IN COLLOQUY – A TOPSY CIRCUS RIDE

Dr. Geeta Sundar, Neurosurgery registrar

Disclaimer: The director of the edition wants me to make this a fun, humorous read, especially stating that making fun of myself might do the task. I hope it suffices its intended genre. But if it fails, pardon the ‘serious’ gene in me. 

As an INFJ (stands for Introverted, Intuitive, Feeling, and Judging personality, aka advocate or counsellor, explaining this for the uninitiated), I have had difficulties with expressing myself and staying shut inside a self-implicated bubble that I feel protects me from all people and their ways. But as my senior (not-that-nice) colleague once told me – “You are nuts. Why choose a profession then, when you have to speak so much and counsel people on surgery? Better still, renounce the world, and go to the Himalayas. Social interaction is wasted on you!”

Ouch! And to feel so close to wanting to punch someone!

I have had so many comebacks, but when it mattered and I was in the bullfight, as is the case with almost all my arguments, I had no words to state. It is very similar to patient counselling and speaking to patients and their families. It’s a very rationed, measured job for me with minimal words. I worry about saying too little or too much, being too honest or just honest, I worry about being detail-oriented versus fear of being too complacent in sharing details. Perhaps there is no right answer. There is no one-size-fits-all. Sometimes, I think it feels like walking on eggshells or a minefield, you never know when the mine will blow. Kaboom!

So how much should I speak, and interact, and how much must I not? Is there a line? A grey zone perhaps? I am still in the cahoots of finding that line I must not cross but I must also cross as needed! And no one knows where the line is, or even if it actually exists. Perhaps Dr Schrödinger drew the line?

Rapports are built on trust, sincerity and empathy. Counselling is an art. The pioneers and stalwarts will tell you that counselling takes probably the most amount of training, just second to surgery. (Apologies to my Internist counterparts) It’s partly observed, partly understood, and largely on how you can adapt, maintain, and pursue a conversation level with the person you are talking to, so much so that you may even convince them of life-altering decisions. Akin to, a PR sales guy, selling your surgical skills to a person who requires it, is willing to accept the risks involved, and of course, to pay for it – money or blessings depending upon where you’re working.

I am wonky when it comes to sales, and even worse when it’s a long-held conversation with someone new, and if you add the convincing I ought to do, I’d rather go back into that bubble I mentioned before. I have been the ridiculous butt of most jokes in this aspect, but I strive to be independent and headstrong. If I come across as confident, it is only a show, probably, the trepidations deep within my soul as I brave on to face yet another patient family is a sad win only I know. Anesthesia people might have it easier in this regard, but then I didn’t want to be one, since I don’t like playing games on my phone while sipping one too many cups of tea.

If my patients are – a) scared of me, b) joke and laugh with me, c) intimidated by me, d) love and trust me, I think they will listen to me and I can endure, ensuring a smooth postoperative home run. Despite that, there are many people I tend to rub the wrong way, and well…that’s for another day, another conversation. (*wink wink*)

Having said that, here are some of the best pick examples of interactions I have with the ‘people’ community as a doctor.

The over-talker/over-sharer

“My three-year-old….my mother-in-law she…the husband has his perks you know, we are all just managing….we have this huge home town, this village on the outskirts….this well-knit neighbourhood…but I can’t help it, I did what I could, tried to save him…then again, life is in God’s hands…we just recently moved out, bought this flat…my kid’s teacher and my colleagues are nice…the new phone in the market, but also the cost of a new car…”

Some people won’t know when to stop talking. They will talk for ages, saying more than the normal requirement of words, sharing so much that it is a burden on the person who hears it, wastes time and is noise in the whole spectrum of running an OPD with over 100 patients to see in <6 hours. I usually keep a real resting face to these conversations, not even an ‘Uh’ or ‘Hmm’, nothing comes from me. I ignore it as much as I can. Sometimes it works. Sometimes it doesn’t. Sometimes it’s just TMI that I didn’t need flooding my RAM. I just use a lot of hand cues to buck them on and out. Sometimes it works. Sometimes it doesn’t, but my cold hard glare helps along.

#irritated. #end-it-already. #enough-of-rambling.

The guilt-tripper

“We would have come sooner. But I didn’t think it was related to his prognosis of the problem. It appeared so common.”

“I pushed it aside. She told me but I pushed it away thinking it might be okay. I’m at fault.”

There is always one of these guys hanging around. Denial and guilt interlaced. Classic combination of self-infliction of guilt and hoping I can sympathize with that. Lol. Joke. I have no sympathy for guilt. “It is okay, you are here now. That’s what matters. Better late than never, right?” I joke. A hung head is shameful and satisfactory.

#guilt-aint-healthy. #sorry-but-not-sorry.

The sublime escapist

These people show up once in a blue moon, escapists at large, lost to follow up (LTFU). Subtle ignorance that is faked. They don’t understand the gravity of their decision-making to abhor and ignore their symptoms and disease. Any crazy amount of explaining won’t do the task, or cut to the chase where they understand that follow-up is lifesaving. And since they brush away their diagnosis, they can brush away even their treatment…

At the maximum, I laugh. Sarcastically. “Nice to see you again. Lost to follow-up, were we? Life-altering decisions stopped you from coming back in? Like the hopefully family function, your dog ate your prescription paper, perhaps a Bigg Boss episode, uh?”

Their sheepish smile is enough proof. My teasing should aid their next comeback, or perhaps the Bigg Boss OTT season coming to an end. hopefully.

#LTFU-the-jokes-on-you-and-your-health.

The paranoid hypochondriac

These people are convinced something is wrong. But they don’t know what. And usually, there is so much going on with them. They have multiple pains, aches, and stressors, and all of them usually point to some psychiatric ongoing condition. I try to be nice and counsel to whatever ability I have, but after a point, it’s just words, and in repetition. My colleagues down at the psychiatry department are far enabled to deal with the mind, I just deal with the brain, you know. Sure enough, coating the word ‘mental health’ in ice cream and sending a referral along is an allowed perfunctory.

#counselling.

The arrogant narcissist

Head high, walking on a God-complex. Expensive smartphone, with a smooth drawl. Read enough to think they know it all, smart enough to know they understand it all (if only, anyway, moving on). They think they can impress anyone with their understanding of the disease and its implications. Basically, think they are the most important person in the room. I’m sure you’ve met them.

I have a huge surprise for them. I go full Deadpool. I tell the truth about the pathophysiology and the intrinsic details of the surgery, of what it’s like to be inside someone’s brain/spine and what we do.

That sound? Ah yes, that sound is of his chair scraping the floor as it moves back, a shaky look on his face, the calm, smooth demeanour shattered. Now they are back on track to understand and listen with their feet secured to the ground.

#reality-bites-a-bit-hard.

The suspicious questioner

They won’t listen or try to understand what you say. Always doubtful. Always suspicious of your intentions. I usually try a few times convincingly, but if I can’t reach them, I send for second opinions or other referrals. I gotta share and care about their concern.

I definitely won’t waste time with someone who doesn’t want to even try to understand, willfully. Life is short. Way too short to play Sherlock with a patient’s attendant.

#let-the-burden-be-shared.

The broken realist

Operated twice/thrice, adjuvant therapy done. Life has hit at the worst. The tumour keeps coming back. There’s not much to do. Palliative. They know. I know. We all know. But we just don’t talk about it. This is it. The end of the tunnel, heading towards the oncoming traffic.

I play nice, I ask niceties, I poke around with family status, try to crack some puny little useless jokes, anything to liven the atmosphere, sometimes they laugh, sometimes, they are just sad, it’s all in the moment. Not too heavy then, let’s just ignore the stark truth prying him open.

#remission-not. #survival.

The large-humongous family

Counselling for surgery is a taboo. I mean it. The night before the surgery is like attending an Ambani wedding – dozens from the family gathered with concerns and worries. They barricade me away from the ears of the patient on everything about the surgery, ins and outs…everything. Sometimes intimidating and bullying me, and at times not even keen to listen or understand the answer, other times, even diagrams in explanations won’t do the needful. Some prefer the patient be present for the counselling, while others prefer to not stress the patient out. It is very arbitrary. The more the learned family, the more the interaction, the more the doubts. The lesser the pay grade, the lesser the literacy, the more the trust (imagine the irony)

With time, I have come to smell the spectrum from the first moment I see them. And it’s gotten easier to interact with the family once I know what to expect.

Lo! There, did it hit its mark?

The discussion on how much to share, and what to share, or share at all is a largely ongoing one (at least in my head) and will continue. I prefer to speak when I have something to add, share or convey. Conversation for me is sacred. But, maybe it’s high time I get outta that bubble and have those ‘normal’ (however over-rated) patient interactions with people, uh, no matter how rattling it is?

Fin.

Bio:

Know me, and you’ll know a star

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