Rajan Sankaran, Rishi Vyas, Sneha Vyas, Ruchita Shah
A 42-year-old-female consulted me in August 2012 with the complaint of nose block and difficulty in breathing due to recurring polyps for which she had already been operated on once. She also had a deviated nasal septum and dust allergy which aggravated her complaints further. The case has been edited for brevity and for a better reading. The index to the short forms is D: Doctor, P: Patient, HG: Hand gesture.
D: Tell me what is happening?
P: I have difficulty in breathing while sleeping at night. I have to breathe from my mouth as I have blocked nose. My nose is running most times and the sense of smell has also faded. This is all due to huge nasal polyps that I have along with deviated nasal septum. I am even allergic to dust and start sneezing immediately even with least dust. My nose is then completely blocked (HG). So I just have to sit quietly for sometime and have to apply some ointment or inhale steam.
D: What is the effect of this on you?
P: I get irritated and angry with this.
D: When you say it causes irritation and anger can you describe it a little bit?
P: My nose is blocked and breathing (HG) is a problem. So then if anybody tells me to do anything then it bothers me. I get irritated I just tell them to leave me alone for some time (HG). I am irritated by any noise then.
D: Tell more about this – anybody tells you to do something?
P: Like the kids asking me for something or my husband asking me for anything. I need some time to myself and not do anything.
D: What do you feel?
P: I feel just to be alone (HG) at that point of time.
D: Be alone?
P: Yes, I just want to be myself (HG). Take care of my problem first and then handle other situations.
D: Tell more about this.. just to be alone.
P: Being alone is not to be disturbed. Just be myself for some time. Feel like just switching off (HG) from everything and just being by myself for some time.
D: Describe switching off and be myself?
P: Switching off in the sense not responding to any phone calls, not responding to any doorbell, not responding to anybody asking me for something. Just want (HG) to be with myself, be within me (HG). Do not feel like talking to anyone. And then when I feel I am ok, then I am up and all around. It is just for that little time, after steam inhalation I am better.
D: Say a little bit more about … be myself?
P: Me, myself is that what I meant like (HG) just to handle the situation and just to sit or lie down calmly for 10- 15 minutes.
D: Just describe this action, what you are showing with your hand?
P: Yes, this means at that time (HG) I do not want to be disturbed.
D: You have any dreams at all?
P: I do dream but nothing in particular; my dreams vary.
D: For example?
P: My dad passed away one and half months back. And since then I think a lot about what happens when one dies, where does the life go. Then I feel that it all remains here. I get many dreams related to this too.
P: My dad passed away due to a cerebrovascular accident. I was the only child I kept him home for two weeks on ventilator and then he collapsed one day. I did not expect him to pass away so soon. He was my responsibility. This has been the first death of an immediate family member.
D: What was your experience?
P: I felt very sad and hurt.
D: What is the experience of this sadness?
P: I didn’t want to talk about it to anyone. I wanted the grief to be with me within myself (HG – hands raised with palms facing each other).
D: Say more about this.
P: I wanted the grief to be there (HG); did not want to share it with anyone.
D: Describe this grief a little bit more ..I wanted it to be within me?
P: Yes, I didn’t want to share it with somebody as they would pity me.
D: Describe “keep it within me”.
P: Keep it within me is not talking about with anyone else.
D: Little bit more?
P: Not describing of what I am going through.
D: Forget the situation just the words – keep it within you?
P: Keep it within me is holding back (HG).
D: Describe this gesture you made.
P: Holding back. I am a very introvert (HG) person. Means I don’t want to open up (HG – pulling apart upraised hands) to anybody. So I hold back a lot of things.
D: So describe these two gestures of holding back and opening.
P: Holding back (HG) is not opening to anyone, even if he is close friend or anyone really close. I don’t want to open up easily. Open up means talking to my heart’s content (HG).
D: What do you mean by open up?
P: Open up is talking to your heart’s content to somebody and feel satisfied.
D: Describe just the word – open up; forget about yourself.
P: Open up is feeling free to talk to somebody.
D: Forget about somebody, just describe the words – open up?
P: Feeling free.
P: Yes talking free, talking free.
D: What is the opposite of opening up?
P: Closing (HG – hands lifted and facing each other).
D: Describe closing?
P: Closing is holding back things I don’t want to share with someone.
D: What is closing? Just the word – closing.
P: Closing is just shutting yourself.
D: Describe shutting yourself?
P: Shutting yourself from the environment (HG).
D: Describe shutting yourself from environment.
P: Is not opening up and not talking the way one should. When you talk to somebody you feel much lighter.
D: Describe the words… shutting the self only this much. What are you showing like this (HG)?
P: Closed (HG).
D: What is this?
P: This is closed completely closed.
D: Describe this only this much (HG)?
P: (HG) This is completely closed.
D: Describe this.
P: I don’t (HG) want to open up to anyone.
D: Why does one close and open?
P: One closes on not getting the right environment to talk to somebody or even if they get but someone’s nature is to keep things within yourself.
D: Why does somebody close? What makes you to close or what makes anything close up?
P: Don’t want to share with anyone. Not even with anyone close.
D: Just think, there’s no rush, we may solve your case today and your nose block will better. But I need to understand something deeper. So take your own time. Tell me about your childhood any dreams any fears anything that scared you or woke you up?
P: That was long back when I was 5 or 6 years old. We went to our grandparent’s place in Calcutta. While returning from there we almost missed our train after loading the luggage in it. But the fear of not boarding the train gripped me, though we managed with all difficulties to catch the same train. After which I remember getting up from sleep with the fear of not catching the train.
D: What was the experience of this fear? How did the fear feel within you?
P: Very traumatic the fear had gripped me.
D: What do you mean by the word gripped?
P: Gripped is to catch you. (HG – hands raised with palms facing each other)
D: Just describe this – what is this?
P: Catch – catching, holding you, gripping.
D: Just describe this little bit more catching, holding.
P: Gripping is the fear gripped me it surrounded me (HG).
D: Surrounded you?
P: I was surrounded by fear at that point of time (HG).
D: Describe this a little bit more… catching gripping, surrounding, forget about yourself. Whatever you can describe.
P: Gripping (HG) or surrounding is the fear, like the fear of losing the train… It just holds me (HG).
D: Describe… holds you.
P: Holds you in the sense you are surrounded with fear and you cannot come out.
D: Tell me your nature as a child?
P: Timid very conservative background. I was brought up in a very conservative background. Had no freedom. I was not allowed to leave home once I was back from school. Was not allowed to meet friends and had to wear only salwar-kurta or saree.