198 - Dealing with difficult patients

16 Jin 4974 | En route to Thenai

Dear Mamin:

I am writing as we sail. Not much else to do. Do you, or anyone else there, have advice for dealing with difficult patients? I mean, ones who won’t do what you tell them to, or seem not to have normal physical responses?

The man is not normal. At least he doesn’t feel pain or fatigue as a normal person does. When he came back to us last night he had a wound in his left upper arm that had been treated by one of the Niah-lur-ana Haians, and a letter of report to me from her saying that the point of the arrowhead penetrated about three minim into the humerus, albeit without chipping. So she ordered him to bed for the rest of the day, but he didn’t comply, so she slung the arm to immobilize it.

But most amazing to me, he’d refused any painkiller, other than self-administered arnika. (Yeoli soldiers are required to carry it by law so they all know it and swear by it.) You just assume, when you see a patient with a wound that severe who is up and around and talking and laughing, that the pain is being numbed with opian or the like. I could barely believe it when I read that line, which I did while he was having an animated discussion with his parents and underlings about how he couldn’t tell them how the battle he’d just been in had gone, except he and the A-niah had won overwhelmingly.

So I thought, fine, he’ll be in bed from the moment I can get a word in edgewise to order him, and he’ll realize he needs more than arnika to sleep, and take it. But, no—we’re setting sail tonight, he ordered, as soon as we can get all our things onto the ship. So, I thought, I’ll make him lie down while the rest of us pack, but no—he had to meet with a Yeoli and a Niah general to plan something, extremely important, he said, and even though they had the sense to sit on the sand, I saw him get up and pace back and forth while they talked.

So finally we were on the ship and heading out, and he agreed to lie down. He looked utterly exhausted by this point. And he’d been a little pale the whole time since he’d come back. But then Krero, who’s sort of his second-in-command right now, asked him about what their plan is, and instead of doing the sensible thing and putting that off till tomorrow he said, “Kanincha, let me just do this and then I’m yours,” and stayed up on deck.

So they talked, and it got animated too, and of course they’re Yeolis so they gesture incessantly, and even if one arm is tied down the muscles still twitch, and he got angry enough to get up and pace again, when his shadow-father Esora-e asked him if he was out of his mind for wanting to ally with Lakans. They amputated Esora-e’s thumb in that war. They did the same to Denaina—that’s Chevenga’s shadow-mother—but she has no objection to such an alliance, wanting to see Lakan mamokal oppose the deadly Arkan heavy horse.

“Shadow-father, if the difference between being enslaved by Arko and being free is alliance with the Lakans, are you going to charcoal it?” Chevenga half-yelled, his right arm gesticulating, and his left arm twitching, furiously. “I am going to hire mercenaries too. Who or what they might be, I’m not going to ask. Maybe they’ll have blue skin. Or hands red with Yeoli blood. At this point, we don’t have any choice!”

“Just don’t marry them, all right?” Krero said.

“My marriage slate is now full,” Chevenga spat back. “Thanks.” Then he went on to say he wanted to ally with the Hyerne, and his blood-mother said if that was so, we should go there first, not Brahvniki, since it’s so much closer, and then they got into another arm-waving discussion-cum-argument over who to approach first and why. This went on hammer and tongs for a good aer, with him pacing back and forth on deck, almost on his toes, looking as if he wanted nothing so much as to grab a sword and go after an Arkan right now, with both hands.

The outcome was that he was persuaded to go to Thenai first, so the captain turned the ship and I finally got him into bed. I was examining him, giving him his remedies and creaming the stitches when it occurred to me that I had not seen him eat dinner. I asked him when his last meal had been, and he said, “Before we fought. I haven’t been hungry.”

“Well of course you haven’t been hungry,” I said. “You are in pain. I’m giving you the juice, no arguments, and then you’re going to force down at least a little something before you sleep.” At least it’s easy to get quick protein into a wounded meat-eater. There were left-over lobsters from dinner, but considering how the Yeolis had gone on and on about how they look like giant bugs, I didn’t think I could ply him with that. But probably the ship had some salt pork or beef.

“I am going to force down nothing, besides this,” he said, as he drank the opian. “Don’t you think I’m suffering enough?” Then he put his head back and closed his eyes and sagged all over, all of it seeming to hit him at once. He was gone as fast as if I’d anaesthetized him.

Mamin… I guess ripping out my hair is not what you’d advise for difficult patients?

I hope this was just an anomaly and my whole service with him isn’t like this.

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Jin 17. He woke up around dawn as he usually does, complaining that the arm was stiff, as much from the sling as from the wound. I gave him a points massage and a muscle-massage on the arm, more opian along with the morning remedies and the order that he sleep in to noon. “If I go back to sleep, then fine,” he said, and blessedly did.

There is nothing to do while you sail but worry if you see red sails and talk, so I asked him about it once he was up. “You should have been in enough pain to want to lie down and take something that would relieve it,” I said. “How is it that you weren’t?”

He seemed puzzled that I’d even ask. “It’s just wound pain,” he said. “It’s nothing… you know what else I’ve been through.”

“So you don’t feel it?”

“No. It’s not that I don’t feel it… it’s that I don’t think about it.” He’d gathered I was studying this, I saw, and decided to help me.

“But how can you not think about pain?” I said. “It hurts. That… has a way of intruding on the thoughts.”

I remember when I stepped on the fire-coral, when I was six, Mamin. I will never forget. I can’t begin to imagine how it can be to not think about severe pain.

He thought for a while before he answered, his thick brows knitting. We were on deck, near the prow; in fact he was sitting with his back leaned up against the figurehead, not bothered by the spray. I think he was doing this because being there rather than, say, at the stern, put him one cormarenc-length closer to his destination.

I like him, though, for how he thinks about questions like this at length before he answers them, wanting to make sure he doesn’t mislead me through a careless answer. I think most others in his position wouldn’t have so much patience for a know-nothing healer.

“It’s something all warriors learn,” he said finally. “Because so often you are still in the middle of it when you’re in pain. When that arrow hit me—well, I can’t tell you how it went, but let’s just say, if I hadn’t kept going it would have been death for me and Niku both, and perhaps others. If you are fighting, it’s natural to have your attention on that and nothing else, not even pain. But sometimes you have to ignore pain by will.”

Then he told me something that happened in his war-training, when he’d been practicing fighting and battle-command at the same time, sparring on a narrow beam and doing pretend commanding while his teacher gave him the mock reports and so on. He fell off and broke his arm—but the teacher didn’t stop, just kept going with the pretend battle. Because a real battle doesn’t stop if a general is hurt! So he got back up and started sparring again, and had to figure out what to do when he started to feel faint and knew he might pass out, which was call for his second-in-command to take over. He was fourteen.

“You live in a different world than I do,” I said, after letting this sink in.

“Warriors have to,” he said. “And it is as it should be, the difference. May your world never become mine.”

I will not live in that world, but I will live so close to it. I am trying not to let it scare me.

Love from your son who already misses you,

Kaninjer.

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