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Failure in Practice

I have been treating a patient over several years. She tends to develop very severe complaints, and over the years while under my care, has developed multiple severe complaints including diabetes, has undergone a hysterectomy etc. I have referred her to good homoeopathic prescribers for a second opinion, followed their advice to the letter over a long time, and also referred her to several allopathic doctors - orthopedic, urology, endocrinology, ophthalmology, and a general physician for diagnosis and supportive management - as she has all these problems, and all very troublesome.

I studied and restudied her case several times myself, retook her case, changed prescriptions and so on. All her complaints would come with amazing severity - for example, she would develop a urinary tract infection in the morning, and by evening would be passing pure blood in the urine several times. I gave her cantharis 1m and she responded to it well, not needing antibiotics etc. The next time, she would come with violent vomiting and weakness, nearly in a collapse - and repeating some earlier medicine which worked brilliantly would not help at all. Then colchicum would immediately act, with remarkably quick recovery. She once developed a terrible cough and wheeze that did not let her sleep, and it seemed as though she might need to get hospitalized. Croton tig relieved her quickly. Over time, in addition to several seemingly indicated remedies, I gave her also sulphur and tuberculinum, based on general indications, and also the idea 'when the well-selected remedy acts, but fails to hold...'

At one point, I wondered why she was continuing treatment with me, as I seemed to be unable to cure her of existing complaints, or at least prevent new ones. I also wondered if I should ask her to find another doctor or even perhaps try some other system of medicine. I scheduled a time to discuss options with her, and I had an interesting insight.

I already knew that she had been treated by several doctors, including homoeopaths, in the past. However, on reviewing the whole case with her, I found that in the past several years while she was taking my treatment, though she continued to have severe illnesses, she had had to take hardly any antibiotics, whereas earlier she was hospitalized several times - every acute episode was so severe. The frequency of the acute episodes were much less, and though severe when they did occur, I was able to manage them. She also told me that most of the other consultants she has had to meet - for the eye, etc. - had a very superficial understanding of her other problems.

I realized that while I was feeling discouraged and discontented, the patient herself was grateful and was able to see a big difference in her health over time. She said she had been to all these doctors, but none of the other doctors had been able to offer any significant, permanent relief. Indeed, that I had done more - both as a doctor and as a guide, helping her find a good ophthalmologist, urologist etc., discussing with them, keeping allopathic medication to a minimum - such as lubricating eye drops and so on.

I had a similar experience with another patient. When he first came to me, his chief complaint was weight loss of 20 kgs over the past 1.5 years, and he was very weak and despondent, afraid he would die. He had taken homoeopathic treatment in his town, and also much allopathic treatment, and also been investigated without any definite diagnosis. He was a farmer, and had stopped driving his tractor, as he did not have the energy. I treated him for 3 years. In the first 3 months, he gained 6 kgs. Then he lost some weight, then again gained, and again lost some. Over the three year period, I investigated him extensively myself, and also referred him to a number of doctors to try and find out the cause of his weight loss. One of the first possibilities was tuberculosis, so common here in India. But all tests came negative - blood tests, ultrasound, CT scan of chest and abdomen, and even tests for connective tissue disease such as ANA, etc. were done.

He was eventually diagnosed by a physician and two gastroenterologists independently as having irritable bowel syndrome. In addition to my treatment, the physician suggested a medicine to regulate bowel movement, which I gladly consented to, as he was steadily losing weight. However, he continued to gain and lose weight, with a net loss of weight over time. For this reason, I did not rest with the diagnosis of IBS, and referred him to an endocrinologist, a general physician at a tertiary care hospital, a rheumatologist, a chest specialist etc. All possible diagnoses were considered, including cancer. Finally, the chest specialist started him on an empirical trial of anti-tubercular drugs, and over the past four months, he has finally started to gain weight steadily, and is doing well.

Watching this patient continue to slowly lose weight had caused me much worry and distress. I had done everything in my power to help this man. For some reason, various medicines helped him at different times - natrum sulph (mainly), hepar sulph, dros, acet-acid, tuberculinum - but nothing totally restored his health. Other than losing weight, he did not have a single symptom - no fever, no cough, the loose stools had reduced from 5 a day to twice a day and so on, and he was working all along. All investigations/ lab tests were fine. I possibly should have referred him to a homoeopathic colleague, but 1) I was keen to first find out if he had some serious disease - and I spent a lot of time and energy on this. 2) He often seemed to respond well to some medicine, gaining 1-2 kgs... but again relapsed. However, it was clear to me that I did not find the similimum in his case, and over time, I became quite discouraged, and wondered if he would have done better seeing someone else.

However, once again in this instance, I found that the patient was very thankful for my help. He said he gained confidence once he came to me, lost the fear of dying, especially after he gained the 6 kgs in the early part of the treatment. He was able to resume his work. I realized that all the doctors who had treated him had been unable to help him - that I was no better or worse. Moreover, at every point, I was following the investigations, interpreting it for him, getting him access to hospitals and care, discussing with the doctors etc. I accompanied him to a tertiary care hospital and presented the whole case to the physician, who I know well.

All of us fail inevitably in some cases. What matters is that we do our best with an open mind, referring patients when needed to a colleague - homoeopathic, allopathic or some other system of Medicine. As doctors, our success does not lie solely in 'curing' the patient, but in contributing to the cure in some way. Or, as in the quote attributed to Dr. Edward Trudeau, we can consider our job well done if we manage "To cure sometimes, to relieve often, to comfort always."