In the beginning was a void called Chaos – an open chasm of emptiness- infinitely deep, dark and silent. The Greek poet Hesiod poetically describes ‘Creation’ as the imposition of a positive reality on this negativity/ absence. Key to this reality was the capacity for change. The nothingness of chaos could have continued, eternally unaltered, but existence, once created, brought with it endless cycles of seasons, generations of humans, birth and death. This ‘willing’ of change, a potential of transformation of phenomenon and entities is a truth as old as time itself.
Hesiod’s poetic prowess inspired me to hold on to the crux of this reality, which is also the topic of my blog today- Transformation, as I recall a case of psoriasis from my early days of practice- just over a decade ago I saw a very kind lady in early 50s undergoing a transformation in her own right.
The onset of menopause and a stressful event triggered the appearance of psoriasis- a skin disorder that causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful and if left unchecked can affect the underlying joints as well (psoriatic arthritis).
She was a well known figure in her community, known for her benevolence and fight against social injustices. She recalled how her father inculcated these values in her and her 3 sisters from a very young age. Her childhood was spent in poverty, but rich in moral values. Being the woman behind a successful husband and raising 2 children, the rags to riches transformation of this couple was built on sheer hard work and the ability to face any hardship with a smile and positive attitude.
It was an unremarkable case not much to play off of in terms of personal life history, no traumas, and on paper looked fairly straightforward and I started her off on her constitutional remedy, Phosphorous and the results looked promising. The remedy also lowered her high blood pressure and transformed her initial scepticism of the treatment process. I was glad I got such a quick result without having to work too hard on the case!
However, during routine follow-ups I would sense that everything was not OK. The psoriatic patches were improving, she could see her normal skin coming back after a period of almost 7 years, but I would sense some dissatisfaction, I could see some cracks developing on a shell of her persona that she had seemingly created in her adult life.
A shell that portrayed strong will and character on the outside to protect something deep and vulnerable inside. 6 months later her psoriasis came back with a vengeance. This time involving the scalp, both her elbows and right shin and knees. Her blood pressure was also slipping out of control.
A physician-patient relationship needs to be built on trust. And I wanted to gain that trust and permission to probe deeper. It was revealed that there was a deep sense of guilt that stemmed from a tragic accident. Out of respect for her, I will not elaborate what this accident was, but sharing this grievous past and how it scarred her for life was a very cathartic moment for both of us. I now understood why she had to put on a smile and portray strength and optimism while she was ridden with guilt and grief inside. There was no other option for her. She had to be strong for her children, husband and his family. She had always been the cement that bonded the clan together. If she broke down, everyone around her would have lost hope too. Clearly, I was seeing traits of remedies like Carcinosin and Aurum metallicum.
She also admitted feeling disgusted of her skin condition and in her words “Everyday is a big effort to make sure everyone around me is happy. I have to ignore my burning pains and this filthy skin and wear a smile on my face to reassure everyone that everything will be fine, the business will flourish and the kids will be alright.”
So with a fresh perspective we changed her plan of treatment and observed results that followed proper direction of cure- from inside to outside, skin healing from above downwards, and from more important organ (BP stabilizing first, followed by resolution of psoriatic plaques) to less important organs.
Sept 2008, relapse June 2009
Little over a year after we first started treatment, we finally achieved the result we yearned for, after a series of transformations- triggered by the remedies at different stages of treatment led to awareness of her true feelings that she kept on suppressing. She started seeing beyond the circumstances that were out of her control, she realized to stop blaming herself. She realized she was allowed to be herself since she had a loving and caring family and she did not have to portray a pillar of strength just for sake of appearances. She accepted her vulnerabilities and recognized she had to start genuinely caring for herself in order to preserve the strength in the family and that putting u a façade was futile. She gladly put it in her testimonial as “Dr Aziz, you did not just transform my skin, but transformed me to a much better human being. Thank you!”
This case transformed me as well. It made me empathize more and this new found empathy helped me to recognize what was the core feeling and cause of the disease process in my patients. And once I identified that, I was able to establish trust and it made the whole case taking process so much easier.
“Real transformation requires real honesty. If you want to move forward – get real with yourself.” Bryant McGill
The Universal truth:
I mentioned will in the beginning of this article. The will to bring about a change, is the key to all transformations. Before we undertake any task, there is Intent, which rises out of the will to make this happen. Had it not been the remedy’s potential to trigger this will in my patient, she would have been resigned to the abyss of her deep seated and suppressed emotions which was the cause of her psoriasis- this was her chaos.
I realized I had to accept my vulnerabilities as a practitioner, the futility of portraying an image that I knew everything and I could promise to treat any malady. I was open to learning every day, becoming more realistic of my abilities and the potential that I had to effect a change in the lives of my patients to whom I am grateful, for the trust they show in me. I learned not to be afraid of failure, but learn from my mistakes and not be in the same place in life, I was afraid simply of not trying to move ahead. And this still rings true today and am humbled by what my patients can teach me, everyday.
It is not true that our emotions are slaves to our circumstances. Remember, we all have the will to transform. This seed of “Will to Transform” was planted when we were all created. We, as a human race have come such a long way, that we have forgotten about this. We just need to find it in us, at the right moment. I did. So will you!
Dr. Aziz Merchant, BHMS, MDHom