Of placebos and phantom limbs

COVER STORY

I 

Years ago, waking up in a hospital bed after a minor surgery, as the anesthesia subsided, I didn’t have to ask. I knew, instantly. Something had gone missing inside.

But, what I didn’t know was that you don’t always have to go to an operation theatre, submit to the numbing painlessness of the anesthesia, leave yourself at the mercy of a stranger’s scalpel to have a part of you removed.

For most episodes of loss, life offers no anesthesia, no prior orientation to the process, no drugs to provide insensitivity to the ruthlessness of breaching the sanctity, violating the integrity of your existence, no artful delicacy, no surgical precision, and no painkillers to help you down the road of healing.

The recollection of the state where you had fallen asleep and that of everything before it dawns with its complete potency. It hits you hard. You’ve been crippled, disfigured and disabled for life. You will never be whole again. It will never be the same. You catch yourself in the mirror and fail to recognize, acknowledge or accept its reflection of your existence, of its misinformed perception of what it sees.

The raw superficiality of the mirror shamelessly lies.

If only there were mirrors that reflected the soul, you would find yourself standing there with the gaping wound in your chest.

In the thickest, most deeply placed layer of your subconscious,

All the clocks have broken.

The needles have suddenly forgotten to tick.

And

The pendulums oscillate no more.

Time,

Forevermore,

Has come to a halt

At the moment

Where the ghost

Of your fallen self stands-

Sculptured to marble

Cold and unmoving.

Life, the owner of that iron hand with spoils of war, your insides, flung over its shoulder- dripping your blood and leaving a trail that rusts too soon, walks away, in reverse, into the labyrinths of the past.

And you, the mangled remains of what is left of your existence stumbles, fall and crawl into the pitch dark alley of the future, clustered with darker, deeper pits.

Despite all that, the mirror declares you intact, the world sees you whole and you, once more, attempt to conform your existence to their judgement so as not to betray the horror of the truth that the unscathed intactness of your visible form attempts to painstakingly conceal.

II

Standing at one end of the long ward of East Surgical Wing, I pick up a folded, square piece of paper from among twenty-six others, with the number nineteen written inside it. It is the Ward Test. I start walking, between the rows of beds, eyeing the bed numbers over the heads of patients on the filthy, ancient walls, aware of their vacant eyes following me; they probably do that to break the monotony of their existence.

I stop by bed number 19 and approach the patient from the right, acting on the first of the instructions drummed into my head in the months of early clinical training.

Post-operative, I make another very obvious observation to myself; one glance at the man before me and the abnormality speaks for itself.

The right thigh is thickly bandaged, slightly above the knee and below it are white sheets, where the knee and a leg should have been.

A quick look at the file, which I’m not supposed to take - diabetic wound infection. I realize I’ve insufficient preparation for this particular case but, well.

I gather all of my scant confidence to get his attention and introduce myself and ask for his consent to talk to me about his ailment. He isn’t too eager and justly so. Nevertheless, he politely grants it. We both know the compulsion of having this conversation: me to gather a history sufficient to present to the examiner in order to pass the test, he out of obligation for undergoing treatment in a teaching, attached hospital.

There is a brief break as he converses with his wife attending to him. I wait. There is a hundred rupee note in her hand and they’re talking about the things that need to be purchased. They’re not sure what will cost how much and conclude by agreeing she goes to see what can be managed in that amount.

Socioeconomic status: poor, I make another mental note.

That is one question I’ll spare us both the awkwardness of asking.

A feeble yet chilling wave of shame washes over me - standing there in my branded kurta, brand new gold earrings, the android phone in my overall’s pocket and all that in my wallet worth more than perhaps months of income of this family before me.

He resumes with the history.

The apparently healthy left leg was paralyzed in a road traffic accident five years ago, I find out. There is a disorderly account of other leg currently in treatment. I try to sequence as I clumsily scribble them down while trying to keep up with the new information I’m bombarded with.

A crack in the skin of the heel, unsurprisingly not attended to with appropriate medical care, the wound infected and gangrenous, necessitated amputation. The surgical wound again failing to heal from diabetes and non-ideal living conditions, the same cycle leading to mid-leg amputation. Another cycle of failure to heal and infection. Above-knee amputation, this time.

He finishes his account of what would be put under “History of Presenting Illness” in my badly-written history with the remark:

“Ab behtar hai.”

(It is better now.)

Neither the patient nor anyone else could have noticed the slightest change in my countenance. I couldn’t have predicted that a statement of this casual, insignificant nature would echo in the darkest of times to come.

Too many things happened at the same time.

Something hit me, hard. And the effect of the blow was not paralysis, but rather the reversal of the one already harboured inside.

The second strongest sensation was that of somewhat maddening nature - to confront him, there and then, and demand: how, after all that he had gone through, could he still have the heart to say that?

In the parallel universe of my mind, it sounded blasphemous, criminal, almost. It enraged me like some grave injustice would. As if surrendering to the havoc played by a catastrophe weren’t an idea repulsive enough to me, I stood there witnessing the vivid demonstration of the possibility of acceptance, of reconciliation with it.

But then, like most conversations that really matter, this one did not take place either.

Without a second’s delay or change of expression, I continue my questions:

“Dard hota hai?”

(Does it hurt?)

“Hota hai.”

(It does.)

He answers, staring blankly into space.

“Kitna dard hota hai?”

(How much does it hurt?)

He pauses for a moment that I find too long, eyes suddenly turning blanker and more unreadable than they had been all this time. I have a feeling he’d rather have snapped at me for the absurdity of my question! But perhaps for the sake of the white coat I had on and all that it signified, or the misery of my sorry existence reflected in my face, he only said, through partly clenched teeth:

“Bardaasht se bahar hota hai.”

(It is unendurable.)

III

There are not many concepts in the course of medical studies I’ve yet been through that are uncomplicated enough to spark my genuine interest or inspire lasting memory, but some have struck enough chords of literary comprehension and duality of meaning to have stayed and stuck.

‘Placebos’ and ‘Phantom Limbs’ are two of those.

Placebos are drugs or rather ‘dummy drugs’ with no therapeutic effectiveness whatsoever, administered to patients unaware of the neutrality of their action. The purpose being to observe how the human body responds to a treatment psychologically and recovers, not only through the actual therapeutic action of a drug but through intrinsic healing of its own that is triggered and potentiated by the mere knowledge and belief that an agent with the ability to heal and cure has been introduced to and is at work in the system.

A phantom limb is the sensation of existence of a limb or a portion of it that has been lost or amputated whenever the nerve endings to the site of amputation are stimulated by touch. For they previously had brought sensations from the lost part, the brain falsely perceives the stimulus to be originating in the part no more; hence, wrongly testifying to its existence even when all other senses declare otherwise.

The diverse concepts of possession and loss, of beliefs of healing and damaging power of things and all that impacts one’s living existence enough to alter the entire course of life - all somehow narrow down and fall into the vastitude of the territories of the above defined pair of terms.

It is all a huge gamble, life.

A game of blind guesses and wild assumptions.

Of thoroughly unquestioned, readily adopted beliefs.

Of uninvestigated, eagerly embraced ideas.

Of giant leaps of faith.

We’re all high on placebos.

Things, people, places, ideas and pleasures thrown our way by the utter randomness that is life, picked up by us with equal thoughtlessness and absolute lack of insight. Making sense out of things that were, perhaps, never supposed to make sense in the first place.

Pasting labels of “meant to be” on products of our own flawed perception - things that were, perhaps, never really meant to be.

Our desperation to somehow impart significance to our utter insignificance.

To somehow instil extraordinariness to the sheer ordinariness of our experiences.

Entertaining possibilities of universal conspiracies having a hand in facilitating the tiniest, profoundly meager of happenings in our lives.

The one sunset you witnessed and that you may never forget believing it had anything to do with the state of your mind was no different than that of the day before or after or the day when you’re no more.

The rose doesn’t bloom in tribute to transient affections your heart may be nursing.

Monsoons do not thunder and shower in honour of your passing emotions.

The poet, perhaps, never meant what you think your favourite song means.

The universe couldn’t be more indifferent to your existence.

We’re broken, bruised and diseased, frantic in search of antidotes to our respective afflictions.

And there are none.

We swallow every pill life shoves down our throats and injects into our veins, telling us it is just what we need to be at peace - we reverently embrace the promise in the prospect.

Most of the time, they’re placebos - things we believe are healing us - while all the time we’re decaying and dying.

So often, we’re prescribed poisons - sweet enough to bring about the strongest of placebo effects, all the time killing us silently. Apparent recovery tricks us into believing we’re healing, but when they’re withdrawn, the mightiest of placebo withdrawal surfaces. We die from the sudden withdrawal of something that was always meant to kill us in the end.

And then there are phantom limbs. Limbs that made you walk, run, reach out and grab whatever you sought to possess; vital organs that pumped, breathed and disseminated life into you.

Lost - lost in the violent ruthlessness of accidents met on life’s insane high road.

Or diseased - diseased gravely enough to threaten to take your life altogether if not cut and separated from you.

It, unfairly enough, ceases to matter what crucial significance that part of you had held all this time. The terror of disability and disfigurement, the grave, crippling incompletion of that which would remain of you when it is gone becomes secondary when it begins to threaten to take your very life, to inflict greater amounts of pain and anguish in case you let it remain attached to yourself.

And, thus, even when the slightest touch at the site of wound reminds you of what once was, of what you once were and even when the greatest magnitudes of excruciating pain rip your insides out every time, you still are able to say through locked jaws and clenched teeth:

“Ab behtar hai.”