Thursday, December 13, 2007

Practice experience

Old age has its advantages it is often said. The disadvantages however overweigh the advantages. Of the many, is the inability to cope with adversity. There was a time when I was able to handle several serious patient related issues simultaneously with out getting unduly affected. This is not so now. Patients who have been with me and have grown old alongside are getting into serious personal, family, financial and health related problems. Often they have no one near enough but not involved, to go to for advise except I. Earlier on when they brought their problems to me I could evaluate them dispassionately and then forget about them soon after. This is no longer possible. The feeling of immense sorrow long after the party has left my premises lasts often days and weeks after the event. My thoughts go back to the days when I was witness to the joys of the newly married couple 25 years ago, now occupied with an intense and hateful war with each other. I find it hard to accept or understand this hatred and not able to sort out any of their problems adds to my owes. This kind of happening is deeply disturbing and leaves me with profound disquiet which does seem to go away as it did in my younger days.
My patients seem to die more frequently now. Don’t be under the impression it is because of my doing, it is because of old age and related issues. Unlike younger doctors older doctors like me have more number of geriatrics. These have been my patients since their younger days and I have been a party who has watched their life’s drama [melodrama] unfold over the years, like they have watched mine. Yesterday I saw a deeply jaundiced patient of mine of 70 years who underwent rescective surgery for carcinoma gall bladder. We including the dynamic young surgeon thought we had achieved a cure as the problem was detected very early. Not more than five months have passed and she is back and almost certainly with liver mets. I have been her friend in the days she suffered looking after her husband who died after a prolonged struggle against restrictive lung disease and IHD. No sooner he went she developed this problem and now she is on her way out. Both have been my patients of over twenty years.
These episodes are becoming common and as I said earlier leaves me emotionally drained. They say in youth the emotions are brittle, but I feel it is so when one grows old. What made me write these few lines and share these feelings is the hope that by doing so I may lighten this burden.

Any naturalist who is lucky enough to travel, at certain moments has experienced a feeling of overwhelming exultation at the beauty and complexity of life, and a feeling of depression that there is so much to see, to observe, to learn, that one life time is too short a time to be allotted for such a paradise of enigmas as the world is. You get it when, for the first time you see the beauty, variety and exuberance of the tropical rain forest, with its cathedral maze of thousand different trees, each bedecked with gardens of orchids, epiphytes, enmeshed in a web of creepers: an interlocking of so many species that you can not believe that the number of different forms have evolved. You get it when you see a vast concourse of mammals living together, or a vast, restless conglomeration of birds. You get it when you see a butterfly emerge from a chrysalis; a dragon fly from its pupa; when you observe the delicate and multifarious courtship displays, the rituals and taboos that go into making of the continuation of species. You get it when you see a stick of leaf turn into an insect, or a piece of dappled shade into a herd of zebras. You get it when you see a gigantic school of dolphins stretching as far as the eye can see, rocking and leaping exuberantly through their blue world; or a microscopic spider manufacturing from its frail body a transparent, apparently never ending line that will act as a transport as it sets on its aerial exploration of the vast world that surrounds it.

Gerald Durrel. Naturalist, zoo keeper and writer.
From his book, ‘golden bats and pink pigeons.’

Truth and Beauty
The light alone, like the mist over the mountain driven,
Or music by the night wind sent,
Through strings of a still instrument,
Or moonlight on a midnight stream
Gives grace and truth to life’s unquiet dream.


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