A class of a different kind

Vijayaprasad Gopichandran 

“I don’t know if the class would work out well. I have planned to ask them to go and speak to caregivers of patients with chronic illnesses in the hospital and bring back stories. Not sure if it is too much to expect out of second year students”, I was speaking to my friend about the class that I had planned for this morning. I was uncertain about how it would go. The students of this batch of MBBS were very good. But were they patient and mature enough to have empathetic interviews with caregivers? Even if they did conduct these interviews were they capable of discerning the subtexts and inner meanings behind what is being said? There were numerous questions running in my mind. With a lot of self-doubt, I entered the classroom. 

 

“Please divide yourself into 8 batches and go to the respective wards that I listed. I want each group to identify one patient who has a chronic condition, which means any illness that disables the patient for more than a month. Identify their care giver and talk to them. Use this checklist that I have shared with you to interview them. Ensure that you conduct a kind, compassionate and empathetic interview. Try and understand them, their roles, responsibilities and bring back their stories to share in class”, I gave these instructions and sent them to the wards. 

 

This was part of the Attitude Ethics and Communication (AETCOM) module. The topic given to me to teach was “being a care giver of a patient with chronic illness” and the main objective was to provide an immersive experience for the students to understand the life of a care giver of a person with chronic illness. I had asked them to interview the caregivers and find out about their roles, responsibilities, what all they did as part of care giving, how care giving role has affected their own personal life, and what physical, mental, social, emotional, and financial burden the care giving has imposed on them. The students had about an hour to conduct the interviews and come back to the class for the debrief and discussion. I had asked the class representative to call me as soon as everyone had regrouped in class. Usually, they never call back. I must go and check on them at the stipulated time. They would still not be ready, and I would give them a call to re-group. It would go on like that for another 15-20 minutes before I could begin the debriefing. But today was not such a day. I had asked them to come back by 10 AM. By 9.50 AM, the class representative called me, “Sir, all of us have regrouped in the classroom.” I was surprised pleasantly, and I picked up my notebook and pen and walked to the class. Even as I neared the classroom, I could hear the noise of excited voices talking and discussing. I did not know what meaning to derive of the noise. Maybe, the whole session flopped, and they are all having fun talking something else. As I entered the class, the whole class suddenly went quiet. Don’t get me wrong, it was not out of some reverence or anything. That response almost never happens when I enter class. This time, something was different. It was like they were all eager to discuss the life of the caregivers they had met. I opened the discussion and asked them to narrate the stories of the care givers they had spoken to. 

 

“We spoke to the wife of a 46-year-old man who had undergone surgical amputation of his right foot as it was infected following a bad injury. They were in the ward for more than a month now. She has been living in the hospital with her husband the entire time. When we asked her how she is feeling emotionally and mentally, she broke down and started crying. But she kept repeating that she thinks it is a virtue to care for her husband.”, said a student in his narrative. 

 

“Does the class believe that sacrificing one’s comfort to take care of loved ones is a good virtue? Is it aspirational? Should we all aim to be like that?” I probed the class. 

 

I threw open this question. One young man in the classroom was the only one who nodded “no”. Everyone else had the look of admiration in their eyes for the lady who was giving care for her husband. 

 

One of the students said, “…. even though she was struggling so hard, she never complained even once about her hardships. Her own personal hardships were so small compared to the fact that her husband lost his leg. She is an ideal wife.” 

 

I asked her, “Do you see this lady as a role model?” To that question she thought for a bit and nodded yes. There was a brief 30 second silence following this. 

 

I asked for the next volunteer to share their experience of conducting the interview. A group of lady students got up and started narrating the story of a young woman who was giving care for her mother who is posted for a surgery for replacement of her fractured hip bone. But due to non-availability of the prosthesis, the surgery was being delayed inordinately. They had already been in the hospital for more than 15 days and there was no definite indication as to when they surgery would happen.  

 

“Sir, what was impressive was that the lady has two children of her own and has her own family to care for. She has left them alone for more than 15 days and is caring for her mother. She has not even spoken to her children for 15 days. Her only focus now is her mother.”, observed one of the students. 

 

“Since she had not gone to work for 15 days, there was a threat that she would lose her job. She was seriously worried about that. But not once did she express any regret about staying in the hospital, with so much inconvenience and so many problems.”, added another student. 

 

“Do you think she really does not have any discomfort in staying away from her family, not going to work, and having to sleep in odd places in the hospital without a proper bed?” I asked the group. 

 

“No sir, we don’t think she is comfortable. But she is not complaining about it. She has accepted it and is doing a great job” replied the students. 

 

“Why has she accepted it? Was there a choice?” I asked and the students went into deep thought. 

 

“Sometimes, there is social desirability in what people say to others. We only say things which are legitimate and ok to say. We don’t say things which make us sound selfish or bad.” I added. 

After this one of the students got up and said, “You are right sir, I felt that she was hiding something. There was something not alright about how cool and calm she was given the situation.” 

 

I then moved on to other volunteers. Now people stood up on their own and started narrating the stories of care givers they spoke to. There was a loving son of a mother who had undergone a surgery, who had given up his job just to be with his mother in the hospital and care for her. There was an 86-year-old man, who was the sole caregiver of a 80 year old lady who was admitted for kidney failure in the ward. Another story was that of a 19-year-old girl who was giving care for her mother who had undergone uterus removal surgery. The stories were flowing smoothly in an uninterrupted manner. Each story had sacrifice, self-effacement, love, kindness, solidarity, and compassion. Even as the students were narrating these emotional stories, I was going through a roller coaster of emotions. The whole class laughed heartily when one of the students narrated a story of how caregivers competed to care for a woman who had recently delivered twin babies. There was a sense of amazement and awe when one of the students narrated the story of the 86-year-old man who cared for his 80-year-old wife. There was a sense of relatability and anxiety when one of them narrated the feelings of a young 19-year-old who was caring for her mother and how she would bring her friend along to stay over in the hospital at night. It was a roller coaster of emotions. 

 

“Do you see the difference in the narrative of the caregiver of the amputee and that of the mother who delivered the twins? While the former evoked a deep sense of sadness, the latter was laced with laughter. Why do u think that is?” I asked the class. 

 

“It must be because of the outcomes sir. When the outcome is good, everything evokes laughter. When the outcome is bad, it is painful.”, said one of the keenly observant students. 

 

There was one last group who stood up towards the end. One of the students got up and started narrating, “We went to the pediatric ward and saw a 11-month-old baby and spoke to her mother. The baby had congenital abnormality in the bile passages in the liver. This had led to severe jaundice. It was planned to have a liver transplant for the child. The child and the mother were in the ICU for more than 4 months now.” 

 

Even as the student was narrating this, her friend sitting next to her, who had also gone to speak to the care giver got up and started continuing the narrative, “She looked like a super strong mother. She did not show any sadness, did not show any confusion, or worry. She had accepted the fact that the baby needed the surgery and was preparing for it. They had to collect some 2.5 lakh rupees over and above the other expenses which will be borne by the insurance. They were worried about it and were collecting that money.” 

 

Even as he was saying this, a third student from the back row just behind this student got up and started continuing the story, “I am 23 years old sir, and this mother is younger than me. I cannot even imagine going through something like this. I saw the list of medicines that the mother is giving to her 11-month-old child. I was shocked to see the long list of 10 items. It all felt very difficult for me to digest. I don’t know how that mother is handling all this.” 

As the student was narrating this there was absolute silence in the classroom. Students sitting in the front benches had completely turned in their seats to face the group in the back row which was narrating this story. Everybody’s attention was on the group who was narrating the story like a well-rehearsed orchestra. But I was quite certain that the whole narration was totally spontaneous. 

 

“Sir, the worst thing is when the mother told they were in the ICU for 4 months and were starting to feel lonely. She was seeing other children coming in, getting better, and going out in a few days. But her baby was constantly there with no certain date of discharge or even transplant surgery.”, said one of the students and her voice broke as she was saying this. This narrative was so poignant that I had tears in my eyes, my colleague also was moved to tears, and we could hear gasps in the classroom expressing the pain and agony of caregiving for a sick infant.

 

The class was so interesting and engaging that none of us noticed that we had already crossed 10 mins into the next class. It was time for me to summarize and close the session. I had no words to put everything together. 

 

“In today’s class you have had a unique opportunity to take a peep into the personal lives of care givers and to have a brief encounter of a different kind. You have demonstrated exemplary sensitivity, enthusiasm, humanity, compassion and empathy in the way you have engaged, understood and narrated the stories of the care givers. The take home message for all of us from this absolutely engaging session is that care giving is a very stressful and often emotionally burdensome process. Therefore, it is very important for us to be sensitive to the condition of the care givers. We should always respect the roles they play in making the lives of our patients better. We only prescribe medicines and treatments. It is the patients and their caregivers who implement it.” I summarized thus and left the class. 

 

It was one of the most rewarding experiences facilitating a session for young MBBS students in recent times. I had doubted myself for planning this activity for the students, unsure of whether the students would engage empathetically with the caregivers. But the students proved me wrong. They went over and above my expectations and doubts and engaged so well with the patients and the care givers. Their narratives were laced with emotions. Only high levels of empathy can elicit the emotions so accurately. Usually, it would be difficult to motivate the students to talk in class. I would have to ask questions repeatedly to elicit answers from them. But today it was like the entire class was possessed. People got up spontaneously and started speaking and narrating. In fact, in the last narrative of the mother of the child requiring liver transplant, the narrative was like a well-rehearsed stage play, all done spontaneously. As I think back about the magical moments of the class, I can sense that something phenomenal transpired inside those walls today. It was the dance of humanity, empathy, compassion, and kindness among innocent young students of medicine. I just hope we can keep stoking this spark of fire in them till it burns bright and radiates its warmth all around the world.