Kindness is God

Yesterday’s clinic was quite eventful. Early in the day, there was a huge crowd waiting outside the consultation room and people were agitated and were fighting with the staff in the reception counter. 

“How much longer should we wait?” 

“Why is one patient in there for so long?”

“We are waiting for so long. We can’t wait anymore”

All these phrases could be heard being hurled around at the staff. A few patients even walked out angry. The reason for all this was a 45 year old man, with whom I had to spend more than half an hour. 

 

Mr. M entered the consultation room with a stooped posture. He was wearing a white shirt and white dhoti. He had a dark blue towel around his neck. There was a bright sandal paste on his forehead and thick salt and pepper beard and moustache. There were Tulasi beads around his neck. He had taken holy vows to practice austerity for 48 days and then visit the Sabarimala temple. 

 

This was his second visit to the clinic. I had seen him about a month ago. Mr. M’s first visit was also quite eventful. He has type 2 diabetes for which he was taking treatment on and off from various doctors. He came to see me at the behest of his elder brother who was also my patient. They were 8 siblings. One of his elder brothers had recently passed away. He was unmarried and did not have children and therefore there was no legal heir for his land, house and other property, the total worth of which was close to 35 lakh rupees. It was huge money and the surviving brothers and sisters were having a dispute over who should inherit the property and how it should be divided. Mr. M got only a small share of 2 lakh rupees and he was hugely disappointed with the deal. He claimed that he was the closest with the brother who passed away and he had cared for him during his last days. So he must get a larger share. He also said all the other siblings are well settled and had property of their own, and he was the poorest of them all. So naturally he must have received a larger share. He was angry and upset with all his siblings. This had pushed him to deep stress, anxiety and sadness. Consequently, his sugars had also been ignored and they were very high. When he came to me first, his sugars were in 400s and he had very severe burning sensation over his legs and thighs which was preventing him from sleeping. Mr. M and I had a very detailed conversation during the first visit a month ago and at that time I identified that he demonstrated symptoms of depression. In addition to optimizing his diabetes treatment, I also started him on treatment for his depression. Alcohol plays an essential role in almost all mental health issues among men in our practice. Mr. M was also using alcohol heavily and we had spent some time talking about the ill effects of alcohol and the need to cut down on it. 

 

When I saw Mr. M yesterday with the holy Tulasi beads and sandal paste, I felt good, because these 48 days he would not be allowed to drink alcohol due to his vows of austerity. 

“Sir, after starting treatment with you, the burning sensation over my feet have reduced a lot. I think my sugars are also under good control. That is why I came back. I usually never go back to the same doctor twice. Somehow your treatment seems to work for me.” 

It was good that he spoke out about how he felt. I asked him how he is feeling generally. How is his appetite and sleep? 

“I am still feeling very low. I am unable to sleep properly. I keep getting thoughts about the major financial loss. I also get angry about my brothers and sisters and how they cheated me. I am unable to eat properly.” As he said this, tears started pouring out from his eyes. Mr. M seemed to be depressed. 

“Last time when we were talking you asked me one question. I am still wondering why you asked me that question.”

I asked him what that question was. 

“You asked me if I sometimes feel like I need to end it all and die. Why did you ask me that question?” 

“You seemed very low and when people have this low feeling, they sometimes feel worthless and the pain makes them want to end it all and die.” 

“You are right. I have been feeling like that for a long time now. But I do not have the courage to end my life.” He said this and he started crying. 

 

I realized that Mr. M required space for ventilating and talking about his thoughts and feelings. I knew that it is going to take a long time. I closed my pen, put it down on the table. Leaned forward and focused on Mr. M. He started talking about how he had cared for his brother during the last days of his life. He said that his brother had wanted to give a large part of his property, especially his agricultural lands to him. But he never wrote a proper will. As he was talking, he was going through phases of sadness, rage, frustration back and forth. All his emotions were pouring out in bouts. I was listening to his narration with keen attention. As I was listening to him, I was also conscious of the time ticking. The consultation room was closed, I could see outside through a small gap between the door and the floor in the bottom, I could see footsteps prancing here and there just outside the door indicating that people were getting agitated about the long time that this patient was taking. My mind was conflicted. Should I gently pause this man’s narrative and re-schedule a session to talk to him later? Shouldn’t I also consider the fact that other people standing outside might have come from long distances and need to get back home by the occasional buses and share autos that come at odd times? The staff nurse peeped in from outside and showed me gestures that other patients are getting angry. She pointed to her watch and indicated that it is getting late. But when I saw Mr. M, I did not have the heart to ask him to stop. He was in full flow, he was explaining how he was feeling about all this, and tears were pouring down his face unrestricted. His pain was real and there was no way I could stop the ventilation. More than any tablets or medicines, this talking itself is therapy, and I cannot abruptly close it. I decided to let him talk. After a brief conflict in my mind, I settled down and once again started focusing on Mr. M.

 

It did not take long after that, Mr. M composed himself, wiped the tears off his face and said, “I know I am consuming a lot of your time doctor. Thank you so much for listening to me. I think other patients will be waiting. I will go now.” And he got up to go. I explained the tablets to him again and added another anti-depression tablet to his prescription. I asked him to come back in 15 days. As Mr. M started walking out, he turned back and asked me, “Doctor, tell me one thing. Why did you listen to me so patiently? I have gone to so many doctors before. I have never had this kind of experience. The way you are listening, it makes me want to talk more and more. Why did you do this?” 

I smiled at the question and said, “The most important treatment you seem to need is to be able to talk and ventilate your feelings. That is why…” 

He smiled back at me and had a fresh flow of tears. He came back and sat down. He held my hands and said, “Before coming to meet you, I used to only go to the temple and talk to God about my problem. That is because my wife and children do not understand my feelings. They console me and say that I should stop thinking of the property and move on with life. If I can do that, I would do that. I am unable to do that and so I am suffering. I cannot even talk to my relatives and friends because they get afraid that I will ask them for loan and they avoid talking to me. So I had only the God as my friend and I used to only go and sit in the temple and cry. Now I feel like I found God in this clinic. I am able to come here and talk and unlike God, you are replying. This is giving me goose bumps. I am so happy that I found your clinic doctor.” When he concluded this and got up, he had some more tears, this time (I am guessing) tears of happiness and gratitude in his eyes. 

 

I have heard many patients tell me that doctors are like Gods. I have been quite apprehensive about this statement. The God complex is a bad thing for a doctor. It makes the doctor believe that they are supremely powerful, they cure, they are infallible and leads to a narcissistic sense of entitlement and superiority. I also believe that such a feeling also raises the expectations of the community about what a doctor can do. It leads to blind faith in the doctor, which is also harmful, because when such a faith is broken, it leads to catastrophic consequences for the doctor-patient relationship. But Mr. M helped me see a new dimension of the same words. What is God? God is after all a belief, a faith that there is a force above me that oversees all my actions and guides and guards me. God is abstract and often requires deep levels of devotion and faith to work effectively as the support system in times of weakness. That is why sometimes, it is easier to believe people, and relationships more than the abstract God. Mr. M gave another set of words for this same phenomenon when he said, “I found God in this clinic. I can talk to you like how I talk to God, the only difference being that you reply.” Mr. M beautifully described that God is kindness. He made me realize that human kindness helps make the abstract construct of God more concrete and palatable.