LESSONS FROM EDMOND
by Heidi F. Mabatid, M.D.
(Editor’s Note: Dr. Mabatid is a retired general surgeon, an alumna of Southwestern University where she earned both her Bachelor of Science and Doctor of Medicine degrees. She did a general surgery residency in Upstate Medical Center, New York, after completion of which she became a military surgeon in the U.S. Air Force, segueing to private surgical practice upon her retirement from the service. After closing her practice in the U.S. she chose to return to Bohol, involving herself in health advocacy, with particular emphasis on breast cancer awareness, prevention and treatment. She has completely retired from practice and is enjoying her little oasis, tending her plants and dogs, catching up on so many good reads, and watching sunsets with an occasional glass of red at hand.)
I have four dogs and one of them is named after Edmond Dantes, one of my favorite Alexandre Dumas characters. Unlike his cool, imperturbable, heroic namesake whose lineage was not uncertain, my Edmond descends from mongrels, the only lineal certainty of which is that there was a mixture of DNAs from dog breeds known and unknown (translate: askal, aspin). Edmond, in stark contrast to his namesake, is a nervous, tightly wound little guy ready to squirm and run off at the slightest hint of even the most benign friendly advances. Because of this, grooming Edmond has always been a difficult task, a daunting challenge on any given day. He absolutely refuses to have his muzzle touched, for example.
And this is why the catastrophe happened.
The fur around Edmond’s muzzle had become so impenetrably matted, dirty and smelly that something had to be done. But he persistently refused any attempts at even combing out the matted fur, let alone shaving it. No matter how I immobilized him, he would still snap like a hungry crocodile whose food is being dangled just so.
As a responsible pet owner, I try to make sure that my pets’ needs and wellbeing are maintained and any problem that arises is addressed reasonably quickly.
I brought Edmond to the vet for sedation so he could be cleaned up. Doc Vet gave the shot and as he became as limp as a tattered rag, I got on with the business of his matted fur. Edmond was always licking the right corner of his mouth so, wanting to see if there could be something stuck between his teeth or something wrong with his gums, I pried his mouth open with ungloved bare fingers. Who’d have guessed that a fully sedated dog could bite?
But bite he did, and with a force that I did not expect.
I was surprised by the intensity of the pain that the sheer unexpectedness of it probably multiplied it a few times more. From two gaping wounds on my right index finger, blood was dripping like a leaky faucet. The vet tech assigned to trim Edmond’s nails was so unnerved at the sight of profuse red dripping, she turned ashy and turned tail after just two nails. I poured betadine solution all over the finger and asked for some gauze to wrap it to stanch the bleeding. I managed to finish cleaning up Edmond even as I tried to keep the gauze around my finger in place.
At home I cleaned my wounds, squirted them with some more betadine and dressed them with sterile gauze. Nothing prepared me for the excruciating pain and throbbing that night. I couldn’t go to the E. R. having no one to drive me as my nephew—my go-to driver— had left for Cebu. After two completely sleepless nights, my house-help texted my nephew who hurried back the next day and we drove to the hospital. The wounds have turned black and required debridement and intravenous antibiotics.
Pain of all kinds and of whatever degree is a stressor. Indeed, pain and stress are two sides of the same coin. Our brain has areas that integrate signals from pain, and the stress from it. In turn, these areas generate learning signals for decision-making to help us adapt to our environment and current situation. Chronic stress and chronic pain share a common behavioral model of failure to extinguish negative memories.
Fortunately, there is a plethora of anodynes at every physician’s disposal for instant relief of somatic or visceral aches and agonies. Physical pain ceases, while the pain from emotional trauma or mental anguish endures and lingers such that it can alter one’s responses to life’s challenges. In part, our humanity is molded from our emotional journey and mental strength and cohesion. The challenge of enduring emotional, mental, psychological, or spiritual torment and distress is the lack of any effective immediate, or even long-term and full, relief. One only has to think of a past betrayal, for example, and some degree of heartache is evoked. While I can still remember that a twisted ankle hurt and how much, the pain itself is already absent from my memory and thinking about the event does not cause any more discomfort.
Unwellness makes us vulnerable and tends to bring out a foul mood that can wreak havoc with our interactions with the very people who will provide the ministrations during our time of need. Thankfully, people are generally nice and kind. But people can also be tactless and unsympathetic. Although I try to start out neutral, sometimes the urge is strong to utter an indelicate phrase but I bite my tongue and look for teaching moments instead. I have learned to temper my expectations, so, for the most part, I am more pleased than disappointed with how people respond to me. People will behave the way they want to; we can influence only so much, or none at all. My encounters throughout my life have proven beyond doubt on my part that honeyed words and a mellifluous tone are more conducive to desirable outcomes.
Doctors tend to be somewhat cavalier in their attitude towards their own afflictions. I am no exception. I have latched on, rightly or foolishly, to the exhortation, “Physician, heal thyself“. But calling on our colleagues and relying on them to heal is no cause for embarrassment or loss of self-esteem. It is, in fact, an affirmation of traditions of medical training we all share. It is trust borne of the common ground of long tedious hours of study and punishing grind that successful and lifelong students of medicine endure. There is this collegial impulse, a reciprocal response, if you will, embedded in living “the oath”.
So Edmond carries on with his doggy spoiled-rotten life oblivious to the physical and financial harm he has fomented. He looks oddly strange without the fur on his face, but truth be told, he is as handsome as any quarter-breed terrier has a right to be. His innocent-looking goo-goo eyes melt my heart and I feed him his treat with the hand that he unknowingly bit. He has no idea whatsoever of that adage…