Illness.
Illness is not just a biomedical problem.Mum called me and told me about my aunt's operation - apparently there are some complications. She described all her symptoms to me and asked me for opinion - but there is nothing I can do to help her. I know nothing about this stuff; my sister knows better than me - even if you give me all her medical records and put her in front of me I still cannot do anything about it.
I am supposed to be good at the biomedical sciences, but it is also a fact that I don't know anything and I cannot do anything about anyone's illnesses. Note the distinction between biomedical sciences and medicine - medicine is the practical use of the biomedical sciences to solve people's problems, while the biomedical sciences are the scientific framework which medicine is based on. My job is to expand the framework, so that medicine has more tools to use. I don't use the tools, I make them.
I was telling my sister: she is going to become the more popular one among mum's friends because her skills are practical - she can actually heal people (yes she has healed quite a few because there are always people volunteering to be her lab mice - I am one of them :P). Haha no one is going to disturb me because no one will even understand what I am doing - and I would be really lucky if no relative or family friend actually criticises me for being useless because I won't seem to be very productive considering the education I am getting.
I am worried for my aunt. MSNed sushi and told her to send my regards, do whatever she can to help her and the family, and update me. Though, when this kind of things happen my reaction would be to trust doctors intelligently, don't do anything extra, don't try to act smart and most importantly, consult your doctor before seeking any alternate treatment. The doctors are doctors because they know what they are doing; the auntie next door who has gone through a similar operation won't know more than the doctor who actually opened her up, and whatever herbs that she used might work for her but might even kill you because everyone is different physiologically. If the doctor doesn't know what he is doing, find one that knows. If they make any mistake, sue their asses off. Anyway, for doctors to work optimally we have to trust them. Common sense?
Hmms, how do people actually react to illness? Illness doesn't only affect the patient - it affects everyone around him. It affects his loved ones, his friends, his colleagues, his doctors, his bosses, practically everyone: and different people react differently.
I just read a graphic novel called Epileptic by David B.. It is a disturbing book - it describes how the author and the author's family dealt with his brother's frequent epileptic seizures, apparently incurable. The book basically highlighted how the parents gave up hope on modern medicine and their religion, and started their tireless search for alternative treatment - macrobiotics, esoterism, mysticism, magnetism, alchemy, you name it - until a point of time when they ceased to believe in these things altogether. They didn't even start a new treatment with any hope.
Throughout his childhood the author locked himself up in strong armour. Throughout the book he didn't mention any friends - he didn't seem to have any, not until he went to Paris (i.e. left home) to attend college. His friends before his brother was down with epilepsy ostracised them soon after. He used a lot of imagery - war imagery, obtained from books about great warriors and which he expressed in the form of drawings, fiction, and comic strips - to fight his own war against his brother's illness. He didn't talk to people about it. When he started to open up this issue when he was in college, his friends too eventually found his stories to be 'too heavy' and began to distance themselves from him. Instead, he had this group of ghosts - including his grandfather's - in his garden which he confided in.
When the illness first struck the brother imagined himself as Hitler - a dictator with supreme power - which, in some sense, gave him the psychological shelter against reality. Intrinsically he wanted to fight - he wanted to be like Hitler, which could control everything when he was in power. As time went on, he succumbed - he became stuck in the past, started to evade problems, wanted people to take care of him, and started using his illness to get things he wanted. Eventually he turned violent, delirious, sometimes to the point of insanity - but he didn't - it is just that, it seemed that he never was going to become independent ever.
I have a lot to share on this topic - from what I have read, to what I have experienced working as a medic in the SAF, to what I have experienced in my family - and I can't say everything. I’ll save them first.
Illness affects the patient, and it affects a whole bunch of people around him. Illness changes people's ways of life, views of the world, standard of living, social circle, roles in society... It is not only a biomedical problem.
Yes to us different forms of illnesses are sets of problems lying there for us to solve. I have been spending my past year working on prostate cancer. But we shouldn't forget: prostate cancer is not a problem confined to the laboratory, or a problem confined to the walls of our outpatient cancer centre. When someone gets prostate cancer, it affects him and people around him in all aspects, in different ways, in various levels. The cancer is not merely weird cells expressing weird proteins at weird times dividing at weird speeds.
The patient is not merely a subject of study. He is part of the social - don't underestimate him. His illness can affect the doctor treating him too; if I am the scientist investigating whatever strange illness he has, his affects me too, even though I am not even at the frontline. A very vivid example is SARS. If I am one of the guys doing the investigations, my life would have been tilted 90 degrees to the horizontal for those few months. Especially when the patients keep dying and we still know nothing about the disease.
Doctors have to see patients as patients, each as unique individuals with his unique set of problems, before the patient and the doctor can build a good relationship with each other and thus both can have a wonderful medical experience. Scientists like me do not have this kind of problem, but we have to constantly remind ourselves that the problems that we are solving are not merely biomedical problems - they all have their social implications. We have to remind ourselves not to become heartless and turn a blind eye to patients' needs and feelings - when we have to fight for funding, when we have to announce our findings, that's when the problem emerges.
All these sound so remotely idealistic, and they have no economic value. NUS/NTU don’t even have anthropology and history of science and medicine. (Also - I am the first Singaporean (as far as I know) in Hopkins doing HSTM.) Not that we have much of a choice either - I can't lecture Singaporeans on the importance of such issues because there are more pressing concerns in Singapore. I’ll be chided as 'idealistic' and 'impractical'. Will talk about that some other time :P
Labels: Philosophy and Religion, Random
