Complications
by Mike Litrel, M.D.

Since her graduation from college 10 years ago, Pam has become increasingly depressed and has received treatment from several counselors and physicians. Antidepressants once helped her feel better, to forget her suffering. But by and large, she has felt worse as the years have floated by, and she continues in her college waitress job, waiting for her life to change.

I have a sample closet full of antidepressants. But in cases like this, I sometimes wrestle with their prescription.

If a patient has a tumor that is causing abdominal pain, narcotics will bring her relief. But only surgery will remove the tumor. Similarly, antidepressants can alleviate mental anguish. But what if the suffering is a sign that one must change one's life - a signal that there is spiritual work to be done?

Suffering was once considered a normal part of life. Martin Luther described it, Job endured it, King David spun it into Psalms. Once upon a time, depression was interpreted as fire for one's understanding, a spur to bring about change in oneself, or one's surroundings.

I have seen antidepressants help a person to take charge of their life. But just as often, I have seen them enable a person to drift along, enduring situations which call instead for action. They are experiencing relief from the pain of life, and sometimes, in corollary, their responsibilities.

I know my patient Pam wants relief. Only she is in the position to judge - relief from what?

Eventually, my post-operative patient learned how to self-catheterize and was ready to go. She felt better, now that her bladder was empty and the catheter out. But she was still mad at me. Standing in the hallway, she made a facetious gesture as if to kick me in the fanny for her suffering. I told her that anyone who can do a front snap kick nine days after a hysterectomy and pelvic reconstruction is doing just fine. She rolled her eyes.

My patient from Guatemala left my office smiling. The ultrasound and fetal monitoring showed that everything was normal, and she walked slowly to the door, physically exhausted but emotionally vibrant.

Like all my patients who are illegal aliens, she shows no sign of depression. Maybe it's the water drawn from the community wells. Or a mineral absorbed by their bodies from the dirt floors. Or perhaps it's only that the people who have the courage to make a new start are the people who do not know depression. The complication accompanying her case, if any, is simply the place of her birth a country where malnutrition, not depression or obesity, is the common complaint.

My patient left her home and journeyed 1,000 miles, so that her child could be born in America. She suffered. She saw that life could be better. And she made a change.

Our dreams are the beacons that tell us who we need to be, where we need to go. When we try to avoid the struggle, life becomes an abyss of dissatisfaction. It's a problem no physician can fix. Only the individual can choose to believe in the importance of his or her purpose in life.

Our efforts are the way we thank God for the gift of life. There is no worse complication than an unfulfilled soul.

Dr. Litrel is in practice at Cherokee Women's OB/GYN in Woodstock and Canton and is a Clinical Assistant Professor at Emory University School of Medicine. He lives in Towne Lake with his wife Ann and their two sons Tyler and Joseph. (mikelitrel@attbi.com)

It's just as true in the practice of medicine as it is for anything else in life - trouble comes in threes.

Number One was a pregnant patient, a woman from Guatemala who had just arrived in Georgia. This was her first visit to a doctor, and although she seemed not to have any problems, her dates suggested she was due any day. We decided to see her immediately. There's nothing worse than arriving at Labor and Delivery to deliver the baby of a woman who has never seen a doctor. It can lead to surprising medical complications and exciting, sit-on-the-edge-of-your-seat deliveries.

We try to avoid those.

My patient's face was lined with exhaustion, her feet covered in calluses. These could be related to the fact that she had just made a 10 week trek to get to my office - I'm pretty sure Guatemala qualifies as 'south of the border.' I ordered her an ultrasound and fetal monitoring.

Number Two arrived in a huff. She had received a hysterectomy from me 10 days earlier. I had also fixed her leaking bladder. The good news, she told me, was that it was no longer leaking. The bad news was that now nothing came out of it at all. In surgical jargon we call that "over-correction." The implication is that you did too good of a job. Surgeons don't like to admit mistakes.

At least, this one doesn't.

In the past 18 months, I had done over 100 of these operations, without a complication. But somehow my patient didn't find it comforting to know that she was the first one to experience a problem.

The easy remedy would have been to keep a catheter in place to allow drainage. Normal inflammation would soon have subsided and all would have been well. But my patient wasn't really enjoying the catheter. She wanted to catheterize herself, as needed - a relatively simple task. Like removing a splinter from your rear.

The patient and I struggled together for the next half hour. Actually, that paints the wrong picture. The patient and my nurse struggled together for the next half hour, and I periodically stepped in to check on their progress. Watching the suffering of another human being produces a very real pain, an ache just below the level of your heart. It aches even more when the suffering individual holds you directly responsible.

By this time, Number Three had arrived. She is someone I know well, and was also in agony. But she does not suffer from a surgical complication. Hers is spiritual.