Monday, August 8, 2016

Personal pain

I do not consider myself to be an expert in pain management, but I do manage the same on a regular basis. Not only have I been managing
pain, I have been helping others to manage the pain. By teaching, helping in planning treatment for the patients admitted to our wards. I have used the WHO ladder, pain ruler etc. to teach and build capacity of JMOs to learn how to manage pain. But all this have been a based on a professional assessment and fairly detached and logical management of pain.

We have had multiple discussions on rounds on how best to manage pain, why the PRN (as and when required - Pro Re Nata) never works. And PRN can be read as “personal responsibility mitigated” by writing an order and passing it on to the nurses, who generally never give the drugs because the patient neither complaints nor relatives ask for it. Because in our culture we are expected to tolerate pain. “Ethana dard to hoga, sahana padega….!” The principle with which we doctors practice. But in the midst of the rounds and discussions with the patient or the JMOs I never felt the pain the patient felt, because I was a professional, taught to care and teach others about caring….and be detached about it….

Till day before yesterday, when at 2.30 AM in the morning, I was at the bed side of a patient who had a Pubic Rami fracture the previous day.

As he was rolling in pain, I felt the pain – almost 9 in the scale. And I was looking out for step three of the step ladder response, where can I get the same. (Two days into yet, I am still unable!). And as I was near his bed, I saw his eyes darting multiple times to a picture which was hung across on the wall. The picture of his spouse of more than 50 years who moved from this world, just about 2 years prior to this. He had cared for her in the journey through a progressive Alzheimer’s. Was he missing her and hoping that if she was around to care for him? Later in discussions he brought up a very frequent talk he had with some of us in the past, how he misses his community of friends.

Later in the day, left to myself, the question arose in my mind – why did I feel the pain he was going through? 

Because the patient is close to me – He is my father! I felt the pain he felt (to some extend – I will never be able to fully feel it ever). I knew the background of his weakened body – weakening because of a progressive renal failure. I know the emotional exhaustion he has gone through in the last few years. He had multiple times told me, I am exhausted in my soul - and I knew the reasons for this exhaustion of soul. The knowledge of what he has and is going through brought the pain much closer, though I would never feel it the way he felt it….

I was left wondering – is this a glimpse, a window into, what God the father felt for His son? Is this a glimpse, a window into what God the Son felt for His creation? Is this what I should be feeling every time I manage pain….?

To feel, I need to know, to know I need to listen, to listen I need to be relate to relate I need to be part of family….



Stations on the Road to Freedom

Dietrich Bonhoeffer(1906-1945) Discipline If you set out to seek freedom, then learn above all things to govern your soul and your sense...