Durban - Gynaecology and obstetrics, paediatrics, surgery, internal medicine, psychiatry, orthopaedics and anaesthetics are the sectors of medicine twins Ashiq and Ishq Pramchand, 25, have travelled through during the past year as interns at King Edward VIII Hospital.

What stands out as they learn medicine in the wards and operating theatres versus university lecture theatres is the importance of communication.

“A doctor must be empathetic and make the patient feel comfortable,” Ishq told the “Independent on Saturday” after he and Ashiq had just knocked off night shift together.

It can be a challenge in a multilingual country and subcontinent, but sometimes little things make a huge difference on the communication front – especially at 3am.

Like when Ashiq put to use the touch of Spanish he had learnt on a brief course while dealing with a Mozambican patient.

“There was no one around who spoke Portuguese and there was no wi-fi (to access a translation app). Somehow my Spanish helped. The patient was overjoyed.”

At the same ungodly hour on another night, his brother found himself having to counsel a pregnant Zimbabwean patient about his Plan A for her uterine bleeding problem not working and explaining that she would need to be gassed, putting her to sleep.

“But there was no (possibly Shona) translator around at 3am,” said Ishq. “However, it happened that the nurse from the labour ward was from Zimbabwe.”

The language barrier was broken, an emergency Caesarean was carried out and the baby came out fine.

Local patients are often reassured by the twins’ knowledge of Zulu.

“They are surprised to see Indians speaking it,” they said, crediting Zandile Khawula, who helped raise them since the day they were born.

Faced with the mental health challenges new doctors face, they are now two chapters into a book they are writing on their experiences as interns.

“But relevant to KZN,” stressed Ashiq.

These experiences do not necessarily have happy endings.

There are occasions when patients come in for what they and their families think is something minor, they appear stable and then, in “seconds before your eyes” deteriorate and even die while their families are still waiting, expecting better news, in the corridors.

It calls on their communication skills to deliver the sad news.

Ishq recalled the trauma of knowing that however many times he told a widow how sorry he was, it wouldn’t offer hope. Her husband was gone, and “she was pregnant, at last, after having suffered miscarriages”.

The husband who had died in this case was in the terminal stages of a disease but had never told anybody he wasn’t well, so nobody knew much about his medical history.

So, communication in medicine also proved important within families.

Then there have been moral dilemmas interns are faced with, such as deciding who, in certain circumstances, should be saved.

“Like a mother or a baby.”

Ashiq added: “We are not robots. We still feel terrible.”

The twins said there were interns who battled to face mental health issues brought about by being at the coalface and being under intense pressure, such as knowing during long shifts that if they fail, a patient could die.

“Many interns break down crying, even leave the internship programme, unable to cope. Many go for psychological counselling,” said Ishq.

“We want to articulate to others that there is a way of dealing with these things.”

Much of their coping mechanism has been rooted in the sport and cultural activities that have been part of their lives.

Ishq recalled how once, on a busy night during a 34-hour shift, he had almost fallen asleep standing while holding the abdomen of a gunshot victim to give the surgeon greater exposure to his organs.

“But you can’t go to sleep.”

He recalled getting dizzy, his legs aching and his visibility becoming blurred.

“Then I used a kung fu technique, regulating my breathing. I breathed deeply through my mask.

“In kung fu we learn that a lot of power comes from your centre, the cores and not the peripheries. So I relaxed my shoulders, regulated my breathing and my thoughts became clearer. I loosened my body as we were taught in kung fu.

“I stood in that stance and held it for 45 minutes.”

When it comes to being able to suture, they credit their training as pianists.

The twins also believe in simply keeping the faith, illustrated to them during a break last year to Ireland when bad weather hid the view of the Cliffs of Moher.

“It was wet, grey and freezing. We couldn’t see anything. Then a ray of sun burst out, illuminating the cliffs. It made us reflect how small we are compared with the bigger scheme of things. That helps in making difficult decisions,” said Ishq.

“If you are invested in the moment, you can live in the moment, persist despite tribulations and stick it through and wait a bit more.”

Impressed by their stint in anaesthetics, both now aim for futures in surgery.

The Independent on Saturday

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Docs prescribe good communications