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Wednesday, October 12, 2016

Settling in Delhi.

“Why Delhi?” Owais messaged. His astonishment palpable.

“Don’t become a Delhi boy or I’ll have to beat you up.” Savni’s warning was as clear as it gets.

A sizeably many more well-wishers sent their mixed greetings, and concerns and tips on surviving a city that we, the Mumbaikars, the people of the maximum city, the creatures who know no sleep, who spend 40% of our cumulative lifetime travelling from home to workplace and back, have grown up to think as of being one of ravages, fed both by our sense of superiority in being the more civilised of the races and media’s constant pandering to that thought.

“Blah blah blah. More blah blah, blah blah. Hence, Delhi.” I replied.
“Why Delhi?” Owais persevered with his CID style interrogation. Now, I was lost for words.

Savni has been kinder and more compassionate though, I must add. She just calls twice a week to put me in line.

But the bullet had left the pistol and so there was no looking back. Till so far, Delhi has been kind enough. The climate here has just turned supremely pleasant – hot and superhumid – just the way we like it back in the Gateway to India, where the philosophical bath time thoughts revolve around ‘why do we bath? So that even as we’re drying yourself, we get drenched in sweat again. Karma is such a pet canine of the female gender. ‘

In a couple of days I managed to rent out a lavish palatial estate to establish my retreat, found palatable, nutritious and hygienic (?? !! OK I’m making this up, but mom also reads my blogs na!) food which taste’s just as good as home food (paneer power).

Now, there are some people who blabber about things like “We Eat to Live”!! I don’t know which mad dog has bitten them. As far as I am concerned,” I Live to Eat.” And good food I’ve sniffed out (I repeat, my mother reads this blog). So when my seniors ask,” Have you settled?” I give an emphatic “Yay!!!” (P.S.: There is, in fact one senior who’s kind enough to spoon feed us, but that’s mostly food for the mind, but food nonetheless.) Spending almost 12 hours (i.e. all the daylight hours) in the hospital, I return to my royal abode, sink into my Jacuzzi (wishes are horses that beggars can ride, I’m just bathing in a Jacuzzi at the end of an exhausting day) before laying asleep in my king size bed.

“So have you settled?” another senior asked loving.
“Yes Sir!” I grinned from ear to ear. But something felt uneasy. So much concern was pouring in my way from home and otherwise, I wondered if was I missing something. Was I so lost in happiness that I was overlooking something obvious? Was I in a misery that I was unaware of? If I had flower at my disposal I would have plucked off its petals,” I am well settled...... No I’m not...... I am well settled...... No I’m not.......” But, alas, this was not to be my luxury.

A few days later, when my Mercedes had to be sent to the garage for maintenance purposes (sochne ka paisa nahi lagta. Insaan ki soch badi honi chahiye), I had to hop into an e-rickshaw, a Delhi commoner’s horse ride. The traffic was no worse than Mumbai’s. Across me were seated a gentleman and a fair lady in her twenties, who probably had delayed neurodevelopmental milestones. The gentleman was kind and tender and polite and probably the girl’s caretaker.

“O look! Wa-all-me-ate!” She exclaimed in her monosyllabic speech as the ride passed across the store. “Wa-all-pe-per-s! Ti-il-es an-d Fl-oo-ri-ngs!” She read the tagline out loud.

'Awww!!!' I thought out loud. The gentleman was unmoved. Some stone-hearted fellow. It isn’t unusual for caregivers of special kids to get frustrated. But, they courageously persevere nonetheless, for which I respect them a lot. There are human boundaries, and they brave them on a daily basis.

“Mu-naa-faa- Ma-rt.” She started again. “Aap-ki ba-ch-at ka des-ti-ne-sh-n. Babu, here we can get good discounts na!”

Babu! She said Babu!!!! She wasn’t no retard! I had been hijacked!

And then, the misery began. I had to bear through her reading aloud all the shop names along with their taglines and a monologue on their meanings. My schooldays flashed up out of the blue. ‘Sandarbhasahit  spashtikaran kara’, used to be a question in which we were supposed to build up on a couplet from a poem and explain its meaning. Though what we ended up doing always was just writing down the poetry into plain text. Just a couple of days ago, I had ventured out after dark (like Akbar used to) against percolated wisdom, to get to know the locality, its lanes and by-lanes and markets and shops. Had I know that I’d be stuck in this ride in heavy traffic; I wouldn’t have risked my safety, my belongings and my life.

"If someone comes to mug you, just give them everything" is all that Savni comes up with anyway.

Medical practice is very different in a government setup than it is in a private set up. Just that morning, I had asked a patient’s relative to sign on the consent form and pointed it out where Relative’s name, Relative’s sign etc. were written.
I can read.” He had snapped at me, not taking kindly to my patronising instructions. Karma, my pet female canine had turned up wagging her tail to bite me that very evening. I apologise dear Sir, if you are reading this, I now know how irritating patronisation can sound. “I can read.” I too wanted to snap out. But, alas, this was not to be my luxury. The caregiver Babu had well developed biceps whose giant compressive strength I didn’t want to ask a demo of.

“Babu look......” she continued. “The light is red, but it is blinking. So the signal is kharab na!!” I couldn’t take it anymore. Looking away at a right angle for such a long time was giving me a neck strain. So, I looked straight into the caretaker Babu’s eyes.

“Wait baby/kuchiku/sonu/monu whatever....., I’ll go and find out. You don’t leave the rickshaw. Aapki chappal maili ho jaayegi na... Aap thak jaaoge na.... Fir mujhehi aapko utha kar ghar le jaana padega na. Bhaisab, aap jara saath chalenge...”

In the year 2006, when I wasn’t even a week old in Ruia, I was chatting with Rishabh while being seated on the first bench, under the then Hindi teacher Mr. Trigunayat’s nose. That was the first time I and Rishabh had met each other. Mr. Trigunayat didn’t appreciate people socialising in his lectures. He used to ask his disobedient pupils to ‘canteen jaao aur mere naam se chai pi aao.

“Uthiye” he had said. I was about to stand up, but Rishabh stood up instead. “Kya batein chal rahi hai?”

‘Sir, iske pass textbook nahi hai, is liye ye mujhe pooch raha tha ki pichali baar aapne kya padhaya tha.’ I would’ve answered. I made eye contact with Rishabh as he arose taking one for the team, which was yet to be forged.

“Sir, mere pass textbook nahi hai, is liye mai isse pooch raha tha ki pichali baar aapne kya padhaya tha.” he answered. We hit it off that very moment and have been friends till date, sharing some great memories.

In the year 2016, I tried to telepathicunate with the caretaker Babu. But, alas, this was not to be my luxury. Too bad Babu, we could’ve made great friends.

I sustained my gaze for a few more moments. Babu was unmoved,by me as much as he was by his pestering baby/kuchiku/sono/monu/whatever. No pain, no angst, no embarrassment. Just pure, divine, serenity (Or maybe not). Seers roam about the world in search of the divine. Divinity comes from misery they say. Must be true.

The human mind is such a sadist! It finds satisfaction in others’ agony. I had been perplexed, if I was settled or not. I still am. But, I am relieved, that if it turns out that I am not, my suffering is nothing compared to that of some of my fellow human beings having to put up with so much misery and face so much judgement in their quest for the elusive divine.

More power to you bro (Your soul and spirit, I mean. Your biceps have a lot of power. Any more and that tendon will rupture). Thank you, if you are reading this.

(P.S.S: Please get the miss to read this out loud in her monosyllable speech as well. Mere aatma ko badi thand milegi.)



Saturday, August 27, 2016

The Dilemma

Victoria was a young, confident lady of all but 21 years of age. Just over 6 months ago, she had graduated from being Ms. Victoria to Dr. Victoria. Life had changed. The comfort and the carefree attitude which the student phase had afforded was over. She was joyous, nervous and enthusiastic as she continued through her internship. She had learnt a few new skills, could now establish IV access, suture cuts and lacerations, ligate bleeding vessels and set broken bones and of course, prescribe the multivitamins to the odd patient who asked for one.

Yet, while she thought that she had seen it all, she actually hadn't. Even while working in those emergency shifts, she didn't realise that she still was in a controlled environment. Which patient she saw was filtered, and even though she felt otherwise, per se, she wasn't yet responsible for anything. The only major worry which clogged her mind was that of the upcoming entrances for her postgraduate studies which were no more than 3 months away, and how little time she was managing to squeeze out for studies.

Her current rotation was away from her parent institute. A "Peripheral" posting, in the medical lingo. It was no small hospital by any means, just not as big as her mater. Smaller place, fewer people, more work, a little more responsibility. She liked that...... just that, if only had it been after the exam she could have put in a little bit more heart into it.

It was her first night shift in the ICU at the new centre. She would get to learn a lot of new skills and procedures here, because the short staffing afforded her that luxury. Probably, resuscitate a gasping patient or two. In her parent institute, one, the number of patients were so high that after finishing her alloted menial jobs there wouldn't be any time left to learn new things and two, there were despite the rampant short staffing, sufficient number of seniors for the difficult things.

At around 8 pm she began her shift. The very first patient she attended to had been in coma since 3 days. She performed het mandatory blood collections. Over the next hour or so he started regaining consciousness. His illiterate relatives thought that her hands were blessed and so they told her repeatedly. "Aapka haath lag gaya na is liye accha hua ye!! Nahi to 3 din aankh bhi nahi kholta tha!!" She knew, that miracles don't happen. She also knew that she had technically done nothing, the medications were doing their job. But, to possess a "miracle hand" is every doctor's dream. We know the realities, yet we dream. And here, just six months into her career, she was being cannonised. How could she let that go! She just smiled, ear to ear. All her worries, anxieties, fatigue, just evaporating into the thin air.

The night went along uneventful, she worked with a skip in her steps. At about midnight, a patient trollied in, referred from the casualty. A middle aged woman, surrounded by her two kids, a daughter of about 15 yrs and a boy of about 10 and her husband. She looked into the casualty paper. The woman had consumed rat poison.

Different people have different reactions to grief and emergencies. The boy was unaware of what was happening, the girl was clearly distressed yet palpably numb. The husband had lost his head, he was inconsolable. He was shouting, blaming himself for being a bad human, rebuking her for not thinking about her children, cursing the creator for destroying his happy family in a split second. The woman, still conscious, didn't look anyone in the eye, didn't answer any of his accusations, just lay there accepting her fate. In between, she would roll her eyes around, glance at her children, but not a drop of tear rolled down anyone's cheek.

There was an eerie vibe to the whole situation that Dr. Victoria had never faced before. She was intrigued by the happenings and felt so sad for the kids. Somewhere she even blamed the mother for being careless.

"Array he kaay kelaaaa...aaa... tu!!!" The husband started yelling again. There were other patients in the ICU who required quiet. Dr. Victoria wanted to sympathise with the man, but was treating all the patients.

"Please go out and do not make so much noise." she said, trying to sound kind and firm simultaneously, having not managed to calm the storm within herself.

"Array doctor!!!! We were having food. Nicely enjoying our dinner and watching TV. Look at my kids, doctor. She just got up, doctor. Went to the cupboard and removed this bottle of rat poison. And then she told me I will drink it. I thought she is fooling..... So I said, OK go ahead.......... Doctor, I did not know she was actually going to drink it. And then, before I could do anyting, she had the whole bottle..... Doctor..... Look at my kids, doctor"

"Go out". The daughter replied. Still numb, still shaken, but her voice firm. Dr. Victoria was puzzled. Here was a 40 year old behaving irrationally. And here was a 15 year old displaying a level of maturity and composure that she, despite being a qualified medical practioner would not have managed, had she been in her position.

"Go OUT." The daughter repeated.

The man stayed out of the ICU for the rest of the night while the daughter stayed by the bedside.

"What's her prognosis?" Dr. Victoria asked the registrar. This wasn't just an academic query, but she had become emotionally invested in her patient. She had committed a mistake, which no doctor should ever make, yet they make, irrespective of whether they are newbies fresh out of the eggs or whether they have lost all the hair on their heads. " She's come pretty early, so we should be able to save her na?" She added.

"This one is a very strong OPC preparation. Lot of patients come here after consuming this. Nahi bachegi." The registrar replied unfazed. He was time hardened, with just the right amount of asbestos coating around him, to insulate himself from the heat of the moment and make proper decisions.

"O!" was all that Dr. Victoria could mutter.

So many things had happened in the course of the night. From being the one with the miraculous healing hand, she was now forced to resign to her limitations. She saw as the police constable came, took the patient's statement and left. 

At 6 am she she began taking ECGs. When she reached the OPC patient and applied the cuff around her arm to measure her BP, the patient whispered, "Mala chhateet dukhtoy. (I have chest pain)." She was having angina, so Dr. Victoria began to leave to inform her registrar. The woman continued, "He beat me up. He beat me up a lot. He beat me all over my body. He punched me, he kicked me......." the woman continued.

"Do you want me to call the constable? Do you want to change your statement?" Dr. Victoria inuired.

"NO. I just wanted you to know." She said, and turned her head away in sorrow.

She only wanted her to know. Nothing more. Dr. Victoria was to be her secret keeper. But, the young doctor was shaken even more.

What was she to do? Was she to inform the police by her own volition? But, the woman wouldn't change her statement. So what was to come out of it? Suppose if she still went ahead, she would manage to get the husband convicted? But that would take time. Courts move at their own pace. She has a dream to be a superspecialist. Would this one step puncture and detract her career? The woman definitely doesn't want her husband to be punished. She has reasons. Maybe the children. With the mother gone and the father in jail, who would take care of the children? But, then a crime has been committed. Isn't it her duty as a good citizen to make authorities aware. But again, the woman won't change her statement. Dr. Victoria had been rebuked once earlier as well to reign in her enthusiasm and not take on responsibilities which aren't her due. So what if the woman won't change her statement, she could always claim that she had received a dying declaration. But does a dying declaration hold up in courts in India? Being an intern, was she even allowed to take a dying declaration? She hurried to her bag, got out her intern's log book. 

It clearly stated: "The intern will not involve himself/herself in medicolegal cases."

But, was that what was legally sound, ethically sound as well? 

It was nearing 7 am. Her shift was about to end. She was drained, physically, mentally and emotionally. Too much of a Roller'Coaster this night had been. She was 21 the previous day, but today she probably was feeling 50.

She had read somewhere," When something is too good to be true, it probably isn't."
She had also read,"There is always more than meets the eye." 
Today, she had a live hands on experience.

She glanced at the registrar. His face was dull and eyes soggy after the tiring night. Yet, he maintained his poise. His brain alert to any abnormality that crept up on the ECG monitor, or any discomfort that his patient developed, but still aloof!




(A work of fiction, with some inspiration from real life events.)

Tuesday, August 9, 2016

Daaktuur

I am not very fond of you Surgery. But it's not your fault, I just like medicine more. I like eliciting a knee jerk more than I would like fixing a broken knee. But this post is not about surgery per se, it's about a patient that I have recently come across in the ESR. Actually, his relative is what I am going to write about.

Abusive, violent, short tempered, drunk..... he isn't any of those. It's Saturday evening. (I always end up in units which have Saturday emergencies. No Sundays for me!! But, I also have my entrance classes on Saturday and Sunday, which I end up either missing inevitably or reaching them so dead tired and sleep deprived, I wonder if I should just ask for a refund. Hmmmmm..... no digressing, back to the topic.)

So, it's Saturday evening. My engineering friends are probably out in bars and discotheques partying hard after having worked harder through the week, probably gulping down shots of tequila till they can no longer stand on their own two feet. Well, why shouldn't they, they can afford. I am a teetotaller, but I know that one shot costs 1700 and taxes extra. 1700, is what an intern's stipend was two years ago. Then it increased, courtesy my seniors who went on a strike. But, it hasn't increased that much either, one can now probably afford 3 shots. And, here I am inserting IV lines, Folley's catheters, Ryle's tubes, and suturing drunkards who've fallen by the roadside and cracked their skulls open. All work, no study. Sorry, I digress.

So, it's a Saturday evening. I've missed one more class. Today has a heavier than usual. Around 9.30 pm one more fellow wheels in. I ready my set of IV lines, one pink and one blue, to be chosen on the condition of his veins, the three way connector and saline flush and adhesive tape. 3 red vials for viral markers, two purples for blood grouping and cross matching and HbCBC. All is done at spinal level. 

His relative approached me. From his attire, he seems like a Koli (Fisherman). His eyes are red shot, not of liquor, but of exhaustion, a lot of which overflows on his face as well. I take a look at him. He is barefoot. After explaining to him where to take the blood samples and all other things that we require before admissions, he goes away and I get busy with other patients.

At about 1.30 am the flow of patients has ebbed. The lecturer has taken his rounds of the esr and has gone to operate. The houseman has fallen asleep on a stool (wooden), the exhaustion of 18 straight hours taking a toll. He won't sleep long, the next patient will come up in 10 min. His head fallen back weirdly, he'll surely have a sprain tomorrow morning. Somehow, he isn't falling off the table.

I too think of catching a 5 min power nap. I look around for any place where I can rest my head and where there isn't blood stain or some such infective secretion. My back has already started getting spasms. Or should I just solve a few mcqs? The 3 mcqs that I'll manage in 5 min, may be the decider between me getting a seat or spending one more year preparing. I do not enjoy reservations either, so maybe I should go for the mcqs.

"Sir, uuu bluuud banka se khun ka report aa gaya." My thoughts are broken by the fisherfolk. I look at his blood group and tell him to attach the report in his file.

He smiles back. Even though his smile is laboured, and his teeth stained, it is still full of warmth and friendliness.

"Array suno!" I call out to him.
"Aise hospital me bina chappal ke mat ghoomo. Khoon vagaira neeche gira hua rehta hai. Needle, kaanch bhi niche rehta hai. Pair me lag jaayega. Bimar pad jaaoge."

He just smiled back again.

"Kidhar se aaye ho?" I ask.

He smiles even brighter, the exhaustion suddenly disappearing.

"Virar ke aage Arnala aata hai." 
I remember Arnala. When I was a kid we had once gone to celebrate holi at the Arnala beach. Back in those days it wasn't so famous and a lot of families only used to come there. We would board a train to Virar from Dadar. Then take a shuttle to Arnala and then there would be rickshaws to take us to the beach. About 2 hours fun packed journey.

"Haan. Mallom hai." I reply.

"Udhar Shivaji ka killa hai!"

"Acchha! Ye nahi maloom tha mujhe. Mai to sirf beach pe hi aaya hu."

"Udhar se hi killa pe jaate hai. Wo beach se ferry karke jaate hai. Killa pe jaane ka hai bolo. Le ke jaate hai. Do ferry hota hai din me. Ek sakali jaata hai aur ek sandyakali wapas aata hai."

"Algi baar gaya Arnala tab jata hu kille pe."

"Aaap aao hamare ghar pe. Taja taja macchli pakadte hai hum. Dega aapko."

"Array mai non-veg nahi khata."

"Koi baat naahi. Hamara ghar k bahar choota bagicha bhi hai. Aao tum. Taja shabji deta hai tumko."

"Lekin aapka ghar kaise milega mujhe?"

"Wo kuch nahi. Aake kisko bhi poocho, 'DAAKTUUR' ka ghar kidhar hai. Koi bhi leke aayega. Hamara idhar daaktuur nahi hai. To fir koi bhi bimar padta to mai ich sab ko leke jaata illaz ko. Karke sab log mere ko ich daaktuur bulate."

He grinned again from ear to ear.

It's barely been 4 months since we've passed our final MBBS and taken the Hippocrates oath.

"Do no harm" is supposed to be our motto. But some of my colleagues have brushed it aside already! I too feel sometimes that I should take a few liberties and short cuts as well. Eventually, my future is going to be decided by my score in the exams and not by how well I have behaved with someone or how honestly and meticulously I have done my job.

"We are interns. Nobody's life depends on us." Says one of them as he sometimes (which is now becoming everytimeunderfills samples in vials so that he can quickly finish his set of blood collections and rush away to the library. "Even if the lab sends sample inadequate, the houseman will send another sample in the evening to the elab. Nobody's life depends on you."

Now I have an existential dilemma, who is a doctor?
One who's declared that nobody's life depends on him or one who is the only source of hope to sick man on a desolate islet?

Perhaps the latter isn't. He will only be a daaktuur at best.

"Wo mera godhali dekha tumne? Hara tha. Idhar rakh ke gaya tha tabhi. Mil nahi raha. Raat ko soneko laya tha.Leke gaya koi lagata hai. Aise hi sona padega abhi. Dekho tumko milega to. Idhar hi rakhke gaya tha mai. Pccccchhhhhhh......"