Saturday, November 25, 2017

The Little Wins

One thing I really missed about our first year in medical school was our classroom.

I mean it, literally.

It was this beautiful well lit oblong room with cross ventilation that could challenge the 'Hawa Mahal' in India.

80% of our subjects in year 2 were based on patient care and so they moved our classes to an odd square shaped room in the basement of our hospital.

It was dark down there and it took 10 overhead lights to keep the room sufficiently illuminated.

The acoustics were terrible, even with a microphone some of our loudest teachers were barely audible at the back benches.

To keep a class engaged was no easy task for the speaker. Not especially for a visiting psychiatry professor with a voice so soft, even dolphins had to strain their ears to listen to him speak.
Dolphins are the best listeners!
The first 45 minutes of his presentation are still a blur to me, I don't even remember the topic. But, from the 46th minute onward I began to pay attention.

'What is love'? He had asked the class, and seeing that no one was volunteering an answer, he picked on me.

'Excuse me sir'? I looked at him with a confused expression.

'What is love'? He asked again.

Of course he thought I knew the answer. 

People had been asking each other this question from before the time fire was invented, but little did they know that a second year med student had all the right answers to all of life's big mysteries.

Before I could speak he interrupted me.

'Let me rephrase, Why do we feel love'? He asked, an even more complicated question, as if the first one wasn't hard enough.

Please don't ask me why I said what I said.
Maybe I was in a trance or something.
But this was my answer.

'Its the dopamine sir'. I said.

'When the dopamine level in our brains increase we feel love'. 

There was silence in the room.

No sooner did the words come out of my mouth did I realize that I had said something extremely stupid.

I felt like kicking myself, but you cant reverse words already spoken, or split milk right?

Thankfully my friend Shruthi stepped in and saved the day.

'It's all about emotions', She said, and the psychiatrist who appeared as though he was in a coma after hearing my answer quickly regained his composure.

The lecture ended with a Q & A.

But by now, nearly every single person in the room was exhausted to the point of passing out, except the speaker himself and me, my head was still reeling (from all the dopamine inside it I presume).
Dopamine Pills
Shashank wanted to ask him what the topic was, but some of us managed to keep him from doing that.

We didn't want him to think we were a class full of imbeciles (Shruthi excluded of course).

In order to redeem myself I stood up boldly.

For the second time that day everyones eyes were pointed straight at me.

I asked him my question.

'Of all the patients you have seen in your life, is there one that stands out'?

I could feel the hate of my peers in the room.

This was the last session of the day, only 7 out of the 10 lights inside were working, the topic of the presentation was unknown to most of us, the speaker was surely a dolphin in his past life and in addition to bumming everyone out with my love is equivalent to 'dopamine levels in the brain' theory here I was prolonging the process with my ridiculous questions.

He took a very deep breath, quite akin to the deep breath of a dolphin underwater.

Then he took another one.

And another.

'Maybe there were many patients who stood out in his practice' I thought to myself as he dove into his fourth deep breath, utilizing every single alveolus at his disposal.

'Every patient of mine is special and I have learnt something from each of them'. He said.
It was a good answer.
Ambulatory medicine is not everyones cup of tea.

It is not as exciting or intense as working in the in-patient setting at a hospital.

But that being said, traditional medicine is best experienced at the clinic.

Establishing lasting relationships with patients is possible only when you have a chance to follow up with them regularly, that happens more often in the clinic than at the hospital.

Some patients religiously keep with up their appointments.

This blogpost however is about a patient who was actually quite the opposite.

When I saw her name on my list last November for the 5th time since I started , I told myself she was not going to show up.

Even though I had never seen her in person, I was familiar with her voice.

We often called her over the phone to ask if she wanted to reschedule and almost always the call went to her voice mail.

‘Hope you have a blessed day’ thats how her recorded greeting always ended.

After closing the visit of my penultimate patient, assuming I was done for the day, I started putting my things back into my bag.

That’s when the something unexpected happened.

I looked up at my screen and the white light next to her name turned yellow and then green.

She had finally made it.

I was excited to meet her and it showed when I walked into the consultation room.


'Hey! How have you been'? I said enthusiastically.

She just smiled back at me.

'I wanted a refill on my medications'. She said as I sat down.

'No problem' I replied and we carefully went through all of her meds one by one.

She never stopped smiling the entire time.

After I signed the last prescription, she got up to leave.

'Thanks, you have a blessed day'. She said in her characteristic style and began to walk out of the room.

'Forgive me but why weren't you able to make it to your previous appointments'? I asked her just as she opened the door.

It wasn't a great or important question, quite like the one I asked the psychiatry professor at my medical school more than a decade ago, but I wanted to know the answer.

She closed the door and sat back down on her chair.

She looked at me for a second and started talking.

'Anxiety is a terrible, terrible thing to live with doctor'. She told me, Still smiling.

'On some days it is hard just waking up and getting out of bed'.

'You want to go back to sleep but you know in your heart that ain't gonna happen'.

'The first time I cancelled I just couldn't put my feet on the ground, but thats ok because the second time I was able to get dressed'.

'But then the thought of driving all the way up here paralyzed me, you see I have not driven my car in a long while.'

'The third and fourth time around I was able to drive a few blocks but then I had to rush back home because i hadn't been out in such a long time and it was scary'.

'But thats alright'.

'I am here today doc, I am here'. She said smiling even more widely.

'I got up, I got dressed, I called my nephew and he drove me to your clinic'.

'3 small victories in one day'.

'Isn't that something'? She asked me.

She didn't wait for me to answer.

'I am hoping that next time, I will be able to get here on my own'.

'It may not seem like much doc, but being able to do these little things is a big deal for me'. She said.

I was left speechless.

I learnt something from my patient that day.

She taught me how important it was to be happy for the little things we accomplish everyday.

The things we struggle with on a more personal level - our fears, our phobias, stuff known mostly only to us that the majority may find trivial, or unimportant or even a little crazy or weird.

The big moments deserve to be celebrated and they will come our way eventually, but we don't live from one major accomplishment to another, no, a large chunk of our lives is spent in the in-between, one day at a time.

So the next time you wake up in the morning with a smile instead of a frown on your face or work out for 30 minutes instead of 20, or show up to work on time or keep your neighbors dog from freaking you out, remind yourself to take notice of it, do a little dance, click your heels, or hug somebody, have a glass of wine or a piece of cake, if none of that appeals to you just be happy and congratulate yourself for doing something that you struggled with before.

Take a little time and celebrate the 'little' wins in your life and let them set the stage for the bigger victories that are headed your way.


Until next time, hope you have a blessed day too.

TGV