Alhamdulillah,
all praises be to Allah SWT for His blessings upon us and the time He
gives as an opportunity to design the kind of end we aspire in this
life. Remembrance and praise be to Muhammad saw, our beloved
Messenger of Allah, his family and companions, may Allah grants them
peace and happiness and may we be among them as well in our dreams,
aspirations and our end insyaAllah.
Medicine
is really interesting and I find it really eye-opening.
In its complexity, there is simplicity, in its simplicity, there is
an
unread
message. It is complex not only because it deals with general
biological sciences but also individualised challenges in each
individual patient. Hardly
is
patient like a single textbook. The best way to learn is to learn
around patients because it involves
bio-psycho-socio-spirituo-culturo and behavioural dynamics. It is
complex because it deals with managing human being who has not got
any single fixed rules regarding anything. SubhanAllah, while it
teaches you to be sharp in mind, supposedly professional and flash in
attitude, it also teaches and reminds us everyday about the value of
humbleness.
Everyday
we are seeing patients. If we are to be asked about the profession
that can bring us closest to the reality of human being, it is indeed
any profession that resembles this approach or profession, listening,
being close, lending ears and humbly negotiate approach and means of
how to save human being. In saying that, it is aware that this
applies much much more when doctors/ anybody comes from within the
society rich dynamics, having difficulties, challenges and hardships
they go through in their lives.
It is an answer today, as time will always provide with every
uncertainty and hence why the prophet was asked to wait when the
unbelievers rejected the message. I have this one interesting patient
with unbearable background history of breast ca bilaterally Rx with
bilateral mastectomy. She also had Hodgkin lymphoma Rx with mental
radiotherapy and chemotherapy. Splenectomy was also done as part of
Rx pathway. Twenty years down the track, this woman developed chronic
chest pain diagnosed as chronic pain syndrome secondary to
radiotherapy effect managed on-goingly with Amitryptyline,
Carbamazepine, Gabapentin, Methadone and Fentanyl patch. In short,
max management of pain but with
unsatisfactory effectiveness.
She
presented to the hospital 10 days ago complaining of worsening chest
pain, with what described as anginic picture. Series of
investigations showed impossibility of Acute Coronary Syndrome,
making us wonder could this be secondary to limited microvascular
reserve giving syndrome X-like pattern but on the background of
re-stented coronary artery because of occluded artery previously.
Tachyphylaxis and limited tolerance from chronic pain syndrome would
then possibly amplify patient's intolerance and hence why she is
suffering in pain nearly each hour.
9
days passed with the team exhausted all the means to control her
pain, subhanAllah, this really amplifies the fact that medicine is
limited and what amplifies and expands it is by the grace of Allah,
teaching human being through their thoughts, discussions, research to
find answers to problems they face. It also sends the message clearly
that without His help, you can load all possible medications but the
pain is not gonna ease itself.
Anyway,
throughout the 9 days, due to severe pain and escalating fentanyl IV
dose( reaching 100 mcg PRN given every hourly), we started to think is this really a true pain or is this acutally attention-seeking
behaviour. Munchausen's syndrome, a term I still remember since my
second year in the college, reading a book, The Art of Healing,
written by one American MD doctor, talking in one chapter about kind
of patients who pretended sick in a really excellent manner to seek
attention. They would damage themselves, pretending sick and even
harming themselves to seek
attention. This came across my mind and the reason being the fact
that she really looked like wanting attention especially from the
registrar. It is very hard when you don't know someone enough but to
formulate what could be the possibility.
Anyway,
cutting the story short.
Repeat angiogram today showed re-stenosed stent artery. This patient
had mental radiotherapy on the chest which causes
radiotherapy-induced coronary artery disease over
time. It is easy to formulate a judgment and to judge people without
first trying to understand patient's perspective. It is also easy to
take subsequent actions based on presumptive idea. Not that the team does not know this possibility, but the index of suspicion that it could be re-stenosis this time after several other visits has been really low. To keep an open
mind and to first seek to understand before being understood would
really be an important element in maintaining human and therapeutic
relationship.
-gambar hiasan-
In
our daily lives, the same applies. It can be easy to label others and
to lose intellectual humility, understanding others' backgrounds.
When spiritual therapeutical relationship fails, then people will
build barrier against the message, not really because of the message
itself, but it can just be because the people who carry the message
fail this rapport and reading others very dogmatically. Quran gives
an extreme example how the art of advising towards Allah should be
done. Musa as and his cousin Harun as were asked to go to Fir'aun and
advised him in a very respectful and full of wisdom. This was despite
the fact that Fir'aun claimed himself as God.
May
Allah SWT enlighten us with things that we are dealing with daily
insyaAllah.
Question
for medical students : How is Munchausen syndrome differs from
Hypochondriasis?
No comments:
Post a Comment