“How are you feeling?” I asked an elderly woman in Tamil, the local language. She had recently been diagnosed with rheumatic heart disease at the hospital. I struggled to hide my excitement of finally being able to interact with an inpatient after three weeks of waiting for a “TB-free ward.”
In the western world, we quarantine patients with tuberculosis; here they are one of the many patients in the general ward who are seen by doctors and students not wearing face masks. The theory behind this, as was explained to me, is that India has the world’s largest TB epidemic, so any single individual is at risk whether he or she is in a hospital or in the grocery store. The only thing anyone can really do besides wear a face mask all the time is to hope that their immune system is strong enough to ward it off. Faith aside, I decided to play it safe and wait for a “TB-free ward.”
“I’m feeling better, I do not have pain anymore,” she replied in Tamil. I did a thorough physical exam, reviewed her chest X-rays and lab results. I took about 15 minutes to explain all of the results and told her that she is looking a lot better, with all of her imaging and lab results supporting that finding.
I was very excited for her, but she showed no emotion. “Doctor, I’ve been here too long. My family is struggling without me. Does this mean I can finally go home?” she asked.
“Yes, of course! We are discharging you from the hospital today,” I replied.
Her face finally lit up, but it left me feeling very confused. How could you not want to know about the progress of your disease? Or be excited for the improvement in your health?
As Dr. Varadarajan and I walked back to the outpatient department, he explained to me, “The patients we see here barely understand their diagnosis, let alone the prognosis or treatment process. The details of their disease just don’t matter to them. Most of them come to us at later stages of their disease because they just can’t afford to leave their families. They live from meal to meal, and that’s all they can focus on.”
With that in mind, I learned to cater my questions and explanations towards these situations. But even then, it was impossible to accept the devastating poverty that people face in developing countries.
The next patient I saw that day was a thin young man with a stained towel wrapped around his right foot. He limped into the room barefoot, which is quite common in poverty-stricken areas. The doctor asked the man to remove the towel, and I felt my breakfast travel back up my stomach into my mouth. “Gangrenous” would be an understatement for what we saw. The patient was sent to surgery, and as he limped out, the physician told him, “Don’t worry about paying for your services here today. Just use that money to buy yourself shoes. I don’t want to see you barefoot ever again.”
Over the next few months, I saw everything from tuberculosis (of course, never in direct contact) to malaria to dengue fever to parotitis to thyrotoxicosis. I even saw rare cases, such as Plummer-Vinson syndrome, Tetralogy of Fallot, leprosy and a cribiform plate injury with cerebrospinal fluid rhinorrhea. But, beyond the mind bending cases, I saw something equally as amazing: faith.
There was one instance where I was asked to interpret a chest X-ray for a woman with severe dyspnea. I walked over to the patient to perform a lung exam. She was an elderly, frail woman, sitting hunched over in a wheelchair. I took my stethoscope out of my pocket and placed it on her chest. She placed her hand on my hand that was holding the stethoscope, looked at me with tears in her eyes, and said “Please don’t let me die. You are all God’s messengers; I trust you with my life and have all the faith in the world that you won’t let me die.” The intensity of that situation and the pain I saw in her eyes left me numb. The level of faith she had on her medical team was humbling, but at the same time overwhelming.
Many times, even after a diagnosis was fully described, patients in some parts of India would still ask “Doctor, am I going to die?” It is not a matter of ignorance, but a preference to trust the physician with that knowledge. These people feel comfortable in leaving the decision-making process completely to their physicians. This is in contrast to the patient-centered model that we see in some of the bigger Indian cities and in the Western world. This system is based on medicine being treated as a team effort, with physicians providing guidance and healthcare, while patients do their best to stay compliant with their medical regimes.
After nearly half a year in India, I learned that providing medical care to the underserved requires a great amount of trust-building. Skills and knowledge come with dedicated practice and years of experience. However, the ability to connect with people and gain their trust requires patience, respect for every individual, and gratitude for the opportunity we’ve been given to touch peoples’ lives. Rabindranath Tagore, an Indian poet, once said, “I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy.”
I’m sure that we have all experienced one moment where we felt pure joy after making a patient smile feel better, or help him or her through a difficult time.I’m sure we can all agree that there is no greater joy than that.