The Malingering (abridged)
[The credit of creating this abridged version goes to my dear friend Abhishek Shukla]
She is 48 years of age and pain has been her constant companion for over two decades now. Perthes disease has destroyed both her hips and the degenerative scoliosis, that set in probably a decade ago, is only making each day more difficult.
With her bag full of investigations, previous prescriptions and treatment records, she met me in my OPD about 2 months ago.
“You don't need to suffer with this!! I could replace both your hips and if need be, correct the scoliosis later on with another surgery!!” I exclaimed even before I could complete my turn and give a meaning to X-Ray box's life's purpose - mounting the x-ray film. Her condition was so obvious...
Too quick and too direct; that’s what it was…I would realize this an instant later.
I gradually lowered the X-Ray film, the barrier between my eyes and hers, a noticeable woebegone air - like a dark halo - had surrounded her. It seemed my words had struck her like Zeus' bolt.
“Wouldn’t you like to go through these reports first” she spoke after an expected silence, seething...
“I don’t have to lady… in factPerthes was my top differential diagnosis the moment you walked into my OPD.Seeing you from a distance of 50 meters - forget these x rays - your gait speaks louder than these reports. And, just like any other doctor, I despise distrust…..” The frontal lobe of the brain is solidly pounded with its social sensibilities and thankfully, none of all this was ever verbalized.
These same social sensibilities simulated a smile and politely undertook the masquerade of going through the heap of papers, wearing a contemplative look, stifling a yawn and wondering what to have for dinner.
“Hmmmm… so please tell me what brings you here?” I asked, having completely exhausted myself, either with the farce of going through the report. Infused with the satisfaction of my sham attention to her records, the lady began speaking. Most of it was a ramble and it continued for a while until my patience weaned and I blurted, “But why are you here now?”
I would never know what worked – the tone of my voice, or all that pent up boredom gushing through the barrage of my patience – but, it had halted her seemingly unending jackhammer of a conversation.
“To be treated of course!” she said defensively.
“Which I have already explained how…So let's discuss only what’s relevant in that regards". I continued.
“But I don’t want to get operated!” she said. I immediately softened because I could almost hear “I cannot afford to get operated", "I am too afraid to get operated", "there is too much at hand currently in my life".
“Pain relief, that’s what you are here for!” (And that’s not treatment, by the way!)
An invisible yes was palpably present even in its auditory absence. A cocktail regime of pain relief was tailor-made as per her requirements and she left.
A fortnight later she arrived in the OPD for follow-up, visibly better than the previous visit.
“So how are you now?” I made a cheerful but redundant remark, I instantly bit my tongue. Off went the train of endless ramblings, obviously confused (considering my diagnosis) I looked at her husband, who had been desperately waiting for an eye contact, which I now realized, instantaneously falsified all her claims in a moment of eye roll.
“But are you okay as long as you take the medicines?” I randomly interrupted at some juncture.
“Yes I am” probably it was the sudden and unexpected arrival of the question amidst the heavy traffic of monologue that brought forth such a short and truthful reply, at least at that instant.
She then went on to describe the side effects she was experiencing; which by the way, do not exist anywhere, in any medical text, on these drugs. I was also made aware of how her life now is even more miserable due to these side effects, albeit without pain.
“These medicines cannot be the cause of the symptoms you are experiencing, they don’t have any such side effect profile!!” with my patience thinned out, I quickly bid adieu to my social pleasantries.
What followed then from this point on, almost on a fortnightly basis, was astounding and annoying at the same time.
As one regimen provided pain relief, she would concoct another set of side effects. As soon as this lady would get better with a particular regimen of pain relief like the first one she would come to OPD and inform me about vague and even fanciful side effects these medicines were having on her. Knowing clearly that no such side effects exist for these drugs I would either inform her so or maintain a disregardful silence regarding the issue……and at the end of each such episode I would find her admitted in the hospital next morning. Admitted at night via emergency due to exacerbation of her proclaimed side effects specially vomiting and fainting.
Then I would change her medicines to new ones and yet the same set of events would recur.
When I saw her admitted for the third time while on plain paracetamol…… I saw red!!!
Then it dawned on me…she was a malingerer!!
It was that time in life where one does a deep dive within to find answers for issues rendered irresolvable.
Why is this experience being given to me??
What do I have to see, learn and assimilate??
This deep dive was effortless as my pent up frustration had already imploded. I was falling, as if through the fabric of space and time, into an unknown place of silence.
And it was there that it happened…
“Do you love your current life position absolutely???” A question seemed to arise
“Not absolutely…”
“Then why don’t you change either??”
“Either??” I wondered…
“The situation or your stance!”
“I mean how can I change this situation…….blah blah(explanations upon explanations) blah blah blah…… and obviously I don’t like it this way so how can I feign to like it i.e. change my stance?”
“Isn't that malingering??”
I felt a sharp stab.
“You complain about your current life situation, wish for a better alternative, resist, ridicule and humiliate the present moment for its ‘not enough-ness’ but when asked to do something concrete about it you shirk behind a barrage of excuses…that’s your vomiting episode… and when asked to change your opinion about the current situation you come out in a firm denial, because you are incapable to change it, stating , “but I don’t like it how can I feign otherwise”, that’s your fainting episode against reasoning.”
“Aren't you malingering your life away??” The knife that had stabbed was turning…slowly…
I was bleeding…
At this juncture you too might have felt an uncomfortable prick if not a stab. I now point this question straight at you, “Do you love your job?”; “Do you love your current life situation?”; “Are you completely at peace with it?” (Excruciating, isn’t it?)
A discomfort encapsulates you now but you have your defense, ready!
“I mean nobody does but it has to be done”; “Bills and EMI’s have to be paid boss!”; “Welcome to the real world, money is the arbitrator of our reality not words and ideas”; “what do you suggest one should do, do you have any better ideas”. If you listen to yourself, you too will hear ‘blah-blah-blah’ in there, somewhere.
To tell you the truth, you are someplace between blatant denial and assertive defensiveness.
And when asked to soften your stance, forget feeling good about the situation (since you cannot change it anyway) the mind goes “this is not what I came looking for, this cannot be the purpose of my life”; “how can I come to terms with it, it is so unfair”; “I deserve much, much better” and a ubiquitous ‘blah-blah-blah’.
As I bled my own reality a great sense of compassion and gratitude arose within me for the lady. At least she paid heed to her physical symptoms, got herself diagnosed and came to know that she is diseased and what exactly that disease is.
But until today I had never even paid any heed to the symptoms – anger, irritation, frustration, lack of love, lack of gratitude and wonderment, lack of compassion – within me.
Until today I had never bothered to even wonder if something was wrong with me, leave alone diagnosing and attempting to cure.
Until today I was living in a defensive premise of “this is normal, everybody is like this”
But it was not possible anymore.
The dagger of honest enquiry had ripped through the veils of egoist mind. The diseases of “self-denial”, “Follow the herd and not your instincts”, “Do things because they have to be done not for the love of doing them”, “Disbelief and Doubt” had suddenly been exposed.
And I was forced to ask myself
“If I am the one sabotaging myself, why is it that I believe so less in my capacities and capabilities?”
“Why is it that I doubt the good that has already come my way, but believe instantly in the most farfetched imaginations of the ominous?”
“Why do I think the way I think, about myself and life?”
“And if it does not serve me well then why do I continue to harbor it within me?”
“If belief is a practiced thought, why then should I harbor such self diminishing, self destructive beliefs within me?”