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"I Ignore The Pain"-- Dr. Sunil Anand |
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A nine year old girl was brought to see me for her recurrent attacks of tonsilitis which would also lead to otitis media with high fever. She was accompanied by her mother who is Indian; her father, who was absent during the interview, was British. The child had a very acute nasal obstruction and had undergone a surgery for removal of adenoids when she was four yeras old. Now the E.N.T. surgeon was suggesting that she needed to get her tonsils removed too. They gave her antiobiotics that resulted in infected boils on the body especially around the buttocks. In fact, when she was bought to me, she had just completed a course of antibiotics and this had resulted in boils in the buttock area. This was mentioned to me but I found it strange that the child did not seem to show any apparent discomfort while sitting due to these. I generally pride myself with being able to break through the defences of even the most surly of kids (an art I am sure must have rubbed off on me through silently watching my father handling children in his practice and of course going through the joy and challenge of watching and learning from my own children growing up. The older one is a teenager so I am definitely qualified on this subject!) But I must admit that this girl tested my skills to the hilt. For her, it was a professional interview and she would answer only to the point and that, too, needed a lot of coaxing from her mother. It was also clear that the failure for an open communication was not due to any lack of confidence on her part at all. In fact, she sat upright on her seat, hardly budged from her place, just kept looking at me warily and answered the questions put to her after a lot of careful reflection and to the point; these were my initial impressions of her. Let me tell you the circumstances in which I had to see her. As this was an emergency case, it had to be accomodated during my busy follow-up timings. Generally under such circumstances I find it useful to allow the attending assistant to start the interview outside my inner office. It not only gives the assistant a chance to test her or his own skills on the method used in the clinic but often, as they are good observers themselves, they present a very accurate summary of their encounter with the patient. I must say that in this particular case the assistant had done a very accurate assesment of the girl and had briefed me with not only the present and past medical history but also her understanding of the vital points in the case. At the same time after spending almost an hour with the girl and her mother and gathering these impressions, she was wise enough not to be biased towards any particular remedy. I find this a mature process and approach and always encourage it in all my assistants. The words that came up and were related to me before I started the interview were: aggression, more like being argumentative; strength, which she uses to her advantage if she sees someone smaller being bullied; not enough perseverance (satisfied with her grades, much to her mother's annoyance); sensitive (towards others feelings or people getting hurt); caring (more as being protective towards younger children); fearless and lastly, content (in her own company). Based on these, the assistant did say that she was tempted to think of a strong metal remedy like Ferrum but there were some aspects in the case that did not fit into that group of remedies, namely the first line of the metals in the periodic table or the Iron series, as termed by Scholten, of which Sankaran has put forward the theme of attack and defence. You will agree that this was not a bad suggestion at all. But we have to learn the importance of being unprejudiced observers at an early stage of the session. As Sidhu in his cricket commentary of one-day cricket puts it, "It aint over till the last ball is bowled". All I had to do was to get the mother and child in and ask them to elaborate on each one of these impressions and keep my mind absolutely open. I could gather right away that the girl found our probing rather intrusive and this had made her clam up a bit. So I had to explain to her the relevance of this information and its importance in understanding her and arriving at the appropriate remedy for her through this exercise. But keeping our latest method of enquiry, I decided that I should focus on the chief complaint. The girl told me that her recent ear infection caused an ear discharge at night which was preceded by acute pain. When asked more about this pain she explained that she generally ignores pain till she cannot bear it at all. She seemed to have a very high threshold to pain. This co-related with my previous observation where she did not seem to be in much discomfort inspite of painful boils at a very sensitive area, the buttocks. When I examined these boils at the end of the case-taking I could see her wince a bit but there was no complaint at all. |
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