Misalignment

I was recently reviewing the stories of the patients about whom I had written, and was trying to reflect on them. As I reviewed a pattern emerged. The patients whom we had to struggle to care due to issues other than “Medical”, has been either women, elderly, or the challenged.  In other words, those whose life was less important than other issues affecting the family institution or care givers. I was left wondering; whose interest are we holding on when we care for people?

For e.g., the 12-year-old girl with massive bleeding from her stomach. As we were getting ready to admit, organize blood replacement, Ultra Sound, Endoscopy etc. the mother, father and a relative got together and categorically communicated, that no way will they give blood. Anything else we want they can do, but do not ask any of them to give blood. We heard them, tried to reason, threaten, plead but with no use! They were adamant. They were not too well off, but money was nowhere in the discussions. We were hearing what they were saying, but we were wondering, what they were trying to tell us, what is the World view or knowledge that is making them to behave this way. Girl child and less value, blood as life giving and not to be given away, money should buy anything they want, not their responsibility to be part of the caring process…We ended up sending the girl off because of their unwillingness to give blood…

The interest of the family, who valued their own “Life giving blood” than the girls life was the reason why this girl did not get the care she required.

Yet another recent story - I walked into the ward, and the junior Doctor was fuming with anger. He told, I am referring this old man, we cannot take care of him. The issue – well of family, father admitted with LGI bleed, needs blood, many relatives walking in and out, but none willing to give blood. The casual attitude and non-caring attitude of the relatives had angered the doctor who was caring for the patient. We did not want a death in our hands because the family was not willing to donate blood.  We had to protect the institution. And our response was – send the patient away. A natural response -  why should we care if they do not care….and we need to protect our interests….

But something stopped us in our response. We saw the face of the wife, she in her 80s, sitting beside her husband….With no ability to take control of the situation, children were in control deciding whether to give blood or not. She would want to do everything, but was in the hands of her children who seemed to be slow in their responses….We discussed, should we put the patient at risk because of the careless attitudes of children? We were about to send him off -  till the eldest son came and sorted out the issue – he said, we want the fathers interest taken care of….He stayed with us and finally died a peaceful death. But we almost send the patient of, before the son came, putting the interest of the institution ahead of the individuals’ interest…

The institutions interest above the individual – this patient was protected, but how many others would have been affected when we put institutional interest above the individuals because of the challenging attitudes of the family and extended community.

I was reminded of man whom we had cared for in SHALOM few years back. A drug addict who would come in every other week, in and out of drugs, and with ulcers and whom I decided to throw out, after almost 20 plus attempts in “transforming” him. The family also did not have much interest in him. I remember the other doctor who was with me, requesting me to give him another chance. And that so called last event of care, becoming a life transformational experience for him. He moved on to a rehab centre and was completely changed over time! I was challenged by that doctors’ perspective and desire – to give people more chances…till she saw change happening. What was driving her? Keeping the potential she saw in that patient above the institutions, families or others interests or perspectives…

The potential in a person, though marred and challenged at this time, to see God’s interest and potential plan for a person and keep this above other interests….

There are many such cases which we come across each day. Care challenged because of institutional interests, family honour, other family interests and sometimes even the individual himself or herself not seeing potential of improvement or change!

Many a times in the care we provide, the individual, family and or institutional interests collide. There might be a mis-alignment of interests. At times there is outright conflict between individual, family and institutional interests. And in the midst of these, “God’s interest” in the individual, the family or the institutional care structures are not even considered!

Is it possible to align God’s interest for the individual, the family, the care provider and the institution together and provide care which is holistic? Facilitating change in the care provider as well as the care receiver and the care structures? Or at least keep God’s interest for the individual as upper most in the midst of providing care?

Can we dream towards a perceived future when all is aligned, though we live in the present when all is misaligned? But at the same time slowly moving from misalignment to alignment each day….?