The good of small things

BMJ 2003; 327 doi: (Published 24 July 2003) Cite this as: BMJ 2003;327:234
  1. Mary J Marret, lecturer (
  1. Department of Paediatrics, University of Malaya, Kuala Lumpur

    I first met “Salmah” when she was about nine. She had cerebral palsy and had spent her life confined to her bed or wheelchair, relying on her family for her every need. To some people it might seem a useless or meaningless existence—always needing someone there to turn, change, or feed her. Yet these were acts of love that her family carried out devotedly. Most of the time she would show no sign that she saw or heard much. Quite often what I elicited were grimaces or protesting moans as I tried to move her stiff limbs while examining her. Once in a while she would surprise us with a broad grin or a near chuckle, as if sharing a good joke.

    As time went on I felt increasingly inadequate, with little to offer except regular prescriptions of anticonvulsants or suggestions to improve her seating or her constipation. She grew larger, making it more difficult for her family to move her. Transportation became a complicated logistical exercise.

    Everything we do for our patients has …

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