Casimiro, wisdom at the bedside of the sick
If there is one thing I am grateful for in this exquisite and nourishing journey called life, it is my faithful and close companion, my complex and enigmatic secretary, my brain. Yes, as you read it, he has zealously safeguarded the records of what has been lived and what has been experienced through the senses. With portentous efficiency, he has worked hard and with little rest, generating a distinguished order, keeping the desired evocations at my disposal, preserving with zeal and as far as possible, the greatest ostentation in detail. Nevertheless, he remains suspicious and crafty, for it holds arcane secrets that I have not yet been able to elucidate.
You may be wondering what connection my prelude has with this week's question, I will tell you that it has a lot to do with it. When I read the invitation, it clicked in my memory, the experiential life story with the patient Casimiro, a septuagenarian carrier of Chagas disease in the disabling phase (enlarged and limited heart function), a pathology caused by the parasite Trypanosoma (Schizotrypanum) cruzi. Our time together went beyond the threshold of the doctor-patient relationship to become a life lesson, true wisdom at the bedside, I will tell you the story.
I walk with giant steps through the corridors of the hospital, heading to the emergency area, engrossed in my thoughts, and everyday things that I have to attend to outside the shift, I refocus on space and place, my course is to go to the inter-consultation call to evaluate a patient who is a priority due to his decompensation, it is Casimiro, I read his diagnostic summary, he has not been a patient of our service, it is a first time consultation.
On arriving at the indicated bed, I find a man sitting up, very dyspnoeic, connected to oxygen, his eyes wide open and his expression frankly frantic and anxious, understandably due to the great difficulty in breathing, at the same time his lower limbs are hanging from the bed with last degree edema. This is not the time for questioning, he is in decompensated heart failure. I visualized the treatment sheet, and the indications are correct. It is up to me to generate calm and accompany him in the process, strengthening his confidence, to contributing over time to the effect of the drugs.
The hours passed without my noticing, Casimiro was calmer, his waterlogging had considerably diminished and his breathing had improved. He was very weak, due to the efforts he had made, he came from an area in the countryside, where health services are non-existent, and he had probably been in that condition for days, accentuating his decompensation. I said goodbye and agreed to see him again at a more opportune time. He nodded his head in acceptance.
Three days passed since that meeting. Casimiro was already tolerating the environment and was beginning to ambulate early, so he was taken to our service in a wheelchair for consultation and admission control. Casimiro, 72 years old, was the youngest of 13 siblings (I remember clearly because he emphasized that it was a "bad" number), all of them already deceased, several of them with the same affectation, as well as his mother and father. He came from a rural area endemic to the disease. In his consumption, he exacerbated his caffeine habits and the consumption of chimó (chewing of tobacco extract paste). He lost his wife and two children in an overflowing river, he did not return to form a home, taking refuge in agriculture and especially in the elaboration of perinolas (traditional toy) and papagayos (traditional toy), which he gave to the children of the town.
In an inopportune way, I asked him: Are you living or surviving, Casimiro? He was abstracted with a lost look for a few minutes and said: "... I tell you, Doctor, that I live as what is, as I am, Casimiro, life pulled me to a corner, it beat me, my taita (father) and my mae (mother) got sick of the chipo (insect) bite and died, then the river took everything of mine, my wife, my boys, my house, my crops, then my brothers died falling one by one.... But the earth has made me grateful, my hands make me happy when I make perinolas and papagayos for the jojotos (small) children, it is nice to see them laugh. I am grateful for the years that God has given me".
As Casimiro, widened in his story, his eyes shone like radiant stars, his words flowed in his will, he distilled his prodigious wisdom, endorsed the value of liberation from material attachment, and in his way, he freed himself from suffering, relying on love, shaping his existence with greater transcendence, in the beauty of the simple, in the affection and understanding of others, especially children and how to ingratiate himself with them to give them joy. Despite the rigidities he had gone through, he was always grateful for the years he had lived, giving a fair value to his life. Casimiro chose to live, finding from his inner recognition, what for him was happiness. His vital wisdom brought new perspectives to the journey, highlighted the importance of letting go and letting go of the insignificant and scrutinizing the gem of the inner self, which guides and expresses itself.
Thoughtful Thursday Prompt #5
What is a piece of wisdom that you have been gifted by an elder? How did this gem help you along on your path in life?
July 14, 2024
Casimiro, sabiduría al lado del enfermo
Te estarás preguntando qué relación tiene este preludio con la pregunta de esta semana, te diré que tiene mucho que ver. Cuando leí la invitación, hizo clic en mi memoria, la historia de vida experiencial con el paciente Casimiro, un septuagenario portador de la enfermedad de Chagas en fase invalidante (agrandamiento y limitación de la función cardíaca), patología causada por el parásito Trypanosoma (Schizotrypanum) cruzi. Nuestro tiempo juntos traspasó el umbral de la relación médico-paciente para convertirse en una lección de vida, verdadera sabiduría a la cabecera del enfermo, te relato la historia.
Camino con pasos agigantados por los pasillos del hospital, dirigiéndome al área de emergencias, ensimismada en mis pensamientos, cosas de la cotidianidad que debo atender fuera del turno, vuelvo a centrarme en el espacio y lugar, mi rumbo acudir al llamado de interconsulta para evaluar a un paciente que es prioridad por su descompensación, es Casimiro, leo su resumen diagnóstico, no ha sido paciente de nuestro servicio, es una consulta de primera vez.
Al llegar a la cama indicada, encuentro un hombre sentado, muy disneico, conectado a oxígeno, sus ojos desorbitados y su expresión de franca angustia y ansiedad, es comprensible por la gran dificultad respiratoria, concomitantemente sus miembros inferiores cuelgan de la cama con edema de último grado. No es momento de interrogatorios, está en insuficiencia cardíaca descompensada, visualizo la hoja de tratamiento, las indicaciones son las correctas, me corresponde generar calma y acompañar en el proceso, fortaleciendo su confianza, para coadyuvar en el tiempo, al efecto de los fármacos.
Las horas transitaron sin darme cuenta, Casimiro estaba más calmado, su encharcamiento había disminuido considerablemente y la respiración había mejorado. Estaba muy débil, por los esfuerzos que había realizado, procedía de una zona campo adentro, donde los servicios de salud son inexistentes y probablemente llevaba días en ese estado, lo que acentuaba su descompensación. Me despedí y quedé en volver a verle en un momento más oportuno. Asintió con la cabeza en señal de aceptación.
Pasaron tres días de aquel encuentro. Casimiro, ya toleraba el ambiente y empezaba a deambular precozmente, por lo que fue llevado a nuestro servicio en silla de ruedas para consulta y control de ingreso. Casimiro, de 72 años, era el menor de 13 hermanos (lo recuerdo claramente porque enfatizaba que era un número "malo"), todos ya fallecidos, varios de ellos con la misma afectación, así como su madre y su padre. Procedía de una zona rural endémica de la enfermedad. En sus consumos exacerbó sus hábitos de cafeína y el consumo de chimó (masticación de pasta de extracto de tabaco). Perdió a su mujer y a sus dos hijos, en el desbordamiento de un río, no volvió a formar un hogar, refugiándose en la agricultura y especialmente en la elaboración de perinolas y papagayos, que regalaba a los niños del pueblo.
De forma intempestiva le pregunté ¿Vives o sobrevives, Casimiro? Se quedó abstraído con la mirada perdida durante unos minutos y dijo: “… le digo Dra., que vivo como lo que es, como soy, Casimiro, la vida me jaló para un rincón, me batuqueó, se fueron mi taita y mi mae, se enfermaron de la picada de chipo y murieron, al tiempo el río se llevó todo lo mío, mi mujer, mis muchachos, mi casa, mis cultivos, luego murieron uno a uno mis hermanos… Pero la tierra me ha hecho agradecido, mis manos me alegran cuando hago perinolas y papagayos a los jojotos niños, es bonito verlos reír. Soy agradecido a los años que Diosito me da dado.”
Mientras Casimiro, se ensanchaba en su relato, sus ojos brillaban como estrellas radiantes, sus palabras fluían en su voluntad, destilaba su prodigiosa sabiduría, refrendada en el valor de la liberación del apego material y a su manera, cómo se liberó del sufrimiento, apoyándose en el amor, plasmando su existencia con mayor trascendencia, en la belleza de lo simple, en el cariño y comprensión a los demás, especialmente a los niños y cómo congraciarse con ellos para darles alegría. A pesar de las rigideces por las que había pasado, siempre agradeció los años vividos, dando un justo valor a su vida. Casimiro eligió vivir, encontrando a partir de su reconocimiento interior, lo que para él era la felicidad. Su sabiduría de vida aportó nuevas perspectivas al viaje, colocó en relieve la importancia de soltar y desprenderse de lo nimio y escrutar la gema del yo interior, que guía y se expresa.
Esta es mi respuesta a la interrogante del
Mensaje reflexivo del jueves N.° 5
¿Qué sabiduría te ha regalado un anciano? ¿Cómo te ayudó esta joya en tu camino por la vida?
14 de julio de 2024
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