ASD and Getting Bullied - ASD VULNERABILITY --> BULLYING: EXAMPLE (Part 4/7)

The Aspie’s initial “empty slate” regarding the facial expressions, tone of voice + body language disadvantages him. Insufficient recognition of such social cues in others, along with other differences (eg statistically reduced verbal fluency) predisposes him to bullying and/or manipulation by others.

Story of me being framed:

I skipped a grade and joined a class whose classmates I’ve seen numerous times, but never interacted with much before. I used to hang around by myself a lot, but I thought I’d feel more comfortable if I could be included. I used to say to the girls in that class, ‘Can I play with you?’, and they’d always say ‘No, you’re not old enough.’

This time though...

‘Ok, you’re in our class so you can join us. Let’s play tag.’

‘Ok.’

‘Ok, you're it. Count one two three before you go.’

‘Ok.’

The girls ran away, but I was relatively fast even though I was still kinda clumsy at the time. I tapped one of the girls on the shoulder.

‘You touched my butt!’

‘No I didn’t , I touched your shoulder.’

‘No, you touched my butt!’

‘No I didn’t, I touched your shoulder over here.’

The other girls who were playing tag, went up to the two of us.

‘Ken just touched me on the butt! Let’s go tell on him!’

I remember seeing the girls having angry/frowny facial expressions. I knew it meant angry/frowny coz I saw it in cartoons multiple times, and managed to associate it with the context. I didn’t understand WHY they were angry, even though I knew it was factually true that I touched her on the shoulder. 

They dobbed on me, and the teacher on recess duty told me that touching a girl’s butt is sexual assault, and for me not to do it again.

The next day, I wanted to play tag with them again, and they said I could join them. They made me ‘it’ at the start again.

I didn’t understand their intentions at the time. They made the game a little different.

‘This time because you run so fast, we’ll make you count to 10.’

‘Ok.’

               
I counted to 10, and ran after one of the girls hiding behind the school hall. I tapped her head.

               
‘I tagged you.’

               
‘You touched my butt! Didn’t Ms. Kogan tell you not to touch girls’ butts?!’

               
‘But I didn’t touch your butt, I touched your head. Your head is not your butt. Your butt is located down here.’

               
‘No, you touched my butt, and I’m telling on you.’

She told the other girls, followed by my class teacher, who already formed a negative impression of me, coz I was apparently smart but immature, and that I didn’t behave like a 5^th-grader.

He said to me ‘Ken, follow me into this room.’

The room was pleasantly dark, and he didn’t switch on the lights, but I didn’t know why.

He told me that the girls have reported multiple incidents of me touching their butts when playing tag and that it is illegal to touch that region, because it is sexual harassment, and in the adult world can be punishable by a jail term, and he use to work with juvenile criminals, many of whom have been convicted of sexual assault and rape. He said that what I did was wrong, and that he would give me several detentions, and physically segregated me from the rest of the females in the class for all activities, including computer skills, to think about my wrongdoings.

‘But I didn’t touch their butts.’

‘Yes you did, the girls said so.’

‘But I didn’t, they keep saying that when I touched their shoulder and heads.’

‘The girls have come up with the same story about you, so I’m inclined to believe them. You know what you did is wrong, and you are not going to get away with it.’

‘But I didn’t touch their butts, I didn’t actually touch their butts.’

‘Don’t lie to me Ken, I don’t want to set you up for failure when you become a grown up so you need to learn things now. See me after school at 3 PM.’

‘I really didn’t touch their butts, you don’t believe me.’

‘Stop talking about it. Now go back to Maths.’

All of my persistent claims of innocence were said with my usual flat affect and relatively monotone voice. At the time, I thought that because what occurred was factually true by my accounts, that I would be believable. But this wasn’t the case.

In retrospect, I realized that I was supposed to show facial expressions of anger, and be more vocal and eloquent about my innocence. I didn’t know what he knew, or the cause of incongruence between factual events and false accusations, which is related to the TOM deficit.

               
I didn’t know what sort of body language to show. And yet the girls were trusted coz they showed the typical facial expressions, body language and vocal tones of innocence and indignation. ‘HE TOUCHED ME HERE! HOW DARE HE!’

These girls can further fine-tune their manipulative/framing qualities over time, and could easily target an Aspie’s initial trustworthiness, and get him fired from jobs, arrested, or divorced (if married) with the settlement (+/- child custody) hugely in favour of her due to his apparent “abusive behaviour”.

I didn’t see the BIG PICTURE, that they didn’t want me to play with them, coz I was focusing on the DETAILS, such as counting to 10 instead of 3.

Of course, some Aspies may commit sexual harassment without realizing it, but that wasn’t the case in my situation.

ASD and Getting Bullied - WAYS OF GETTING BULLIED (Part 3/7)

- Intentionally disrupting one’s non-pathological routines.

- Intentionally disrupting one’s preference for sameness not from therapeutic attempts to improve cognitive flexibility (eg hiding favourite objects, constantly changing their positions).

- Intentionally causing sensory overload by making local environment overstimulating (especially audio/visual), constantly staring, touching* or standing/sitting near them --> impairing their work or study (as if there’s a presence of “Qi” that can be detected by the ASD person).

                * Exceptions are hard hugs/grips.

- Harassment (especially homophobia) based on erroneous assumptions about an ASD person’s physical traits (eg gait, possible hypotonia or motor incoordination, notably in childhood), behaviour or “unusual” special interests.

- Stereotyping an ASD person and penalizing without understanding their scattered cognitive profile of strengths, weaknesses and personal compensatory techniques (many of which are intellectualized, especially algorithms for social situations and piecing details to form general concepts).

- Physical abuse

                - Can easily trigger a meltdown + “violent lashing” from an ASD child/teenager, especially if     

                   ganged-up on.

                - Even worse is when they claim that the ASD person started it.

- Verbal abuse

                - Can also trigger a meltdown.

                - Bullies love to see a reaction, and this is more so the case with Aspies/HFA who have better 

                  verbal comprehension.

                - Difficulty in giving a successful impromptu retort --> frustration, humiliation.

- Sexual harassment, coercion (especially female ASD people, initially reduced street-smarts).

- Getting framed for sexual harassment (especially male ASD people, initially reduced street-smarts, overly trusting of others but this quickly converts to cynicism/caution following adverse events).

- Lying, exploitation, blackmail (ASD person has initially reduced abilities to read people and check for situational red-flags).

- Framing an ASD person when they were led to believe that they were doing something harmless. Often paired with bully appearing to be the “innocent victim/bystander”.

- Passive-aggressiveness, and withholding of relevant information to get an ASD person into trouble. Refusal to give details, and intentionally use vague language to make an ASD person confused or doubt their ability, and then claim that the ASD person is being unreasonable or aggressive.

- Spreading rumours about an ASD person who has more difficulty defending it in a “believable” manner to the others, because they’re more inclined to believe the BS-artist, and also his difficulty in figuring out how to convince them due to his statistically reduced TOM.

- Taking credit for an ASD person’s work and presenting it as if it were his own, often in a more charming, fluent manner.

- Wilfully misinterpreting what an ASD person says and responding negatively (especially in front of others), this is often done by over-generalizing what an ASD person says about a topic or targeting a specific bit and going on a tangent, even though he meant it in relation to that specific situation only.

ASD and Getting Bullied - WHY MANY ASD PEOPLE GET BULLIED (Part 1/7)

My dictionary defines bully (noun) as “A person, esp. a schoolboy or schoolgirl, who hurts or intentionally frightens weaker people.” and bully (verb) as “To act like a bully towards, often with the intention of forcing someone to do something.”

Whilst it’s clear to many that these definitions are rather basic, it’s also important for people to realize that for ASD people, there are additional complexities on top of what already exists for NTs.

Of all of the formally diagnosed ASD people I’ve met in person, pretty much all of them have been bullied at some point, even as adults. The ways they’ve been bullied isn’t particularly different from that of NTs, but the presence of an ASD makes them much more vulnerable and sensitive to such suffering to the point where it becomes a ubiquitous, ie near 100% guaranteed experience.

I’ll try to explain this increased vulnerability as best as I can based on personal experiences, observation, and from speaking to other ASD people. In short, from how I see it, the (increased) vulnerability of ASD people to bullying is essentially a combination of:               

                - NEUROLOGICAL WIRING (NEURODEVELOPMENT)

                - ACQUIRED KNOWLEDGE & SKILLS

                - ENVIRONMENTAL FACTORS

In this basic model, all 3 categories are inter-related, influencing each other for the positive or negative. Even the factors within a category can affect each other. Significant deficits in any category without sufficient compensation from the others greatly increases the chances of bullying occurring and/or adverse outcomes from it. It’s difficult for me to quantify the impact on a factor from one category on another, but I’ll try to list as many as I can (how Aspie of me), and then explain some relationships.   

NEUROLOGICAL WIRING (NEURODEVELOPMENT)

Given the heterogeneous nature of ASDs, ASD children / adults develop at various rates. What is universal though is the relative developmental delay of various skills, particularly social / linguistic. My impression is that the altered neurological wiring (as with ADHD) results in a relative frontal lobe deficit compared to NTs which underlies several of the symptoms.

                1.  Speech delay, statistically reduced verbal fluency.

                2.  Initially reduced language pragmatics, a tendency to take things literally with difficulty understanding the intended meaning by the speaker due to the context and external cues.

                3. Focusing on details initially, difficulty integrating the information and seeing the big picture.

                4. Initially reduced “TOM” (Theory of Mind towards NTs), ie reduced ability to understand the true intentions of the NT, again influenced by context and external cues.

                5. Initially reduced ability to read social situations and to follow (arbitrary) hierarchies as established by NTs.

                6. Relatively more repetitive behaviours, routines and cognitive rigidity, more difficulty being flexible in (social) situations. More likely to have a preference for narrow interests and orderliness. Tendency to brood/hyperfocus on things (inc. things that made them angry or upset).

                7.  Lower threshold for sensory overload and meltdowns (further exacerbated by any communication issues). More likely to be irritated by direct eye contact.

                8. Strong preference for honesty, dislike of dishonesty, superficial rules/norms, and perceived injustice.

                9. Relatively poorer short-term memory / Executive Dysfunction.

                10. Relatively poorer motor skills (esp. in childhood)

ACQUIRED KNOWLEDGE & SKILLS

                1. Internal algorithms for communication / different Social Situations, Social Scripts. A lot of “polite” or “flowery” phrases (as deemed by NTs) have to be rote memorized because they’re less literal and are often more lengthy.

                2. Intellectualization of socio-emotional (including adult) issues & rules that would more likely be intuitive to NTs. A lot of it is acquired by rote memorization.

                3. Problem solving strategies / Troubleshooting, including those relating to First Principles so they can be generalized to other areas and / or be used in Emergencies.

                4. Pattern-recognition abilities, that are applied to both social and non-social situations, to facilitate the use of learned Internal algorithms and Problem solving strategies. Helps recognize danger too. Helps promote internal comfort due to perceived repetitions of previously seemingly un-related phenomena.

                5. Knowledge of personal strengths and weaknesses (esp. from life experience) and numerous attempts. Understanding why one does the things they do and how to maximize productivity and happiness.

                6. Knowing how to incorporate newly acquired knowledge to internal database and known paradigms.

                7. Coping mechanisms for meltdowns, stress, burnout, knowing when to move on / have a break / seek help.

ENVIRONMENTAL FACTORS

                1. Parents

                                - Educating the ASD child.

                                - Personal beliefs (may help or irritate ASD child).  

                                - Support, monitoring & feedback.

                                - Implementation of home environment amenable to ASD cognition.

                                - Access to a Specialist (Paediatrician, Psychiatrist, Psychologist etc).

                2. School

                                - Staff (knowledge of ASDs / bullying, supervision of students in classroom and breaks, care factor, student & work-loads, communication with parents, presence of teaching aides).

                                - Students (awareness of ASDs, level of diversity, upbringing, internal disposition).

                                - Anti-Bullying Policies, enforcement of it.

                                - Extracurricular and lunch-time activities.

                                - “School Culture”.

                3. Workplace

                                - Anti-Bullying Policies, Diversity Policies, enforcement of them.

                                                - Willingness to provide workplace accommodations.

                                - HR (care factor, level of bureaucracy).

                                - Staff (awareness of ASDs, upbringing, internal disposition).

                                - “Work Culture”.

                4. Adult Society (extremely basic)

                                - Public awareness of ASDs and care factor.

                                                - The ability to differentiate between aggression and (provoked) meltdowns in ASD adults (esp. by Police and Healthcare Staff).

                                - Laws on Disability Discrimination and implementation.

TBC...

Long Case Exam

The long case exam is one of the exams that can occur during the clinical years of some medical courses, and is also a staple in postgraduate exams for certain specialties/fields (quite notably the barrier exams for BPT, Basic Physician Training in Australia which is usually 3 years' long before one applies for an Advanced Medical Specialty).

It typically involves a student/doctor candidate seeing a randomly allocated patient from a predetermined pool of hospital/outpatient patients who were deemed as "suitable long case material", relatively cognitively intact, and gave consent to participation. The candidate then has a limited time (on average ~ 1 hour) to interview the patient about their history of presenting complaint, hospital admission, past medical history, social history etc, and then perform the relevant physical examinations (documenting the findings), then formulating a summary, issues and management plan catering to that patient's "unique" presentation and needs. When the time runs out, the candidate then goes into another room to do an oral presentation in front of a few (often 2, maybe 3) examiners who are doctors themselves, regarding the patient's complete history, relevant findings, summary and management issues within a time limit (eg 15 minutes), which is then followed by answering questions from the examiners about detail clarification or about the discussed medical conditions.

My Medical Course has the long case exam as a hurdle, which means that you MUST pass this in order to pass the whole subject (as opposed to the Multiple Choice Exam where you're technically allowed to get < 50%, but still pass the whole subject if you compensate in other exams to get an overall mark of 50+%). I did my long case exam recently, and I was really anxious, for multiple reasons (same for many other med students too). While I have received reassurances from a few students in the year above (and a few doctors in lectures) that the long case exam at med school standard is not too harsh, and that the examiners want to pass you, I was still super freaked out. The long case exam was THE ONE that I was fearing my whole time this year (OSCEs and MCQs were less anxiety-provoking in comparison).

I can think of the following factors that contributed to me feeling like this:

            1. I didn't know what patient I was going to get for the long case exam (that's the point of the exam!).

            2. Due to other issues that made me extremely stressed this Semester, I didn't have sufficient alertness or mood throughout the Semester to thoroughly make notes on all the listed conditions (let alone the un-mentioned ones) in the Block/Rotation guides. So hypothetically, what am I supposed to do if the patient has a condition that I was supposed to know about?

            3. My AS means that I usually have a reduced verbal fluency (and increased difficulty with forming coherent sentences relative to NTs) when trying to talk/ask about things that I'm not familiar with and haven't rote-memorized or practiced a lot (which gets exacerbated by the previous point).

            4. My holidays before the next Semester were short, and I didn’t want to have it reduced by spending more time preparing for a resit exam should I fail. I was already tired from studying for the MCQ and OSCEs the week before, and really wanted to have more days to sleep and bum around.

I did my Long Case Exam outside of my home clinical school. I went into the listed room and registered my details while frantically reading my long case guidebook on the different core conditions. Sooner or later, it was my turn, and I had to leave my bag in the room, and carry my stethoscope, pen and paper and other testing tools into the ward.

The “administrator” guided me to the relevant ward, by then I was already having clammy hands and palpitations.  I waited outside the patient’s room while the “administrator” spoke to and prepared the patient for the 1 hour interview. The waiting felt like ages and for a short while I thought she was trying to mess with my mind by adding extra suspense by delaying me from starting it.

She came out later and said I could go in, with time starting now. I said “Ok thanks” and entered the room. It was a bit annoying coz there were a few other patients in the room with their relatives talking. I wasn’t sure if they were aware that I was doing a long case exam.

The long case patient I had was an elderly woman. I introduced myself and told her that I was doing an important exam with a time limit, so I’ll have to ask lots of questions and have to cut her off at times, with an apology. She said it was perfectly fine coz she had been a patient for numerous other candidates at other hospitals in the past.

I started by asking her name, age, address, past occupations, allergies, and comorbid conditions (name only). When it came to comorbid conditions, she talked a lot about each one and mentioned about some past operations. I then asked about those. This went on for about 20 minutes because she had the tendency to go off-track and I was too afraid to cut her off a lot at the time lest she get pissed off at me and refuse to cooperate. I think around this point, I asked her what medications she was on for each one, and she said she couldn’t remember. I then checked the folders on her bedside, but could only find one listing Vital Signs (the medications list got taken out!).

I was getting really freaked out coz they forgot to include the medication list. I asked her to push the “ASSIST” button to attract one of the nurse’s attention. I then remembered that I had to ask her about her presenting complaint (omg silly me, I should’ve asked that sooner), and then she went on about how she was experiencing a lot of pain etc several weeks ago. I was able to ask the relevant history questions and form a plausible story in my folder as she was talking. I decided to cut her off more times than before and ask numerous direct questions because I really wanted to hurry to the psychosocial history before starting physical exams.

By the time I finished the history of presenting complaint, there was about 20 minutes left. I rushed through the psychosocial history bit in about 10 minutes, asking her about her husband, 1^st-degree relatives (I had to cut her off again when she wanted to talk about her cousins and grandchildren in excessive detail), hobbies, diet, activities of daily living, and mood. Unfortunately I was absent-minded enough to not ask her about alcohol and smoking. She kept on talking about G-d and how he was so glorious to give her and her husband a long life, and I tried to “acknowledge that”.

After rushing through those questions and writing her comments, I checked my watch. There were 10 minutes left and I haven’t started my physical exams or formulated a summary and management plan yet. In my mind I was thinking “OMG OMG OMG OMG OMG OMG OMG OMG I’M SCREWED” .

The patient could tell that I was stressed out, and she said to me that if I continued on like this, that I wouldn’t live as long as her and that I’d get a heart attack. She said that I was one of the most stressed students that she has met so far. She may be right, but I didn’t want to argue with her, so I said “Thank you for your observations”.

I said to her that I had to do physical exams now and managed to do a very gross (basic) assessment of her Cardiovascular, Respiratory and GIT system before time was up. I said to her that I was sorry for being rushed and abrupt, but she said that she was happy to help students and that she wanted to make a contribution in the remaining years of her life. In my mind, I was thinking that I was going to fail my long case exam coz I didn’t write *anything* at the back of my folder for the summary and management plan.

The “administrator” came to pick me up, and I walked with her back into the hall to wait outside the examiner’s room. While walking, I felt like a lamb being led to the slaughter. During the 1 minute wait, I was profusely formulating management issues (the “topic titles”) but didn’t have time to further elaborate on it.

One of the 2 examiners opened the door to their room and let me in. I went in and started presenting my findings as they asked. I was afraid that I would muddle up my sentences when I spoke them, so I tried to speak in a relatively slow (compared to my “normal” speed when talking random stuff) rate, using simpler sentence structures that I could manage. I couldn’t tell if they thought that I was speaking too slowly/robotic.

I was halfway through presenting my physical findings when the timer buzzed, and it was question time. I didn’t have time to present my summary or management issues (which I didn’t exactly prepare for), so it was a double-edged sword, a possible blessing in disguise?! I knew that part of the marking criteria included the ability to formulate relevant treatment and referrals for the patient, but I technically didn’t mention any of that, so I feared I’d get a 0 in that section.

The 1^st examiner who was a medical doctor asked me various questions to clarify the patient’s history. I was able to answer most of them, except for the bit about smoking and alcohol. One of his questions was “Did she really say that her pain was 13/10?” That was what I said (based on what the patient said), and I thought he was trying to manipulate me and make me change my mind, but I said “Yes”.

The 2^nd examiner who was a surgeon asked me about physical signs, and I missed out on several vascular ones as I didn’t check all the pulses. He asked me about investigations, which I suggested a few, but not all of the relevant ones. It was embarrassing but educational when he stated the others that should’ve been ordered.

Question time ran out, and I was told to leave. It was strange, I no longer had palpitations, but there was huge unease. I had to wait several (“very long”) days to find out if I passed this exam or not, in which I did.

I got the lowest pass mark, but was still very relieved coz I didn’t have to do a resit, but I was still disappointed in myself based on the experience. Sure, this is an exam which can provoke anxiety, but so is the workplace where you might have to clerk several new admissions a day, and be expected to do so in a timely fashion. I understand that I’m still a student and expect to improve with time in terms of structure, asking in a systematic manner, and cutting off more frequently and strategically, but I predict I may get turned off it (in the very long term).

She was a kind woman who was willing to talk, but I still felt like an asshole for cutting her off a lot (relative to when I normally clerk patients on the wards, which is more relaxed and has more chit-chat). After what I’ve been through in the past, I don’t want to become a horrible asshole when I work, and I fear that such time pressures may give me the propensity to do so in my innate desire for efficiency and systemizing information (to reduce my being overwhelmed by details) instead of maintaining a balance, because systemizing and following an internal routine is when I am most productive (as an Aspie), especially if I enter hyperfocus mode.

I felt like I was objectifying the patient, and not taking into consideration all of the things that they value. My psychiatrist has told me of ways to redirect the discussion, and I’ll probably improve with more practice, but I still felt guilty and upset given her vulnerable state and my “exploitation” of her during the exam.

Superficially for now, if I pass the med course, I feel that I might be less suited for a general medical specialty, and would be better suited to a specialty with less patient contact such as Pathology. Less direct patient contact means that there’s more focus on the technical/procedural work itself, with most of the other communication with other doctors. I feel that if I manage to pass the med course and later on enter Pathology, I am statistically less likely to offend patients and let them complain about me. It's not that I hate patient contact, it's just that I fear I will perform a disservice to them if I were to work in my optimum Aspie style.

Let’s see what happens in the future…

Experiences and Impressions from Clinical School (Part 5: Clinical Patient Interactions)

“Robert” (TERMINAL CANCER) Last Semester, I spoke to a patient called “Robert” who had an M1 cancer (cancer that has metastasized), and was considered to be terminal (incurable, patient will die from cancer complications). He was one of the first terminal patients that I spoke to. A classmate recommended that I speak to him coz he had “interesting” physical presentations and was nice but was feeling quite sick. I wanted to see his physical presentations, but was initially hesitant on doing him coz he was feeling sick, and may not have wanted to spend energy speaking to another medical student, but I decided to try, because that’d be the only way to find out, and I didn’t like the uncertainty of never knowing what happened to him.

I went into the room, greeted Robert and introduced myself and asked if he could answer my questions regarding his medical history. He consented, and so I asked about his symptoms. He noticed a few lumps in his chest earlier last year, which later grew in size and became very painful to touch, and he felt a pain akin to being “hammered in the chest” whenever he breathed normally. He visited a GP and complained about the pain, in which he was prescribed analgesics. Eventually, investigations for his chest pain (X-ray, CT, biopsies) indicated that he had cancer which metastasized to his chest, and he was planned to start on “chemotherapy” quite soon. He was still experiencing a lot of pain in his chest and back, and found it disruptive and upsetting. I was able to see several lumps on his chest, and on his sternum.

He said the doctors may be considering radiotherapy as well, but he wasn’t looking forward to it because he thought that surgery would’ve been better (even though surgery isn’t usually indicated for his metastatic kind). Although I wasn’t 100% sure that his cancer was terminal (I only knew that when I spoke to the Oncologist later on), I suspected that the radiotherapy wasn’t curative, and was to treat the bone metastases, aiming to reduce its prominence on his ribs. I wanted to try to make my thoughts be more “valued” by him so I had to figure out what was of his biggest concern atm, which I (luckily) guessed was pain. I was confident that he was going to die within a few years or even a few months coz of his Cancer staging, and felt that long-term survival would be more important, but I DIDN’T DARE TO SAY THAT TO HIM coz I thought that informing him about death wasn’t my role yet, and I was scared that being an NT, he’d be more likely to get angry/offended instead of facing reality. This led to my hypothesis that he cares more about his quality of life.

I told him that he’s experiencing a lot of pain and it’s one of the negative things directly affecting him, and that the chest pain is likely to be caused by the metastases, and that if the radiotherapy targets the tumours and make it smaller, it may place “less pressure” on the intercostal nerves, thus producing less pain in the long term. He was pleased by this explanation and changed his attitude towards the radiotherapy and was optimistic, saying “oh that’s great then!” I wasn’t sure if he only thought of cancer as causing pain, and that he was aware that the radiotherapy was most likely not curative, but more to alleviate pain, and systemic complications leading to death are still highly likely. I didn’t want to instill false hope and tell him that it was going to be a cure, so I was trying to talk about the benefits of the treatment in terms of what he valued, and he was joyful. I initially felt kinda guilty coz I made radiotherapy sound really good (although it wouldn’t restore life, I didn’t say this) but I looked back and realized that I technically didn’t lie, and I’m sure that his priorities may have been different to mine, hence his response countered my initial concerns.

I was aware that he had pain, and I asked what medications he was on. He said he was currently using Endone and Oxycontin (IR and SR-oxycodone), Panadol, and an anti-inflammatory drug. I asked him if he felt constipated, nausea and loss of appetite on the Endone/Oxycontin. He said yes, and that it accelerated his weight loss, and that he can go for days without passing a bowel movement even if he ate 3 meals/day. I also asked him if it made him feel drowsy or spaced out, and he said yes, he felt sleepy and spaced out with poorer short term memory. He was happy that I knew what he was going through and said that I was the first person on the ward to tell him about these possible side effects, and said that I knew how he was feeling.

This experience made me realize that while I’m unable to intuitively empathize towards most patients, I could simulate “empathy” for most patients at a technical level by studying the common side-effects of varying medications at a pharmacological/physiological level, and ask them about these experiences. It can then give these patients the impression that I know what they’re going through, and that I value their experiences and “psychically” know them “better” (even though that’s sometimes not the case). The statistically more predictable effects of medications has given me more inspiration to study pharmacology in more detail when I have spare time, coz it enabled me to connect to patients (especially NT patients) more easily and make them feel a bit more comfortable even though I’m not the one looking after them.

His daughter phoned him, and he let me say “hi” to her on the mobile. I didn’t know why he asked me to say hi to her as I didn’t know her, but the gesture made me happy, coz it indicated that I didn’t piss him off, and I felt good that I made him feel a bit more comfortable that day even though his prognosis was technically poor.

I recently checked the patient database this year and discovered that he died a few months after my encounter (in the Palliative ward). RIP…