Humanism in Rehabilitation: A Heartwarming Triumph

Sir,

Hippocrates wrote in the fifth century BC: “Where there is love of humanity, there is also love for the art of medicine.”

It was a hot sunny morning in the month of May 2007. I was going to appear for my final university exam of post graduation in a few weeks. That is the time when every post graduate realizes that ‘time is precious’. I was working in the department when the attendant came and told me that the HOD Sir, who was also my guide, had called me. When I entered his cabin, I saw a patient with his teenage son. As my college was within the premises of the Government Medical College of Aurangabad, the patients who underwent any intraoral surgery were referred for rehabilitation to the Prosthodontics Department. After seeing the person with Ryle’s tube and his adversely deteriorated health, anyone could have figured out that he must have recently undergone a major surgery. “He has undergone maxillectomy seven days back,” my guide said, “Make an acrylic feeding plate for the patient. The doctors are removing his Ryle’s tube today.”

At such a critical time of my post graduation, this was the last thing that I was expecting. I was not at all contented. After treating so many patients; simple and complex for past three years, such a simple case could have been given to any of my juniors. With all the agony, I came back to the post graduate working section along with the patient and his son. I made the patient sit on the dental chair. Due to the surgical defect, the patient was not able to speak. Hence, after going through his case paper, I turned towards his son, and I noticed the intensity and seriousness on his face. With lot of grief, he said, “My father was operated seven days back, and since then he is not able to talk and have food.” “Will he be able to have food again?” he asked. Keeping aside all the tension of my life, I replied positively, “Yes, sure.” Without wasting any of my time, I made preliminary impression of the intraoral defect, and asked the patient’s son to bring his father again the next morning.

As the priority of the patient was to have food, I focused on the proper adaptation of the feeding plate. Next morning when I was doing final polishing of the feeding plate, the patient arrived with his son. The surgeon had removed his Ryle’s tube. I made the patient sit on the dental chair and placed the sterile feeding plate in his mouth. It seated accurately.

And as I ask all my patients, I asked him too, “Babaji, is it ok?” I looked at him for an affirmative reply. The patient closed his eyes and joined his hands, and uttered “Ram.” As I heard the word, I shivered from toe to head. The word hit me like a bullet. There was a person in front of me who along with his family had undergone so much of psychological, social and financial distress; he was not able to speak and eat from the last seven to eight days. On the other hand, here I was who inspite of being in a noble profession, was treating the patient like ‘just another case’. Though it was just a case of simple feeding plate for me, it meant entirety for the patient. It was truly a mystical moment of insight. I realized that because of my preoccupations, I had forgotten that I am seeing a person and instead was treating just a condition. I got back to my senses from the very moment of introspection and maturation, and heard the patient’s voice, “Yes. It is ok”, he answered by opening his eyes. I turned to his son, and this time I noticed a glimpse of relaxation on his face.

I taught the patient and his son about the removal and replacement of the feeding plate in the mouth. I gave them all the instructions regarding wear, care and maintenance of the prosthesis. As the feeding plate was a temporary option, I asked the patient to come back after 15 days so that a temporary obturator could be made. The patient and his son agreed to this. As they left the room, a thought came to me mind that hopefully I was able to make a difference to their lives during this difficult time of theirs. I know that they had certainly made a difference in my life in such a way that they will never be aware of. All too often in rehabilitation, humanism and compassion is placed on the back burner. Cancer care needs to be holistic and patient-centric, addressing every aspect of the patient’s problems.

Advances in the management of oral malignancy have resulted in significant improvements in survival rate [1]. This has led to a large number of patients with extensive post surgical defects and disfigurements [2]. Speech, swallowing, control of saliva and mastication are all adversely affected. Prosthetic rehabilitation restores functional and psychological setback; thereby improving the quality of patient’s life [3]. Certainly normal function may not be achieved by an artificial prosthesis, but optimal function is always achieved so that the patients can lead a near to normal life.

This case taught me that when the cure is worse than the disease, I should be compassionate and empathetic, especially to those who have undergo irreversible surgical procedures and are in need of extensive rehabilitation. Being able to connect emotionally with patients, makes them feel supported and understood during what are often very stressful times in their lives. This is one of the few lessons of life, not learnt in the confines of a classroom [4]. Technology, whether a robot or a DNA sequencer, can provide a lot of information and make our jobs easier; however, there is no substitute for a caring relationship between a clinician and a patient.

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