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 and painful for her.
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 the need be correct the scoliosis later on with another surgery” I exclaimed instantaneously amidst a partially completed turn of my chair towards the x ray view box with x ray still in my hands and the view box still awaiting the completion of remaining 60 degrees or so of my turns arc.
Too quick and too direct ………….. that’s what it was…….I would realize an instant later about my response ……..
As I gradually lowered the x ray film, the barrier between my eyes and hers, a woebegone air like an ill halo surrounded her ………. My words had struck like a calamity it seemed.
“Wouldn’t you like to go through these reports first” she spoke after a poignant silence.
“I don’t have to lady …… infact perthes was my top differential diagnosis the moment you walked into my OPD, seeing you from a distance of 50 meters, forget even these x rays …….your gait speaks louder than these reports …. And just like any other doctor I despise distrust…..” but thankfully the larynx is not directly connected with the mind. The frontal lobes of brain intervened with their social sensibilities and none of all this was ever verbalized.
Having given into the social sensibilities I simulated a smile and politely undertook the masquerade of going through the heap of papers wearing a contemplative look.
“Hmmmmmmmnnn …….so please tell me what brings you here?”, I asked, having completely exhausted myself with the farce of going through unnecessary reports and continuing to feign to go through them with my head still buried within them.
Infused with the satisfaction of my sham attention to her records the lady began speaking. Most of it was irrelevant leave alone insignificant and it continued for a while until all my pent up irritation blurted out as “but why are you here now?”.
Was it the tone or the forcefulness of the prohibitive dam of patience giving way I would never know but it had worked. These words had halted the seemingly unending train of her conversation.
“To be treated of course” she said defensively.
“And I have explained it to you already……”
“So let us discuss only what’s relevant in that regards” I continued
“But I don’t want to get operated” she said …….and I softened immediately because I could hear “I cannot afford to get operated, I am too afraid to get operated, there is too much at hand in my current life situation etc etc …..” from behind those words.
“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 thought (she obviously was better)
And off went the train of endless ramblings, obviously confused I looked at her husband, who had been desperately waiting for an eye contact (I now realized), who instantaneously falsified all her claims in a moment of eye roll and gesture.
“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.
Of course she followed it up with various complaints about the side effects she was experiencing with these medicines (none of which have ever been noted in any text of medical knowledge anywhere for those drugs)………. And how her life now is even more miserable than before; though without pain but with these side effects now.
“These medicines are not the cause of the symptoms you are experiencing, they don’t have any such side effect profile” with my patience thinned out I was very direct (no intervening social pleasantries).
I could sense her withdrawal ……..
What followed then from this point on, almost on a fortnightly basis, was astounding and irritating simultaneously.
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.
Tired of this vicious cycle my frustration began to grow and when I saw her admitted again for the third time one morning, while she was only on plain paracetamol for pain relief, it could be contained no more. The pent up frustration at this seemingly unresolvable situation had to burst out or implode within.
Obviously a patient on the hospital bed cannot be told that he/she is a malingerer, not on the face at least.
So as it is with most unresolvable issues in life, where one does not even get a chance to react the way he/she deems appropriate, it was time to dive within and ask why??
Why is this experience being given to me??
What do I have to see, learn and assimilate??
And it was effortless my pent up frustration, not finding a vent outside, had already imploded ……… I had fallen ……….. as if out of the fabric of space time net …….. 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 ………..” was the reply
“Then why don’t you change either??”
“Either??” I wondered…..
“The situation or your stance (reaction/feelings) about the situation”
“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 about it ……..”
“Isn't that a malingering??”
Suddenly I felt stabbed……the innocuous questioning had, like a dagger, penetrated somewhere very deep now and all of a sudden so.
“You complain about your current life situation, even propose a better alternative to it in your mind, resist, ridicule and humiliate the present moment for its “not enough- ness”……..but when asked to do something concrete about it you shirk away offering a barrage of excuses ………..that’s your vomiting episode……… and when asked to change your opinions about the current situation (when you are so incapable to change it in actuality) you come out in a firm denial 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??”
I was bleeding torrentially now …………
(Suddenly at this juncture of reading you too might have felt an uncomfortable prick…..it’s a prick (and not a full blown stabbing) only due to a verbal illusion of me and you. If this question now is pointed straight at you, “Do you love your job?”; “Do you love your current life situation?”; “Are you completely at peace with it?” {Something feels stabbed now}
A defensive discomfort encapsulates you now ……….. “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” etc etc……
From blatant denial to assertive defensiveness the mind would position itself somewhere within the spectrum of these two extremes.
And when asked to soften your stance, forget feeling good, about whatever is (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” etc etc…….)
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 of 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 it and attempting to cure it.
Until today I was living in a defensive premise of “this is normal …….everybody is like this”
But it was no more possible now ………..
The dagger of honest enquiry had ripped through the veils of egoic mind ………. The diseases of “self-denial”; “Follow the heard and not your instincts”; “Do things because they have to be done not for the love of doing them”: “Disbelief and Doubt” etc had all been exposed all of a sudden ………
And I was forced to ask myself
“If I am the one sabotaging myself?”
“Why is it that I believe so less about my own 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 believe whatever it is I believe about myself and life?”
“And if it does not serve me well then why do I continue to harbor it within me?”
“Isn't belief a practiced (much repeated) thought alone?”
“Why then should I harbor such self diminishing, such self destructive believes within me?” …………………
