It’s the middle of the night and through the haze of anti-malaria drug-induced dreams I hear my phone ringing. It is the ER. Nothing too dire, but a patient I should probably see. Clumsily I throw on my salwar kameez and headscarf with a little less class than I feel I have begun to manage during the day. Into the starry night and through the compound I stroll.
It feels wonderfully safe here as I walk past people sleeping on the ground outside the surgical ward – family members of the admitted patients, I presume. At the ER I am greeted by the friendly smiles of the night watchmen and cheeky grins of the ER team. “Were you very busy?” they ask. “Indeed I was,” I reply with a sleepy grin. The patient is an old baba in respiratory distress. Probably a combination of fluid overload secondary to heart failure and an acute exacerbation of chronic airway disease. But what was most striking about this patient was not so much his pathology, but his social history and how it was presented to me.
In medicine, as I believe to be true of life in general, a person’s story, their history, tells us more than anything, shaping our view of each other. And for a doctor, it helps to piece together the puzzle of a patient’s health – or ill-health, as the case may be. The night ER doctor tells me, “This baba is all alone in this world.” This is his opening statement and in his mind, I believe, is meant to tell me more about where he has come from, the enormity of his problems and his likely prognosis. In a society where the extended family unit is paramount, being socially isolated is almost viewed as a diagnosis as much as a pathology. Like a chronic illness with no cure, it slowly wears people down.
Earlier in the evening I had been discussing the very same concept with the same doctor. I can’t remember how it came up, but I was explaining that in my country the different generations don’t usually live together and that in fact my grandparents live on their own. He was very shocked to discover this, especially when he found out they are in their eighties! “How can they look after themselves? What do they do?” he asks. I know both my grandfather and grandmother would proudly say that they are doing just fine, and of that I am sure, but there is that little twang of guilt – are they really ok? I can’t help but ask myself. I appreciate there is no perfect society and – ask my family – I am a staunch advocate of independence. But at what cost? Has our society gone too far in pursuit of individualism and independence?
I am very fortunate that I come from a wonderful family, both the nucleus and extended family (a distinction that is a somewhat foreign concept here). They have enveloped me in folds of love whilst giving me the opportunity and blessing to pursue my individuality and dreams. But is it really possible to have both? When asked why I don’t look after my grandfather, why he doesn’t live with me, I couldn’t help but think how much I would love to care for him and share these years with him, but wouldn’t that also mean that I couldn’t be here, doing this, pursuing this dream?
I need to work on getting back to sleep after these night calls. And yet I cannot help but lie here and ponder. Every clinical presentation leaves me marvelling at the life people lead here. Every conversation with my amazing team in the ER teaches me something about a world view that is different to my own.