One of them is “I know what I’m doing”.

Consider these gentlemen.

The only thing common among all four of them except their Darwin award-worthy overconfidence is that they are all dead.

1. Henry Winstanley - An English engineer who was so certain of the build quality of his lighthouse that he decided to stay inside it during a storm to prove its strength. Verdict: The sea took it on ego.

2. John Sedgwick - An American Major General who took the snipers lightly during the Civil War. “They couldn't hit an elephant at this distance”, he famously said. Verdict: Got relieved of his delusion.

3. Stockton Rush - The CEO of ‘OceanGate’. The company that made the submersible pod ‘Titan’ to reach the debris of Titanic. He ignored the dangers cited by his team of engineers and responded with “At some point, safety is just pure waste”. Verdict: Crushed in the depths of hell.

4. Timothy Treadwell - Believed that he understood grizzly bears like no one did and went really, really close. Verdict: Fed the bears his own liver that day.

We read news like these and move on with life, thinking we would never be in their spot because who on Earth has the time and resources to dive to the bottom of the ocean or play with hairy beasts. Well, it’s not about dying, per se. It’s about the common thought process that leads to it.

“I know what I’m doing”.

What You See Is All There Is

It isn’t possible to be a fan of Daniel Kahneman and not quote his pearls of wisdom when going down the rabbit hole of cognitive psychology. So here we go.

We are intuitive beings.

And we judge.

Be it your boss or your distant aunt. Everything about you is noticed and opined upon in whispers that are loud enough to reach back to you. Your dress, your smile, your ‘no’ to someone, your ‘yes’ to someone, your burp, your fart, you coming across as over-smart. Everything.

People say that it is easy to judge but it really is not. A true judgement requires a brainstorming that would exhaust the wisest of all. It requires an unbiased consideration of all perspectives of every party involved. The more information you have to base your judgement upon, the harder it is.

The easiest task is to pass a judgement based on limited information. That new girl in your workplace who smiled at your boss? Surely an opportunist who just wants to climb the professional ladder in the easiest manner. That intern whom you think rolled eyes at you today? Must have been feeling vengeful for what you did to him yesterday.

It is because when the facts are few, they fit coherently into a story that we frame in our minds trying to understand what could have happened. The more coherent a story appears, the easier it is to comprehend (cognitive ease) and the more truthful it seems.

Kahneman called it ‘What You See Is All There Is” aka WYSIATI.

Now, compare this with a complex case having convoluted facts and numerous contradictions in its arsenal. It isn’t easy to arrive at a judgement and the hearing keeps getting delayed. If you realize that the new girl is a bubbly person and smiles at everyone, your judgement seeks a hold. Unless bias or misogyny or being-a-hopeless-chauvinist makes you blind toward the facts.

This is one of the reasons why the candidates being interviewed for army officer vacancies are shown a still image for interpretation. It screams of an obvious clue but the candidates are expected to think out of the box.

Oh come on! Panic attacks are nothing

From “I know what I’m doing” to WYSIATI to this. One leads to another.

I’m talking about the denial of the existence of mental disorders in the world around us. All the more glaringly in healthcare.

The very nerds in white coat who are taught about mental health issues are the first to dismiss those of their juniors when they complain about toxicity and inhumane working hours.

There is an interesting thing about mental illnesses—they are invisible. And anything that is not visible cannot be validated until it is felt.

There are many individuals in this world who have not been mentally ill, or have compensated their distresses with such strong psychological defense mechanisms that they feel mentally healthy. It includes our parents. Even our bosses.

How do you tell them that their conviction in mental illness being a hoax is actually a result of their ignorance combined with WYSIATI?

How do you make someone aware of their lack of awareness? And that they probably shouldn’t believe they know what they are doing?

TheUnknownDoktor

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My legs don’t lie still and I lift them against the wall beside my bed while my torso lies flat. My elder cousin sister chides me for not changing into something comfortable. Not the position. The clothes.

A tight-fitting jeans held in place by an extra-holed belt. It was the usual home-warming ceremony for every belt I purchased. Getting the extra holes to fasten the tongue of the buckle around my skinny waist.

I’m five years old. A kid who has no idea that this simple comment by his cousin would connect all the dots retrospectively twenty years later.

Why don’t I change into something comfortable?

I wish I was taught that I don’t need to be taut.

It isn’t about the pajama

If you want to deliver sweet agony to anyone on the OCD spectrum, try asking them to correct a spirit level. I learnt it the hard way while fixing my pull-up bar.

I don’t even have OCD. Just the recesses of it. I have come long past the full-blown version I had in school. When I would jump over the shelves to correct the knot on my treasury tag file, just to make it a neat ‘figure of eight’. I remember doing that a hundred times in one day. My God…the soreness I had in my thighs.

The obsession part still lingers in my everyday life, though. Like the scar mark all of us have on our knees. This obsession is a reflection of my perfectionist attitude toward life. Something that I have inherited from my dad. He had no choice but to be perfect, considering that he was the eldest sibling of a single working mother.

His uptight way of life was a wall he made from the bricks life threw at him, cemented by his desire to keep the family boat afloat. Elder sibling syndrome in all its glory.

It all makes sense now. Why I had internalised that rigid way of life. Why I wanted things to be a certain way with no scope for compromise.

Why I kept my pelvis tight. To the extent that I had tender points in my whole abdomen and pelvis. Painful regions of contracted muscles that would yield in a sweet agony when pressed hard. Something that I have been dealing with for ten years now.

When my friends would go on a loo break in the recess, I would think how come they are so inefficient at controlling their bladder? For someone who would just wash his hands, have his lunch, and use the washroom only at home when school got over, it never made sense to me.

I had never learnt to relax. The tension in my bladder. The tightness in my muscles. The constricting feeling of the clothes. I had normalised it all. This alone was the reason that I suffered from an undiagnosed illness in the prime years of my life.

I have come a long way ahead. I can sense my uptight behavior hindering a pleasurable experience when I don’t feel like taking a shower before bed, even though I’m all exhausted and stressed.

I can see through my unwillingness to relax. And yet, it catches me up.

That boy lying in those tight jeans wins over at times. Refusing to let it go. At work. At home. With my partner. With strangers. It grabs my arm and whispers in my ear.

Maybe that’s why there is only one way I want my Americano, and nobody can make me wear the pajamas here.

TheUnknownDoktor

A flash flood had submerged their necks leaving only the heads bobbing along the waves of peril. Were it not for the human chain they formed, their impromptu plan to trek in the valleys of Mahabaleshwar would have turned into a lifelong lesson for us college juniors.

The terrain was unforgiving but what kept them alive was the trust they showed in each other. The trust that the one holding their hand would lead them to safety.

You don’t really need help of a certain herb smoked in a rolled up piece of paper to contemplate the importance of this five-letter word.

Trust is an indispensable tool at the disposal of Man. And animals, for that matter.

Take my Senior Consultant of Medicine, for example. I remember sitting with him seeing the OPD when a patient presented to me with breathlessness. “What’s his oxygen saturation?”, he asked.

I quickly pulled out my pulse oximeter and told him the reading.

“92, sir!”

He thought for a minute and then asked me to perform an arterial blood-gas analysis on him. But immediately, he applied the oximeter again on another finger of the patient, just to confirm.

It then read “96”.

The value was no longer abnormal.

He looked me in the eye and said, “Tell me. How can I trust you again?”

A laptop bathed in oil

I was in first year of college and had just bought a laptop. A 360 degrees foldable tablet-cum-laptop I couldn’t take my eyes off. More so because I imagined doing the stuff of writers on that machine. Going all clickety-clack on its keys as I poured my thoughts on the screen.

One day, my roommate asked for it. He was planning to watch a movie and although, I’m not very fond of sharing my gadgets — because of reasons that would be obvious very shortly — I agreed.

The next day I got my laptop back in a condition that had my heart shattered. There was a layer oil on the keypad and the screen. Basically, everywhere my rommate’s fingers wandered. Who doesn’t like munching on snacks while watching a movie, after all?

It was not a major offence. But it was something that consolidated my already established opinion. That I can’t trust anyone just like that.

Maybe people aren’t as uptight and anxious as me when it comes to living life. Maybe I take it too seriously. Like not wanting my books dog-eared by another classmate. I agree that I had asked him to not disturb my bookshelf even before he had a chance to sabotage the corners of the books, but not like I could have waited for that to happen. I knew them. I knew how they do what they do. I knew that these things didn’t matter to them and I might come across as a snobbish jerk but I couldn’t help it. I like my things a certain way and that’s the reason I can’t trust people enough to share them.

Just like my senior consultant who liked it his way. Immaculate. Flawless. No chance of error whatsoever because for him, patients reigned supreme. It was his way of conducting his professional life.

It is my way of keeping my gadgets.

Not oiled.

A little obsession is the rule of life, I guess?

TheUnknownDoktor

The espresso arrived in a shiny white cup, bathed in sunlight, casting an eloquent shadow on the only cookie beside. This is all it takes to put a smile on my face because I have a clearer sense of what I reject than what I seek — a reflection of my not-so-flexible personality.

The sophisticated customers you see in cafes, placing very precise orders with very specific customizations, aren’t always snobs who pretend to be superior to others. Many have an outer shell toughened with tightly wound perfectionism to make life less unpredictable. That’s why they prefer ‘the usual’ because it doesn’t kickstart the fight or flight reaction their nervous system is so habitual of.

I’m rigid in a special manner, though. It’s not just the taste but also the fascia. The whole abdomen and pelvic region that goes stiff like a wooden board and constricts me from within. The muscles, the nerves, everything becomes irritated as if physically manifesting my behavior on the outside.

I have considerably outgrown the anxious, uptight kid I once was a decade ago while preparing for the medical entrance exam.

Even though the behavior has largely changed, the fascia still holds the memory.

Of the habits carved out that haven’t faded.

The miracle drug

It was the night of boundless despair. My tummy screamed from inside as I coughed my guts out. The acid in my airway just wouldn’t budge. The stiff fascia was pushing my stomach so high that the sphincter couldn’t work and acid refluxed constantly all the way up, spilling into my upper airway.

I am certain that had the doctors witnessed my symptoms, they wouldn’t have brushed them off as just another case of GERD. It was the label affixed to my ailment. Plain old GERD (Gastro-esophageal reflux disease). This happens when your set of symptoms does not fit into one cliche diagnosis. Either you are a freak or a hypochondriac. Imagine getting a Band-aid for an amputation. This is what it feels like.

My misery knew no light at the end of the tunnel. I was in a chasm that kept cracking towards the centre of the Earth. There was one last resort, however.

The drug that was prescribed to me when all of it began.

Ten years back.

A strip of escitalopram — an antidepressant — lay untouched on my bookshelf. I had ordered it that morning itself, driven by an impulse I can’t explain.

It was mainly to feel better and come out of the dreaded sorrow of helplessness by numbing down my negative emotions. But partly, it came from the idea that I was on the same drug for two weeks while preparing for my entrance examination. The symptoms had originated then as mild discomfort, and were managed by this medicine by my doctor. Although it just consolidated his belief that my illness was all in my mind, his confidence would later prove to be fallacious. We doctors are notorious for this.

What escitalopram did was soothe the nerves entering the core of tender points in my fascia. The constantly irritated bundle of fibers blaring the ‘pain’ alarm.

Calm nerves lead to relaxation of tender points, releasing the deep knots within my fascia and muscles. The effect was magical. Within five minutes, the cough stopped. I finally had a Eureka moment.

And I knew that the effect didn’t stem from the anti-depressant action of the pill.

The daze

Escitalopram goes by the brand name Lexapro in the United States. It is the most common prescribed anti-depressant because of its minimal side-effects. When I say minimal, it’s relative. Because in the absolute sense, they are still a lot.

The biggest downside I find of escitalopram is the sedation it brings along. The calm of serotonin surge also makes you sleepy. The thought process becomes foggy, and your decision-making ability slows down. Calm indifference takes the centre stage, and cognition goes into hibernation. Dream takes over reality. This was the state I appeared for my exams in. The final year exams of my graduation degree.

I remember sleeping for ten hours each night, even before that dreaded theory exam of Surgery, when other students put in an all-nighter to complete the syllabus. I remember waking up early in the morning and forcing myself to walk while studying because my brain was in snooze mode.

Things would have been better had I known that black coffee negates the sedative effects, something that I realized three years later.

For most, a cup of coffee is just that.

For me, it is the difference between reality and dream.

Whenever I have to pop in lexapro.

TheUnknownDoktor

My left wrist was bandaged with a hot roti (a bread made in south-east asia) because nobody had told my mom that warm compressions needed to be aesthetic.

I remember telling everyone at home that a basketball had sprained my wrist. That it hit at an unusual angle. That it wasn’t my fault.

It actually wasn’t. Not any more than standing up for your self-respect is.

It was the fault of the punch that had landed in the most unfortunate manner on that stocky kid who bullied me, that gave me the sprain. Kids don’t realize that their words can pierce through the protein-deprived shell of insecurity that many body dysmorphic teens carry.

Right after my wrist got hurt, I enveloped it with my other hand like a splint, trying to make the pain go away. In that moment, the bully grabbed my wrist and encircled it with his thumb and index finger touching by the tips of each other.

“It’s just that easy”, he said, making a snapping sound with his tongue, which of course implied that breaking my bones was no big deal for a giant his size.

Alas! Brother forgot that my bones didn’t carry my will.

TheUnknownDoktor

All I want to hear is, “I totally understand. It happens”.

All I want is reassurance. A warm hug.

A friendly tap on the shoulder, not a brisk yanking of advice.

I want to hear what embraces me gently, not what tries to solve my problem.

Because frankly speaking, I’m aware of what I need to do to get out of my once-in-a-while gloom.

We all are adults. We know that loneliness sets in now and then because every friend is busy with their own life. Everyone has graduated. It’s not college anymore.

Do you think I need to be told that interacting with people around me and indulging in a productive activity shall dissolve the loneliness to a great extent?

Do you think I’m oblivious to the fact that an intensive workout shall leave me feeling good?

I’m aware. Dear friends! I’m aware.

But don’t you realize that nothing can be a substitute for ‘everything’?

The ‘everything’ that included a warm coffee session with your best friend in college days?

How can an intensive workout match the feeling of being validated and understood over a brunch?

How can it be a substitute for the long drives and fun treks?

The urge to help

Naturally, every one of us has this tendency to craft a solution for our distressed loved ones.

We can’t see them in pain. We can’t see the smile waning off their face.

Hence, we immediately come up with a solution that sounds perfect in our own head.

There you go! You came to me with a problem, and I coughed up a solution that sounds fine to me, no matter how impractical it is, because I can’t deal with the anxiety of not being able to help a friend in need. I had to justify my sense of worth with an outcome, which I hereby serve to you on a plate of absurdity garnished with reason.

The patients with clinical depression, who are bereft of an inherent motivation to perform tasks can very well relate to what I’m trying to say.

I remember being the only student in a psychiatry class, and the Head of the Department sat just a metre across from me.

“Ask me anything you like”, he showered generosity.

“Why don’t depressed folks just perform a physical exercise, when it is known to enhance our mood?”, I asked naively.

What followed was a session of pure bliss, wherein I was informed about the nuances of mental illness, suicidal ideation and more.

“Depressed patients lack an inherent motivation to perform basic tasks. Sure, exercise can physiologically help to dampen the effects of depression. But how will the patient initiate the exercise without an impetus, when his neural circuits aren’t conducive to that? How will he sustain the exercise without his motivational neural pathways kicking into action?”

And there went the explanation for why “Just move your body” is a bs advice to be given to a psychiatric patient.

If not emerging out of empathy, your advice is most likely to be useless. And you cannot empathize unless you have experienced what it feels like to be in the other person’s shoes.

This is why most people throw impractical advice to people with a mental health problem, or any other situation that they have never experienced themselves.

The one who has been on a shrink’s couch is seldom quick to judge and is always more empathetic and understanding than any other random person.

My point is, most of the time, your friend just seeks a warm company. An affectionate touch of empathy. A plain and simple “I’m there for you”.

Advice flows in plenty all over the internet. One can just Google and be informed. The reason your friend chooses you is because he expects empathy which a glass screen hinged on a few buttons cannot provide.

TheUnknownDoktor

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It all began in college. Having cracked a tough medical entrance, I had secured admission to an envy-provoking medical institution. Life was good. Making new friends and developing new skills was not on the horizon anymore. It was in the palm of my hand. I had caught lightning in a bottle.

“This is my path, finally. All paved with gold”, I thought.

Then life threw at me a rock so large that I tumbled down all the way to a dark, secluded place in a chasm of endless despair.

I could see people above enjoying their life and making memories, but they couldn’t see me. I was the only person in the audience of a drama performance, sitting in the dark, visible to none, while everybody in this world was out there on the stage, illuminated with plenty of sodium lamps for everyone to see.

I and my struggles hid in plain sight. This was not the kind of invisibility cloak I had dreamed of.

When I was a kid, watching all the fantasy TV shows with magic as the common theme, I would think, what if someone was troubled by a supernatural entity that couldn’t be discussed with others because nobody else could understand him?

Something akin to Harry approaching the Muggles to save himself from the dementors?

The child in me never knew that it doesn’t exactly need to be supernatural. There are certain phenomena that nobody may ever understand because they fall into the blind spot of science.

Whatever is counterintuitive but true is just a step away from a scientific explanation to be rendered intuitive and true. Until then, it is mystical.

So, when something is inexplicable and can’t be empathized with unless experienced personally, it is akin to magic. Quite a dark one.

And I was unfortunate enough to be in those shoes, running away from a soul-sucking sickness, trying to explain my condition to the Muggles of healthcare — the doctors who thought they knew everything.

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The beginning

I remember the day clear as a mirror. I had woken up from sleep, and my throat was burning. I didn’t feel like having breakfast, and my tummy hurt.

A quick consultation got me diagnosed with GERD (Gastroesophageal reflux disease). An illness in which a valve-like structure — called the sphincter — otherwise preventing the contents of the stomach from entering into the food pipe, malfunctions.

It fails to close properly, and as a result, acid literally comes up the food pipe into the throat and even the nose. It also trickles down into the windpipe and initiates a cough reflex. The resulting symptoms are burning pain in the throat and beneath the chest, cough, sneeze, runny nose, etc.

There exists no medicine to strengthen the sphincter. The only possible medical intervention is to take proton pump inhibitors that reduce acid secretion and lessen down the impact of the disease while the body heals on its own.

Sometimes, a Helicobacter pylori stomach infection is the culprit and hence I was administered a course of antibiotics as well.

But all in vain.

I was not improving, but the gastroenterologists dismissed me as a case that was not worth much attention.

Anybody who has suffered from GERD knows that lifestyle changes are important for the cure. Some of the adjustments that need to be made are avoiding oily food, caffeine, chocolates, and raw tomatoes, raising the head-end of the bed to prevent reflux, and having smaller and more frequent meals. And if someone fails to improve, the doctor quickly labels him as a lazy lad who didn’t put in enough effort for improvement. I was blamed similarly despite employing all the corrective measures.

“It’s not that big a disease; stop whining,” the men in white would say.

I got several invasive tests done. A portable camera through a scope was inserted via the mouth into my stomach to visualize what was wrong. It’s called endoscopy, and it was done three times and came normal every single time.

Unable to see the light at the end of the tunnel, I pleaded with the doctors to surgically correct the defect and tighten my sphincter.

It required me to undergo another diagnostic test called a 24-hour pHmetry to observe whether my disease was significant enough to benefit from the surgery. Whether the benefit-to-risk ratio was in favor of having my innards handled and manipulated in a procedure that could go wrong in many ways.

So, I had a scope inserted in my food pipe via the nose for 24 hours, which measured the amount of acid my food pipe was exposed to.

And the verdict came not in my favor. The result showed acid reflux, but it wasn’t significant enough to cut open my tummy.

Another test was performed to assess the motility of my food pipe, called esophageal manometry (sometimes, the coordinated muscular movement called peristalsis is dysfunctional, which can cause sphincter problems). But alas! It was again normal.

By now, the doctors were fully convinced that it was ‘all in my mind.’ I was wasting their time on something I should have ignored as if it wasn’t real.

I was dejected and helpless. There wasn’t a day when my throat wouldn’t burn. I was unable to eat or drink anything and lost 10 kg of weight in just a month. My skeletonization was in progress, and it appeared like I was getting decomposed alive. Nobody had a clue what was going on. I changed innumerable doctors, but everyone failed to see beyond the walls of orthodoxy.

During the COVID lockdown, the acid trickled down into my windpipe and damaged its inner lining. The latter could no longer act as a barrier against the bacteria, and infection followed. I coughed thick greenish-yellow sputum tinged with blood streaks. The cough was so vigorous that my chest hurt whenever I coughed. I wanted to end it all. My helplessness knew no bounds.

Unable to satisfy even the most basic and bottom-most rung of Maslow’s hierarchy of needs, I was very demotivated and low in spirits.

My life seemed like a free fall without a parachute. And the worst part was that nobody could understand my pain. It was not a fracture or a paralysis to glare in their face. People wondered why I was getting skinnier. Some made fun of my condition, while others ignored.

And I continued to suffer.

Despair was in the air. I remember assessing my wrist for the exact point that could end all my troubles. A single nick on the bounding pulse would exsanguinate my worries.

It was the morning of an exam, and I broke down. A barrage of tears flooded down my cheeks. My friend hugged me and assured me that whatever came, we would handle it together. After somehow appearing for the exam in a mentally clouded state, I headed straight to the psychiatry department.

Sitting in the shrink’s chair, I vented my heart out. How I had been suffering from a mysterious illness, and nobody had a clue about it. He quickly labeled me a malingerer and dismissed my complaints. The downslope didn’t seem to end.

When grief strikes, we go through many stages, from denial to anger to, finally, acceptance. The process of emotional healing requires empathetic support from friends and family. When this support is deficient in your journey through the gloom, you are left fighting alone in a strange, cold world where nobody understands you.

Rising from the ashes

After two years of squirming in the thick soup, the cosmic wheels turned a little.

Fortune smiled upon me, and I came across this video of Dana Sterling.

A physiotherapist by profession, she described a concept called the ‘myofascial continuum.’

She explained how all our body parts are wrapped around in a tough sheath called fascia which was hitherto supposed to be only a supporting structure with no essential role whatsoever.

This layer of connective tissue wraps all our muscles, nerves, and blood vessels. In the first year of medical college, while performing dissection, nobody bothers about the fascia. It is a structure that is carelessly removed while focusing attention on the apparently more important muscles, nerves, and blood vessels.

But Sterling believes that everything in our body is connected to the other via this fascia and that it has the ability to contract (a big statement as it was long since believed that fascia is a non-contractile structure). Sterling says that when a region of this fascia gets contracted into a tousled mass called a tender/trigger point, a distant point much away from this tender point feels the stretch. The distant point then manifests as a pathology because the fascial stretch reduces the range of motion of that particular part.

To understand this, let’s create a hypothetical scenario. Suppose you are in a group of four, and each person holds one corner of a bedsheet without pulling it toward himself such that the bedsheet lies slackened. Now, if one person suddenly pulls the bedsheet toward himself, the other three experience a pulling force that has actually originated from one particular point much away from them. Consider that point as the tender point and the bedsheet as the fascia. A similar stretch is experienced at locations further away from the focus of contraction (tender point) as the fascia is stretched in the body.

So, if your shoulder feels stiff and painful, it could be that the fascia around it is getting stretched because of a tender point (felt as a taut band or a knot in the muscle), say, in the back. Releasing that tender point releases the stretch of the fascia at the shoulder, and the person improves. That’s the concept of the myofascial continuum in physiotherapy.

This breakthrough has been a boon for people with chronic pain. Sadly, though, many practitioners are still unaware of this phenomenon.

It was the ultimate Eureka moment for me.

I could sense gravity, a constricting force in my pelvic muscles, which made me suspect that this phenomenon was at work.

But there was a problem. India is deficient in skilled physiotherapists. Most of them couldn’t crack the medical entrance and instead studied for a bachelor’s degree in physiotherapy from a tier 3 college. All they ever do is sit in a toilet-sized room and perform infrared therapy, whether indicated or not.

I was in Pune, and I rummaged through the whole city. I also travelled to Jaipur but all of them were a disappointment as they knew nothing about the theory.

Then, I contacted a physiotherapist in the USA who was well-versed with the fundamental concepts. Since I was a student and long-distance therapy couldn’t work, she advised me to search for some physiotherapists nearby in Mumbai.

My stars aligned, and I met one. She was the first person to initiate some improvements in my illness. But after a while, I reached a standstill. The kind lady then referred me to a friend of hers who emerged like a knight in shining armor.

He, too, had a clinic in Mumbai and approached patients holistically with a bird’s eye view.

As I stood bare-torsoed in front of him, he spotted the problem in an instant.

“You are breathing wrong,” he said.

I was breathing with my chest, not my tummy. The tension in my abdominal muscles was visible to him. I wasn’t fully using my diaphragm to breathe, and hence, my pelvis, which had somehow contracted into multiple tender points, refused to relax.

What’s more, I would sometimes unconsciously pause my breath when stressed, physically or mentally. This was a result of my disturbed, tensed-up fascia.

This resulted in the fascia lining my stomach being pulled upwards, taking along with it the sphincter we discussed. The resulting abnormal location of the gastro-esophageal sphincter disturbed its functionality, as in a hiatal hernia (the esophageal sphincter herniates through an opening in the diaphragm called esophageal hiatus), leading to severe acid reflux intractable to medical treatment.

What followed next was a series of visits twice a week. I would travel to and fro Pune and Mumbai for my physiotherapy. I learned abdominal breathing — which recruited my diaphragm in a better manner —and various abdominal relaxation exercises to release the myofascial trigger points.

The improvement was dramatic. I could see my worst nightmare vanishing before my eyes. It was magic taking its due course.

The struggle was real, though. By the time I reached college, the gates would be closed, and I would have to jump over the walls. It was quite tiring as well. The travel, the therapy, and the constant effort to study amidst all of it. Ultimately, I had to pass my exams also.

Even after the therapy ended, it was a long process wherein I had to be mindful of my breathing patterns and muscle tightness.

I wish I could say that I’m perfectly alright now. I wish I could end this fable on a happier note. But life isn’t a fairy tale, and the universe is indifferent to how the curtain falls.

Even after significant improvements, I have a long way ahead.

That’s just how my cookie crumbled, but thankfully, I had very supportive friends. Few, but enough. I always preferred quality over quantity and that is what helped me navigate the choppy waters. I had, and I’m still having a tough time dealing with the issue. Looking back, the disease was debilitating enough, but more than that was the fact that I wasn’t understood.

The journey was tough, but if I had to point out the silver lining, I would say it has made me a more empathetic doctor. Having been on both sides of the table, I know what a patient feels like and how a doctor should behave.

I’m aware of the grinding feeling of helplessness—the desperation to try anything and everything that could possibly affect a cure.

I’m aware of the need for soft skills in my fraternity, the need to not ride high on ego, and the need to accept that nobody knows everything.

Empathetic assurance goes a long way. Sometimes, all one requires is someone to say, “I’m with you, and we will fight together.”

TheUnknownDoktor

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References:

Myofascial pain syndromes and their evaluation

Focused review: myofascial pain