On the Other Side of the Stethoscope

June 1, 2012

My experience as an OB patient in Pakistan

This fall I was blessed with motherhood. But, my pregnancy had been difficult: I had gone into preterm labor and was rushed to the hospital. I was carrying twins and while I felt that I was mentally prepared for complications, as soon as I was admitted for an emergency C-section I became an impatient, non-cooperative patient in the eyes of my doctors. 

Even though it was an emergency, I felt I was in control of my senses. But, I guess my doctors forgot what they had been taught about informed consent. I had chosen the best gynecologist in town, who was thoroughly experienced, yet no one explained the procedure to me or introduced the surgical team. They did not have me sign a consent form before the catheterization - they just assumed I knew everything because I was a doctor. Perhaps they felt that an emergency C-section was good enough reason for not explaining anything and doing things in a rush. I was frightened, and thought "What's going on? Are my babies OK? Why so much panic?" but hesitated to ask my doctors. I discovered that you do not remember your training when you are on an operating table. The doctor becomes a lay person - the tables turn.

Looking back, I realize that values were forgotten at every step. Staff told my husband "you need to deposit money before we can take her." I remember thinking "who cares about an emergency situation?" Hospital staff made me feel responsible for their inconvenience. Obviously, my mistake was to enter into labor when nursing duties were supposed to change. The nurses fought over who was going to take care of me. I felt bad for interrupting their schedules, but my babies were in a hurry. I made another mistake by asking an experienced nurse why I couldn't feel my babies move. Unbelievably she said, "Oh I don't know, just lie down!" She complained that I had gained too much weight, and wondered aloud how I would pass the catheter. Again, it was my mistake to carry twins.

However, hearing my babies cry for the first time took away all my pains and complaints. The minute I was brought to my room I asked the nurse if I could see the babies."They have to be kept in the nursery darling, but they are OK," she said. The neonatologist had left the hospital earlier without meeting with me or my husband, and the junior physicians thought we would feel bad if we were told about the babies' poor health, so they kept quiet. For three days we didn't see the neonatologist; I finally lost my patience and asked to be discharged. It was only then that he came and told me that my babies had an infection. When I asked why he didn't feel a need to talk to me, he said "Oh I did what was best for your children; they are improving and you can go home in two days."

But that type of paternalistic treatment didn't stop with the neonatologist. My gynecologist visited me and demanded "I want you on your feet tomorrow. Don't be lazy. You don't even know how to breast feed." Even though I was a doctor, this was the first time I had given birth. I thought "they didn't teach me to breast feed in medical school." He went on to tell me I would make my babies lazy, and instructed me to feed my twins every hour. How would I do that with all the pain? I was hurt by the whole experience. My initial response to his lack of compassion was to start disliking my babies. I felt useless and I blamed them for my difficulties. Later on I tried to think more positively. From my medical training, I knew it was important to learn from both good and bad experiences.

As doctors we are trained to be empathetic, have good communication with patients and their families, and provide them the treatment of their choice. But, it is sometimes necessary to ignore these values and act as decision makers for our patients. I learned that having a taste of your own patients' medication is a life changing experience for a doctor.

I realized that it was too easy to ignore patients in the hustle and bustle of a busy ER. It was too easy to make decisions for patients in the name of doing good. I realized that even though there might be situations where this is the only option, physicians aren't always justified in doing so. I remembered that when patients shouted or complained we labeled them non-cooperative, impatient. How often did we load patients with drugs to calm them, blamed family members for not trusting us?

Such situations are not uncommon in Pakistan where public hospitals are the only choice for poor patients. And thanks to their poor standard of care, those patients who are able pay heavily to private hospitals for so-called "standard treatment." Underpaid doctors are frustrated and do not feel motivated to carry out their work morally. They don't take the psychological and social aspect of healing seriously. Treating the reports, rather than patients, becomes more important. Unfortunately, healing a soul doesn't result in being paid.

I had faced this same lack of motivation, but my experience as a patient taught me how it feels to be unable to move, unable to think and act. It taught me how every patient is dependent on the doctor to make good and informed decisions. It has taught me the pain of not knowing, the pain of losing trust. I have learned that a few minutes of healthy communication could bring an exceptional change in the recovery of our patients, and I regret all those times when I was too busy to ignore these realities.

These lessons are more deeply rooted than my two years training in psychiatry. I do not want to be treated the way I had been treating my patients in the busy hours of training. I know that the tables can turn at any time.

Sana Durvesh, MD, graduated from Sind Medical College in 2006; after which she joined a specialization program in psychiatry. She currently works as the manager of clinical audits for the Marie Stopes Society Pakistan.