Lessons From the Obstetrics Ward: The Dichotomy of Physical and Mental Wounds

-Written by Dr. Japjee Parmar, Intern, GMC Amritsar

TW: Mental Health, Self-Harm

I maneuver my way to the Obstetrics and Gynecology ward to do what is second nature to every intern after a few days of internship …taking the vitals before the morning rounds. Being an intern comes with its own share of boons and banes. Albeit the imposter syndrome that often kicks in foreign situations, familiar ones tend to get monotonous, and then there are the times…  times you’re faced with an unfamiliarity that jolts you.  

So, as I go on to tie my cuff around yet another arm and proceed to palpate the familiar radial artery, I spot an unfamiliarity. Across the nimble wrists of a patient were displayed streaks of dried blood. On further prodding, she confessed to having been the one to inflict the wounds owing to a feeling of complete inadequacy in handling her predicament, a child she can’t bond to, and the ridicule she faces at its behest.

When I tried to enquire why she didn’t tell anybody about her grievances she replied rather meekly, “I couldn’t vocalize it and nobody cared to comprehend. Showing them seems to have worked.”

And hence there I was, faced with the hypocrisy of my question and with the dichotomy of how we treat mental wounds

We simply don’t.

Not till it has a physical scar attached

If then.

Women have had a rather dubious history with medicine. Whilst their clinical symptoms are deemed exaggerated and attention-seeking and their pain dismissed as somatic and fictional, there is a certain cruelty in the relentless ridiculing of their mental anguish which is especially vile. The world has had this predilection of shunning voices and ideas which have had a genesis in the minds of women. Shunning them for the simple reason that these ideas are too emotional, too nuanced, for they lack structure and logic, for they come from the woman with the wandering womb, the hysterical woman. What has occurred as a consequence then is the perpetual rearing of generations of women propagating the ideas of being coy yet stoic, meek yet resilient, beautiful but not conceited, and concealing all suffering behind tightly closed doors. The mood swings then simply warrant a better diet, the mental anguish requires exercise, and if all else fails, marriage is a viable coup de grâce.

This collective ignorance, however, doesn’t negate the existence of post-partum blues, depression, and psychosis. In a country where the one thing each woman is expected to be is a mother, and one who is immediately and irrevocably bonded to her child and a nation that is not ready to acknowledge that there are times when that simply doesn’t happen is the predicament of many ailing women, labeled abhorrent and unnatural when what they really are is patients.

Patients who require reassurance, support, agency, regular follow-up, and at times psychiatry referrals, counseling, and potential medication. Patients who simply need reassurance that this is NOT their fault, that they are not alone in this, and that this does not make them a bad mother whatsoever, it simply makes them one who needs a little more and potentially different care from what she anticipated.

The nuance is not lost on me that there might be times when we can’t help our patients, the efforts we make might prove futile, and you might argue that kind words or reassurance are but little consolations to the morbidity and mortality that postpartum depression or psychosis can bring forth. Well my response to that would be that at any given time when it comes to making a decision (especially one regarding your patient).

Two roads shall diverge in the yellowwood, and both paths would be the correct ones.

The choice you make is how you choose to tread them.

So, choose to tread with kindness, lest you crumple the fallen leaves.

About the Author

I am currently an intern at Government Medical College Amritsar. I’m what you could call an ‘inevitable doctor’, I’ve always been passionate about science and have wanted my legacy to be one which echoes empathy and advocacy. I find solace in my writing as an outlet to combat the ugly sides and experiences that come with my otherwise incredibly rewarding profession. Each patient encounter is a story in itself and as someone who has always turned to books and novels for comfort giving these stories a voice is an immense privilege

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