my pain is no more

You won’t understand why, you’ll think I was selfish. You’ll say I had so much to live for. You’ll say you never knew but the signs were there. I didn’t become withdrawn because I was mad at you, I didn’t start covering myself because I was cold. I didn’t stop eating because I was on a diet, I didn’t stop talking because I had nothing to say. I just got tired of not being heard, I got tired of screaming but feeling as though I was simultaneously put on mute. I got tired hurting, I got tired of crying myself to sleep every night. I got tired of pretending I was coping. I got tired of trying and that I did, I tried, I really did but I’m sorry I failed. You won’t know how to mourn me because you’re hurting and you’re angry but you’re also confused. It was never my intentions to cause you any hurt and I’m sorry that my liberation has become the source of your pain. Maybe now you’ll understand why I hugged you longer and tighter than usual the last time I saw you, maybe now you’ll understand why I felt the need to keep telling you that “I loved you” over the last few days. Maybe now you’ll understand.

My name is Yannick Leyka*, I’m 25 years old and I’ve suffered with depression for as long as I can remember. It was my secret and I guarded it with my life, the very life it has now taken. I guarded it because depression is weak and how dare I as a black man ever portray weakness. It was my secret until it wasn’t, it became too big to keep. I thought that maybe if I spoke about it, it would make a difference but no one understood. So often it was brushed off with comments like “it’s just a phase, you’ll be fine”  or “stop mopping around and be a man about it.” You just didn’t understand but I don’t blame you. From the outside looking in, I had no reasons to be sad, to be demotivated or to feel broken or empty. My life showed so much promise and being unhappy always made me feel as though I was being ungrateful. It didn’t help that I just never learnt how to express myself effectively so I shut the world out because words always escaped me, in a similar way to how they’re escaping you right now. It isn’t your fault and I don’t ever want you to think that it was.

I tried, I really did but to feel sadness without cause and to try fill the void to a black hole created a paralyzing frustration. I remember sitting alone in my room staring at the wall for hours on end, wondering what life would be like for you if I was no longer around. I cried everyday because I was in pain. Sleep was my only escape and even that was taken away from me, as I’d lay in bed for hours before eventually dozing off, sometimes dawn would come without me shutting my eyes at all and wondering off to my perfect world; to the world where my pain was null and void, the world where I didn’t have to hide myself, the world where I was free. Maybe if the sleep was permanent, I’d finally know peace, I’d finally know happiness.

Every 1 in 10 persons you meet are suffering from depression, you may have missed it with me, you may have overlooked the signs with me but now I need you to learn to pay attention, it may just be what saves a life.


Mental Health

I want to do a series of entries all in the hope of raising awareness around mental health. The hope is to challenge the stigma and ignorance around the matter.

While I was in one of the wards of the Sterkfontein Psychiatric hospital I met two very interesting patients. They had both been diagnosed with Schizophrenia and were both on medication and that’s where the tales of 2 cities began.

The first patient, lets call him Peter. White male in his mid 30’s, he was diagnosed 10 years ago after weeks of bizarre behavior. He was brought in by his family and Schizophreniform was the diagnosis made at the time and treatment was initiated. He responded well to the medication, his family participated in counseling and he is now an outpatient who just comes in for his scheduled check up. He seemed well groomed, euthymic and reactive (this is how you say normal in Psychiatry), however there was a sign or two of residual symptoms I was able to note but nothing alarming. Peter works for his family and lives what he calls a ‘relatively normal life‘.

The second patient, lets call him Tshepo; a black man, also in his mid 30’s. He was brought to the hospital by the police after he was involved in an altercation with a security guard. He’s convinced that the security guard had been following him and trying harm him for years and he was just defending himself. On further investigation, Tshepo tells you that he’s been living on the street for 8 years now. His family and community chased him away as his behavior, too, became bizarre. They believed that he was possessed by demons and would harm the people in the community. He spent years on his own moving between neighborhoods, where his symptoms worsen. The diagnosis of Schizophrenia was made upon admission and he’s had a poor response to medication, including Clozapine.

Risk factors, socioeconomic status and genetics asides. These two cases started off in an almost parallel universe to each other. Both man developed Schizophreniform in their mid 20’s, elicited bizarre behavior and eventually found their way to a hospital. There’s no telling that if Tshepo had been brought in sooner, he would have responded to medication better, or that he would, too, be an outpatient living a ‘relatively normal life.’ The sad part is that we will never know. I was saddened by his history but the inspiration to write only came after I made my way home that day to tell my family about my first day in Psychiatry and my very well educated sister asked me if black people also suffered from mental health, in her words “no, it’s a white people disease, isn’t it?” 

Unfortunately that is the general perception in our black communities, mental health isn’t something that is accepted or even seek out. Parents hear that their children are performing poorly at school and start calling their them stupid or get frustrated with them. Never realizing that it could be because they have ADHD or an Adjustment disorder. We distance ourselves because of the stigma and ignorance we continue to perpetuate. I’m not disregarding cultural and religious belief, but I’m challenging every person reading this to find a way to bring awareness to our family, friends and community. Mental health doesn’t discriminate, it can affects anyone; any age, gender, sex, race or religious background.

How many people are roaming our streets everyday with undiagnosed Schizophrenia, Delusional disorders, Schizoaffective, or mood disorders with psychosis that we have separated ourselves from because we want to protect family names, the community’s dignity or refused to deal with the burden of the disease. It’s nobody’s fault and instead of rejecting mentally ill individuals and leaving them out on our streets where they may post a danger to themselves and to others, where they are vulnerable to mob attacks and other form of abuse, we should take them to hospitals and mental facility that specialize in aiding them, just a Peter received aid. 

Let’s educate ourselves and let’s educate our people. 

They are patients, not disease presentations.

Having Family Medicine as my first clinical rotation felt like a cursing and a blessing. A curse because of the extensive gap in my clinical knowledge and reasoning, and a blessing because it’s a rotation that really makes one think about the type of doctor and ultimately person they want to be. It made me question everything I thought I knew about doctor-patient interaction. It was an amazing experience seeing the actual practice of Mcwhinney’s principles; a doctor who knew his patients’ names, history and diagnosis before he even read through their files. Being committed to the patient, the patient’s family and understanding the psychological, social and environmental background from which they come from. Both the acute and chronic management was founded upon a relationship where the patient’s opinion and views were considered and discussed, allowing for the decision and commitment to be mutually made by both parties.

However the high of the experience only lasted so long, shortly into my first day at the general practice I was allocated to, I started feeling an overwhelming sense of sadness. I had seen sick patients before during hospital practice day in third and fourth year but somehow it felt differenct this time. I guess I realized that my experience of sick patient was mostly being told to percuss their chest for a pleural effusion after 3 members of my clinical group had already done so. I’d greet and ask for consent all the while knowing that the choice has already been removed from their hands. For as long as I can remember I’ve always looked at a disease as an isolated organ or a system, imagining the changes, breakdown and death of tissue. The way the drugs would interact with receptors, how systems would get blocked and how pathways would proceed. As I stood in that consultation room, all of a sudden it wasn’t an organ or a system that I saw, it was a 65 year old woman named Marie* who had gotten diagnosed with hypertension 10 years ago, her blood pressure has been getting worse in recent months and it’s not because she had been defaulting on her medication. She also reported getting this left sided chest pains for the past month, but the hypertension and chest pain were not her reasons for encounter. Today she brought with her 3 year old great granddaughter, Sarah*. Sarah’s mother and Marie’s granddaughter died from Tuberculosis after months of struggling with AIDS two years ago. Marie has been looking after the child since. She’s complains that Sarah has been acting different for a few weeks now and just two days ago while bathing her, she noticed vaginal discharge and a swollen labia. She’s been having nightmares and more frequent chest pains since then. Although she’s suspicious, she refuses to believe her own gut feeling because the only male in Sarah’s life is Marie’s son 38 years old Paul* who moved in with Marie 3 months ago to help her out financially. I quietly sat in that consultation holding back tears, feeling helpless as I realized that I lack the emotional maturity to handle such a delicate situation.

I found myself asking a very important question, ‘do we receive the proper psychological training to deal with our clinical years?’ Or is it just estimated that in a difficult situation we will know what to do, that our skin will be thick enough and that the decision we will make will be the right one. The only conduct that I have is that I must respect autonomy, make sure that my practice not only uphold justice but is also non-maleficence and therefore completely beneficent to the people I serve. I’m supposed to be patient-centred but what happens when my baggage becomes too much to bear, how do I tell Marie that her only son and household provider is also abusing her great granddaughter? This is the part where I should rely on my community resources; refer Marie to the Teddy Bear clinic at Charlotte Maxeke Academic Hospital or an equally equipped organization to deal with the matter. How do I even say it out loud? I’m supposed to follow queues but she has a blank stare on her face. What do I say? How do I go on with my day and see another patient after this? I do not know how to keep going and ignore the feelings that I’m not supposed to have. I don’t know how to smile when I really feel like crying. I don’t know how to tell you it’s going to be okay when I can’t begin to imagine what you’re going through. I can’t minimize your situation, pain or anxiety to a statistic. 

I was never told and I was never ready. How could medicine hurt me so much? We are taught everything from a scientific point of view, it isn’t infertility until you’ve been trying for longer than a year, HIV is not a death sentence if you take your ARVs, changing your diet and exercise reduces morbidity in hypertension etc. We’re so focus on dealing with the disease but we fail at addressing the illness. We don’t know what the inability to conceive, even if it isn’t scientifically diagnosed as infertility means to a couple or the family dynamics. We don’t understand a person’s ability to grasp that their lives will never be the same because of their status. We don’t understand that sometimes it isn’t a lack of will but rather the feasibility in having dietary changes and exercise, especially when we don’t engage the patient in details; substitute for food types and what type of exercise to do. We’re told to be biopsychosocial doctors in a biomedical setting.

Over the past two years, I’ve learned about diseases’ pathophysiology, presentation, complications, differentials and management. My main priority has always been to remember it in that order, essentially make a diagnosis and treat the disease. I never learned to remember a patient’s name, I never learn to address their illness, help them understand or come to term with their condition and how it may be impacting their livelihood.

I also understand that it doesn’t help me to point fingers at the ‘system.’ I am a student doctor and it’s time for me to take responsibility for my learning and the type of person I want to be. At what point do I stop allowing myself to be a product of a system I consider flawed? I needed to ask myself ‘what makes a good doctor?’ is it someone who has the highest possible marks in pathology but struggles with the patient interaction and expressing empathy or is it someone who’s great at expressing empathy and social interactions with patients but struggles at pathology? In my opinion, we have to thrive at both, we have to be socially aware, trade with caution and understand that we are trusted to deliver healthcare, to promotes health and rebel against the mediocracy seen in the public setting, in our schools and even amongst our peers. How long are we going to continue to hide behind the lack of resources as an excuse to continue providing a poor service?

A good doctor is more than a healthcare professional, a doctor is a teacher, a leader, an advocate and an agent for change. We need to stand for the very patients we treat, we need to promote ethical and moral behaviour. Challenge structures that we disagree with in the hope to transform the medical world not only for ourselves but for those who are coming after and those that are coming to us. Academics will make me a great scientist, social awareness makes you a great socialist and empathy makes you a great human being. As an aspiring doctor I need the all package, I need to pursue and learn more than what is made available to me in the classrooms and in the ward setting.

I am truly grateful for this experience, I’m grateful for having learned how to look at patient as a whole rather than a disease. I found myself trying to remember at least one detail about the life of every patient I saw, their spouse’s name, what their children are studying etc. And after a patient had received a negative prognosis, I’d sit with them in silence and let my presence represent a sense of support. I do not know that I’ll become a family physician, but I know that I’ll take their values with me everywhere I go.

Starting to resemble medicine, maybe a little bit. (Pt 2)

For most people, including myself, today is the first official day of fifth year. We’ve all been separated into clinical groups of either 14-16 students (mine is called 4A) and scattered all over different hospitals and rotations. My life has also officially been broken down into periods of either two or six weeks; the duration of a rotation and the amount of time between exams.

See one, do one, teach one, get comfortable, get inspired, write series of exams, move on to a new rotations and repeat. We should no longer refer to ourselves as medical students, but rather young doctors in training; It’s time to be on your feet the whole day, clerk patients, be on call, all the while trying to study, eat, sleep, stay healthy and maintaining a normal life too, basically doing all that Grey’s anatomy growing up stuff.

I had a hard time falling as sleep last night, I felt quite anxious and overwhelmed. I don’t like not knowing what’s happening and right now I’m as clueless as could be. The expectations and pressure is sky high and sometimes I forget that I don’t need to know it all, I’m here to learn and that’s kind of the all point. Change is uncomfortable, especially when it’s needed so I’m consciously having to remind myself to not be so hard on myself.

All I know is that today I start with Family Medicine, it’s a two weeks long rotation which probably means that my first exam and/or assessment is in two weeks. The overall break down is that the first two days comprise of a pre-test (based on contents I should have learned but probably didn’t in third and fourth year) and lectures with the HOD. You then get assigned to a general practitioner near you that you have shadow. You’re expected to go on a home visit, do a presentation, an observed consultation and as well as clerk as many patients as possible. I’m as excited as I am nervous.

Wish me good luck

The King who was also a Doctor (I hate pathology but I loved the pathologist).

Many had heard of him, but few had ever set their sight on him. He was a legend, the greatest who had ever lived. He barely ever left his dark castle but whenever he did crowds from all over the land would come to hear him speak, many young men and women hoping to gain favor in his eye. Many had come before us and many will come after us, all in the hope to make his rankings. A dark cloud covered up the sun and this darkness came with it. The silence was deafening. There he was; white crips shirt, red bow-tie and a wooden stick, he had a blunt look on his face and hoarse voice.

We struggled to hear him but no one dared to complain or ask him to repeat himself. He spoke of foreign concepts, told us of stories of strange deaths, laughed at his own jokes and coughed a lot. He spoke in great length of what he had planned for us, all the activities and trials we had to perform to gain his favor and commented on how many had fail him in the past with the spirit to frighten us. He was the king, no one dared to defy him, he wanted you to learn as he taught, speak and understand as he did, if you didn’t, you’d be struck with the red sword and forced to come back in the next season to try again.

As he finished talking and slowly walked away, the cloud disappeared and the sun was again visible. The timing could not be ignored. There we stood terrified by the images he painted to us, most of us were overwhelmed by the confusion, wondering what he meant by inflammation, the different types of necrotic tissue and why polymorphs were so important.

Yes, He was King, not by tittle or profession but by name. He was the adorable pathologist from the third floor, Dr King.

A letter to 2017

It’s that time of the year again; resolutions, reflections, new journeys etc. A new year is on the horizon and once again we’ve been given an opportunity to try, to do better and achieve more. It means so many different things to me.

Emotionally – it doesn’t erase whatever hurt, worry or other negative feelings I may be experiencing at the moment but it definitely redirects my attention towards hope, peace, happiness and optimism. There’s also a sense of accomplishment in having survived a year many people deemed to be worse in a long while. I’m ready for what’s coming ahead.

Physically – I’m all for a year of gym, healthy living and and fitness. Definitely going back to basketball, I’ve even gotten myself a new ball. I’m also really looking forward to having to smarten out my everyday look. Smart shirts, ties, chinos and smart shoes. It’s time to be a grown up.

Mentally and spiritually – it understanding how difficult this new year is going to be. It’s really going to challenge many of my core values, my priorities and my ability to cope with it all. I know school will be a thousand times harder. My sense of responsibility as a man is also developing quite drastically so that’s pretty exciting.

Academically – it’s goodbye blocks and hello rotations, hospital time, finally. To be honest I don’t know how to feel about fifth year yet. It’s nerve racking, but it’s also exciting. It’s a chance to finally see what being a doctor is all about. I think the thing I’m looking forward to the most is cancelling out on plans because I’m on ‘call’, it just sounds so Grey’s Anatomy. I love it.

2017 will be a great year, I’ll make sure of it.

Wishing Everyone a Happy New Year.

Medicine (An abusive love story)

I must have been 6 years old when we first met. In a blink of an eye we became inseparable. You were that friend that always kept me out of trouble so I knew my mom loved you. I stuck around you because you understood me and never once judged me. Young, but I cherished the values you preached and represented. Even though our bond and friendship grew, life started to happen so we’d sometimes go months without talking but you were always there when I needed you. You were there for me through the awkward puberty phase and the overwhelming sex drive that came with it. I started to notice the curves off your body, the scent you gave off and just how beautiful you were growing up to be. As you grew so did your complexity, you started to learn foreign languages, you read a different book everyday, spent a lot of time in the library and carried yourself with such esteem. However, the older we grew the bossier you became too; you took advantage of my kindness, told me what to do, how to dress and even which subjects to choose at school, forced me to be good at maths, physics and to abandon the arts. I was young and naive so I complied to your every demand with the hope that one day you’d be mine. Completely mesmerized by the being you were becoming. You hated how much time I spent playing basketball and hanging out with friends, hated how close I had gotten to other girls. You felt unappreciated and so you punished me by playing hard to get, claimed that I wasn’t ready, I lacked drive, spirit and wasn’t mature enough. I wasn’t ready to have you, I wouldn’t know what to do with you. Broken hearted I had to survive through the confusion and hurt in the hope that one day it will all make sense.

Time lapsed and I met another, she had features that reminded me of you, and I hated that about her. I grew up, moved on and reinvented myself. Never really keeping tracks on who you had become but hearing stories through the great vine of some of your accomplishments from the friends we shared in common, physiology has always had a big mouth. 4 years since I had last saw and really thought of you, you creeped up on me without a warning. I couldn’t ignore the chemistry or the beauty in our interaction. The endless conversations and laughs as we caught up on life. I had grown crazier and you had become even more beautiful. I asked you out and you said no then said yes a few days later.

It started out with us spending everyday together and staying up till the early hours of the morning talking on the phone. I could never forget the electricity in our first kiss. The sex was heaven, the journey was poetic and we seemed something rather magical. In love, yes I was. This was new to me and quite indescribable. The more time lapsed, the more of you started to become revealed and the more of me fell for you. Life happened we got busy but still managed to talk though. Sometimes you were clingy, moody or seemed emotionless, I equated that to the possibility of PMS. We fought more and laughed less, you hated how much I’d spend on my phone and claimed that I didn’t give you enough attention. I did not take you seriously enough and my efforts were limited. You needed more romance, more time, more sacrifice. You started driving me up a wall and frustrating me as I was already giving you all I had. How dare you say I don’t give you enough time, I couldn’t recall the last time I saw my friends and family, the same way I couldn’t equally recall the last time I wasn’t with you. You’re my life and I’ve admitted that, you own my heart, thoughts and body but still have the audacity to say it’s not enough. I’ve given up my friends, my job and even my family for you. Must I die for you before it’s enough. You control my life in a way that is frightening to me. I want to chill and watch a movie, but you want me to study – so we study. I want to see my family over the weekend but you want to me revise – so we revise. I want to sleep in and recover from last night’s study marathon but you want me to attend lectures and PBLs – so we attend. This is so toxic and yet I can’t walk away, the sex is too good, the love is too deep, we’re too intertwined. I couldn’t escape you if I wanted to then again I don’t really want to. What have you done to me? Why do I hold on so damn hard to you. You’ve become a part of me.

I love how you say my name and talk of a future with me. It’s quite clear that I love you more than you love me. Another fight you’re too jealous and controlling, I can’t take it, I’m out, I’m done with this. Frustrated and angry I refuse to think of you, it’s been two days now, I miss you but a man’s ego is a lot. You call me crying, you want to make up, I’ll come see you, I really hope your neighbors aren’t home, they’re really starting to hate us. It’s loud, it’s passionate, it’s messy. We get high, we eat and repeat. I stay longer than intended. Cuddles and booty rubs, love bites and endless talks. I wonder how long this peace will last.

This is abusive, you’re terrible, an horrible lover, but I’ve never loved anything the way I love you and so I’ll stay. It’s simple, it’s complicated, it’s messy. I hate you but I also love you, you’re my soulmate so we might as well get married.