BELIEF VERSUS KNOWLEDGE

There are three parts to my job: treating patients, teaching medical students and doing research. Each of the three components is important to me, but the one I take with the most seriousness is teaching. It is the part that stresses me the most, because it’s the part that I believe requires the most thought and
the most preparation. Not only does it require me to pass across the core message of the subject, it also requires passing on skills, attitude and character, for my field is a character forming one; you cannot but marvel and be humbled when you encounter the human mind in health and disease.

Teaching is also an opportunity to pass across lifelong career lessons to those coming behind one. A few years ago, one of my students had a mental illness characterized by disorganized speech and disorganized behaviour. She first presented at the staff clinic, from where she was referred to us.

Expectedly, her parents were very worried, and it was my job to allay their fears and give as much information as possible in the process. At first they appeared pacified. But their daughter remained disturbed for the next few days, which was not unexpected. It would take a few days for her to settle down. But to the parents, it must have seemed like eternity.

It was therefore a bit of a surprise when the student’s father approached me after she had been on admission for a couple of days that he wanted his daughter discharged against medical advice. He had been told, he said, that the condition was a spiritual one, judging by the nature of the symptoms. She had consulted an Islamic cleric and they were taking her there for healing. He did not think the hospital would help her as such.

He wasn’t illiterate at all. In fact, he was in the most senior echelon of the civil service. Ordinarily, we would sit down and I would give a lengthy explanation of his rights and responsibilities, as well as the implications of his decision and his right to make the decision if he chose to, and then get him to sign a document that he understood it all, and they would be on their merry way. But I was also a teacher, and I saw a teachable moment there. I saw one action that I knew was going to destroy a career before it even got started. So I decided to do more than was required of me.

I told him that it was his right to take his daughter to an Islamic cleric. It was not compulsory for me to be the one to care for her. In fact, it wasn’t going to affect my salary at the end of the month if I didn’t treat her. As a matter of fact, another client would be in soon to take her bed as soon as she was discharged.

However, it would do her career a lot of good if she could be treated on a proper mental health ward. She would become a doctor soon. For the rest of her life, she would be telling others to come and receive orthodox medical care from her, but she would be a fraud all her life, because at the time when she needed to use the service herself, she did not. Because her parent had decided for her that her job was bullshit.

I told her father that she had learnt the theory of her job, now she needed to experience the efficacy of the tools of her profession. She had had an intellectual engagement with knowledge, now she needed an emotional one. She needed to partake of what she would be selling to others for the rest of her life, and it was important that she not be sentenced to a lifetime of hypocrisy and illogicality by her father. What moral justification would she have to offer to others what did not make sense to her, and which she did not trust to get her well? That career would be totally destroyed before it even got started. Her life and her career would be a contradiction.

The gentleman listened and agreed with me. His daughter eventually got well in our care, came back later for her rotation in psychiatry and at the end of the rotation, she wrote an extended essay on her illness and I checked the section on management. It was exactly as she was cared for while she was on the ward. How else would it be? That was what she learnt in theory and that was what she got in reality that got her well. Why would she not remember it and offer it to her own patients?

She is a doctor now and I believe she is doing well wherever she is. I am a happy teacher today, because I did not miss a teachable moment that if left unutilised would have probably ruined a career that had not even started. That’s one doctor who will most likely not be peddling demonic possession on Facebook as the cause of the illnesses she treats, anytime soon.