The Struggle Beyond Life-By Dr Hena Jawaid

[The following article is a narration of my patient followed by my assessment/ reflection on her life]

I was awoken by her pulsating shrieks. She was in the room adjacent to mine. I pulled the blanket off my head and looked around. She must have gotten agitated again with no preceding event of provocation.

I stayed in bed silently, deliberately and indeed shamelessly, kept on staring at the walls and ceiling. Her voice was growing louder with obscenities and abusive language now. I could feel the heat around my ears, heart pounding within my chest wall; I could feel the trembling of my fingers and the churning of my stomach.

I did not know if it was my sweat or my tears, but it was all admixed. I pursed my lips as an ambulance horn blared in the distance. Someone must have taken action. Suddenly, she stopped shouting. Many shoes tapped on the floor and climbed the stairs of our apartment. A door opened, and something fell down. She started yelling again and this time brutally; I immediately covered my ears, pressing down tight on my head with all my might.

This was the second episode of aggression in a month.

My mother was suffering from schizophrenia.

I was a year old when my father divorced my mother because of her mental illness. Since then my two sisters, mother and I had been living with my aunt – my mother’s sister, the woman who called the ambulance that would whisk my mother away to the hospital.
My older sister got married and left our house when I was 7. 

I had to go to school early in the morning, and my younger sister would not be ready to come out of the washroom. She used to wash her hands for 1-2 hours per visit due to her obsessions regarding contamination and dirt. She had been suffering from itchiness and fungal and bacterial infections secondary to her excessive hand dryness.
She was the most beautiful and intelligent girl in my class, and I wanted to be her best friend, but I did not know how to talk to her. I was aware of how awkward and unlovable I was. So I distracted myself and looked out of the window instead.
The result was to be announced in an hour.

I got 96% in class, but I was second and not first. I took my prize and came back to my chair. My heart was beating faster than last night; my fingers were trembling, and I was sweating profusely. My body was aching due to pain and dejection as if someone had slapped me in front of everyone. She had done better than me; she had obtained 97%.
I stood up and rushed to the washroom. It was hard to hold back tears anymore. I was ashamed of myself, my life, my failures, and my unquenchable thirst for excellent grades. Success was a dream, and it seemed like it was bound to remain just a dream. I was a loser. Utter loser!   

“I can't go on like this.”

I put my head down on the table and started crying. The doctor pushed a tissue box towards me and offered a glass of water.
I drank it and then answered her questions.

It was my first consultation with a psychiatrist in her office. It was one hour long. A vent out journey, one could call it.
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After she had left my office, I started writing about her current medications, signs, and symptoms.

A 24-year-old female student of fine arts, with a family history of parental discord and separation, schizophrenia, obsessive compulsive disorder and depression; she currently suffers from bipolar affective disorder current episode depression and with borderline personality disorder.

After writing her medications and recommendations; I closed her chart and picked up a newspaper from the table.

Her first story had been published today, and she was excited to show it to me. I read it. It was astonishingly well articulated and a comprehensive story regarding manners, discipline, and school conduct.

I have been following her for the last three years and in these three years; she has been persistent in her desire to attain excellence in writing and painting.

Today, occupational therapists celebrated her success. Her first painting was sold yesterday for a good sum.

Learning does not always occur on one side of the desk. Sometimes people learn, grow and evolve through thick and thin, regardless of whether they are the patient or the clinician, whether they are the counselled or the counsellor. She was indeed a special one in my life who taught me resilience, courage, struggle and optimism. She has paved her way through the most turbulent of times and has taught me how to see life from within and not without.

Sometimes theoretical perspectives do not help as much as the lessons from the practical ground. It is incredible for me to learn from her and find resilience in a life amid of hassle and chaos.

​ACKNOWLEDGMENT
I appreciate and acknowledge the help of Dr. Asad Mian* in guiding and teaching me the art of narrative medicine.
*Dr. Asad Mian is an Associate Professor in the Department of Emergency Medicine, Aga Khan University Hospital, Pakistan.