There is always something you can do
In spite of the tremendous progress made by modern medicine there is so much we still do not know and so much out there that needs to be learned.
In this context the problem faced by a physician is how to treat patients with diseases/ problems that are still poorly understood or considered ‘untreatable’?
The perplexing ‘sore throat’ that never seems to go away, the pain in the ear for which no cause can be found, the cough that seems to come and go at will and no amount of treatment seems to help?
sound that a person hears inside the ear in the absence of any external stimulus.
(Vincent van Gogh had troublesome Tinnitus, probably on account of Meniere’s disease, and there are anecdotal reports linking his attempt at cutting his own ear to his troublesome Tinnitus – though the truth of that story maybe something else.)
It is a perplexing complex disease which, in spite of volumes of literature on the subject, we are unable to effectively treat.
About three decades ago the teaching was to tell the patient that there is not much we can do for you and wash your hands off the whole affair. At least it spared the ENT doctor the frustrations of an unsuccessful attempt at treating this vexatious disease.
Research taught us that this approach was wrong – expressing helplessness to manage this symptom caused patients to become severely depressed. There were also studies linking Tinnitus with suicidal tendencies (according to one paper 16% patients of Tinnitus had suicidal thoughts).
It was then conceptualized to create a step ladder management protocol for treating Tinnitus – and many approaches are tried- pharmacotherapy, counselling , sound enrichment, Tinnitus Retraining Therapy (TRT), Device placement etc.
We have been working with this protocol and Tinnitus management, though still far from satisfactory, is still much better than before.
In this management strategy we have used two common principles of treating
- Counselling – explaining the nature of the problem, explaining why and how it occurs, reassuring that it is not life threatening, talking about simple home remedies – sometimes as simple as keeping a ceiling fan on at all times. There is also a proposal of creating a ‘Tinnitus Club’ where sufferers can interact with others with a similar disease – this reassures them that there are others with similar or more problems and gives them a chance to discuss their strategies of coping
- Relying on the human body’s mystical and tremendous powers of healing. Quite often Tinnitus may reduce or go away spontaneously. This of course follows Voltaire’s famous aphorism- ‘The art of medicine is to keep the patient entertained while nature effects a cure.’
We learnt over a time that even if there is no drug or surgery to help a patient the physician’s deep understanding of human nature and desire to help will always succeed where nothing else can.
‘To cure sometimes, to relieve often, and to comfort always.’
To explain this a little let me narrate a scene from a heart-warming Marathi movie called “Cycle”. While visiting a remote village an Astrologer is suddenly called on to attend to a medical emergency.
An elderly lady fell down a few days previously and since then was neither eating nor drinking. Looking in the eyes of the elderly lady the Astrologer knew there was not much time left for her.
In the meantime the elderly lady’s daughter in law goes into labour in the next room.
The Astrologer holds the elderly lady’s hand, looks into her fading eyes and talks to her –
“You know Aayi last night I saw you in my dream. Guess what were you telling me?”
The lady looks deep into the Astrologer’s eyes and motions him on –
“You came to me in my dreams and told me that you are not going anywhere – that you will be reborn in this house itself.”
The elderly lady’s face assumes a beatific expression and while the light fades from her eyes the room next door is filled with the cries of the new-born girl child.
Even when there is nothing you can do you can still do a lot.
Comments
Post a Comment