Friday, November 2, 2012

A New Way To Pray?

Prayers in the Exam Room: A New Way to Elicit Prayers with One’s Patients?

He was an elderly Cameroonian man that fit the description of “Pa” to the letter. He wore a loose suit sewn of brown polyester and sported a small round knitted cap of green, which he respectfully removed for the physical exam.  His short wiry hair was white and a bit thinned from his earlier days. His eyes were still bright and his expression sharp despite his advance years.

Smiling at me with teeth stained brown from years of chewing kola nuts and drinking local mimbo, he enthusiastically bobbed his head up and down while I asked questions. From his answers it was clear that he only understood parts of my English. I began by asking him his reason for coming to consult the doctor today. I find this a rather useful question when someone tells me that he or she has been having a particular problem for “long time” or in other English, “years”.  Why today? Why consult me today versus last week or last year? This is a valid question with surprisingly revealing answers at times!

Our communication wasn’t ideal but after much repeating and rephrasing of questions, I finally deduced that he was here to see me because, well, the pain in his right leg was a bit worse than usual and I was the next doctor in the queue to consult. Upon review of his medical book it was apparent I was one of many in a long string of doctors he’d been to over the years.

In Pa’s case, one would not have required an understanding of Pidgin to realize he was having pain in his right leg. With much fanfare and flair, he indicated his right hip area and patted it firmly to emphasize how the pain began in his right flank and went all the way down to his toes! Just so I couldn’t miss this fact, he demonstrated how the pain traveled by re-enacting up and down motions with his hand several times, each time with more flair and emphasis.

Ee de pain me! Doctor, he persisted. “Ee de pain me all the way to ma foot and my back! Ee no de waka fine!”

I nodded my head in understanding and observed his charade. “Does anything make the pain worse?” I asked him.

“Yes, doctor, ee de pain me!”

“Is it a sharp pain or more like a bruise inside?” I asked more out of routine than any expectation of a useful answer.

“Ee be in ma bone, doctor!” He pointed from hip to lower leg again. “Ma bone, ee pain me for ma bone! Oooeeee, ee pain me plenty!”

(I was rather getting the picture!)

After a few more pointless questions on my part, I gave up and had him climb up to the exam table in hopes of discovering a few more clues to his diagnosis. Our verbal interview had definitely reached its limit! He was quite fixated on the pain and I found I was not getting any helpful new information.

Pa limped painfully over to the table and removed his sandals and clamored awkwardly onto the table while I watched and waited.

“Ee de pain me here.” He repeated as he patted his right hip and groin having seated himself on the bed.

I nodded. “I de hear you, Pa.”  I thumped and prodded and attempted to figure out more precisely where his pain might be originating. He cooperated rather a little too enthusiastically. This turned out to be an advantage while I listened to his lungs. However, when I wanted to assess his knee reflexes -- then we had problems.

Even under the best of circumstances it is difficult to relax your limbs and allow someone else to manipulate them. Cognitively the brain is telling you that you must not actively move your arm but reflectively, your body rebels at such an absurd thought.

For my elderly Pa with less than ideal communication, getting him to relax his legs so I could check reflexes was nearly impossible!

“Just relax,” I soothed as I tried to get him to sit on the table and let his legs dangle. Instead, he straightened and stuck out his right leg for a closer inspection of his kneecap on my part!

“No, relax.” I repeated. “Soften your legs. Just let them be.”

He straightened one leg then the other. Clearly we were getting nowhere.

In this type of circumstance, I sometimes find the art of distraction helpful! If you’re concentrating on something else, you’re much less likely to interfere with my neurological reflex exam! “Pa, put your hands together and push, like this.” I held my arms at chest level and placed my hands in the prayer position keeping them tightly together. “Keep pushing your hands together.” I cajoled as he tried to obey my instructions.

“Perfect!” I praised him as he concentrated on pushing his hands together in prayer while I successfully tapped his knees and assessed his reflexes.

“Ok, finished,” I exclaimed. “You can get down now.” He hesitated a moment. “We’re done.” I affirmed and nodded. Then I turned my attention to writing up my medical findings in his book.

After a few moments, I shifted my weight to my other foot and turned slightly. A pair of bright, beady eyes staring intently at me startled me! His hands were still held reverently together in the same pose as previously. He positioned himself just behind my shoulder, much closer than my personal space bubble generally felt comfortable with.

“Umm, you can sit down now,” I politely informed my patient after my initial shock wore off. “Have a seat. Sit, while I finish writing everything.”

He seemed hesitant at first but at last he limped over to the chair indicated, hands still held in prayer pose. “It’s ok, Pa,” I insisted, “You can relax your hands now.”

Finally, he released his grasp and situated himself in the chair to wait for me. I finished writing up everything and turned to give him my full attention. This time, he was sitting normally. His face still eager and hopeful, he looked up at me.

“Ok. We’re going to do a few tests to check out your bones and nerves…” I continued my explanation knowing he probably understood less than three percent of it but he was very happy to have me talk! He nodded in rapt appreciation. Thankfully, communication between doctor and patient is not completely dependent on me. After humoring him for a few minutes, I escorted him to the reception desk where our register translated my recommendations and explanations. He nodded his head with the same enthusiasm although this time I knew he actually understood what he heard!

As I think about this elderly man and his enthusiastic praying hands, I wonder what he thought. Did he think I was asking him to pray? Did he think such a posture was good for his health or just another odd thing doctors make patients do? He was a Christian and as he was leaving the clinic he informed us he would ask for blessings on us all. Maybe my reflex prayer pose served more than it’s intended purpose? Maybe it helped him feel more comfortable in bringing up spiritual issues, or maybe he concluded we were simply a clinic that was serious about praying. I’m not sure. He did come back the next day! We prayed officially with him then!


“And when you pray, do not be like the hypocrites, for they love to pray standing in the synagogues and on the street corners to be seen by others. Truly I tell you, they have received their reward in full. But when you pray, go into your room, close the door and pray to your Father, who is unseen. Then your Father, who sees what is done in secret, will reward you. And when you pray, do not keep on babbling like pagans, for they think they will be heard because of their many words. Do not be like them, for your Father knows what you need before you ask him.” Matthew 6: 5-7