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By Howard R. Hernandez MD
I MET Bien inadvertently while
rushing through the pediatric wards for an exam. I had dropped my
folder of review materials. As I gathered my documents and looked
up, I chanced upon a little boy curled in a fetal position on his
bed, looking at me. An oxygen tank beside him assisted his labored
breathing. I vividly remember his faint smile, as if he was reaching
out, wanting to talk to someone. I wanted to say hello and chat but
I was short on time for my exam.
It was my third year of medical
training and by then I was steeped in medicine. I regularly
diagnosed from my textbook knowledge and applied the appropriate
treatment for the all the myriad of diseases I encountered.
Little did I know I was so used
to it that I learned to treat the disease and not the patient.
“Dehumanized” was the apt
term for it, as we perfunctorily reached our differential diagnoses
and the corresponding pharmacological management without getting to
know the human who meekly offered his body and gave us permission to
do whatever we pleased. Then in a snap, after fixing his body like a
mechanic in a repair shop, we moved on to tinker with another body
as if they were put on an assembly line.
The next day, I started my
elective rotation in Palliative Care. There was no orientation until
the afternoon, so I decided to visit the boy I saw the day before. I
retrieved his medical records. His chart clearly showed his
condition: disseminated tuberculosis (TB). To my consternation, the
little boy with that faint smile had such a poor prognosis that he
would never be cured. It was such a shame that he and his family had
not been aware of treatments early enough. His disease was a more
advanced type, and his untreated TB had rapidly become
drug-resistant, spreading to his spine, and compromising his posture
and breathing.
What do you do when there is no
cure? This question echoed in my head and I decided to postpone
seeing Bien; I headed back to the department office for my
orientation instead. As fortune would have it, I found out at the
orientation that the little boy was going to be my assigned patient.
The most interesting thing about
Bien was his background, as recorded in the notes of the social
worker and his medical chart. Bien was not your run-of-the-mill
13-year-old boy in the neighborhood. In the alleys of Manila where
he lived and played before he was stricken with the disease, he was
an active and charismatic kid. He appreciated beauty and paid
attention to nuances, as reflected in his interest in the visual
arts. He drew and dyed watercolors in the wards. He earnestly
studied and persevered ever since he set foot in school, ranking
first in his class. Bien had fervor and an intense yearning to
learn. Learning all this about him, I did not hesitate to see him,
despite his infectious illness. However, I thoroughly underestimated
the experience of meeting him. I developed more than a professional
interest in Bien, but rather genuine care. Bien constantly reminded
me why I chose the medical profession.
Whenever I visited Bien, he
greeted me with a chuckle and called me “Superman.” It was
embarrassing when my classmates overheard him, but heck, it seemed
to uplift his spirits. I slowly became Bien’s confidant. One of
the most difficult things I have ever faced was not an exam in
medical school, but the time I had to tell him of his imminent
death.
The day I told him, I mustered
all the strength left in me to face Bien squarely about the
eventuality of his condition. I forced myself to look at him
directly and felt that I was piercing his soul. My heart tore
inside, but being his Superman, I did not show any hint of weakness
on the outside. At the back of my head, I thought that making him
aware and accepting of this reality gave him the chance for
spiritual and emotional growth that could make the end of his life
fulfilling. I was taught in my Palliative Care rotation that the
more patients know about their conditions—the earlier they
understand what lays ahead—the better prepared they can be for the
repercussions of their illnesses. I came to realize that the more I
comforted and cared for patients in these vulnerable moments of
their lives, the more trust they gave me. We believed in each other
more.
I imagine it was the most
difficult thing he had ever heard in all his life. He needed all the
support he could get from his family, friends, doctors and
volunteers. I was connected to him in my profundity. It was through
this bond that I learned to appreciate each and everyone’s
existence. I vowed to be by his side until the end.
To not tell Bien the truth was to
rob him of his time to make peace with himself and the world around
him. Eventually, with the proper support and care, the news gave him
a certain level of control that he needed over his condition. We
never gave false reassurances but we never shattered his hope
either. His strength and eventual acceptance came from his hope and
the unyielding support he received from his family and the medical
staff.
I will hold this experience close
to my heart as I form long-term meaningful relationships with my
patients. It is in the act of comforting and compassion that we
cultivate our souls and launch toward our higher purpose. We may
sometimes cure the patient; comforting, we can always do. It was a
good experience—a “Bien” experience.
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