Me and the Advisor to the President Karzai

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A Hospital with Antique Decoration

Today I went to see Afshar Hospital. It is located faraway from the centre of the city. It looked to be in another part of the world. They have tight security. You have to register your name on the gate, seen by strict guards, given a visitor card, and than enter. It takes a little bet time. For a visitor it is ok, but for an emergency case it is too much. As I entered the hospital, it looked almost a military base, with lots of security people inside. And as I went further inside then it seemed almost like a hotel or a museum. It had interesting design. Furniture’s, design of the window, and doors, and even the small cabinets for the patients were of antique decoration. There were some antique items and lovely rugs hanging on the walls. Latter on I found that founder of hospital was fun of antique designs. I was thinking; for a hospital is it good to such decoration. Maybe not. If I was sick I would love to be in peace, not looking around and wondering about those fancy things.

I need to break my proud

Some days ago one of my geriatric patients died. She had a hard family to deal with. Sometimes dealing with them was frustrating, and sometimes I was upset for what they were suffering. She was more than 70 years old, with hip fracture, chronic renal failure, chronic UTI, depression. She never received an appropriate treatment for her UTI, because her son, who was the closest to her, was thinking it would harm her. She was admitted several times to the hospital for confusion, decreased appetite and change in her bevahior, and investigations at every time showed she was septic. The first time she was in the hospital, I had almost one hour chat with the family to explain them why she needed antibiotics. And then everyday and every visit it became a trend to repeat my lecture about antibiotics, indications, contraindications and side effects. I was acting like a patient doctor, but latter on I was easily annoyed by simple questions. I could not satisfy the family with the way I was treating their mother, in terms of medicine. So they went back to dozens of doctors who were treating her before. She was taken to internists, cardiologist, urologist, and psychiatrist. But could not find the satisfaction for their own and for their mother, and so the family came back to me. To my surprise there was no appropriate medicine relevant to her illness, and letter on I found that the family were interfering with treatment plans. I realized that they were hard to deal with, so I referred her to my senior consultant, who referred her back to me with some advice. She was sick, and I was sicker for her. With some medicine I sent her home. Some days letter son called me that she was not improving, and if I could see her at home. I rejected home visit gave just some advice on phone. At this time I realized that I was a kind of ignoring her. I should have not rejected home visit, but then I was hearing a voice from my inside telling me that you can not help her, and your advice is not heard. The next day son came and almost begged me to visit her mother at home. I was thinking that the patient and family were desperately searching for help and hope, and they are knocking my door, how should I ignore it. So I promised with myself to be again a good, kind, and patient doctor. At home I found her to be quit septic, brought her to hospital and again started antibiotics. Urine culture revealed a very resistant microorganism and needed a very strong antibiotic, she slowly recovered but fear from side effect of the antibiotic and other medicine brought her son back to me to hear my old lectures again. We had a long chat, and I thought that I have given her enough reasons to continue the full course of medicine. Next day I got a phone call from him with repeated concern, and I again repeated my lecture on phone. Latter on in the middle of the day I got calls from his secretary and my brother that the family are concerned about the strong medicine she is receiving. Now I could not stop my anger and said that the son is absolutely mad, he needs treatment for his mental disorder. And so the second phase of ignorance started. I changed all of the medicine according to what he wanted though I knew that it was not appropriate, but I had no other choice. She deteriorated again at home, and I again become a good doctor and did several home visits. At this time I was just giving none medical advices and guiding her to different specialists. She was not improving and I did not know what exactly wrong with her. I could not ask for hospital admission because I was afraid that they will not follow my instructions in the hospital. I was feeling guilty when doing home visit and I could not anything for her. And one day son called me that her mother is not doing well and if I could come to see her. I excused and said that I was busy. He said he would send car and I denied, and finally he said he himself would come to pick me and I said that I could not help her mother at all. This mad him upset, and he complained to my brother that I was not kind to him. He was right, I was not kind to him at that time. And the next day I heard that his mother died. It made me deeply upset. I truly could not help her, but maybe I could help the family. Why I did not continue to be a kind doctor till death of his mother. She was kind to me till his death, but I was not kind to her at the end. I want to go to his son to apologize for my behavior but my proud is against me. I should break this proud.