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?
One of the most troublesome problems to
treat for an ENT specialist is a condition called Tinnitus – a sound that a
person hears inside the ear in the absence of any external stimulus.
(Vincent van Gogh apparently had troublesome Tinnitus,
probably on account of Meniere’s disease, and there are anecdotal reports
linking his attempt at cutting his own ear in an effort to cure his Tinnitus – though
the truth of that story is questionable.)
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 school of thought was to
tell the patient that there was nothing much that could be done for them. This approach spared the ENT doctor the frustrations of an
unsuccessful attempt at treating such an unpleasant 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% of patients suffering from Tinnitus had suicidal
thoughts).
It was then conceptualized to create a step
ladder management protocol for treating Tinnitus – and many approaches are now tried :- pharmacotherapy, counselling , sound enrichment, Tinnitus Retraining
Therapy (TRT), device placement etc.
We have been working with this protocol and
Tinnitus management, and though still far from satisfactory, is still much better
than it was.
In this management strategy we have used
two common principles of healing :-
·
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 patients can interact with others suffering with a similar
disease – this reassures them that there are others with similar or more serious 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 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 heartwarming Marathi movie called “Cycle”. While visiting a remote
village an Astrologer is suddenly called on to attend a medical emergency.
An elderly lady had fallen 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 you were 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 newborn girl child.
Even when there is nothing you can do you can still do a lot.
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