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 ||

Fireflies

|| Hari Om ||

Fireflies

It was a cold and silent night. The village was silent and still. The Child sat at the porch of his house, looking at the gentle mist descending on the fields. Everything was bathed in a gentle moonlight.

He shivered, and not from the cold. A chill ran down his spine, as he thought of the horrible things he had heard on the radio. A scary new disease, a virus. To him, it sounded almost like one of the Asuras from the stories His grandfather used to tell him.

A living entity, full of malevolence, causing pain and suffering wherever it went.

Theirs was a remote village, far removed form the world, a place where you could still see the stars at night. But, the fear was already creeping in from the outside world, taking root in their little community.  People were falling sick, supplies were starting to fall short. He understood none of the details, but felt the chill in his bones just the same.

As he thought of all this, a single tear rolled unknowingly down his cheek. It fell with a soft splash on the porch, where it glistened in the faint moonlight.

A sudden creaking of the floorboards woke him from his musings.  He turned, and suddenly felt a little warmth creep into his chest, somewhere near where his heart must be. There stood his beloved Grandfather, with His white moustache and unkempt hair, a gentle twinkle in His eyes. In a second, those wise old  eyes saw the tears that the child thoght he had so effectively hidden. Grandfather smiled even wider than before. “Let us take a walk my child”, He said. “ I want to show you something”

 

Hand in hand, they walked towards the fields. The clouds had moved and had totally hidden the moon now. Everything was dark. The rows and rows of crops were barely visible in the gloomy mist.

“ Are you scared, little one ? “,  Grandfather asked. “ No!” said the child, clenching his fists to hold on to his bravery. He turned to face his Grandfather and saw such warmth and understanding in those dark eyes, that he melted.

“ Yes, I am scared! I am so small, and all alone and the world is such a frightening place. I am worried for you, for me, for our family, for all of us.

 

Grandfather swept the child into a tight hug, held him close till his fear melted away.

He cleared His throat, and the child looked at him expectantly.

“Well,” said Grandfather, now that we have accepted that We are afraid, lets do something about it !’

He stepped forward and touched the crops with a gentle hand.

The child watched with wide eyes, all his fear forgotten. A single glowing light rose from the gloom. “ A firefly !” , he exclaimed with amazement,  all his fear forgotten. 

 

“ Yes my child, and that is the answer to your fears as well”

 “ How ? , asked the child, still watching the little dot of light, spellbound.

 

“ Well,”  said Grandfather, “ when we are surrounded by so much darkness, all we can do is spread a little light ourselves. If there is someone you can help, help them in any little way you can. Brighten their day a bit.

Care for your loved ones, take care and keep them safe. And as you care for others, as you give someone a little bit of hope, you will start glowing like this too!

Above all, keep your Faith. Fear is real, suffering is too. Just remember that He is there with you, through all the darkness, you are never alone”

 

The child, being a child, was still not convinced. “ All this sounds correct,” he said, “ but what difference can one little firefly make in so much darkness. See, even now, the field is dark and scary !”

 

Grandfather laughed. There is great wisdom in the innocence of a child.

“ Close your eyes my child, let us call out to Him, He will answer your question”

 

So they stood together, hand in hand, the soft voice of the child joining the deep voice of the Grandfather, as they chanted:

 

’रामा रामा आत्मारामा त्रिविक्रमा सद्‌गुरुसमर्था

सद्‌गुरुसमर्था त्रिविक्रमा आत्मारामा रामा रामा’

Rama Rama Atmarama Trivikrama SadguruSamartha SadguruSamartha Trivikrama Atmarama Rama Rama'. 

       

A gentle breeze started blowing then, bringing with it the subtle scent of flowers.

“ Now open your eyes!”

The child opened his eyes, and couldn’t find the words to speak.

The field was lit up with a thousand fireflies, woken from their slumber by the breeze.

He watched entranced, as they danced among the crops, their collective light banishing all traces of the darkness.

So they watched this magical transformation, this light emerging from darkness, and somewhere, the prayer moved from the child’s lips, to his heart.

 

Grandfather understood.

 

“See, how one tiny light can inspire so many others.. A single person, firm in his faith, working hard to give some light to others, will wake many others who were sleeping. Soon, you will have a whole swarm of fireflies!

 

There is great power in a single good deed, in a single act of kindness, in a single prayer. This is a light that comes from within.  And when so many fireflies gather together, there is no need to fear the dark. “

 

They sat down in the grass, watching the little dancing lights. Soon, the child was asleep in his Grandfather’s lap. When

 he awoke, the Sun had risen and everything was bright again...

 

These are difficult times for all of us. There is so much stress and fear. There is no denying the darkness everywhere. The best we can do is to hold on to our own little light, keep faith and brighten the path for someone else, if possible.  

 

One little light can give hope to so many others;

all of us, together, can bring back the light of hope,

tiding over the night,

till the Sun rises again

as it surely will

                                || तमसो मा ज्योतिर्गमय ||

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. 

 

|| Shree Ram ||

|| Ambadnya ||

|| Naathsanvidh ||

|| I Love You my Dad ||

 

-Dr. ArnavMHT

4/5/21

  

 

 

‘ The Lamp Blinked Twice’

 

|| Hari Om ||

‘ The Lamp Blinked Twice’  

“Do you believe in Ghosts ?” He looked at her with a twinkle in his eyes. “ Do you mean the ones with clanking chains and bloodstained clothes? No, definitely not.“ An open-ended reply that invited his next question:  “Is there any other kind of ghost then ?” 

They were sitting on a bench in a quiet part of the Park. The leaves of the nearby trees were rustling gently in the breeze, as a subtle twilight light bathed the surroundings in its surreal hues.

Just a few feet away, the cliff sloped off gently to the sea below. It was a place where you could just stand still, a place to pause and breathe again. 

She grinned. “ Actually, there's a story about this very park ! “ She had a dreamy look in her eyes. He braced himself as she took a deep breath to launch full-tilt into a story.

“ There’s an old street-lamp along the walking path here. Its in a very quiet part of the park, and people generally don’t go there after dark. Only very specific people go there; the ones who wish to communicate with their loved ones, with people who are no longer here. The rumour is that if you walk past that streetlight, thinking of that specific person, they appear there, not physically, but just enough to give you a sign.” She made wide eyes to emphasize the other-worldly-ness of it all. He was more amused by her story-telling antics than by the story itself. 

“ What kind of sign ? “, he asked, dutiful in his role as a listener. 

“When they appear near you, the lamp blinks twice! “, He raised a skeptical eyebrow. She looked hurt at his utter lack of appreciation.

“Come with me, I’ll show you the place.”

They got up and started walking, breathing in the scent of the evening, the sound of the waves providing a subtle music to the scene. They walked on in silence, gathering in the details, saving each moment, trying to focus on trivial things like Ghosts and flickering lights, to avoid thinking about why they were actually there.

Soon, they reached a quieter part of the park. It was probably his imagination, but the air seemed to be very still. All the birds that had been chirping so merrily were silent here, not afraid, but waiting. 

They walked on, and as they rounded the last corner, he saw an old, rusty swing, lit in the orange light of a single old-fashioned gas lamp.

There was definitely something different here, something that brought out strange feelings, nostalgia and longing, as if the past and the present were yearning to meet, separated by only a thin veil of light.

They stood there in silence, would have stood there for God-knows how long. Suddenly, the lamp blinked twice. She looked worried now, he could see it. He felt an involuntary shiver run down his spine too. “ Did you call out to someone ?”, he asked. “No,“ she said, positively frightened now.

“ Why did you ask me that  ? “

“Because,” he paused and pointed a trembling finger over her shoulder: “There’s something behind you !

She turned and saw something large and white move right before her eyes.

She screamed her lungs out and burst into tears.

He, on the other hand, couldn’t control his laughter. The “Ghost” was just a fluffy white cat, sitting largely unconcerned by the world, atop its throne on a fence.

She saw his smile and burst out laughing too. They walked away from the “magic” lamp and back to their peaceful, non-haunted bench.

He thought for a moment and said, serious this time  “If ghosts are just supposed to be the energies of people who have moved on, why is it that they are supposed to be tied to places and things? I think they would be more attached to people”

“ Friends and family, the people we love, I’m sure a part of them is always attached to us, wherever we are. I’m not talking about the dead, but about actual living people. The memories of the time we spend together are enough to call out to each other's souls, even when we are miles apart. Some people don’t need to be there, to be there ! “   

“Aren’t you philosophical today” she laughed, but he could see in her eyes that she knew what he meant. He closed his eyes, at peace in her presence.

When he opened his eyes. She was gone.

He could almost see the after-image of her smile, of her silhouette sitting next to him. 

He shook himself back to the present, a different evening, a different season.

It had been more than a year, but the memory was still crystal clear.

That last evening, before all of them went their separate ways. Friends, from different places, with different pasts and different futures, converging for the briefest of moments before their paths branched out again.

Friends, colleagues, a temporary family, each of them with so many different colours to them.

And each had left a lasting imprint on his mind, none more so than her.

He got up and stretched. He started walking, completing a well-practised ritual, down a path that he had walked a 100 times now. 

He reached the old swing, with “that” lamp, feeling the warm glow inside of the people he carried within. “Some people don’t need to be there, to be there” He stood there in silence, waiting…

A 100 miles away, in another part of the world, in another park, she stood near an old street lamp. 

And as the memories flooded her mind, she looked at the lamp, calling out to those she had left behind, with all her heart,

…. and the lamp blinked twice

…. and the lamp blinked twice

“So when I smile

for no reason or rhyme

I know I’m in your thoughts

as you are in mine”

------------

This story is a work of fiction, however, it is as much the truth. Each of us have people in our lives that matter so much to us, that we carry them in our hearts. Particularly since the start of the pandemic, we have faced the cold reality of isolation and loss like never before. In these times, it is the warmth of our memories, our friends, our families that gives us the strength to keep going. 

And even when it may feel that you are alone and all is lost,  

Have Faith in Him. He is always with you, even without you calling out to Him.

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. 

  

|| Shree Ram ||

|| Ambadnya ||

|| Naathsanvidh ||

-Dr. Arnav H. Tongaonkar

17/4/2021 

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 ||