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| Hpathy Ezine - May, 2004 | |||||
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"This is Mine"-- Dr. Sunil Anand |
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This is a case of a 4 yr. old girl with constipation. Her chief complaint seemed to match her obstinate temperament. The circumstances around which her appointment was taken are important aspects of the entire case. There was a frantic call by the relatives of the girl urging for an immediate appointment. They explained to me that the girl had suffered from constipation since almost a year and currently had not passed a stool since the last 5 days. She belonged to an Indian family who had settled in Africa and had been visiting her relatives in India accompanied by her paternal grandparents. The concerned relatives further elaborated that the entire household was affected by the ailment of the girl. When I asked them to bring her over, they further explained to me that as she was resistant to any form of treatment they would have to convince the girl that they were going to consult a doctor, concerning her younger male sibling who was one and half yr. old and had remained behind with the parents. These were the strange circumstances in which I relucantly gave them an appointment. During the entire consultation, the girl hardly spoke to me, except towards the latter part. The entire symptoms were conveyed to me by the relatives and the grandmother while referring to her in male gender. At one point the child was busy playing with some toys and there was a lapse on the part, of the relatives who mentioned "she" instead of "he". The girl immediately shot them a glance and confronted as to whom they were talking to me about. It took a lot convincing to reassure her. Since a year she could move her bowels only with the help of an enema and this time even that was not having the desired effect. She used to get sudden urges which were ineffectual, during which she would throw all shorts of tantrums. She would want only the grandmother to carry her, and move with her. It seemed like she did not want any position that would give pressure to the rectal area. During these urges she would scream and make unreasonable demands which would go on for hours and finally out of sheer exhaustion she would go off to sleep, by lying on top of her grandmother. She would refuse to go to anybody else during these moments. The old lady’s plight due to these demands was indeed pathetic. As the child was refusing to eat anything this too was a big cause of concern to the relatives. Any attempt on my part to befriend her was refused. Talking about her nature to me, the grandmother informed me that it was very difficult to please her, and she always appeared dissatisfied. Inspite of having of lot personal possessions, she was always envious of others who had things that she didn’t possess. This I could confirm too. One of the rare dialogues that she had with me was when she brought to my attention that she did not have a particular soft toy in the shape of a snake that she had found in the toy basket in my clinic. While mentioning this she refused to let go off the object, and it took a lot of cajoling on the part of the relatives to make her part with the desired object. She was extremely resistant to talk about herself. It appeared that this difficult behavior had got worse since the birth of her younger sibling. What is interesting to note is that her constipation too surfaced around the same time. The only other time that she agreed to talk to me was when I asked her about her brother’s nature. She said "he is a very naughty boy." She was very upset about the fact that her mother preferred to give everything to him, rather than to her. The grandmother explained the girl was very possessive of her and would not allow her to attend the sibling even if he was desperately crying. |
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