What you want to know will hurt you.

There was this 25 years old Lady who had a very successful life. She had a caring family and a loving husband.
The couple was trying to have a baby; they tried for more than a year before they decided

“We must get a professional's opinion.”

A series of tests led to Karyotyping, in other words the Lady’s genetic map to see if there is any abnormality with the chromosomes.
As you know the male has 46 chromosomes and an X and Y (sex chromosomes) the female has XX.
Now this Lady had an XY! So she was a man trapped inside the body of a woman. Only that is not true. She was a female, she had all the organs for a female but her ovaries were not functioning, and she did not have a developed womb. Otherwise everything was there.
Now The Doctors had 2 options.
1) To tell her the Truth.
2) Hide the Truth.

Nobody likes to make a decision on behalf of someone else.

Do we tell someone who lived for 25 years as a woman that she is a man?
How is she going to take it?
How is the husband going to take it?
How is the family going to take it?

We know from experience that women with breast cancer who end up losing their breast suffer psychologically as a result of feeling like “incomplete females”. So one could only imagine the profound impact such revelation will have on this lady.

The Dilemma:

We could conceal the truth and tell her you have non functioning ovaries, you can continue with your life but you will not have babies, it happens even in normal females!
Or we could tell her you are actually a male we don’t care how that may affect you psychologically but there you have it we are honest.

Well, you can argue being honest with being thoughtful.
Children, often ask a very annoying question : WHY? … why cant we fly? Wy do I have to eat? Why take a shower? So on.
But in this case it’s odd to ask: why do you want to be honest?
Is honest under such circumstances the right thing to do? hmmmm

on the other hand:
what gives us the right to say when to be honest and when to conceal the truth? Maybe lie?

one has to make up his own mind.

The Doctors ended up telling the parents and they came to a decision NOT to tell her that she has an XY chromosome.

Frances Peabody concluded a lecture called “the care of the patient” with these words:
“One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient”

Time to choose a straitJacket

I don’t know about you but I did misinterpret images, I did mistake random shouts for someone calling my name. I did wake up at nights thinking I heard someone screaming.

scary; is when u r sitting with a schizophrenic patient and u start counting the similarities between you and him/her. Well coming to think of it , it’s not scary It funny. The thought that I maybe psychotic makes me laugh.
Thu I do have a positive family history I don’t take it seriously. I only hope that if I became psychotic I will have insight and realise i need help.

While I was doing my attachment in psychiatry, I came to watch a documentary on the Exorcist. Apparently the movie is based on a true story. take it easy i didnt know that!

What was interesting is that one of the preists interviewed, who is a specialist in chasing Demons, said: 99% of those who claim to be possessed by Demons need psychiatric help.

With that thought I went to my consultant and Asked him: what do you think of possession so he said: go to the ward and ask to talk to Mr M, we will discuss it afterwards.
Mr M was a preist, but according to him he fell a victim of temptation. He now sees the Saviour telling him to preach Christianity.
Mr M is a smart person but he is puzzled as to why has the Lord chose him althu he failed the church. The psychiatry report reads visual/auditory hallucinations.
I thoug to myself well George Bush said he talks to God. No one is raising an eye brow.

Now me being me, thought JINN, muslims believe in Jinn, those of you who watched Aladdin know Genie.

(for more info on Jinn read: http://www.geocities.com/WestHollywood/Park/6443/Jinn/

Now if you cant be bothered reading about JINN here u go, Jinn in Oman is similar to Ghosts/demons in the western culture.
There are many cases in Oman where people claim that they are possessed by Jinn.
Let me pause here and bring the definition of Delusions: A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g. it is not an article of religious faith).

(note: see if you memorised this definition word for word?... Id be worried)

last bit makes a huge difference.

So if a muslim believed that Jinn exist and they have overpowered him this on its own does not make him psychotic because it is within his belief.

Anyways, so how many cases of Omanies are being treated by “spiritual healer” rather than by a professional psychiatrist? more importantly how many "spiritual healers" believe that the patient does need medical intevention.

society is opposed to the idea of taking their child for mental check up. a family of someone affected would rather believe that he/she is being overpowered by the mysterious Jinn, Ghost, demons whatever rather than believe that there is mental illness that could be treated before more damage is caused.
Is the Omani public finally coming to terms with the fact that the mind/brain can become ill just like any other part of the body?
I hope so..

It makes me also think that your best Doctor is not the one living thousands of miles with all his PHD, MSC, PMS, LOL, BRB, TYT after his name who knows nothing about your culture, your beliefs, your way of life.
sometimes the Best Dr is the average GP whos been treating you and your family for the past 10 years.

The Work of Nestle

A couple of weeks ago I was with the midwife as she was interviewing this Lady with a 2 years old son, she was 20 weeks pregnant at the time.
One of the Questions mothers-to-be are asked is: whether they will breast feed or bottle feed.

This lady smiled and said ill breast feed. Great news for everyone, healthy child healthy mother. healthy community.

The midwife told me afterwards that this lady suffered a lot with her first baby because her husband and her mother in Law were dead against breast feeding.
I could not understand. It is one thing for a woman not want to breast feed for many reasons, but for the husband to be against it knowing that it will benefit the child and the mother as well. I don’t understand it.

The midwife’s best guess was it’s because of the way the society looks at women who breast feed.
I thought to myself our society is blessed; no one would frown upon a mother breastfeeding her child in Oman provided she is not showing flesh.

I made a simple comparison in my mind. when people in the west talk about Breast feeding in public they assume that they will see some flesh, where as, when we talk about it , our imagination is of a woman who is wearing head scarf or a veil and she can cover herself and her child and feed him without being frowned upon.

This is an over simplified view but its an example of how a simple issue like breast feeding can be used to highlight social variations between 2 societies with different dressing codes and traditions.

I talked about how the way women dress could contribute to the difference in our perception, but imagine including things like, life style, having a maid, extended family, being a single mother etc. all these can be used to compare the 2 societies with breast feeding at the centre of it.

Needles to say while we are not that concerned about it in Oman, the National Health Services NHS in the UK has to set a whole campaign to encourage mothers to breast feed.

“Breast is Best”

less than an ideal method of care

A man cut his hand and went round to his neighbour for help. The neighbour happened to be a doctor, but it was not the Doctor but his 3-year old daughter who opened the door. Seeing that he was hurt and bleeding she took him in, pressed her handkerchief over his wound, and reclined him, feet up, in the nearest chair. She stroked his hand, and told him about her marigolds, and then about her frogs, and, after sometime starting to tell him about her father-when he eventually appeared. He quickly turned the neighbour into a patient, and then into a bleeding biohazard, and then dispatched him to hospital for ‘suturing’ (The neighbour had no idea what this was). He waited 3 hours in Casualty, had 2 desultory stitches, and one interview with a medical student who suggested a tetanus vaccination (to which he was allergic as it turned out). He returned to his doctor next door the next day a few days later, praising his young carer, but not the doctor (who turned him into a patient), nor the hospital (who turned him into an item on a convenor belt), nor the student (who turned him into a question mark; does a 50-year old man with a full series of tetanus vaccinations need a booster at the time of injury?)

It was the 3 year old who was his true nurse-and-physician and universal health worker, who took him on his own terms, cared for him, and gave him time and dignity.
Question her instinct for care as you will: point out that it could have led to harm, and is inadequate for scientific medicine, and that the hospital was just a victim of its own success. But remember that the story shows that there is, as T S Eliot said, at best, only a limited value in the knowledge derived from experience… the child had the understanding and natural compassion that we all too easily lose amid the science, the knowledge, and our stainless steel universe of organised health-care.



(From Oxford hand book of Clinical medicine)

I wish it was "mind the Gap"

I never had a problem with tattoos.
Some people can be creative with them and some are quite artistic.

But this was a step too far.
I was at the Early pregnancy assessment clinic last week, this is where ladies come for their first check up after becoming pregnant.
This mother with thick glasses well dressed walked in with the midwife. I introduced myself and smiled. As you do.!
Anyways I started with the normal questions: how many weeks do you think u are?
any oedema? any nausea? discomfort pain?
All that is fine.

Now I asked her to go up the couch and make her self comfortable coz I need to examine her tummy and then listen to the baby’s heart beat.
Btw, listening to the heart is the mother’s favourite part. . mine as well Its nice to see people smiling.

Now time for examination
I lower her pants a bit to feel the baby’s head… now get this. Im standing there, the midwife is standing next to me, quite lady with thick glasses is laying on the couch with an innocent smile on her face and im smiling back. (Pretending to know what im doing)

I look down and about 3 inches from her belly button a Tattoo with an arrow pointing downwards I read:

“slippery when wet”.

ok pause.

Now I am not a pre-judgmental person (ever heard anyone describe himself as a pre-judgemental person?) but when this lady walked in I never thought she is a tattoo kinda person, certainly not that inda tattoo!!.
well I don’t know what goes thru a persons head when he/she is drunk but that was one Huge mistake. Coz the day that lady will go to the labour suit and if she has to go for a C-section, I am telling you, the whole town will know about that tattoo,,, Not that I care. coming to think of it, It would be nice to hear about it so I could stand with a Grin and say: I was there.

unpause

Slippery when wet!!
Well you may think: so what? it’s a personal choice!... indeed I agree but then imagine how I had to be dragged with the midwife all over the Health centre to tell the Story over and over and over and over…

Now you know why I hate tattoos.