Tuesday, October 28, 2008


"Mechanic and Volkart (1961) define 'illness behaviour' as 'the way in which symptoms are perceived, evaluated and acted upon by a person who recognizes some pain, discomfort or other signal organic malfunction'."

"In a pioneering study conducted in New York, Zborowski (1952) found that patients of Old-American or Irish origin displayed a stoical, matter-of-fact attitude towards pain and, if it was intense, a tendency to withdraw from the company of others. In contrast, patients of Italian or Jewish background were more demanding and dependent and tended to seek, rather than shun, public sympathy."

Donald L. Patrick & Graham Scambler. (1982) Sociology as Applied to Medicine. London: Bailliere Tindall.

I felt I should go home after I ended my work late that afternoon but I thought about having a rest for few minutes in the hospital's garden. Patients took their rest either in the television hall where they usually keep silent, or in this garden. I like to see how they act in the garden. I was shocked many times before of how some patients look very different in the garden than in the examination room. What I liked the most in the garden is that they don't care about my existence and act the way they like.

That day I found an old lady burping frequently. She drew my attention with her frequent loud widely opened mouth burps. She was sitting on the ground with a bottle of something next to her. When I sat I tried to know what the bottle contains. It is something brownish. Is it soil and water? I asked myself, couldn't be! I answered myself. The woman took the bottle and drank from it. After that she vomited many times. I looked around and saw her family, a man and three young women sitting just on the other side of the garden and asking her to join them, but she was not answering. One of the young women went and sat next to the old lady who continued to do the same. She must be psychotic, I said to myself. And that must be a bottle of soil mixed with water. God help me.

They did not stop her from drinking from her bottle. Instead, one of three women was giggling while looking at me. That giggling woman, maybe her daughter as I supposed, is knowing what is going in my mind and laughing at my panic wide opened eyes. This giggling woman seemed the only one who understood that this is wrong. Maybe she knows that it is better not to interfere. She is maybe the only educated woman in her family. She may be tried to change their way of behaving before but in vain. Now she giggles at my surprise of her family dynamics she may be aware of.

I felt annoyed. We are in a hospital and we should not allow this to happen.

Something told me to be cautious. The giggling woman seems examining what I would do.

Something told me that this maybe a traditional healing method. So I should show them some respect while asking them to take the bottle from her. I decided to go to her first and have some talking to see how she would respond.

- My stomach, doctor. Or wait, you call it something, ehhh colon? (she said while putting her hands on her upper abdomen area)
- Yes, colon. (I said while I was now sitting in a chair near her).
- Yes, colon. Food poisoning. I am a case of food poisoning.

Her reaction to me was very normal. Her reaction was a mixture of being surprised about me asking about her health, showing respect to a young inexperienced doctor (or is he a student? Or a nurse? Or what? He'd better be a doctor or I would burp in his face), silence and waiting to see what will come next.

Totally normal.

She didn't feel shy from her burping, vomiting, her bottle, or sitting on the ground. She is not shy either because she is ill and do not have space in her mind to shyness at time being, or because she is just behaving culturally normal. Well it is a little mixture of both.

Being poisoned by food to any naïve psychiatrist would mean the patient may have persecutory delusions. But I felt this lady is not psychotic.

- What is this? I asked.

- It is soil taken from near Imam Al Hussain grave dissolved in water. (she said that while her eye contact was lost. She is now looking at her feet. Moving her toes. She was saying to me something like "you'd better go now young man, I am little ill for this conversation" but maybe I was wrong cause she looked at me again and added): people say it helps to heal many diseases (a shadow of a smile around her eyes).

And oops, the old woman's behavior seems to be clearer now. But to be sure I asked her if she is an inpatient. She said that she is a mother of a new patient that had just entered the women ward. I looked at the three women. That woman is still giggling. Still looking at me. From a small opening in her Abaya (= a traditional woman dress) I saw her holding red, purple, and yellow pieces of clothes which seemed to be woman's underwear. He father was examining me. His eyes were far but I knew how sad he was. The giggling continued.

- Do you want me to bring you any medications Youm? (Youm= Mom).
- No, son thank you for your care, I will be ok in few minutes. (She nodded her head with a slow and clear up and down movement which means "we are grateful").
- Ok mom, sorry to disturb you, just try not to drink much from this bottle now, I think you drank too much till now, anyway…. (I stood, took a breath)… it is up to you…you know….
- Yes….I understand
(Her smile is clearer now, still a bitter smile).

I went walking slowly to my previous place while the daughter whom I thought was the only mindful aware woman in the family was giggling while looking at me.

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