Pharmacology in mind

I used to cry silently because of the lesson that my patients unknowingly taught the doctor.

I still remember vividly the visit with her, an unfortunate 70-year-old patient with metastatic lung cancer. She has a lot of fluid in her chest, also known as pleural effusion, and needs palliative care. Four months ago, she also had another skin-chest metastasis, related to a catheterization procedure to reduce breast fluid in another hospital. Due to pain in the chest wall, she also received radiation therapy to the tumor. The pain was controlled for a while, when the pain again, she was referred to my hospital by her close home.

We talked and asked very happily at first, but when I touched the lump on the skin for examination, she suddenly burst into tears. I panicked, immediately asked why.

"The doctor's hand is so warm, I feel so comfortable," she said. She honestly continued to tell a more unexpected story. Visiting hospitals in the past four months, she has not been touched by anyone. Everywhere, people only ask questions, prescribe painkillers, look at CT scans, and show her the lump on the computer screen.

I heard the story while thinking of an explanation to defend my busy colleagues. That the tumor was so obvious on the image that the doctor thought it didn't need to be touched, or that the doctor was too busy to wait for the patient to pull up his shirt. Touching the lump usually doesn't change the "treatment strategy", and the doctor may not have had time to think about the patient's feelings either.

Fortunately, she did not cry because she was angry with the doctor, but because the nagging pain suddenly disappeared unexpectedly. Unbeknownst to her, I also cried silently after meeting her, from the lesson she unknowingly taught the doctor. I cried because it turned out that my clumsy hand could mean so much to someone.

A few months later, another patient told me that she was also comfortable with the doctor's visit. I silently thank her for helping motivate young doctors like me. The patient is both a teacher of the doctor and a physician profession becomes meaningful.

Most patients actually have high expectations of being seen directly by their doctor. Most of them still think that doctors have to touch - see - knock - hear or at least "touch people" to be called "examination". Whether readings such as blood pressure or heart rate have been taken by a nurse with a machine or an automatic measurement, many patients in Japan tell me that they still want to have a "traditional" pulse taken by a doctor even for a few seconds. In a busy clinic setting, this "classic" need can be difficult to fulfill, but I always remind myself not to upset the patient.

Another time, I had the fate of meeting a patient who had difficulty breathing because of lung cancer with pleural effusion. Doctors had previously told her that it was difficult to breathe because "the lungs were flooded". After knocking and hearing her lungs, I laughed, telling her that the translation made up only 1/3 of the chest and the other 2/3 "still runs fine". She had less difficulty breathing that afternoon.

Incredibly, one patient who still complained of difficulty breathing with the sedative, the optimal dose of morphine was better with just one sentence. More unbelievably, she was also the recipient of the prediction "maybe only six months", but in the end life was four times longer.

"The doctor himself does not know what will happen to them tomorrow, how can I accurately predict the lifetime of her?", The patient laughed and nodded as I joked.

By reviving her belief, her spirit has improved markedly. With some other methods such as changing her posture, sitting more comfortably, using additional support tools to focus her on reality and continuing her hobby of knitting, we have helped her to live a life. meaningful time.

Talking to patients, especially those with terminal cancer, is an art. Many people ask that this is called patient lying or not?

When a glass of water is only 1/3, the statement "dead 2/3" or "still 1/3 still" does not change the harsh truth, but can change the perception of life of the patient. The patient not only suffers from the truth, but also suffers from the interpretation of the truth. Sometimes, suffering is caused by the patient's own self-implication or self-association that the doctor must be the one to recognize and resolve those hidden questions.

A senior doctor told me that this was written in the Sutras of the Thousand Years ago. The physician needs to bend his tongue seven times when talking, with a pure mind praying for the well being of the patient. It sounds vague, but what the Buddha taught was not unreasonable.

Many patients in Vietnam told me that it is the same drug, but when they meet a caring doctor, communicate with good body, speech and mind, they often become more confident in the treatment results.

Bodhisattva Samantabhadra once told his disciples: "Go to the forest, find herbs that are not medicines to bring here for me", implying that everything is medicine but not medicine. It all depends on the usage and the effectiveness also depends on the "medicinal properties" of each person's mind. Everyone has the ability to become a Buddhist medicine, precisely because of the medicinal properties of their mind.

I write these lines when the world is in turmoil from an epidemic. In the favorable material times, information spread on the internet, many patients are easily confused by "remedies" or "advanced treatments" via Youtube, Facebook, or Google or think that they must be scanned by computer. New modern hook peace of mind. Doctors' words are sometimes not taken seriously. However, I still believe that there will be times when people realize that nothing can replace the value of "medicinal properties" in every physician.

"Money, fame may be the goals that many people aim for in a short time, but nurturing medicinal properties is the factor that helps long-term peace," my teacher, a Japanese, told us like so.

Pham Nguyen Quy

Source: https://vnexpress.net/duoc-tinh-trong-tam-4229978.html