am granted a trial period of treatment irks me a little. I am puzzled by the doctors’ attitude towards my role at the hospital. Although I am seemingly welcomed as part of the staff, there is an unspoken underlying resentment whenever I suggest
something different from what has already been prescribed.
At times, I wonder if it is all in my imagination; perhaps I am a little paranoid and hear criticism where none is meant. Yet I cannot shake the miserable impression that I am treading on somebody’s toes.
In any case, today Choden is coming to physiotherapy, accompanied by her mother and her little five-year-old daughter, Yeshey. Choden is a very pretty young woman of twenty-six, with large brown eyes and a full head of shortcut black hair. She smiles readily, and her expression is one of intelligence and understanding. Self-confident and remarkably agile, Choden has learned to manipulate her legs in such a way that she can get around by supporting her bodyweight on her extremely muscular arms and
pivoting her hips to the side. This method allows her to at least move from the bed to a chair or, if needed, to the ground.
Transverse myelitis struck her a few years ago. Again, the number of years varies between different versions of the story, but it seems clear that the onset occurred after her daughter’s birth. Since then, she has gone from being completely paralysed below the waist to her present status of painful lower extremity spasms. She says that her catheter is the main problem. She only has one and, in her village, it is difficult to keep it clean. Over the past few years, she has been in the hospital several times for urinary tract infections.
Curious, Yeshey, the little daughter, looks at me. She appears intrigued by my blond hair and pale skin, but 83
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remains quietly standing beside Choden’s wheelchair. Like a tiny guardian, she assesses my trustworthiness.
‘Do you want to sit on the bed with your mom?’ I ask.
Yeshey nods seriously. She does not intend to leave her mother for even one minute.
I ask Pema to translate our assessment plan to the three women. Choden’s mother asks a few questions, but Choden remains quiet. Smiling, she pulls her daughter closer, and although Yeshey must not understand all that is being said, she visibly relaxes.
Pema turns to me with a frown. ‘It would be better to be in Thimphu.’
‘Why is that?’ I ask.
‘Thimphu has more equipment and better room. It is much easier to work there.’
‘I don’t think it’ll make much difference for the
assessment,’ I counter.
‘Still, it is better to work in Thimphu.’
‘Well, let’s see what we can do here. We should be OK.’
Pema’s sudden appraisal of our primitive conditions in Mongar astonishes me. Could it be that Choden reminds Pema of her son, and now Pema is wondering if Nima could get a better treatment in the capital? I resolve to encourage my faithful assistant to bring Nima to our physio room.
Maybe if we see some success with Choden, Pema will feel more confident in my treatments and let me try with Nima.
I look from Pema to Choden and am struck by the same quiet determination which both of these two young women share. But for once I am grateful that my patient does not speak English.
‘Please don’t discourage Choden before we have even started,’ I plead with Pema.
84
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C H O D E N
My usually diligent assistant shrugs her shoulders but affirms once more, ‘Thimphu has better facility.’ Then she starts the physical assessment.
After several attempts at moving Choden’s legs to
evaluate her range of motion, Pema has to abort her efforts.
The more she tries to push, the more Choden’s legs go into spasm. Once triggered,
something different from what has already been prescribed.
At times, I wonder if it is all in my imagination; perhaps I am a little paranoid and hear criticism where none is meant. Yet I cannot shake the miserable impression that I am treading on somebody’s toes.
In any case, today Choden is coming to physiotherapy, accompanied by her mother and her little five-year-old daughter, Yeshey. Choden is a very pretty young woman of twenty-six, with large brown eyes and a full head of shortcut black hair. She smiles readily, and her expression is one of intelligence and understanding. Self-confident and remarkably agile, Choden has learned to manipulate her legs in such a way that she can get around by supporting her bodyweight on her extremely muscular arms and
pivoting her hips to the side. This method allows her to at least move from the bed to a chair or, if needed, to the ground.
Transverse myelitis struck her a few years ago. Again, the number of years varies between different versions of the story, but it seems clear that the onset occurred after her daughter’s birth. Since then, she has gone from being completely paralysed below the waist to her present status of painful lower extremity spasms. She says that her catheter is the main problem. She only has one and, in her village, it is difficult to keep it clean. Over the past few years, she has been in the hospital several times for urinary tract infections.
Curious, Yeshey, the little daughter, looks at me. She appears intrigued by my blond hair and pale skin, but 83
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B U T T E R T E A A T S U N R I S E
remains quietly standing beside Choden’s wheelchair. Like a tiny guardian, she assesses my trustworthiness.
‘Do you want to sit on the bed with your mom?’ I ask.
Yeshey nods seriously. She does not intend to leave her mother for even one minute.
I ask Pema to translate our assessment plan to the three women. Choden’s mother asks a few questions, but Choden remains quiet. Smiling, she pulls her daughter closer, and although Yeshey must not understand all that is being said, she visibly relaxes.
Pema turns to me with a frown. ‘It would be better to be in Thimphu.’
‘Why is that?’ I ask.
‘Thimphu has more equipment and better room. It is much easier to work there.’
‘I don’t think it’ll make much difference for the
assessment,’ I counter.
‘Still, it is better to work in Thimphu.’
‘Well, let’s see what we can do here. We should be OK.’
Pema’s sudden appraisal of our primitive conditions in Mongar astonishes me. Could it be that Choden reminds Pema of her son, and now Pema is wondering if Nima could get a better treatment in the capital? I resolve to encourage my faithful assistant to bring Nima to our physio room.
Maybe if we see some success with Choden, Pema will feel more confident in my treatments and let me try with Nima.
I look from Pema to Choden and am struck by the same quiet determination which both of these two young women share. But for once I am grateful that my patient does not speak English.
‘Please don’t discourage Choden before we have even started,’ I plead with Pema.
84
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13/01/2006 14:59:12
C H O D E N
My usually diligent assistant shrugs her shoulders but affirms once more, ‘Thimphu has better facility.’ Then she starts the physical assessment.
After several attempts at moving Choden’s legs to
evaluate her range of motion, Pema has to abort her efforts.
The more she tries to push, the more Choden’s legs go into spasm. Once triggered,
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