Chapter 28 Haemophobia, in practice.
Together with all the others, Martin and Louisa stood up to leave the conference room and to walk to the restaurant where the lunch would be served. Like on their first date on the night that they went to Holly's concert, Martin shyly tried to find Louisa's hand, which she took and comfortingly squeezed.
'Are you OK, Martin?
'Mmm, yes, interesting so far and not too badly explained.'
Louisa looked up at him and stated once again that his face didn't show any emotion whatsoever. He was very pale, though and his hand clammy.
'Will you excuse me for a moment, Martin…? Technical pause!' Louisa asked.
'Of course... hmm, I will save you a place at the table.'
Louisa went to the ladies room. She took out her smartphone and texted a message to Morwenna:
Are you in the neighbourhood? I think Martin needs something else to think of for a few moments. Can you find an excuse and bring JH to the restaurant?
No problem we're just coming back to the hotel after a nice stroll through town. JH saw thousands of pigeons and we went to feed the ducks in the park, Morwenna texted back. She added a picture of James and herself to the message. James' first "selfie" made Louisa smile.
CU then! We're at the restaurant.
Louisa washed her hands and checked her make-up, when Lisa entered the ladies room to do the same.
'I am so excited to be here, but also so worried about Martinus', she said. 'He suffers from haemophobia, you know..'
'So does Martin, what a coincidence! I bet that's one of the reasons they like each other.'
'Hmm yes, they have more in common, I believe. Martinus told me Martin in the past was a surgeon, the head of vascular, even. Well, Martinus also was a brilliant surgeon here in Amsterdam, but at a certain moment he developed this blood phobia. I am a bit worried about the afternoon'
Louisa, as always hiding her own worries, tried to look at it in a positive way and answered 'Well never meet problems half way, shall we wait and see what comes next? I mean, they didn't show any sign of stress or panic so far, did they? Except from being a bit pale and having sweaty hands, that is..'
'You're probably right', let's go to our table. I presume that the two M's have organized to be at the same table.'
'Yes and I just organized a small show-up of our son. It'll change their minds for a moment'.
The two women entered the restaurant, where their husbands were still standing behind their chairs, while the others were already seated.
'Look at that! What a gentlemen, where do you find a man with such exquisite manners nowadays!', Lisa commented with pride.
When they arrived at the table, they were introduced to all the other Martins, Martine, Mateo and Markos, Lisa was also introduced to Peter Cronk.
'You missed a very funny outburst of these two doctors, Mrs. E!, Peter said. 'Your husband and Dr. Elzenbosch had some difficulties in convincing the restaurant staff that this table had to be one for ten persons today. I have to say, they are equally armed with an extensive range of appropriate words to express their dissatisfaction'
'I don't want to know, Peter', Lisa and Louisa said in unison.
Before she sat down, Louisa looked through the window and just saw Morwenna passing by. James seemed quite excited and he pointed at the window. He obviously was trying to say something. Louisa smiled, she was pretty sure that her son had spotted his father, who was standing behind the chair that was closest to the window. As Martin was facing the rest of the table, he hadn't seen what happened outside.
Finally, they were all seated and waiting for the first course of the meal, a tasty asparagus soup.
Martin looked up and saw a young woman, with a toddler in her arms walking towards the table
'Morwenna, what's wrong with James? He immediately stood up and took the boy over from his assistant, sat down again with James on his lap and touched his son's front to check his temperature.
'Nothing Doc, he just saw you in the window of the restaurant and said 'dada', I supposed he wanted to see his daddy!', Morwenna replied. James confirmed the hypothesis with a loud and clear 'Dada'.
'Oh what a cute little boy', Lisa said and everybody at the table uttered something likewise. Safely seated on his father's lap, with his strong arms protecting him from falling, James enjoyed all the attention of the adults around him and treated them with the broadest two-teethed smile he could produce.
'Just like our Harry, isn't it Martinus?, Lisa said. 'Indeed', he agreed.
On Louisa's request, the two women soon bent over their smartphones to show each other pictures of their little treasures. The two men started a discussion about the pro-'s and contras of the vaccination program for babies and small children. Both were convinced that the decision to roll out this program in the late fifties of the previous century was a step forward in national health matters.
Resting his head against his father's chest and hearing his father's warm, soothing voice, James soon fell asleep. Morwenna waited another few minutes and then gestured to Martin that she would take the boy upstairs for a nap. Martin showed her a hint of a smile when he handed the sleeping boy over to her. 'Thank you Morwenna, that was adequate'.
Except for the incident with the table for ten, the group of M's didn't cause the waiters much trouble. Most of the persons at their table didn't eat much. Neither of them had chosen the beautifully cooked roasted beef, they had all chosen to eat fish.
The hostess who made a fuss of Louisa's presence at the conference decided to be wise and not to pay any attention to this group of grumpy doctors this time.
Only Martine and Peter Cronk really enjoyed their meal. None of the doctors seemed to be very hungry. Peter started to understand that all of these doctors had more in common than only a first name starting with an M. He was wise enough though not to say it out loud.
'Peter, do you think what I think?', Martine asked him.
'About the docs and the subject of this conference? Yes I do, but don't let us spoil it for them. I reckon they are already nervous enough. I can see Doc Martin is..', he replied in a low voice.
Soon enough, it was time to return to the conference room for the last part of the program.
When they entered the conference room, they all noticed that two armchairs and a small table made with some glass of water were placed on the podium. The presenter pointed to the new setting and announced:
'This will be used later this afternoon. For the moment, we continue the last part of the theory. We will treat the following question'.
With a mouse click he showed on the screen: How can we help our patients to deal with their blood phobia
He then explained :
'Haemophobia responds very well to many treatment methods.
Cognitive-behavioural therapy, or CBT, is possibly the most common form of phobia therapy today and very effective to haemophobia. CBT focuses on stopping the negative automatic thoughts, beliefs, feelings and behaviours that the patient associates with the feared situation, in this case the exposure to blood. CBT aims to replace them with more rational thoughts and feelings instead. The patient will learn to replace his fearful self-talk and thoughts with healthier responses to the sight of blood. CBT will also learn them new behaviours and coping strategies.
Let me explain this. According to the principles of cognitive-behavioural therapy, a phobia sufferer believes that the feared situation is inherently dangerous. This belief leads to negative automatic thoughts that occur as soon as the feared situation is encountered. The automatic thoughts lead to a phobic behavioural reaction. As we have seen this morning, this reaction can have various forms, sweating, feeling nauseous, vomiting, fainting even.
Techniques that are commonly used in CBT therapy are based on the theory of behaviourism and learning theory as well as the school of cognitive theory. Behavioural techniques that may be used as part of CBT include flooding and systematic desensitization, in other words: step by step and systematically take away the sensitivity the patient has developed for the subject of fear, blood. Cognitive techniques include cognitive reframing and psychoeducational techniques. In more common words, the patient learns to cope with it. Coping skills are used. Those skills are used to outweigh the disadvantages of the blood phobia in day to day life. Coping skills can be seen as a sort of adaptation, such as the finely tuned hearing that many visually impaired people develop. Teach clients healthier coping skills for dealing with their issues. For a phobic client, coping skills may include deep breathing, guided imagery and use a support person when facing their fears. Of course CBT and Coping skills are not exclusively used for haemophobia, it is effective for the treatment of a wide range of other phobias.
A more specific example of a coping skill that works pretty good for haemophobics is the opposite of relaxation techniques which are usually suggested for overcoming other common specific phobias. In this method, rather than relaxing, the individual is asked to 'squeeze his large muscle groups into tense knots' in order to prevent himself from fainting. This technique is especially helpful for patients who faint when exposed to blood.
Some therapists encourage their haemophobics to gradually expose to blood. This can help one slowly get comfortable with their fear.
'That only helps temporarily', Martin mumbled softly, but loud enough for Louisa to hear it. She made a mental note to ask him later what that was about.
If the patient's phobia is severe, medications can help control the anxiety. That allows the patients to focus on treatment strategies. Other forms of talk therapy, hypnosis, and even alternative treatments may also be helpful. A skilled therapist can guide the patient through the process of recovery, which can be difficult or impossible for the patient to do on his own. The patient has to be convinced of the fact that with help, professional help, there is no reason for haemophobia to control his or her life.
Enough theory for now, let's have a look at some practical cases…'
He gestured to two young persons standing at the entrance of the meeting room to come in.
'May I present you Jeroen Bakker and Saskia Smit, both suffering from Haemphobia. That is to say, Saskia has followed a therapy that was very effective for her, but Jeroen, didn't. Both volunteered to share their experiences with us.
"Gawd no..', Martin moaned. Martinus and some others in the meeting room squirmed as well. But most of the other doctors present applauded the initiative taken by the organization of the conference.
'Let's start with Saskia… Saskia, can you tell us about your phobia?'
Saskia answered a bit shyly 'Well, ever since I was a little girl, I had problems with the sight of blood.. and the smell of it too. It started on a day, when I walked our dog, a German shepherd. Those dogs are known for protecting their owners, so my parents always felt confident when I took her for a long walk. Sometimes I took the bike and she went alongside with me. On that particular day, I had to go to the village to do some shopping and I took her with me. We had to cross a rather dangerous road and for a reason I can't recall, I fell with the bike on the middle of the road. I lay on the ground and suddenly saw that my knee was bleeding. There was blood everywhere. Actually it was the dog that saved my life. She stayed in front of me on the side where the cars came from and barked to alert the approaching car. She was amazing. Anyway, somehow, I managed to get up and to stumble home. The wound wasn't very deep and it was cleaned thoroughly. Still, the memory of this accident made me sick at the sight of blood since then. But it was only thanks to the CBT, that I discovered what was the origin of my fear. The therapist explained to me that my fear of being killed by a car at that traumatic and very stressful moment had turned into a blood phobia. Now it has all been rationalized and I don't mind seeing blood anymore.'
'Jeroen, can you tell us your story too please?
Jeroen shrugged and said somewhat disinterested, 'Dunno.. I always faint when I see blood. Or I feel all clammy and have to puke'.
'Did you follow a therapy Jeroen?'
'No, I didn't.'
'Do you know where your fear of blood comes from?
'No'.
Jeroen was definitely not very talkative and the presenter had difficulties to drag interesting informations out of him.
'Well, I promised you a practical case and Saskia and Jeroen both volunteered to participate to a small exposure test.
Martin bent forward to hold his medical bag from under his chair, opened it and took two white paper bags out of it. He handed one of them to Martinus, who looked at him quizzically.
'Just in case', Martin suggested.
'So you diagnosed me as haemophobic then?'
'Hmm, yes.. I guess you did the same?'
Despite the nervousness about the subject, they exchanged a hint of a smile. Both men felt really relieved to have found a sparring partner and both made a mental note that they should stay in contact after the conference. Probably that wouldn't cost any problem, given the fact that their respective wives also seemed to get along quite well.
Three jars with red fluid all of the same colour, were placed on a Perspex pedestal, about 4 feet high.
'Saskia, may I invite you to come here and examine the content of the jars, please? The idea is that you look at it in such a way that the audience clearly see what you're doing. You open the lid of the jar and smell as well, I you like. Then you write down on a notepad what fluid you detect in each jar, but please don't talk about it. Is it clear for you?'
Saskia nodded affirmatively end came close to the pedestal. She accomplished the task in a few minutes. She showed not a single symptom of haemophobia. She didn't turn pale, no vomiting and no fainting. The presenter took her pulse and confirmed
'No racing pulse, no elevated heartbeat. Thank you Saskia. It's you turn now Jeroen.'
Jeroen stood up from his chair and approached the pedestal with the jars. He looked at the red fluids. It all looked like blood to him and he already got nauseous. But he didn't want to be a wimp – that's what his father used to call him. The times he was told to grow a backbone were countless. In the eyes of his father, a well-known and respected surgical dentist, but also in the eyes of his mother, since many years the receptionist and phlebotomist of the local GP, he was a loser because he couldn't bear the sight and the smell of blood. On top of that, he didn't want to follow his parent's footsteps. He wanted to become an artist, painter or sculptor or both.
He decided to be brave and continued to step forward to the jars with the liquids. He lifted the lid of the first jar. Piece of cake, that was a jar with tomato sauce. He disgusted the colour, but the smell reassured him. One done, two to go. He opened the second jar. Then the irony sickening smell of blood entered his nose. He became pale, his heart was racing. He also experienced a chest pain and sweat drops pearled on his forehead and his knees didn't seem to support him anymore.
The presenter looked at it, but didn't do anything. Just like most of the people present, he watched to see what would happen. Martin and Martinus looked at each other, alerted. Martin already reached for his medical bag, still holding the paper bag in his hand.
Then, they saw the young man getting hold on the pedestal, trying to get a grip to support his weakening legs. Of course the Perspex rectangular pedestal couldn't support his weight so the whole thing staggered and then clattered on the ground with a hard slap. The Jars with fluid were quite heavy so they hit the ground first. The containers splashed apart into a thousand splinters of glass, flocking the three different fluids into a bizarre cocktail and pouring it out on the flour.
The limp body of the now unconscious boy fell on top of it. Less than a second later, a pulsating jet of blood prayed on the snow white shirt Jeroen was wearing.
Dumbfounded about what just happened, Martin looked at Martinus. His reflexes immediately turned him into what Louisa always called his doctor's mode. It made his brains work at full speed. He grabbed his medical bag and shouted
'Martinus come quickly, the man has an arterial bleeding, we must act, NOW!
'What happended Martin?', Louisa asked fearfully, but Martin didn't hear her, he ran towards the stage, with Martinus in his wake.
Approaching the scene, both men felt the nausea coming but they simultaneously seemed to try the advice giving earlier: they tried to strain their muscles to overcome the urge to vomit. Both bent down over the patient. The presenter and a large group of other doctors came to see what happened.
'Give us space, don't stare like some idiots!, Martinus exclaimed 'You there, he added pointing at the presenter, 'dial 112 and ask for an ambulance!'
While Martinus directed the scene, Martin took care of Jeroen. He pressed his finger on the bleeding spot and with the other hand, he moved the boy into a more stable position.
He opened is bag and quickly prepared for an emergency procedure. Martinus understood what Martin was about to do, so he put his own finger on the bleeding artery, which gave Martin the possibility to proceed the temporary repair of the artery with two hands. Without much words, only an incidental grunt, they worked together as if they had done that for years.
When the ambulance arrived, the paramedics were surprised to see this weird crowd of doctors, two of them dressed in what must have been immaculate suits now kneeling in a puddle of blood. But when they saw what the two had done to prevent an accident of becoming fatal for this young men, they were impressed.
When the paramedics left with the patient, Martin and Martinus were still standing in the middle of the red coloured mess. Both Louisa and Lisa came to see their husbands, although they assured that they stayed at enough distance from the mess on the floor.
'That was brilliant, Martin!'
'You are an exceptional man, Martinus' they said in unison.
'Hmm.. not exactly the way I wanted to deal with this bloody phobia! Martin replied dryly…
To be continued
As said before: I am not a doctor, nor have I any experience with medical issues. Don't blame me for any medical incorrectness or incorrect conclusion I might have distilled from the information I found on Internet on the subject of haemophobia. I am aware of the fact that such an absurd test would never occur in a real medical conference, but I wished to find a way to make the two men work together. I hope you enjoyed it.