Medicine - Goethe style!

"I am still suffering with the lower abdominal pain. It is not going away. Help me!" These words keep reverberating in my ears. It was a 65 year old man, who had come to our clinic several months ago with a vague lower abdominal pain. He also complained of difficulty in passing urine. We made a clinical diagnosis of benign hypertrophy of the prostate, which is a common condition among men his age. It is a condition where the prostate gland enlarges. As it is situated encircling the urinary passage, it leads to urinary obstruction. We treated him with some medicines to relieve the obstruction. It usually works very well for many patients. But they did not help him. A couple of weeks later, he came back with similar symptoms and some vague lower abdominal pain. We optimised his treatment but there was no relief. We referred him to a urologist, who evaluated him thoroughly and adjusted his medications; still no relief. The urologist advised surgery. This man belongs to one of the common demographic conditions today in India, an elderly man living alone with no family support. So he was too apprehensive to undergo surgery. He deferred that option and continues to come to our clinic every week hoping for a miracle relief. 

Seeing him week after week, with disappointment and frustration written all over his face, makes me feel very bad. I wonder why he keeps coming back. I have already explained to him that surgery is the next option and there is nothing much we can do other than surgery. He understands well that our clinic is a low resource clinic with very basic facilities. He was a landowner and farmer in the past and has reasonable savings to fall back on. He can afford surgery as well as visits to a higher private health facility, where he may get better treatment than what we can offer. But he chooses not to go there and continues to visit us, even when we have very little to offer. One day I asked him, "Ayya, why is it that you keep coming back here, even though we are not able to offer anything to help you?" The frown on his face disappeared for a fraction of a second when I asked this question. But then it came back and he never answered the question. 

I have since then been thinking why he continues to come to us. Our clinic is located very close to his village. He has to just take a 10 minute share-autorickshaw ride to reach us. Our consultation fees is Rs. 20 per patient, extremely reasonable for that community. Our medicines are generic drugs and cost almost one-tenth the cost of drugs in the market. The waiting time in our clinic is not as bad as the public health facilities. The clinic has a home-like ambience and all the staff are locals who know the people well and strike up friendly conversations. But are these reasons enough for someone to come to a clinic repeatedly even when the services there are not giving them relief? I have a feeling it is more than just these factors but could not pin down on what it was. 

Yesterday I was reading a book "Everything the light touches" by Janice Pariat. I am still not finished. It is an engrossing novel with an interesting plot. I will try to review it in a different blog after I finish the book. In that novel, one of the lead characters enjoys the study of plants and she engages with the ideas of Goethe, the German scientist, philosopher, writer, novelist, poet. 

She joins a Goethe Scientific Society in her institution to discuss and learn about his works. Goethe's works resonate with her deeply and she discovers that is the kind of science she likes. She hates the objective, clinical and sterile science of modern botany where every plant is classified, boxed and identified based on its morphology. She believes in experiencing the plant, the leaves, the stem, the flowers, and not just cutting them preserving them, studying them under the microscope and classifying them. She believes in a holistic intuitive, immersive science that see the plant as a whole. This science sees the plant as belonging to the ecosystem, it sees the whole plant in the leaf, as much as it sees each leaf as a part of the plant. When I read this I had an epiphany of sorts. I remembered the experiences of this elderly man. Maybe the Goethian sciencet is what will help me decode this man's experience. 

Modern medicine teaches doctors to see patients as bearers of health problems. They have one part of their body which is not working well. They have symptoms arising from this bodily dysfunction. They come to the doctor with these symptoms. The doctor must try to correct this dysfunction. That would lead to healing. This is the medical paradigm that is taught to doctors. But experiences like that of this elderly man teach us that patients are not just bearers of diseased organs. This elderly man has come to the clinic with not just a blocked urinary passage. He is a social being, who is living alone and has no family support. For an older person like him in a rural area, there aren't many socially sanctioned places to visit, socialise and feel a part of the community on a regular basis. A hospital or a clinic is one such place where he can go to fulfil his social need to connect with others without being judged. While the clinic is not offering anything for this man's prostate problem, he also has a much more important problem than that, the problem of loneliness. He is probably using the clinic to rid himself of that social disease. 

Janice Pariat and through her Goethe, taught me that I too have to start seeing the social being that is human in all my patients, as much as I see the disease and dysfunction in them. The person who is visiting my clinic is not just a bearer of the disease which needs to be cured. It is a person, a father who has been abandoned, a husband whose wife has passed away, a friend most of whose friends have died, who is lonely and also happens to have a prostate enlargement. It is now clearer to me that I am not just someone who writes prescriptions for people. I am not just a trained and skills physician. I am also a human being capable of providing that human connection that my patient wants. That is probably medicine, Goethe style!