The Other Side: Getting a Diagnosis

As an undergraduate medical student and now as an intern, I have subconsciously considered patients as entities with a

collection of presenting complaints, who come to us so that we may pick out the ones relevant to our differentials to

reach a provisional, and subsequently, a definitive diagnosis. The natural hierarchy dictating that this must be followed

by a treatment plan and then advice.

I had never given it much thought as to what must it feel like to be at the receiving end of a debilitating/life-altering or

lifelong condition. I can justify this by crediting it to working in a resource-limited government facility with a patient

flow where sometimes the bare minimum - the medical treatment of symptoms - is a drain to a doctor’s physical and

mental strength. Burnout and exhaustion are so potent that empathy and holistic patient care takes a back seat.

In my case, this was the attitude by which I breezed through the first quarter of my rotation and started the next quarter

of the 6-month surgery rotation in Surgical 4, a ward located on the second floor of the Dr. Ruth K. M. Pfau, Civil

Hospital Karachi; primarily catering to the disease demographics of obstructive jaundice, acute appendicitis,

cholangiocarcinoma, pancreatic cancers, and other operative procedures leading to stoma fashioning as the outcome.

Everything was going by the book except for the fact that 24-hour shifts were becoming a disaster for me. It started

with a nocturnal dry cough that won’t recede. Living in 2021, the immediate culprit that came to my mind was SARS-

CoV-2. This was absconded from the differentials after 2 consecutive negative PCRs and negative covid marker tests.

By then, it had been 15 days and no improvement in my condition. I had a fair idea as to what that may mean but I shot

down those thoughts telling myself that what I was suspecting was a childhood diagnosis.

It was one of those tiring calls at the hospital when I woke up at 3 AM with an unstoppable cough that lasted for 2

hours before changing to shortness of breath and an audible whistling sound at the end of my inspiration and

expiration. I had a tightness in my chest that was preventing me from taking in air.

I could no longer ignore the signs even if I wanted to.

Sitting in the consultant’s waiting room for my appointment, I already knew what was coming and was barely surprised

when the term asthma was uttered. Despite a strong positive family history, my father had difficulty accepting that his

24-year-old daughter was asthmatic. His protest ended after being told about the adult-onset variant.

So, I sat there while Baba came to terms with the new reality, after which we proceeded to the counseling part and the

use of LABA and SABA, the most commonly used medications in the treatment of asthma. Studying those in

undergrad, I was aware of their pharmacokinetics and their importance in my life, henceforth. Therefore, at the end of

this consult, you could say that I was the epitome of calm composure.

At night, while on a WhatsApp call with my best friend, I finally allowed myself to cry and come to terms with the

transition in my health status from “no known comorbid” to “known case of asthma”. In the middle of a sob, I asked

her a multitude of questions - she had it since childhood and was used to dealing with all the issues I was having - like

having to use an inhaler in a public place, should the need arise. The response to this query was a soft laugh after which

she walked me through what I essentially call ‘Asthma 101’, not from a doctor’s point of view, but from a patient’s

who had had it for well over a decade.

Being a doctor is hard. We are an overworked, exhausted, and sleep-deprived species that are constantly telling our

patients about the importance of an 8-hour sleep and a healthy meal of salad loaded with greens. It is sometimes easy to

lose your cool and skip the necessary pause after the pronouncement of a life-altering or a lifelong condition.

At times like these, I will now be sure to remember the other side: of how difficult and confusing it all is, how

necessary it is to make that small pause, to be patient, to allow them to ask questions, to help them come to terms with

the reality, and to support them in their new lives.​

DISCLAIMER: ​Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences. The views expressed do not necessarily reflect the views and policies of CCIT or AKU.​

​ ​About the Author​

​​​Mariam Baloch is a graduate of the Dow Medical College Class of 2021. An avid Harlequin fan, she spends her time catching up with latest releases when she is not studying or writing papers​