Letters to the Editor
This site is supported by Health ONE"...medicine could afford me a precious chance.
The chance to get something for nothing. The chance to
bring much joy to strangers just by a word calmly
said, a smile well-timed, a warm hand on the shoulder."
Tell Me I Have Been a Good
Anthony (his real name) was in his late 50s when he passed away. He suffered from motor neuron disease, and died from its complications. I have to admit I probably would not have had much interest in getting to know him if not for the sake of a case study all M3s have to submit as part of their continual assessment for Community, Occupational and Family Medicine. Yes, he was my case study, and I ended up with more than I bargained for _ much more.
I remember the first time I spoke to him. He refused to tell me what he was suffering from, saying it would be better if I went back and thought through his symptoms and what I found on physical examination (a confusing mix of upper and lower motor neuron signs), and return the next day to check if what was written in the case notes concurred with my diagnosis. He was right of course, I did learn more. I also found out that he did not have much longer to live.
Anthony was warded for most of my medicine posting in TTSH. I tried to visit him everyday, just to say hi, just to find out how he was faring. Many times I did not know what to say. How does one comfort a man totally paralysed from neck down yet completely in possession of his mental faculties, whose life must certainly (to me) be living hell? All my "how are you" and "did you sleep well last night" seemed to me to be thoughtless and unfeeling attempts at striking up a conversation.
But Anthony never made me feel bad. In fact, I never failed to feel better after speaking to him. He never needed me to comfort him. How presumptuous I was to think that he needed my shoulder to cry on. Having known of his illness and its prognosis since 1992, he had since come to terms with it. Rather, there were many times when it was he who comforted me.
"Hows your studies?" he would often ask. "Quite tiring" was the answer I often gave. And I was tired at that time, not so much from actual work, but from worrying whether I had made the right choice in entering medical school. When I saw bylines of friends who worked with me during my post-"A" level internship at Times House, I would think of my first byline in the Business Times, the heady newsroom buzz, those 2-hour lunch breaks, and wonder if I had bitten off more than I could chew, and gone into something demanding more than I even wanted to give. Not surprisingly, I found most days a drag. When one is mulling as much as I was at that time, the biggest spleen becomes impalpable, the clearest murmurs inaudible. Needless to say, some tutors were hardly impressed.
Anthony, though, was always happy to see me, or at least he gave me that impression. And I was most comforted to know that despite my countless foul-ups, with him at least I was doing something right. "You must not give up," he told me more than once. "Promise me youd carry on," he would plead, as if I were his own son, and not some opportunistic medical student probing his life history for a project. I did not doubt the sincerity of his words, I never doubted him even when he told me he loved me like his own son. After all, this was a man who even asked one of the girls in my clinical group who already had a boyfriend to give me a chance.
I often wondered if Anthony had read Dylan Thomas:
Probably not. But even if he had, Anthony had too much peace to rage and too much wisdom to see the point. That much I knew. He would have gone gentle into the night.
Yet, I could have done more for Anthony. I could have spent more time speaking to him. I mean real conversation and not those rushed 5-minute hi-bye affairs that took place mostly when I needed to be in his ward to clerk a case or meet my group for tutorial. I could have visited him more often on Sundays, my church being a mere 5 minutes drive away. How could I have thoughtlessly driven past TTSH those mornings after listening to the sermon, where the speaker invariably exhorted the congregation to become "salt of the earth" without even the thought of visiting him crossing my mind?
How easy it was for me then to "make his day" and yet I failed to seize the many opportunities. Certainly I did not have these regrets while Anthony was still alive. In fact, many times I thought I had gone the extra mile. And indeed he did make me feel that the little time I gave him was special and cherished.
He also made me realize that medicine could afford me a precious chance. The chance to get something for nothing. The chance to bring much joy to strangers just by a word calmly said, a smile well-timed, a warm hand on the shoulder. And that was something journalism would seldom provide. Of course, these intangibles can hardly put food on the table, but they do make the meal that much more fulfilling.
Anthony died on 5 December 1997. It was a Friday. I did not know about his passing away till Monday the following week. I must have been too caught up with my own work. I knew he was slipping away. The case notes clearly documented his deteriorating condition. What was I doing at that time? Cant be anything important since I do not remember a thing now. Many times I wish I had said goodbye. That I had said thank you.
Maybe I can still do something. Below is the concluding paragraph in the report I eventually submitted. It was never intended as criticism of specialists or neurologists or praise of GPs, and no one should read it as such. Anthony never blamed anyone, and who am I to point fingers on his behalf? Still, if it does help bring to mind the oft-quoted credo, "support always, relief often, cure sometimes", I am sure Anthony would be pleased.
The role of the doctor in the management of motor neuron disease is largely in providing emotional support. Perhaps that is why the management of this disease is lacking in Singapore and from reports in journals and textbooks, many parts of the world as well.
Without a local centralised support agency for patients with motor neuron disease, the burden lies on the neurologist or the primary care physician who made the referral to keep the patient and family in the know about community services available medical social workers after all rely on referrals from hospital doctors. But perhaps more importantly, instead of "passing the buck", we should take a personal interest in the affairs of these patients.
An Englishmen, Roger Carus, wrote a first hand account of his experience with motor neuron disease. It was published in a 1980 edition of the British Medical Journal. He said "I have the highest respect for my consultant neurologist as a man who can label and diagnose neurological illnesses, but in the context of my illness, he is no more use to me than the milkman." Of his general practitioner he said, "To his external credit, my GP has never stopped coming to see me, no matter what the circumstances, even though he can do nothing constructive."
Not all doctors can be specialists, but we all certainly can continue seeing our patients even if we can do nothing "constructive" anymore.
MR TERENCE LIM