Saturday, September 27, 2008


One of the most important things I've learnt this past year is how crucial it is to communicate well. Caring for patients involves planning out a course of treatment and this needs to be communicated not only to families but also to nurses and social workers and healthcare reps and, of course, your colleagues. So, in the course of the day, I end up talking to several different people, each of whom require me to adapt the conversation based on their level of engagement. For an introvert like myself this was a hard thing to learn. I prefer to just do stuff and leave the talking to others but now I can't afford to be so passive. Miscommunication, or an absence of communication, runs the risk of lost opportunities and the off-chance that a patient may actually suffer from their stay in the hospital. So not talking is not an option.

As I think about it now a lot of this applies outside the hospital as well. In any relationship, one of the most important things is the ability of individuals to communicate well with each other. Self-help guides abound with platitudes about understanding the other person, about talking things out but I notice that in South Asian, or desi, culture people seem to be somewhat averse to the idea. Some of this has to do with an innate stoicism and the need to shield our feelings from others but a large part of it is just a passive-aggressive attitude to relationships. Instead of openly discussing problems with one another, people internalise their aggravation and vent it out in subtle, less obvious ways. An example of this would be someone inviting me to their home for dinner for an important occasion, say his wedding anniversary or a child's birthday. If I'm busy that night and casually brush off the invitation without deference to that individual's feelings or emotional investment in the situation, my inappropriate response will insult him but he won't confront me about it. I won't even realise I've done something wrong. However the next time we meet, he may ignore me or may make some stinging remark in response to an innocent question which act is meant to alert me to the fact that he has been wronged. This is a dysfunctional social dynamic and, truth be told, it pisses me off. I think that, by indulging ourselves in these convoluted forms of expression, we waste a lot of time and emotional energy over what are essentially misunderstandings. We also run the terrible risk of ruining precious relationships as misconceptions multiply and the rally of passive-aggressive responses escalates into a permanent rift.

I don't have any easy answers to this. I know how hard it was for me to start communicating and I can understand that reluctance in others. At the same time, I think that if you really care about a relationship, it's important to sit down and talk things through when differences arise. By opening yourself up you do run the risk of being hurt, especially by the other's locked-up resentment and reactionary criticism, but at the same time you also admit the significance of that association. Even on a less personal, more societal level, I think we could all benefit from being clearer in expressing our expectations and disappointments, if only to articulate and make public the standards of good behavior we all privately acknowledge to be true.

Wednesday, September 10, 2008


A friend and I were sitting and reminiscing about our medical school days. Arif was talking about oral exams, or vivas, which all medical students are required to take at the end of each year. Vivas are, or they used to be, the bane of a medical student's existence. There were usually two or three examiners, one external, from an outside institution, and one or more internals who would all be sitting behind a desk waiting for you as you walked into the room. The external would usually begin the questions and after a few minutes, which either went by very fast, if you knew your subject, or painfully slow, if you didn't, the internal examiners would take over. The whole process was fairly subjective and very stressful and we all dreaded it.

"I remember when my wife was going in for her final year surgery exam," Arif said. "She walked into the room and sat down. The internal asked her name and then asked the external examiner to start the viva."

"Saniya was very nervous. We had just got married two days before and with the wedding and everything, she hadn't had much chance to prepare. You remember how brutal those surgery vivas could be. It was like those surgeons were operating on you!"

"So she sits down and waits for the examiner to start questioning her. He's an old man, a professor from a big medical school, dressed in an immaculate suit and tie, like the old British surgeons. The examiner looks at her hands and asks her "What's this?"

"Mehndi, sir," she tells him. "I got married two days ago."

"Then what are you doing here?"

"I'm here for the exam, sir."

"No you're not," he says. "Hogaya exam! Chalo bhago yahan se!" (We're done! The exam's over!)"

Arif grins. "She passed."

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