A DIFFERENT DRUM
Dr. Malaya Santos
Dr. Malaya Pimentel-Santos is a long-time community health advocate, having worked with several nongovernment health organizations. She is a fellow of the Philippine Dermatological Society and a professor of microbiology at the St. Luke’s College of Medicine.
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In a conventional clinical setting, the respective roles of the doctor and the patient are well-defined. When these roles are reversed and the doctor becomes the patient, there is a subtle shift in the dynamic that [sometimes] disrupts the delicate harmony of the therapeutic partnership. It doesn’t help that the medical community is small, and more often than not, we end up consulting our friends.
Deconstructing the relationship
Do doctors really make the worst patients? Although it’s difficult to generalize, this may be one instance when knowing too much about health can actually be detrimental. I do know that when I fall ill– for whatever reason – I tend to overthink the diagnosis, overanalyze my symptoms, and obsess about the remote (or not so remote) possibility of freak accidents and catastrophic adverse events: some real, but mostly imagined.
I am fortunate to have had few major health complaints. I try to eat right, exercise and engage in recreational activity, all in moderation. This hasn’t stopped me from becoming a statistic: one of the 25 percent of reproductive-age women who suffer from abnormal uterine bleeding (AUB). Looking back, my first occurrence of heavy bleeding was about eight years ago. Around four years later when I became clinically anemic from blood loss, I sought professional help and consulted a specialist, who is also my friend.
Thus began my journey of doctor’s visits (few and far between), punctuated by occasional trips to the emergency room, intravenous iron infusions, various medical interventions, and a multitude of laboratory tests. For years, my general game plan was a combination of denial and ‘compassionate neglect’ in the hope that I would go into menopause (I didn’t) and the problem would resolve itself (it didn’t).
Finding myself in the emergency room three months ago with palpitations and dizziness following a particularly serious bleeding episode was a wake-up call. It made me realize that I owed it to my family, my work, and myself to finally do something about my problem.
Road to a hysterectomy
Gynecologic conditions in general are an awkward topic. When I am asked about the nature of my surgery, part of me wishes it was for something less taboo like, say, my appendix or gallbladder. Despite being a relatively private person, I am publicly sharing this story as a patient, a doctor and a woman, in an effort to open up the dialogue and create a safer space to talk about female health concerns without having to worry that it might make others feel uncomfortable.
If I may digress, I have always wondered about the origin of this medical term for the surgical removal of the uterus. I also don’t quite know how I should feel about its obvious (and most likely sexist) similarity to the word hysteria. Apparently both are derived from the Greek hystera (or hustera), meaning ‘uterus’.
The past few months – in all honesty one of most trying periods of my life – have been hysterical (pun intended). I experienced dizziness and fatigue from anemia due to blood loss, and mood swings that may have been from the hormones I was taking. I underwent a flurry of medical tests and procedures, and refused a blood transfusion (which got me ‘discharged against medical advice’ or DAMA). All this while struggling to meet my many personal and professional responsibilities despite increasing frustration and physical and mental exhaustion.
On bad days I suffered from anxiety, excessive sleepiness, dizzy spells, palpitations, weepiness, and fatigue. As the weeks went by, I began to feel guilt-ridden over neglected obligations to my superiors, colleagues, subordinates, co-workers, spouse, children, and my dog. Even worse was my lack of productivity and seeming inability to focus or concentrate on work, research, studies, housekeeping, family, and personal hygiene. While there was really nothing cataclysmic, this increasing sense of failure slowly but insidiously chipped away at my self esteem and eroded my quality of life.
Physician, heal thyself
This proverbial phrase has its origins in the bible (Luke 4:23). While it may be arguable, my own opinion is that many health providers pay little heed to self care, instinctively placing work and the needs of others before their own well-being.
Maybe because we have witnessed so much sickness and suffering, caring for ourselves is a luxury many of us don’t feel entitled to. In our desire to help others – or possibly because we yearn to feel needed – we avoid taking time off from our busy schedules when we ourselves get sick. When we do manage to get away, we fret about the patients we left behind and itch to get back to work. We cut corners, postpone doctor’s visits and delay laboratory tests, rationalizing to ourselves and to others that we are simply too busy. Or maybe, we are just too terrified that further investigation might confirm our worst suspicions.
I confess that I haven’t always had the best attitude towards self care, and that my health-seeking behavior sometimes hovers around the region of ‘poor.’ But trite as it may sound, I try to consciously remind myself that I am human, and that this deeplyingrained (and possibly misguided) practice of putting off eating, sleeping, using the bathroom and taking time off tends to be counterproductive in the long run.
Picking up the pieces
As I reflect on recent events, I cannot help but feel a sense of loss. But with two wonderful grown children, I am essentially done with childbearing, and in the end my uterus was nothing more than a cause of distress. I have been told that I probably held on to it way longer than I should have.
Having a hysterectomy was the definitive and fitting conclusion to two months of almost continuous bleeding, and nearly a decade of AUB-related symptoms. After all is said and done, I am thankful that my condition was curable, and that I had no further complications. All that is left now is a list of items that I sincerely don’t ever want to see again: sanitary pads, intrauterine implants, contraceptive pills, hormone injections, tranexamic acid (a pill for blood loss), and ultrasound probes.
As I turn the page and close this chapter, I would like to extend my heartfelt thanks to my family, friends, superiors and co-workers, and above all to the most amazing team of doctors any patient could ever have. Words cannot express how much their patience, understanding, care and compassion meant to me. For the moment, I’m eagerly looking forward to the prospect of a full recovery, and to getting on with the rest of my life.