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ഹൃദയത്തില്‍ നിന്നുള്ള കഥകള്‍: ഡോ. എം.പി. രവീന്ദ്രനാഥന്‍

Published on 28 August, 2013
ഹൃദയത്തില്‍ നിന്നുള്ള കഥകള്‍: ഡോ. എം.പി. രവീന്ദ്രനാഥന്‍
ഹൃദയത്തില്‍ നിന്നുള്ള കഥകള്‍, പ്രസിദ്ധ ഹൃദ്രോഗ വിദഗ്ധനായ ഡോ. എം.പി. രവീന്ദ്രനാഥന്‍ എഴുതുമ്പോള്‍ ഹൃദയത്തെപ്പറ്റിയുള്ള കഥകളായും മാറുന്നു.

ഇന്ത്യയിലും ബ്രിട്ടനിലും അമേരിക്കയിലുമായി മനുഷ്യ ഹൃദയങ്ങളുടെ നാഥനായി ആശ്വാസവും സൗഖ്യവും നല്‍കിയ അദ്ദേഹത്തിന്റെ ആഴത്തിലുള്ള ചിന്തകളും ജീവിത ദര്‍ശനങ്ങളുമാണ് 'സ്റ്റോറീസ്{ഫം മൈ ഹാര്‍ട്ട്: എ കാര്‍ഡിയോളജിസ്റ്റ്‌സ് റിഫ്‌ളക്ഷന്‍സ് ഓണ്‍ ദി ഗിഫ്റ്റ് ഓഫ് ലൈഫ്' എന്ന ജീവിത ഗന്ധിയായ ഗ്രന്ഥം വിവരിക്കുന്നത്. (
Stories from My Heart: A Cardiologist's Reflections on the Gift of Life: M. P. Ravindra Nathan, MD)
 
ആകെ 46 സംഭവങ്ങളിലൂടെയാണു് അദ്ദേഹം ഭിഷഗ്വരനെന്ന നിലയിലുള്ള ജീവിതാനുഭവങ്ങള്‍ കുറിച്ചിട്ടിരിക്കുന്നത്. ഓരോ കഥയിലും മൃത്യഭീതിയില്‍ നിരാശയോടെ എത്തുന്നവരെ പ്രത്യാശയുടെ പടവുകളിലേക്ക് കൈപിടിച്ച് കയറ്റുന്നതാണ് കഥാതന്തു. ഭിഷഗ്വരന്‍ ദൈവമോ, ശാസ്ത്രം സര്‍വ്വശക്തനോ അല്ല. എന്നാല്‍ രോഗിയുടെ മനസറിഞ്ഞ് പ്രത്യാശയുടെ കിരണങ്ങള്‍കൂടി ചികിത്സയ്‌ക്കൊപ്പം കൈമാറുമ്പോള്‍ വലിയ മാറ്റങ്ങള്‍ക്ക് കളമൊരുങ്ങുന്നു.

താഴെ വിവരിച്ചിരിക്കുന്ന ടെഡ്ഡിന്റെ കഥ എടുക്കുക. ആറുമാസം കൂടിയേ ജീവിതമുള്ളൂ എന്ന് ഒരു ഡോക്ടര്‍ മുഖത്തുനോക്കി പറഞ്ഞതാണ്. അതോടെ അയാള്‍ വിധിക്കു കീഴടങ്ങാന്‍ തയാറെടുത്തു. നിരാശയുടെ ആഴങ്ങളിലേക്കുള്ള വീഴ്ച.

ആറുമാസം കൊണ്ട് മരിക്കുമെന്നു പറയാന്‍ ആര്‍ക്കും കഴിയില്ലെന്നും ഓരോ മനുഷ്യനും വ്യത്യസ്തനാണെന്നും പറഞ്ഞു കൊടുത്തപ്പോള്‍ അയാളുടെ കണ്ണില്‍ തിളക്കം. മനസിന്റെ ശക്തിയും ചിട്ടയായ ജീവതവുമൊക്കെ \ിര്‍ദേശിച്ചപ്പോള്‍ രോഗിയുടെ സ്ഥാനത്ത് ഒരു പോരാളിയെ ആണ് കണ്ടത്. ആറുമാസം ആയുസ് വിധിച്ച ആ എഴുപതുകാരന്‍ 5 വര്‍ഷം കൂടി ജീവിച്ചു.

ഓര്‍മ്മകളില്‍ ഇങ്ങനെ മായാത്ത ഒരുപാട് ചിത്രങ്ങള്‍. താങ്ക് യു കാര്‍ഡുകളും. ജീവിത നേട്ടങ്ങളുടെ പട്ടികയില്‍ ഇതില്‍പ്പരമെന്താണ് വേണ്ടത്?

ഫ്‌ളോറിഡയില്‍ പ്രാക്ടീസ് ചെയ്യുന്ന ഡോ. രവീന്ദ്രനാഥനും പത്‌നി ഡോ. സുശീലയും അറിയപ്പെടുന്ന എഴുത്തുകാര്‍ കൂടിയാണ്. പുത്രന്‍ ഡോ. സന്ദീപ് നാഥന്‍ പ്രശസ്തനായ ഭിഷഗ്വരനും.

Prescribing Hope

Empathy and open communication should be in your doctor's bag when treating seriously ill patients

How would you react if your doctor tells you that you have 6 months to live? An impending death. Shock, depression, extreme anxiety, fear, despondency, and, finally, an, "Oh what the heck, I have to die one day" attitude may ensue

       Ted Nolin (all names have been changed) felt this way when he was told that his days were numbered. At age 70, heart failure was diagnosed. Ted had suffered from hypertension and diabetes, but when he was admitted a third time in severe pulmonary edema, gasping for breath, he thought that his worst fears were coming true. And his cardiologist, Dr. Hamby, wasn't very encouraging.

       "Your husband has severe recurrent heart failure and probably has about 6 months to live," he told Mrs. Nolin. She was in tears. When the news was communicated to Ted, he was sad but stoic.

       "It's God's will, I suppose," he said.

       When Ted was admitted to the hospital for the fourth time, I happened to be on call for cardiology. The primary care physician called me and said, "Dr. Nathan, can you take care of this patient? He has dilated cardiomyopathy and recurrent heart failure, and Dr. Hamby thinks it is end stage and that he probably has only 6 more months. The patient and family know this. And Dr. Hamby is not coming to this hospital that often."

       I knew Dr. Hamby still came to the hospital to take care of his private patients there. Thus, it appeared as if he had given up on Ted. Initially, I felt uncomfortable accepting the care of a dying patient just because his own cardiologist had given up on him.

       "What do you want me to do? If his condition is end stage and everything has been done already, what more can I do, except give comfort measures?" I politely asked the primary care physician. Finally, I accepted the patient and got ready to give some palliative care.

A CHANGE OF HEART

        It is always my policy when I take over a patient's care from another physician to take a fresh history and review all aspects of the care to get a true insight into his or her illness and see whether I can do anything more for the patient or find something that had been overlooked. I want to learn the facts first-hand. All of us have busy schedules, and sometimes we just don't have enough time to sit down with the family and go over every aspect of the disease management, despite our best efforts.

           In reviewing the history, clinical data, and all the tests, it was apparent that the patient was indeed in end-stage heart failure. His work-up had revealed that he had developed severe nonischemic dilated cardiomyopathy with an ejection fraction barely over 10% (normal over 55%), no doubt contributed in part by his diabetes, moderate hypertension, and some alcohol usage. He had been prescribed the standard drugs such as digoxin, diuretics, and vasodilators; however, the use of those drugs wasn't enough to prevent these recurrent admissions. Cardiac transplantation was considered, but Ted was too old for such exotic therapy.

          Now that his care had been transferred to me, I decided to do the best I could to alleviate his suffering. When I saw him first in the emergency room, he was almost frozen with terror and had difficulty breathing, coupled with a sense of impending doom. I quickly got him out of his pulmonary edema. Once his condition was stable, I sat down with him and his wife to offer some counseling.

           First, I discussed his diet, explaining how he could live without much salt, and I enforced some fluid restriction. "Only about 6 glasses of fluid total," I warned him.

           "And one more thing," I added. "You can't simply sit at home and watch TV, waiting for death to come and grab you. Nobody in the world can make any predictions. But maybe we can beat death at its own game. What do you say?"

           He must have thought that however provocative the idea may be, it was still a mostly hypothetical concept.

           "How long one lives or when one is likely to die is a guessing game, and every individual is different. We must give it all we have before accepting defeat," I tried to encourage him.

           Suddenly, his ears perked up. He became more attentive; there was a twinkle in his eyes now that I had never noticed before.

          "You mean I have a chance?" he asked.

          "Of course. Nothing is written in stone here. Together, we can stretch this heart to work a few more months or even years. Count your blessings, Ted. At least you don't have a rapidly spreading cancer."

          The look on his face told me that he had changed from a timid man to an intrepid soldier ready to fight for his life.

          "That's the spirit! Let's give it our best shot," I reassured him, knowing well that this journey would be difficult.

A NEW APPROACH

          During the next several office visits, I started him on a gentle exercise program suitable for heart failure patients, and he even went to the hospital cardiac rehab program tailored to his needs. A home healthcare agency set up oxygen and administered occasional intravenous furosemide as needed. Although he was only mildly overweight, he managed to lose a few pounds.

          Next, I went to work on his drug therapy. He was prescribed some of the newer medications such as carvedilol, which had only just come to the market at that time, a diuretic, potassium supplements, amiodarone for his ventricular arrhythmias, ace inhibitors, and later a dual-chamber pacemaker when he nearly coded one day with a slow heart rate. Finally, he started walking short distances without dyspnea. As he continued to improve, hospitalizations became less frequent, and his quality of life got better.

          When he passed the much-anticipated first-year mark, both Ted and his family were exhilarated and brought me a nice card.

          "So, it looks like I am going to make it, eh?" he asked my office staff with a smile.

NOT JUST SCIENCE

           It is often quoted in United States that heart failure is the single most frequent cause of hospitalization in older people and that the death rate from heart failure exceeds all forms of cancers combined. When not treated and monitored very carefully, heart failure progresses inexorably, shortening the ultimate life expectancy. Therefore, it is important to teach patients (and their relatives) how to take good care of themselves, follow a strict regimen of treatment, and modify lifestyles. The new treatments certainly have helped halt the progression of the disease and in some cases even reverse it.

As scientists, physicians generally put much emphasis on the technologic data of a patient while trying to gauge the prognosis. But medicine is also an art, and many other factors must be considered. The attending's words and body language are important when communicating with seriously ill patients. Along with the body, the mind also has boundless potential, and when used properly, can aid in the healing process. We must find time to dispense compassion, sympathy, and understanding when treating seriously ill patients. Instead of saying, "You have only 6 months to live," a better statement would be, "You have a serious illness, but we will do everything possible to control your illness and make you feel better." None of us can predict the future.

Ted Nolin lived for 5 more years and, finally, when I turned him over to hospice, his wife sent me a sweet note: "Thanks for giving Ted the hope he badly needed and then making all this happen. God bless."

Ted's case reconfirmed the general dictum: "Always give hope to your patients, and never let anybody take it away from them." As physicians, we must realize how much hope we can bring to our patients by providing empathy, communicating openly, and acting in their best interests.

Publish date: Dec 17, 2010 By:  M. P. Ravindra Nathan, MD

Stories from My Heart: A Cardiologist's Reflections on the Gift of Life

Authored by Dr M. P. Ravindra Nathan 
Edition: First
Stories from My Heart is a collection of stories and essays that come right out of the author's heart. Dr Nathan has had a remarkable journey in medicine under different conditions in many parts of the world. These are real life experiences that capture the fascinating details, challenges, drama and at times humor as well, while working through three different countries in three different continents in the world - India, England and USA. 
There are altogether forty six stories in this book. Through these well crafted stories he captures the drama, challenges, tragedies and triumphs with great compassion, sensitivity and humor where it can be found. Dr Nathan is an amazing story teller who writes with fervor and inimitable fascination for the human spirit and he is endowed with a natural gift for interweaving cutting edge medical technology with lucid and concise literary finesse.
The book also gives the reader a peek into the medicine of the 21st century America as well as a preview of the art of medicine which is as old as human history itself. All these are compelling stories touching on various aspects of human lives. As Hippocrates said, "Wherever the art of medicine is loved, there is also love of humanity.

Publication Date:  Aug 09 2013

ISBN/EAN13:  1484053583 / 9781484053584

LCCN: 2013906892

Page Count: 280

List Price: $19.95 

Available through https://www.createspace.com/4230283 or www.amazon.com


ഹൃദയത്തില്‍ നിന്നുള്ള കഥകള്‍: ഡോ. എം.പി. രവീന്ദ്രനാഥന്‍ഹൃദയത്തില്‍ നിന്നുള്ള കഥകള്‍: ഡോ. എം.പി. രവീന്ദ്രനാഥന്‍
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