The nights get cooler during the rainy season here. I have been comfortable sleeping with the windows open, not needing the air conditioner. However, there is a pond, a grove of trees and an open field outside my bedroom window, and the racket from chirping cicadas and croaking bullfrogs has been keeping me awake. So last night I closed the windows and set the air con to low, hoping to get a good night’s sleep.
I must have drifted off at midnight, but woke up in the wee hours of the morning, still befuddled with night dreams morphing into day dreams. I was pondering fate. What did the future hold for those patients I had encountered with complex medical conditions since I arrived in Mae Sot, almost three months ago?
Regular readers of this blog will already know that I’m a “story person”. I like narrative. I teach using stories. Studying the story of a patient with disease X makes the book-learned facts of illness come to life, as well as making them easier to remember. I give advice to my patients using stories. Stories help them to understand what’s happening. Creating a story is distilling experience to reveal meaning. (My BS detector has just gone off!)
I prefer stories to have an ending. I don’t like stories which end without anything having been sorted, leaving you “up in the air”. Conclusions might not be pleasant, but they help me to make sense of the tale.
I wanted to know what happened to the man with advanced lymphoma who still had to work to support his family. His disease was progressing rapidly and I was amazed at his resilience, but wondered how long this would last.
Would the three children I saw with kidney disease recover? They all defaulted from follow up when it became clear there was no instant cure available. Their parents promised to bring them back, but they never did.
How long would the young mother with diabetes be able to manage on oral medication? Insulin would not be an option for her. What would become of her disabled child?
Would the lady who was the victim of domestic violence be able to escape from her abusive husband?
What sort of life awaits the poor baby born with no hands or feet? The mother had delivered at home and brought the baby to the clinic for its first immunisations. Even for the NHS and social welfare system of the UK, these deformities would present enormous challenges. I just hope it does not end a life of mendicancy.
Would surgery be a successful cure for the little boy whose massively swollen kidney needed to be removed? It was bigger than a rugby ball, filling the central part of his abdomen. Could the baby with congenital cystic adenomatoid malformation lead a healthy, normal life after it was surgically removed from the lung? Both these children have been referred to the medical children’s charity, Child’s Dream (www.childsdream.org), for operations in Chiangmai.
In my “borderland state” (a curiously appropriate term used by Andreas Mavromatis to describe the transition between sleep and wakefulness), I wanted to gaze inside the crystal ball, to see the future. The medical terms for phenomena occurring when shifting from “awake” to “asleep” and vice versa, are hypnagogic and hypnopompic hallucinations. Hallucinations being the operative word. I fantasised about a film sequence, like the final scenes of the HBO TV series, “Six Feet Under”. This is a montage of the fates of the major protagonists, to the haunting soundtrack of Sia’s “Breathe Me”.
Well, not quite. But after my first cup of coffee this morning, I had a minor epiphany. A light bulb of insight illuminated what this was really all about. It was about Me. My fate.
I like to feel I’m in control, even when I’m not. I like to have a plan, to know where I’m going. I admit, I do have a hankering to see a sneak preview of the next chapter of my life, but I know this is futile. We can’t predict the future. I have spent my working life coping with uncertainty. I should be an expert at it by now. Perhaps I need to adopt a more taoist approach to life, to go with the flow, and not to fret about the direction.
I’m leaving tonight to return to UK for my youngest daughter’s graduation. She got a first in her dissertation and an upper second class degree with honours at Leeds University, in medical sciences. I’m very proud of her, as well as my two other daughters (doctor and graduate entry trainee nurse). They are a credit to their wonderful mother.