Last night I sat alone in a midnight blur. I was surprised to find myself silently crying, somewhat despairing at the thought of a patient I had met earlier in the day. There was a sadness within me I had not felt for the longest time, an inexplicable heartache that I could not ignore. A woman in her fifties, with striking resemblances to my own mother, was wheeled into our clinic in a makeshift wheelchair, pushed lovingly by her husband, followed by a dedicated grandson, no more than six years old. Her hands had the slightest tremor and her facial expression was vacant, her eyes blinking and gaze blanking into the distance.
Her story was simple. Two years ago the woman fell and hurt her leg but was still able to continue walking as normal, albeit with some residual pain. Her injuries were not too severe. However, to relieve her mild symptoms, she would buy painkillers from her local town’s pharmacy. Over the course of weeks, and then months, and then years, she noticed herself getting weaker, not stronger. She developed muscular aches and lethargy, more pains in her hips, more bruising of her skin, more swelling in her face. Her weakness had progressed so far she could now only get by in a wheelchair. She was now complaining of severe difficulties.
X-rays were taken of her hips by our centre, showing barely visible bones – the spheres of her hip joints disappearing into darkness. It became clear from just watching her and reviewing her x-rays that she had likely been sold steroids from the pharmacy. And so when I asked to see her medications, her grandson, much like my little nephew, proudly pulled out a neat packet of her medications. The tablets were lovingly (and surprisingly) organised into neat compartments, and when I saw the little white steroid tablet this woman had been taking for years, a deep, unfamiliar stab penetrated my heart. This poor patient, in the hope of relieving her pain, had been slowly and sadly poisoning herself with drugs to the point of life threatening debilitation. This circumstance was only as a result of miseducation, disinformation and a health system that had failed her and her family. This is not an uncommon event in Cambodia, for steroids are truly available by the bucket load, but this particular story, whilst remembering my own mother, hurt me deeper than expected and last night, as I tried to fathom my feelings, I discovered now what hurts the most.
We all suffer hurt at different and defining moments in our lives, changing us forever in ways we will often never understand. When these moments of pain arrive, we, as beautiful individuals, each palpate our pains differently, reacting to the noxious stimuli in a combination of instinctive and learned ways. From the physical hurt of a fractured bone to the internal pains of a breaking organ, we either cry out in despair or hold back the tears, bite our lips and watch as our wounds develop, forming the scars that appear slowly on the outsides and insides of our skin.
The grief of emotional trauma often form the longest scars, both visibly opaque and yet clearly invisible within us. The emotional scars run through the entirety of our inner core and outer sphere, dictating which way we turn when challenged, which words we scream out when anguished, how tightly we close our eyes when we are already in darkness and in which moments we decide to let the tears flow past the barricades of our eyes’ resolve.
As healthcare workers, our pain thresholds often take a specific pattern, for we are continually exposed to the physical and emotional pain of others on a daily, if not hourly basis. It is not surprising our own reactions get numbed, as we are drip fed psychological anaesthesia to move on to the next patient, and the next case, without accumulating the burdens that come from consulting and treating fellow humans in pain.
As a child, I remember the times I would feel the loneliest, the saddest and the most vulnerable. It was the times when I felt out of control, when events were beyond me, events that I could not influence, that I could not change, that left me so overwhelmed and despondent. From the tragic disasters and sadness in the news, to the passing of loved ones, I would cry at the hopelessness of all that was out of my reach. I still remember sinking into a stupor after reading the diary of Anne Frank when I was eleven years old, so overwhelmed I could not go back in time to prevent this incalculable injustice of my new friend.
And yet now into the middle of life, those feelings of sadness and despair when faced with a situation out of my control have largely disappeared. Perhaps it is our growing experiences in life that help put perspective on our pain, for I did not feel such personal hurt during my work in Haiti, when in the blink of an earthquake, thousands lost their lives and millions lost their loved ones. And in Pakistan, I did not personally feel the hurt of those displaced millions, losing their homes to the rivers of floods that swept down the nation. Or in Cambodia, and Myanmar, interacting with those bright eyed people that were soon to lose their lives to cancer did not open scars that had not already formed within me.
Now I have realised what truly hurts the most. It is not horrendous outcomes of situations where we out of control, like an earthquake, or a flood, or a rare diagnosis of cancer – but situations when injustices occur to people where we are in control, when mistakes could be minimised, when man-made disasters could and should have been avoided. As healthcare professionals, we take an even deeper burden of this responsibility, to ensure we do no harm, at all times, at all events, for all of our patients. This patient, so reminiscent of my mother, so dedicated to the medicines prescribed to her, should not have been to the point where her life is at risk, simply by getting poor medical advice.
Similarly, in our small surgical centre, often providing life changing operations, we should uphold the enormous burden to prevent easily avoidable mistakes in our own practice, to minimise the complications we may encounter, to eliminate any harm we may cause. In the short period of time I am here in Cambodia, I can only hope to implement safer practices to our surgery, in an attempt to gain back control in seemingly uncontrollable environments, to ensure at least our standards are robust, even if there are pitfalls elsewhere. Most human errors can be curtailed with an open heart, good communication and a willingness to improve – a mantra I explain to my colleagues each day – that talking to each other is free of charge, performing safer surgery costs no extra to plan and prepare in advance. I truly want to ensure we are doing the best with the free tools we have, to ensure that we do not hurt our patients and the people of this country, to not replicate mistakes made by others, and deep down, not hurt each other in the process, for I do no want to feel this pain each night in Cambodia.
With love always,