I always look forward to meeting new patients--and I confess that I have a particular fondness for young patients. They are, you see, at the point in their lives where everything is possible. It's possible to have fun when other people might feel upset, possible to enjoy oneself on Friday night after a hard week of work (or study) rather than complaining about being too tired. I love sharing in their dreams, their joys, their fun and their excitement.
My first patient this morning is 30-year-old Kieran. We've never met; I wonder what she's been up to, and if she's planning any adventures. I'm looking forward to chatting, to exploring the "biopsychosocial" aspect of her medical complaint, as I keep urging my own students to do.
If only I didn't have this damn toothache.
It's my right lower wisdom tooth, I think. It's been throbbing on and off for the past few weeks. I've been chewing on my left side in the hope that the ache will just go away, but it hasn't; it catches me unawares whenever I absent-mindedly chew on the right.
Kieran, smiling and energetic even at this early hour, tells me her medical troubles--mainly an intermittent headache. She describes it vividly, with such dramatic passion that I'm swept away: I almost feel that I'm the one who's experiencing the headache.
Okay, it's time to explore her social history. After some discussion, we agree that her headaches are most likely tension-related. We arrange a return visit in one week, and I give her some general stress-reduction advice.
As we talk, I learn that she's a dentist.
Now, there's a bit of luck! I ask her to take a look at my tooth, which she readily agrees to do.
Rising from her chair, she asks for a tongue depressor and a flashlight.
"Do you have thirty-two teeth?" she begins.
"Er...I don't know," I answer, thinking that this sounds like rather a lot of teeth for one mouth.
"Umm..." she says, scanning my molars, "You have a cavity. You may need RCT."
Randomized controlled trial? I think.
"But I've only got a bit of toothache," I say. My face shows my confusion.
"Root canal treatment," she says.
I get up, thanking her for her help. But something has been bugging me, and I feel I just have to ask.
"Where do these teeth come from?" I say, pointing to my bottom molars.
"From the mandible," she answers.
"So this tooth"--I point to the throbbing molar--"is in fact the mandible in a different version?"
"Would it be more accurate to say that the tooth is the mandible?"
"No," she says firmly. "It's a tooth."
"But that part of the mandible becomes the tooth?"
I thank her, and we say goodbye.
I feel ever so slightly satisfied. But hang on a minute--the mandible comes from whatever it came from, which means that the mandible isn't the mandible, it's a different version of whatever gave rise to it. In this sense, it would seem that everything is the same as everything else. It's all just different versions of a single "oneness."
When my tooth is hurting, I observe, my right hand stops what it's engaged in--it puts the pen to one side and lifts up compassionately to soothe my aching tooth. Even my mind stops whatever it's engaged in and concentrates instead on how to relieve the discomfort. The pain is in my tooth, not in my arm, my eye or my mind--yet this entire body feels the pain.
I wonder if a similar oneness applies to me in relation to another suffering human. Can his or her suffering also be mine? Are we all just different versions of the same oneness? Do we depend on one another in this way for our very existence?
Tomorrow I'm flying to New York for a mindfulness retreat; I'll ask the chaps there what they think about it.
Packing my bags at home that night, I cast furtive glances at my mother, seated across the room. This is the third time I'm travelling this year, and I know she disapproves of my going away. But such is the life of a Pakistani man in the UK: mum's opinions are still important.
"Where are you going?" she asks.
Attempting to translate "a three-day retreat in mindful medical practice" into Pashto would be ridiculous, so I answer simply, "For a meeting."
I wait for the flaring of the nostrils, the disgusted sweeping away of the face. Quickly, I change the subject.
"What do you want me to bring you back?"
"Whatever--do they do head scarves there?"
"I'm sure they will. It's America, after all."
Her mood lightens, and because of this, so does mine. It is as though her mood has become mine.
"Shall I make you some tea?" she asks.
"Okay," I reply.
The teabags, water, sweetener, cinnamon and milk miraculously become the tea, which the two of us sip together, sitting cross-legged on the floor as is the Pakistani custom and talking about the good old days--my long-deceased father, what it was like in the village where they grew up.
I reflect on the utterly incomprehensible number of conditions that have led to this moment. Somehow, all of these conditions have given rise to this mother and son, sitting together on the floor of this front room. We are not separate from these conditions; we result from them.
Suddenly I remember Kieran. I wonder how her headache is. It's as though Kieran's pain is mine, because it could be no other way.
Soon, though, my thoughts are interrupted.
"Majid," says mum.
"Yes?" I ask quietly, like a father speaking comfortingly to a two-year-old.
"My tooth has been hurting me...."
About the author:
Majid Khan is a general practitioner in Birmingham, UK. He works with substance abusers in prison and teaches communication skills at Warwick Medical School, where he is also in the process of setting up a course in mindful medical practice. Another of his stories has appeared in BJGP: British Journal of General Practitioners. Other personal interests include Buddhism, spirituality and mathematics. He dedicates this story:
To my books, for teaching me much,
To my teachers, for teaching me much more,
To my patients, for teaching me everything.