Behind the Iron Curtain of Duty

India

Living in a conservative small town in northern India, my desire to join the medical profession with the utopian ideal to alleviate human suffering was fuelled by my missionary school background and the portrayal of doctors in movies. My selection in a premier medical school made me the darling of my mentors and teachers, who rightfully claimed some credit for my success.

My naiveté to believe in the divinity of this "noblest" of all professions modelled a path of selfless service that imperceptibly ingrained itself into my very being. Instead of the squeaky clean wards portrayed in the movies I had seen, and polished textbook segregation of diseases into chapters I had read, the complex, uncertain reality of multiple dimensions of human disease struck me like a bolt from the blue. Somewhat shell-shocked, I went along a path of critical evaluation of the repertoire of symptoms, harmonizing it with investigations, balancing the evidence and confusion it created with the management goals, guidelines and protocols only to be obfuscated by patient (and caregiver) desires and financial restrictions. The variety of patients and volume of medical information put me to the test repeatedly. I matured quickly in this charged atmosphere of successful "outcomes," with a large slice of the pie being agony, despair, helplessness, and loss, a somewhat difficult piece to swallow. I rallied time and again as a soldier of this army of drifting professionals, constantly hiding my emotions and tears behind the iron curtain of duty.

The profession of medicine extols us to strive for a nebulous virtue of a "good" doctor, a Dr. Jekyll, and I followed this to the hilt. Armed with a specialization in Internal Medicine and attempting to emulate what I perceived was the poise of William Osler and modern day evidence-based medicine, I fell in love with my role of "controlling" the fates of the myriad of patients who passed in and out of my life. The time schedules, night shifts, and the constant drive for perfection led me slowly and inexorably along a beaten path well-trodden by many others before me. I assumed myself indispensable, multitasking adequately so as to be 'good' in every aspect. Unsurprisingly, worry intruded into my life and soon became a habitual companion! My internal critic would often nag and rebuke me for my shortcomings. My constant preoccupation with analysing, judging and catastrophizing ultimately culminated in an awful panic attack five years back. I still remember that Saturday evening—it was weird.

It started like a subtle tremor building up to earthquake intensity, throwing me into a bottomless pit like Alice in Wonderland. The mild heartburn and palpitation attributed to a bad cup of coffee, a streaming rivulet of sweat across my face, an inability to breathe fully, and it appeared just as the commonly tossed phrase in our ER "impending doom." I could only describe it in Hemingway's beautiful prose "Because, just then, death had come and rested its head on the foot of the cot and he could smell its breath."

It was strange! All my knowledge, my medical education was floored that day. I wondered how an audacious and strong person like me could succumb. What! Me a nervous wreck! I wondered if I was really ever educated to handle myself, my emotions, my feelings, let alone handle the whole world.

I felt defeated.

After a while, my real trauma began. Was I puzzled, exhausted or dizzy? Was it PSVT? We talk so much of the dizzy patient and the algorithm springs to mind. Was it palpitation? We ask students to "define palpitation" as if the whole mystery of medicine lies within this profound statement. My friends offered kerbside consults "Breathe slowly," "Control yourself," "You're tough," "Keep your chin up," "You can handle it," "Take an anxiolytic," "Are you asthmatic? No, take a beta-blocker," but the worst was to be told to breathe into a paper bag.

The spouse appeared from nowhere and gently whisked me away. I recovered from this episode soon, but this led to another chain of events. Harrison's kicked in "Is it!" the endless...