Me and the Advisor to the President Karzai

Today I had one of advisors to president Karzai in my office. He was suffering from stress and some degrees of depression. It was an interesting consultation; between one of high officials who flying in skies and never looked down and a doctor who thinks all people, poor or rich, high class or low class should be respected equally.

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Me and the Advisor to the President Karzai

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Today I was sitting in my office checking my email, that nurse entered my room and said: "Sir! one of advisors to president Karzai is sick. Are you willing to see him?"
I said: "yes send him with a file". So a chubby advisor entered my room, very proud like walking in the sky. The way he entered my office made me a little bet uncomfortable. After introduction by the nurse and saying hello i said "Ok Sir! what is the problem". He proudly said "which of the problems. Which one should i say?" and than he started interviewing me "When did you finish your medical school? Where did you go to medical school?" and then changed from the national language to English and continued asking. It made me more frustrated and said "Lets talk in our own national language" and he said: "But you should know english, you need to use in your proffession" I said: "I know English and I use it in my profession. I talk in English when i am talking to a colleague. But with my patients i prefer to talk in my national language." He started to talk in hard Pashtu and said "here i am talking in national language. Where are you from?" I stopped him and said " Sir! lets talk about your own problem. I am sorry to say, but when some of high officials from government come here they are dealing a bet diffirent with doctors, and want to put a bet pressure on them." He suddenly came down from the sky, change and said "no, no, no i was just asking question, i didn't mean anything else"

Me and the Criminal Abortion

I was asked by a colleague to see a young single lady with complaints common in sexually active ladies. After a short history, and explanations from the colleague I decided to do an ultrasound. On ultrasound we found she was 2 months pregnant. Now it was hard for me to believe if she was not sexually active, I again asked her if she was married and she said “NO”, “-Engaged then?” “Yes”. So I had my answer. After a through evaluation of pregnancy by ultrasound I explained that she was pregnant. It was shocking news for her. She was pregnant before marriage. I saw she was almost shaking from the news she heard, started crying. She started to talk about her family, that she was from a well known family in the country, and she was the eldest and the most respected member of her family. She said she was almost somehow like a leader for others in whole family. She was a kind of abused by her fiancé, who she loved him the most. They had gone in appropriately closer to each other in a period of time which was religiously prohibited. She was thinking pregnancy was a kind of punishment from GOD. Now she was in the worst time of her whole life. If people know she is pregnant while she is still not married, the whole family will lose their respected in the community. She would have the worse trouble from her family. She will be lost from the eyes of those who were respecting her and believing in her. Her fiancé had just started a long trip outside the country, and it was impossible to be married before a year. She started begging for help. But what could I do? Maybe Abortion? Yes; she thought that was the only help I could offer to her. I rejected doing a criminal abortion; but still offered her my support in terms of counseling. We had a long chat to find a right way to deal with the situation, and at the end she came to conclusion to get rid of the pregnancy. She even said that their will be one of the two people killed; either she herself or the fetus, and asked me which one I would prefer to be killed. And I said that there will be one of the two people murderer; either me or she. And I would prefer no to be the murderer. I asked her to go and think more, talk with fiancé, share the situation with him and ask his help. She went and came back the next day again asking for termination of the pregnancy, and I again repeated my previous day’s lecture. This coming and going happened several times. And every time I rejected her request. The last time she called me on phone; and I in a short sentence but in a firm voice said “I am sorry I CAN NOT help you”. And she said “Ok Doctor! Thanks for all your help. You have been kind to me, and I appreciate your advices. I will not call you anymore and will not waste your time in office again”. I felt she was almost hopeless and afraid she would harm herself. Days passed maybe 3-4 weeks and one day I got a phone call from a lady. “Hello Doctor”. Yes it was she, with a stronger voice now. She had terminated her pregnancy, and now had psychiatric problem. What happened next I will continue it in the next day.

A Hospital with Antique Decoration

Today I went to see Afshar Hospital. It is located faraway from the centre of the city. It looked to be in another part of the world. They have tight security. You have to register your name on the gate, seen by strict guards, given a visitor card, and than enter. It takes a little bet time. For a visitor it is ok, but for an emergency case it is too much. As I entered the hospital, it looked almost a military base, with lots of security people inside. And as I went further inside then it seemed almost like a hotel or a museum. It had interesting design. Furniture’s, design of the window, and doors, and even the small cabinets for the patients were of antique decoration. There were some antique items and lovely rugs hanging on the walls. Latter on I found that founder of hospital was fun of antique designs. I was thinking; for a hospital is it good to such decoration. Maybe not. If I was sick I would love to be in peace, not looking around and wondering about those fancy things.

A Hospital with Antique Decoration

Today I went to see Afshar Hospital. It is located faraway from the centre of the city. It looked to be in another part of the world. They have tight security. You have to register your name on the gate, seen by strict guards, given a visitor card, and than enter. It takes a little bet time. For a visitor it is ok, but for an emergency case it is too much. As I entered the hospital, it looked almost a military base, with lots of security people inside. And as I went further inside then it seemed almost like a hotel or a museum. It had interesting design. Furniture’s, design of the window, and doors, and even the small cabinets for the patients were of antique decoration. There were some antique items and lovely rugs hanging on the walls. Latter on I found that founder of hospital was fun of antique designs. I was thinking; for a hospital is it good to such decoration. Maybe not. If I was sick I would love to be in peace, not looking around and wondering about those fancy things.

I need to break my proud

Some days ago one of my geriatric patients died. She had a hard family to deal with. Sometimes dealing with them was frustrating, and sometimes I was upset for what they were suffering. She was more than 70 years old, with hip fracture, chronic renal failure, chronic UTI, depression. She never received an appropriate treatment for her UTI, because her son, who was the closest to her, was thinking it would harm her. She was admitted several times to the hospital for confusion, decreased appetite and change in her bevahior, and investigations at every time showed she was septic. The first time she was in the hospital, I had almost one hour chat with the family to explain them why she needed antibiotics. And then everyday and every visit it became a trend to repeat my lecture about antibiotics, indications, contraindications and side effects. I was acting like a patient doctor, but latter on I was easily annoyed by simple questions. I could not satisfy the family with the way I was treating their mother, in terms of medicine. So they went back to dozens of doctors who were treating her before. She was taken to internists, cardiologist, urologist, and psychiatrist. But could not find the satisfaction for their own and for their mother, and so the family came back to me. To my surprise there was no appropriate medicine relevant to her illness, and letter on I found that the family were interfering with treatment plans. I realized that they were hard to deal with, so I referred her to my senior consultant, who referred her back to me with some advice. She was sick, and I was sicker for her. With some medicine I sent her home. Some days letter son called me that she was not improving, and if I could see her at home. I rejected home visit gave just some advice on phone. At this time I realized that I was a kind of ignoring her. I should have not rejected home visit, but then I was hearing a voice from my inside telling me that you can not help her, and your advice is not heard. The next day son came and almost begged me to visit her mother at home. I was thinking that the patient and family were desperately searching for help and hope, and they are knocking my door, how should I ignore it. So I promised with myself to be again a good, kind, and patient doctor. At home I found her to be quit septic, brought her to hospital and again started antibiotics. Urine culture revealed a very resistant microorganism and needed a very strong antibiotic, she slowly recovered but fear from side effect of the antibiotic and other medicine brought her son back to me to hear my old lectures again. We had a long chat, and I thought that I have given her enough reasons to continue the full course of medicine. Next day I got a phone call from him with repeated concern, and I again repeated my lecture on phone. Latter on in the middle of the day I got calls from his secretary and my brother that the family are concerned about the strong medicine she is receiving. Now I could not stop my anger and said that the son is absolutely mad, he needs treatment for his mental disorder. And so the second phase of ignorance started. I changed all of the medicine according to what he wanted though I knew that it was not appropriate, but I had no other choice. She deteriorated again at home, and I again become a good doctor and did several home visits. At this time I was just giving none medical advices and guiding her to different specialists. She was not improving and I did not know what exactly wrong with her. I could not ask for hospital admission because I was afraid that they will not follow my instructions in the hospital. I was feeling guilty when doing home visit and I could not anything for her. And one day son called me that her mother is not doing well and if I could come to see her. I excused and said that I was busy. He said he would send car and I denied, and finally he said he himself would come to pick me and I said that I could not help her mother at all. This mad him upset, and he complained to my brother that I was not kind to him. He was right, I was not kind to him at that time. And the next day I heard that his mother died. It made me deeply upset. I truly could not help her, but maybe I could help the family. Why I did not continue to be a kind doctor till death of his mother. She was kind to me till his death, but I was not kind to her at the end. I want to go to his son to apologize for my behavior but my proud is against me. I should break this proud.