel more comfortable sharing their problems. People. It is not just patients who can share their problems. We doctors have problems too. And more than that, we have small joys that we want to share as well. Before you know it, you end up sharing tiny bits of each other’s lives. You know that patient X has been staying away from her dog due to chemo, and really misses him. You know that Y is an artist and has promised to show you some of his sketches at the next visit.  You know that the elderly gentleman, bedridden with high fever, is a professor with a mind sharper than Sherlock and looks forward to playing a game of chess with you once his fever settles. Suddenly, you have a tonne of well-wishers for a sports event you are going to as fun, and actually end up winning something! You get the idea.  We share prasad from poojas at our respective homes, and stay in the hospital like a family. 

 

Does that mean that there are no rules to be followed ? Well, not at all.  Particularly for patients on chemotherapy, there are a lot of restrictions to be followed. A degree of discipline is definitely necessary. But discipline is so much easier to digest with a topping of love. 

 

Diagnosis, treatment, planning, cure, control, palliation, decisions: these are all the big things. These are the things we always have covered.

But is Healing in the big things, or is it in the smallest of things?

Healing is visiting a doctor who remembers you by name when you visit after a gap of 2 years. Healing is visiting the person who remembers that you were having problems looking for a job, and asks how that is going. Healing is sitting down with a friend and discussing the places to visit in Mumbai after the treatment is complete.

 

Healing is meeting a patient who tells you that she doesn’t know if she will be well at the end of the treatment, but that you have made the treatment journey a very pleasant experience.

Healing is seeing one more person smiling because you have touched their lives, and they have touched yours. A bond that lasts forever.

 

When we take the time to get to know each other, what is it that we are healing ?

Are we healing the disease: not really, we had that covered with the treatment. What we are healing is Faith. We healing the Faith of the patients; they believe that the person who is treating them is doing so out of genuine goodwill. They know that they are more to us than just an investigation chart, a collage of lab reports and vital parameters. They are living breathing human beings, and the people treating them are human too. 

 

We are also healing our own faith as doctors. Healing our faith in our profession, in ourselves, in our ability to do good. This is very true in oncology, where outcomes measures are very different, but equally true to the rest of medicine. 

The moment we remember that we are humans on both sides of the table, just cast in different roles by health and disease, we automatically step down from the pedestal. 

Not deities to be worshipped, not villains to be attacked when things go wrong. Just people, plain and simple; people just like the patients themselves.

 

True, the hospital is a busy place. The work itself is so much, that this kind of extra-curricular conversation, so to speak, really seems impossible.

 

It is impossible, if you treat it like another task on your To-do list.

·      Vitals

·      Temperature

·      Auscultation

·      Conversation

 

Life doesn’t work like that. 

 

Instead, make this connection something natural, a part of the way you live your life. 

Offer the same courtesy to your patient/ doctor that you would offer to anyone else.

We can be a very caring species, let us be so where it matters most.

A slight shift of perspective, and everything changes. As doctors, we can’t guarantee that the treatment will be pleasant. What we can do, is create an environment where our patients look forward to meeting us, to speaking to us as friends.

 

A few years down the line, you will get a phone call from a person you met ages ago, and you will talk about everything except medicine, everything except treatments that may or may not have been successful. Just a person, catching up with another person, to find out how they’re doing.

This is the most rewarding thing of all. 

 

P.S. The concept of "Healing the Faith" was actually something that was said to me in the context of the doctor- patient realtionship. This was the inspiration behind this blog post 😇 

Here is a link to my previous article: "Connect"

https://arnavht.blogspot.com/2019/03/connect.html

My older blog posts are listed at the top of the page.
If you liked this, do read the others too!

-Dr Arnav H. Tongaonkar ( DrArnavMHT) 

Senior Resident, Medical Oncology

Tata Memorial Hospital, 

Mumbai

 6/11/2021

|| Shree Ram ||.    || Ambadnya ||. || Naathsanvidh ||

Ward Stories-TMH Tales- Token No. 108

 

|| Hari Om ||

For those of you who do not know me personally, a brief introduction:

 

 I have completed my MD in General Medicine from KEM Hospital in

September 2020.

I joined Tata Memorial Centre, Mumbai as a Senior Resident in Medical Oncology in December 2020.

This is a collection of my thoughts and feelings that I have imbibed in my Oncology residency. This is a branch that not many are ready to step into. A branch everyone, patients and doctors alike, associates with suffering. But where there is suffering, there is hope. And in the midst of darkness, we appreciate the light even more.

At the end of the day, there is a lot more to learn from the patients than the diagnosis and management of their disease! Now, on to the story.

 

Token No. 108

Tired. A strange word to start a story with, but there it was. The Doctor was always tired. Happy and tired, sad and tired, but always tired. Tired was the way of life at the Hospital. So much so, that even though it was a holiday, he was still tired. A person who has been working continuously should jump to embrace the smallest amount of free time. But more often than not, they don’t know what to do, when they actually have time to do it.

He rolled around in bed for a bit, and then decided it would be worth it to at least see a bit of sunlight. He got up, unfolded his tall frame and dressed in the least battered clothes he could find.

He left the building without any real plan. His feet wandered one way, and his mind another. The previous day had been a storm. 150 patients in the OPD, or 150 “tokens” in Hospital lingo, even more than the not so modest 100 that came there everyday. And as the day wore on, everybody grew more and more worn out. Patients and doctors alike.

Without realising it, he reached the entrance of the park nearby. He hesitated at the threshold. It had been a very long time since he had interacted with people other than those suffering from or treating disease. Anyway, a walk couldn’t hurt.

So he followed the beaten little walking path and soaked in the smell of the wet mud as the gardener watered the plants. He heard the chirping of sparrows after months and the birdsong sparked long forgotten feelings in his weary soul. The sunlight played hide-and seek with the shadows of the rustling leaves. He was mesmerized.

Everything was so ordinary, and yet so alien to him. Slowly , the Doctor remembered what it was to be human, and to celebrate the small delights of the soul. A part of him was surprised that such simple beauty and warmth could exist so close to a war zone, the battlefield between health and disease. For a moment, a wave of despair washed over him. He wished he could have more time to himself, more time to spend appreciating life as it was. 

His trance was broken by the sound of children shouting. He followed their little high pitched voices and found two children, a boy and girl, locked in a fierce argument over one of their toys. Their mother was seated on a bench nearby. He watched the scene from afar,  like the audience to a stage drama, appreciating this snapshot of how other people spent their time.

As he approached, he saw that the mother had an expression of such deep and profound joy, as if watching her children play was worth all the riches in the universe. In that moment, her face was awash with a thousand tiny expressions, so much joy, hope, bliss; and also a hint of pain and longing.  Suddenly, he realised that she looked oddly familiar.

She looked up as she saw him approach and raised a hand in greeting. He still couldn’t tell where he had met her. “ Good afternoon doctor, so nice to see you here. “ He knew now that she was somehow related to one of his patients , but still couldn’t place her. She saw his confusion and said.

“We met at the OPD yesterday . I was token number 108 !

I was in a lot of pain, and the medicines you prescribed have really helped. So much so, that I’m up and about today. I’m using this day to spend time with my children.  God bless you for helping me“

He bowed his head and accepted her blessing, said a hasty goodbye and walked away. He had tears in his eyes. To him, she had been a number, a diagnosis with a symptom that he had treated. To see her here changed his perspective totally, the world shattering and realigning  like the turning of a kaleidoscope.

For the first time, he saw the difference that a single medication could make. How treatments literally changed lives and brought smiles to forlorn faces. All the fatigue and work was worth it for this.

The next day, a new OPD. He was still tired.  They all were. But even in his weariness, he saw new light. He saw the patients as more than numbers; it was almost like he could see them carrying their families with them,  waiting to play in the park together. He could see now how he could touch their lives.

It may be the 10^th, the 100^th or even the 200^th patient for him, but it was a loved one, a dear parent, spouse, sibling or child for someone else. So he worked now with renewed vigour, realising that God had sent an Angel, a ray of guiding light  to show him the path forward. His world would forever be changed by Token No. 108

Author’s note

This story is a work of fiction, inspired by feelings and moments that may be completely different from these events. However,  it is also true that many of us medical professionals live a life of sacrifice, away from our loved ones, with almost no time for ourselves.  And in such trying times, it is such tiny moments of joy that give us the strength to keep working, to keep moving forward.

 

My older blog posts are listed at the top of the page.
If you liked this post, do read the others as well ! All comments and feedback are welcome. Subscribe for updates and new posts. 

-          Dr. Arnav H. Tongaonkar

       11/3/21

|| Shree Ram ||

|| Ambadnya ||

|| Naathsanvidh ||

 || Jai Jagdamba Jai Durge ||

|| I Love You my Dad ||

 

 

 

 

 

Ward Stories 1 : Hope

  || Hari Om || || Shree Ram || || Ambadnya ||

|| Naathsanvidh ||

Dear readers ! For those of you who don't know me, a brief introduction: 

I am a 3rd year Resident Doctor in Internal Medicine at KEM Hospital, Mumbai.

Residency is always a roller-coaster ride, full of  struggle and hardships, but also full of the most wonderful memories. Moments to be treasured forever.

I am starting this series to share some of the beautiful experiences and interactions that I have had during my residency. These incidents have really inspired me; and they are God's Supreme blessing, which have carried me through many difficult times. Hope you enjoy reading them as well.

Now, on to the story ! 

 

Ward Stories 1 : Hope

There are many times during the practice of the medical profession that we feel that we are fighting a lost battle, and all our efforts are going to be futile. We feel that we are swimming blind in a sea of darkness, fighting a many-headed enemy that we cannot even see. It is in such situations that we are truly humbled, when we realise how little we actually know, and how little is in our control.

The best we can do is not give up, and keep fighting, with whatever it is that we have.

The story I wish to share highlights this principle. 

The story is of a young boy (for the purpose of this story, his name is Hope) who presented to us with Refractory Status Epilepticus. Avoiding technicalities, this basically means that he was in a state of continuous seizure activity. He required constant sedation and was on a ventilator in our ICU for life support. His seizure activity was not controlled on more than 5 different anti-epileptic medications. Finally, he was introduced into a state of drug-induced coma. Any tapering of the medications, resulted in an immediate recurrence of his symptoms. He was in this state for more than 60 days.

His relatives were very poor and not well educated. They were very simple people. Our morning rounds used to always end with speaking to them at length. It was heart-breaking for us to explain to them everyday that our best efforts were not working. More so because of two things: it would have been almost impossible for his parents to understand what was wrong with him, since it was far beyond even Our understanding; and because they always looked to us with great hope and faith. They believed in us, even though we felt then that we were fighting an enemy we could not hope to defeat.

During my tenure, I have seen him requiring 3 inotropes ( life support medications) just to maintain his blood pressure, completely on mechanical ventilation. He used to throw a new challenge at us everyday, and we used to respond as best as we could. But it was like fighting a forest fire with a water bottle. But, we never gave up on him. And his family never gave up on us.

And one day, after a very long time, Hope woke up!

 He opened his eyes and began gesturing with his hands. Gradually, with careful monitoring, he was now off the Ventilator.

 Literature tells us that seizure activity persisting more than 30 minutes starts causing irreversible brain damage. Well, this was more than 60 days ! Who knew what state his mind would be in ? Would the parents get their son back, or just a shadow of what once was ? Here, again, he surprised us all.

 He woke with no deficit, completely recognizing his relatives, as if the last 60 days just hadn’t happened. The best start to our new year as that we spoke to him, and he spoke to us. And his parents, the simple farmer family, showed us such love, such as is difficult to come by these days. The smiles on their faces are something that I will carry as a talisman for the rest of my life.

We had tried many novel treatment modalities, something must have worked eventually. 

But, the bottom line for me is what one of my seniors at MICU said while we were discussing his recovery:

“ We kept him alive, God saved him”

I am not disregarding our efforts, for countless Faculty and Residents from various departments, Staff Nurses, Ward Mamas and Moushis (Helpers) have invested their hearts and souls in this struggle. But there is forever a part of the battle that is not really in our hands.
 

There are many times when we lose, and fall over and over again. The only thing that we can do is to keep rising and keep fighting. Victory is never guaranteed, but the effort is what we can and must give. It is easy to get tired and frustrated, to think of giving up, but even if you win only once in a hundred battles, it is worth it for that one person, that one family! 

Hope woke from his slumber, and in doing so, became a beacon for a hundred medicos. The next time that, we are stuck in the darkness, fighting an invisible enemy, fearing defeat, we will look back and say: “ We will give it everything that we have. Hope lives on, for all of us”

SETH G.S. Medical College & KEM Hospital

-Dr ArnavMHT
( This story has appeared in print in The Larynx: the college Newspaper)

My older blog posts are listed at the top of the page.
If you liked this post, do read the others as well ! All comments and feedback are welcome.

  || Hari Om || || Shree Ram || || Ambadnya ||

|| Naathsanvidh ||