The Patient, My Coach.

Chitra, a 61 year old bespectacled, sari-clad lady came to consult me for pain in both her knee joints that she had been having for about three weeks. It had resulted from her tripping over a watering hose in her compound while she tried reaching over to her neighbor over their common wall in an attempt to pass on a delicacy she had just made.  This neighbor, a lady of about the same age, had accompanied Chitra.  While I was not particularly looking forward to this depth of detailed description of her injury, it seemed to flow quite naturally from her. I noticed that she was actually quite casual in reporting it to me and had sought my opinion perhaps as a last resort now that the pain was causing a limp even after three weeks of, what was in her assessment, a trivial trip over a hose pipe. Usually, patients are reticent in giving their details, and I could not but help noticing the absence of that trait in Chitra.

The injury seemed to be bothersome to her in other aspects of her activities of daily living, and the knees were minimally swollen. As a part of getting more information about her medical history, I asked her if she had diabetes; declining that she had it, she volunteered that she did have hypertension, and that it was well controlled with just a tablet twice a day.  Saying so, she paused and then looked at her neighbor. Now, this lady urged Chitra to tell me “everything”. 

Taking that as a cue and meaning to assist her in being forthcoming, I asked, “are there any other medications that you are taking; have you undergone any major surgery in the past?”

“Doctor, “she said, “I have donated my right kidney as a part of an exchange transplant program, where my husband received another lady’s kidney, while my kidney was transplanted into her husband -that was about three years back”.

That statement from her ruled out a list of pain relieving medications that I could prescribe for her.

“How is your husband doing?”, I inquired.

“He died six months back from complications of immunosuppression therapy after the transplant, and diabetes” she replied in a matter of fact manner.

“Oh, I am sorry to hear that” I said, offering my sympathies.

“Doctor, what was to happen has happened. We did our best.” She said.

Noting that she was not keen on receiving any sympathies, I continued my inquiry as a doctor, and asked her whether there were any other medical issues that should be brought to my attention.

To my surprise, she appended quite some medical conditions that she was facing. She had recently undergone a hysterectomy for a uterine malignancy. She had got this surgery done in another city where her daughter –her only child- lived. The cancer was detected rather early and she took that as a boon. Not only this, she was soon due for a cataract surgery. However, she added, and it was actually quite apparent, that she also needed to see an eye surgeon right away for a black eye that she had sustained at the same time that she had injured her knees. Since the black eye was on the same side that was due for cataract surgery, the eye consultation too had that sense of urgency to it in her mind.

This sudden surge of facts about her medical and personal situation lead to a spontaneous and an unguarded expression of concern from me, and I blurted out, “Madam, I can see that you have so much pain and are facing it quite bravely.” (I had used the Hindi word, dukkha).

Cutting me off with an innocent smile and a disarming simplicity of speech, Chitra  said, “Doctor, I am quite happy with how my life is right now and these injuries just need some attention; I have no dukkha  at all”.

Just how did she manage to do what she did under the enormously challenging conditions is what I would have liked to know from her.  But she answered that unasked question as she went out of the door.

“Doctor,” she said, “I have a lot of friends and there is the whole of life still to be lived; why should I be unhappy? I have so many activities that I enjoy doing and look forward to participating in.” Smiling, she went out of my room.

I could sense that there was no duplicity in what she was speaking. There was none of the self-righteousness of a person who had somehow come on top of a difficult situation. No, she was just stating a fact that she had some physical pain; apart from that she was not perturbed about the situation of her life. The calmness of mind and the steadiness of purpose of living her life to the fullest were inspiring.

This was one consultation where I, the doctor, felt a therapeutic benefit from what the patient conveyed in the brief ten minutes of her presence.