Sunday, 13 November 2016

Neither burden nor feather

André Silva

This post was originally wrote for the Brazilian Blog of General Practice: “Causos Clínicos

Attention: The following personal essay is based on a real case, but all names are fictitious. Further, all the story elements occurred in different situations. I saw main story with a wire of my life story. In this patchwork some details are older, some newer. But all are thea background of memories and heart.
As a suggestion please listen this soundtrack to read this story, this is the playlist that I listened when I wrote it. They are songs that made me smile, cry and touch as human in my vulnerability. Good reading!

 -   You're kidding me! I do not believe in you !! This is absurd !!
I heard the shouts at reception, a woman's voice. All while I was talking to two undergraduate students in their final year of medicine. They were preparing to meet the last person in the morning at that Thursday autumn. It had up a music of Enya which the resident had said that she was fed up of listening it.
I'm going to the front desk, and I come across a lady I had met three weeks ago, Mrs. Matilde. Skinny, black, with hands punished by time and hard work in the fields and at home in their seventies. So slight that it was hard to imagine that she had four children.
-          Doctor, why are you doing this to me? - She said almost in tears.
As she screamed, a short film went through my head: the diagnosis of HIV for more than month and she denying it. The case discussion with the nurse and the difficulty to make her understand. And those cold data on paper: 14000 and few viruses per mL of blood, 350 leukocytes type CD4, numbers that leave no doubt, but Matilde only increased her anguish.
I almost as a reflex, call her to the office, the same that had Enya as background music.
-          Doctor, I couldn’t have AIDS, I am with no man for over 30 years since I husband had died, I did not take blood... what will I become? How much life do I have?
       I ended up stopping the music. I thought it was worse, because it was possible to hear the strained breaths of both students, Bruna, Pamela, and my own.
-          Mrs. Matilde, let's talk calmly. I'm here to clarify all your doubts.
-          Doctor, I'm not with a man for over thirty years, my life was taking care of four children, and just now I met my first granddaughter. Look, you need to wash the chair where I sat, so people will not be contaminated when sit here! – She was sobbing, already standing.

"Hard to believe that today there are still people who think that HIV is transmitted like this." - I thought in my smallness. "I need to act fast, accurately and undressing of my prejudices and my fears."
I turn on the music again. I ask Mrs. Matilde to sit and breathe deeply with me. The students in the corner observing were seedlings.
-          Mrs. Matilde, the main point now is not where this virus came from. What matters is that today we have treatment and we will always be here to care you.
-          But doctor, people will not be able to get closer to me and ...
-          Mrs. Matilde, please give me your hands.
-          But but...
-          Mrs. Matilde, give me your hands. Let's go. - I speak with her more firmly.
I welcome those skinny little hands, and look at that old lady with a scarf on the head.
-          You see? We don’t get HIV like this? Can you see thaat you don’t need to be afraid? You still could play with your grandoughter.. You just need to slow down. You will be able to take the medicine and live quite yet.
-          Doctor, you have the age of my grandson. Aren’t you lying to me, right? I'll even be able to continue to come here, sit in this chair and be cared by everyone here at the Health Basic Unit?
-          For sure, Mrs. Matilde.
-               And I can get my granddaughter on my lap?
-               Of course.
-               And could I hug anyone?
-               You can even hug me, Mrs. Matilde.
Them, the lady opens her arms and wraps me in a hug, weeping. "Thank you," she said. And a new film goes through my head, my poor childhood, the youngest of eight children, the causes and conditions that led me to medicine, family medicine, for living the distance of five thousand kilometers of the city where I was born and raised. The miss of my mother, that great friend the lives over thirty years with HIV, that another friend who has been diagnosed recently, the fragility and richness of this phenomenon called life. And drops a tear inside my being, while I hug that little person.
-          Doctor, so I'm going, much more peaceful. I do not want to take you time. I can come tomorrow with my daughter for you to explain to her how it will work from here on?  The exams... medicines...
-          Please Mrs. Matilde. We will be waiting for you.
  And Mrs. Matilde leaves the surgery, light as a feather. I observe Bruna and Pamela thrilled.
-          Professor, how beautiful was this! But we have a question: a doctor at the hospital told us once that we should never hug patients, neither in private practice, because "gives a lot of freedom" for the patient to ask for more and more things, and it becomes a burden. Do this mean that we can hug?

"I need to be careful with the words," I think as I remember the zeal I learned to have when I do ikebana, those Japanese floral arrangements.

-          But even ICU doctors say that touch helps, what about us, family physicians, doctors of people, of lives, stories and emotions? Hug is therapeutic for patients and for us. And I imagine you have had a good example just now.
-          Undoubtedly teacher. We will bring it to life. Thank you - tell the students at the same time.

So I say goodbye to the students and I'm thinking about it at the office. The clock mark midday, lunch time. I look at the picture of “Lord”, my dog that died few months after 14 years of affection, and I am there, absorbed in my thoughts, in my longing, in my tears, in a vacuum. Moreover, remember Master Dogen, an ancient Japanese Zen master, who said that our practice in life should be "no gain". I think it is. Only family doctor, of people, of lives, stories, emotions. Without any gain or burden, nor feather.

Several months later, after comings and goings of Mrs. Matilde she is "very well". When I was doing another ikebana before dinner during a retreat as I finished the floral arrangement, I remembered Mrs. Matilde and what it means life: a breath, a flower that blooms and withers, a force, the bird flight that leaves no trace, a moment. And ikebana was like this picture. I am grateful to you, Mrs. Matilde. And I found myself not burden nor feather.

André Silva is a Family physician in Brazil and works in a Rururban area located at Porto Alegre within rural characteristics with local creation of animals but the influence of urban problems like drug dealing.

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