Medical impressions

Every day, doctors witness the extremes of human life. They are there as stories of tragedy, illness, death and defiance unfold in ways that many of us would find hard to cope with once in a lifetime. When your job involves telling patients their loved ones won't be coming home or their child may never get better, keeping a bigger picture about life's priorities suddenly doesn't seem quite so hard. There might be a global recession to contend with, but having your health can be a sadly under-appreciated blessing.

General Practitioner, Dr McCulloch's Clinic, Abu Dhabi I have been in the UAE since December, 1974. I started my clinic in Abu Dhabi in 1975. One of the first things a doctor here may notice is the different experience of practising medicine in a country where you may only know your patients for a few years. In the UK, you get to know your patients over decades but here expatriates tend to stay for around two to four years and few doctors have patients on their list beyond a decade.

The saddest case I remember is a young couple who came to see me in 2002 or 2003. They were both so happy and chirpy and they were engaged to be married. I examined the man and a female colleague examined his fiancée. Everything seemed fine, as they both looked so healthy. Then I noticed a lump in his neck. Tests revealed that it was cancer and it was terminal. They had been about to embark on a happy life so it was a devastating blow. They had been due to travel but decided to go straight home. They had a hospital wedding and he died the next day. People marry in tragic circumstances.

Sometimes I see patients and they are obsessed with the idea that they might have cancer. They are focused on this even when the news is good. I always think: "How lucky you are to leave with a pat on the shoulder and not a death sentence." None of us knows what is around the corner. Just because you have passed a physical doesn't mean you are going to live longer; it just means that at that moment you are healthy. You could be the only non-smoker on a balcony and it collapses.

I think doctors often have a kind of gallows humour about life and death. It helps us cope. What makes my career worthwhile is when I come across inspiring people. There was a patient who was diving in Khor Fakkan and he was involved in an accident. He came to the surface too quickly and got the bends, a decompression sickness. A helicopter took him to Dubai and of course that made it worse because of the air pressure.

By the time he got to the hospital he was paralysed from the neck down and told he'd never walk again. Yet, 18 months later he was able to walk. That was a real case of mind over matter. Then there was the case of a marathon runner who is paralysed and did a marathon in two weeks. It would take most people four hours. Reading about inspiring people is uplifting. A lot of people are depressed about the downturn yet there is something so uplifting about a story like that. It puts the little things in perspective.

Infectious diseases specialist, American Hospital, Dubai Of all the patients I have seen, there are a few that I remember more than others. There was one case in particular, a lady I saw in Texas about four years ago. She was 44 years old and completely deaf and mute. She had been brought to the hospital because of persistent seizures and was diagnosed with a kind of viral encephalitis. Over the following weeks, she developed one complication after another and eventually slipped into a comatose state.

By all normal medical standards, it looked as if she was not going to make it. At the time, her son had been overseas. He returned home and came to the hospital to see her. I had a long and difficult talk with him and explained gently that she would likely die, or be permanently afflicted with severe neurological disabilities. But rather than accepting this, her son looked straight at me and said: "No, mum will do as I say. Now that I am here, she will improve."

I was naturally sceptical, as family members often see things like involuntary movements as a sign of cognitive function, so the next day I asked him to ask her to move her hand. To my surprise, she did. From that day on, she started making a rapid recovery. She eventually woke up and was able to communicate in sign language and even walk. Medically speaking, this case is not that unusual. People often wake up after months in a coma. However, for me this case was a lesson because I was so sure of the outcome; all the scientific evidence was on my side, yet I was proved wrong. It taught me to never take hope from a family and that having faith is a strong healing force. As they say in medicine, anything can happen.

There have been several patients whon I have helped to face death. Some are so fearless; you wonder how they can be like that. They have been suffering for so long yet they maintain a cheerfulness that feels almost unreal. They face each day with enthusiasm. Almost all of these patients have had a strong faith, and I believe that has been a pillar of support to them during their suffering. I have learnt things from patients that I have incorporated in my life. The first is to remember to be grateful for being healthy. I never take my health for granted. I silently thank God for it as I walk in the corridors of the hospital or ride in the lift. Ours is an emotional field and sometimes you can go through a whole range of feelings in one day. The second thing I have learnt is to do everything in my power for my patients. The reason that physicians can go to bed at night and sleep peacefully is not that we cure all our patients but that we know we do all that we can.

Senior consultant for neurology, German Center for Neurology and Psychiatry (GNP), Dubai Healthcare City Many patients stand out, but there is one case that I remember because it is so exceptionally tragic; it reminds me that we are sometimes helpless in the face of illness.

The patient, a middle-aged lady, developed a very progressive dementia disorder that took hold within a matter of months. You can lose your vision or your limbs or even develop paralysis and spend the rest of your life in a wheelchair, but that is nothing compared to losing your memories, your feelings and the experiences you have made in your life. Without memory, you lose your personality. So, in my opinion, the most terrible illnesses are dementia disorders such as Alzheimer's disease.

The inspiring thing to take from a situation like this was that the family tried to get her all the help available. As a doctor, I always try to help a patient in the same way I would a member of my own family. It is important for doctors and patients to get on with each other, to have that authenticity and respect for each other, because human beings aren't just machines that it is our job to "fix". You have to remember the psychological aspects.

In that respect, one patient who haunts me is a man who I treated in my first year as a doctor. He had a malignant brain tumour. Both he and I knew there was no cure for him in the long run, but I was able to offer him a month more of life if he would agree to take some cortisone to control the oedema (excess accumulation of water in the inner brain). Unfortunately, he refused to take this treatment. As the doctor responsible, I had a long discussion with him about his decision but he remained absolutely clear and sharp in his mind. I encouraged him to take the medicine, as otherwise the oedema would affect his brainstem and he would die within 36 hours. But he refused to do this.

His son came and they also had a long discussion. After three hours, the son came out of the patient's room feeling beaten down and helpless. The next day the patient became sleepy and the day after that he died. His son was at his bedside the whole time. At the time, I felt helpless, but now I understand his intention; it is the quality, not the quantity of life that is important and I think he knew that.