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ss nucleus - summer 2005,  Living with disability

Living with disability

This article is an account of some of my reflections following a road traffic accident in 2002 after my second year at University College London, which left my right arm paralysed. The accident damaged my brachial plexus and following this I was in hospital for about three months. As you can imagine, the loss of function in my right arm has had a considerable impact on my training in medical school.

Time out

I found the process of going through my emotions hard: understanding them, expressing them and resolving all my feelings. If I'm honest, I am still getting to the bottom of how I feel. What helped me most was doing some voluntary work in Swaziland in Southern Africa eight months after the accident. As always with these experiences, I'm convinced I learnt more than I contributed! Seeing the poverty that the Swazis endured and their acceptance of suffering left an indelible impression on me. In contrast, we in the West presume perfect health is a birthright, often without comprehension of the difficulties people encounter in our own society, let alone those in other countries. Living alongside the rural people of Swaziland and witnessing how they dealt with the AIDS epidemic that was systematically destroying many families made me realise that dwelling on my own suffering and disability was hindering me and my faith.

The apostle Paul writes in Romans 5:15 about the benefits of suffering, and how we can rejoice in the hope of the glory of God. Because of the recent struggles I had gone through I was able to identify hugely with the people I met who were going through struggles of their own. I was able to begin thanking God for helping me to understand the suffering he had given me through the past year.

After Swaziland, I switched medical schools to Cardiff to begin the third year, but there weren't nearly as many difficulties as I had anticipated. Clinical examinations were the first obstacle, but there are plenty of alternative techniques that can be used. An example of this is in the respiratory examination: instead of percussion, a combination of tactile vocal fremitus, vocal resonance and whispering pectoriloquy provide an adequate substitute. I still can't do some things, such as kidney palpation, but thanks to modern medicine, investigations may help to provide a clear clinical picture based on a thorough patient history alone. Career-wise, surgery and various other dextrous specialties are no longer possible future options; I am fortunate to have interests in other areas of medicine.

A new angle on illness

This experience has given me the incalculable advantage of seeing medicine from a new perspective: the patient's. I cannot overstate the impression this has had on my attitude towards practising medicine. My first realisation was the astounding sense of anxiety and insecurity one feels when placed in a hospital bed. We as medical students become overly familiar with hospitals, so that we actually have no comprehension of how alien an environment it is. Irrational thoughts pop into your head, like, 'Do the doctors actually care what happens to me?' and, 'I mustn't irritate the doctors in case they stop trying to make me better.' I think this is a surprisingly common way of thinking in patients that we can overlook.

Another revelation I had was the amount of appreciation I felt for a doctor or nurse who shared a little of themselves with me. Often this was a very small, casual interaction, for instance the doctor reminiscing about when they were at my stage of their medical career, or talking about how they could empathise with me, having coped with a broken arm many years ago. This tended to restore my confidence and undermine my paranoia about my needs just being an irritation to the doctors.

I also began to empathise with patients' needs, their yearning to feel physically 'whole' or 'well' again. Although my accident was no-one's fault, I felt I had received an unfair dealing of the cards. It annoyed me that something was wrong with my body, yet no-one was to blame. This inner conflict manifested itself with my belief that the keys to resolving these thoughts were the doctors, by treating my physical condition. As a result of this I have found that I have not been able to view doctors merely as professionals doing a job, where I can just be grateful for whatever they can achieve; instead, I have expected the doctors' very best efforts, almost as if they were responsible for resolving my internal grumbling. I wanted the doctors to understand what I was going through, so they really would do everything they possibly could for my injury.

Thus, I've finally understood the meaning of emotional transference: how some patients use their doctors as a source of emotional stability in the face of unjust suffering, because they recognise that 'only their doctors can help' to correct that injustice. From a holistic perspective, it's essential that we should be aware of this, so that as future doctors, we're able to meet patients' needs effectively.

The genuinely important call

However different I may be physically, it's comforting to know that even while disabled, I'm as capable of continuing my relationship with God as my able-bodied companions. Jesus gave us two commandments in Mark 12:29-31: to love God and to love our neighbour. Even with just a little thought, it's obvious that a Christian's relationship with God is not impeded by disability; in fact, it may serve as an advantage. In our culture, we spend a large amount of time thinking about what we look like, and how our bodies look. On reflection, I can see now that my appearance (particularly to the opposite sex!) bothered me too greatly. Physical impairment has helped to shed an excessive concern about image.

God has been at work in what I have gone through, and I can honestly (and not piously I hope) say that I am very thankful to him for faithfully being with me through all of it. I don't know whether God meant for it to happen, but he certainly allowed it to happen, and for that I am grateful. The things I have learnt about how I should be in my relationship with God and also about myself I consider indispensable. Despite feeling hampered at times, this experience has alerted me to a patient's mindset such that I hope to have the sensitivity and understanding required to be a competent doctor. In a way, corny though it might sound, I have been disabled as a medical student, but will hopefully find myself enabled as a doctor!

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